Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

SCREW, TALON LAB 12.7 X 85MM

Facility

$1,014.00

Service Code	HCPCS C1713
Hospital Charge Code	27267235
Hospital Revenue Code	278
Min. Negotiated Rate	$709.80
Max. Negotiated Rate	$861.90
Rate for Payer: Cash Price	$659.10
Rate for Payer: Community Health Alliance Commercial	$861.90
Rate for Payer: Priority Health Commercial	$709.80
Rate for Payer: Priority Health PPO	$709.80

SCREW, TALON LAG 12.7 X 80

Facility

$969.00

Service Code	HCPCS C1713
Hospital Charge Code	27867276
Hospital Revenue Code	278
Min. Negotiated Rate	$678.30
Max. Negotiated Rate	$823.65
Rate for Payer: Cash Price	$629.85
Rate for Payer: Community Health Alliance Commercial	$823.65
Rate for Payer: Priority Health Commercial	$678.30
Rate for Payer: Priority Health PPO	$678.30

SCREW VAL LOCKING 3.0 X 16MM

Facility

$428.75

Service Code	HCPCS C1713
Hospital Charge Code	27885119
Hospital Revenue Code	278
Min. Negotiated Rate	$300.12
Max. Negotiated Rate	$364.44
Rate for Payer: Cash Price	$278.69
Rate for Payer: Community Health Alliance Commercial	$364.44
Rate for Payer: Priority Health Commercial	$300.12
Rate for Payer: Priority Health PPO	$300.12

SCREW, VHS LAG W/COMP SCREW

Facility

$884.00

Service Code	HCPCS C1713
Hospital Charge Code	27872953
Hospital Revenue Code	278
Min. Negotiated Rate	$618.80
Max. Negotiated Rate	$751.40
Rate for Payer: Cash Price	$574.60
Rate for Payer: Community Health Alliance Commercial	$751.40
Rate for Payer: Priority Health Commercial	$618.80
Rate for Payer: Priority Health PPO	$618.80

SED RATE

Facility

$31.00

Service Code	HCPCS 85651
Hospital Charge Code	3007340
Hospital Revenue Code	305
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$26.35
Rate for Payer: BCBS BCN 65	$4.48
Rate for Payer: Blue Care Network Medicare Advantage	$4.48
Rate for Payer: Cash Price	$20.15
Rate for Payer: Cash Price	$20.15
Rate for Payer: Community Health Alliance Commercial	$26.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.48
Rate for Payer: Meridian Health Plan Medicare	$4.48
Rate for Payer: Priority Health Commercial	$21.70
Rate for Payer: Priority Health Medicaid	$4.48
Rate for Payer: Priority Health Medicare	$4.48
Rate for Payer: Priority Health PPO	$21.70
Rate for Payer: United Health Care Medicaid	$4.48
Rate for Payer: United Health Care Medicare Advantage	$1.97

SED RATE SBMF

Facility

$6.10

Hospital Charge Code	3010387
Hospital Revenue Code	305
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$5.18
Rate for Payer: Cash Price	$3.97
Rate for Payer: Community Health Alliance Commercial	$5.18
Rate for Payer: Priority Health Commercial	$4.27
Rate for Payer: Priority Health PPO	$4.27

SEL CELL RULE OUT PEG IBC

Facility

$105.00

Hospital Charge Code	3101931
Hospital Revenue Code	300
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

SELENIUM

Facility

$28.51

Service Code	HCPCS 84255
Hospital Charge Code	3007365
Hospital Revenue Code	301
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$26.81
Rate for Payer: BCBS BCN 65	$26.81
Rate for Payer: Blue Care Network Medicare Advantage	$26.81
Rate for Payer: Cash Price	$18.53
Rate for Payer: Cash Price	$18.53
Rate for Payer: Community Health Alliance Commercial	$24.23
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$26.81
Rate for Payer: Meridian Health Plan Medicare	$26.81
Rate for Payer: Priority Health Commercial	$19.96
Rate for Payer: Priority Health Medicaid	$26.81
Rate for Payer: Priority Health Medicare	$26.81
Rate for Payer: Priority Health PPO	$19.96
Rate for Payer: United Health Care Medicaid	$26.81
Rate for Payer: United Health Care Medicare Advantage	$11.79

SELENIUM RBC

Facility

$89.00

Hospital Charge Code	3102088
Hospital Revenue Code	300
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$75.65
Rate for Payer: Cash Price	$57.85
Rate for Payer: Community Health Alliance Commercial	$75.65
Rate for Payer: Priority Health Commercial	$62.30
Rate for Payer: Priority Health PPO	$62.30

SELENIUM WHL BLOOD

Facility

$28.51

Hospital Charge Code	3101411
Hospital Revenue Code	300
Min. Negotiated Rate	$19.96
Max. Negotiated Rate	$24.23
Rate for Payer: Cash Price	$18.53
Rate for Payer: Community Health Alliance Commercial	$24.23
Rate for Payer: Priority Health Commercial	$19.96
Rate for Payer: Priority Health PPO	$19.96

SELFCARE HOME MANAGEMENT

Facility

$91.00

Hospital Charge Code	4300045
Hospital Revenue Code	430
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$77.35
Rate for Payer: Cash Price	$59.15
Rate for Payer: Community Health Alliance Commercial	$77.35
Rate for Payer: Priority Health Commercial	$63.70
Rate for Payer: Priority Health PPO	$63.70

SEMEN ANALYSIS/FERTILITY

Facility

$124.00

Service Code	HCPCS 89320
Hospital Charge Code	3007360
Hospital Revenue Code	300
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$105.40
Rate for Payer: BCBS BCN 65	$12.93
Rate for Payer: Blue Care Network Medicare Advantage	$12.93
Rate for Payer: Cash Price	$80.60
Rate for Payer: Cash Price	$80.60
Rate for Payer: Community Health Alliance Commercial	$105.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.93
Rate for Payer: Meridian Health Plan Medicare	$12.93
Rate for Payer: Priority Health Commercial	$86.80
Rate for Payer: Priority Health Medicaid	$12.93
Rate for Payer: Priority Health Medicare	$12.93
Rate for Payer: Priority Health PPO	$86.80
Rate for Payer: United Health Care Medicaid	$12.93
Rate for Payer: United Health Care Medicare Advantage	$5.69

SENDOUT LCB

Facility

$25.00

Hospital Charge Code	31027463
Hospital Revenue Code	300
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

SENSITIVITY ANAEROBIC

Facility

$100.00

Service Code	HCPCS 87188
Hospital Charge Code	3008360
Hospital Revenue Code	306
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$85.00
Rate for Payer: BCBS BCN 65	$6.97
Rate for Payer: Blue Care Network Medicare Advantage	$6.97
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.97
Rate for Payer: Meridian Health Plan Medicare	$6.97
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health Medicaid	$6.97
Rate for Payer: Priority Health Medicare	$6.97
Rate for Payer: Priority Health PPO	$70.00
Rate for Payer: United Health Care Medicaid	$6.97
Rate for Payer: United Health Care Medicare Advantage	$3.07

SENSITIVITY EACH LC

Facility

$5.00

Hospital Charge Code	3102423
Hospital Revenue Code	300
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$4.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health PPO	$3.50

SENSITIVITY KB

Facility

$27.00

Service Code	HCPCS 87184
Hospital Charge Code	3005509
Hospital Revenue Code	306
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$22.95
Rate for Payer: BCBS BCN 65	$7.85
Rate for Payer: Blue Care Network Medicare Advantage	$7.85
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.85
Rate for Payer: Meridian Health Plan Medicare	$7.85
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health Medicaid	$7.85
Rate for Payer: Priority Health Medicare	$7.85
Rate for Payer: Priority Health PPO	$18.90
Rate for Payer: United Health Care Medicaid	$7.85
Rate for Payer: United Health Care Medicare Advantage	$3.46

SENSITIVITY MIC

Facility

$38.00

Service Code	HCPCS 87186
Hospital Charge Code	3006150
Hospital Revenue Code	306
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$32.30
Rate for Payer: BCBS BCN 65	$9.08
Rate for Payer: Blue Care Network Medicare Advantage	$9.08
Rate for Payer: Cash Price	$24.70
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.08
Rate for Payer: Meridian Health Plan Medicare	$9.08
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health Medicaid	$9.08
Rate for Payer: Priority Health Medicare	$9.08
Rate for Payer: Priority Health PPO	$26.60
Rate for Payer: United Health Care Medicaid	$9.08
Rate for Payer: United Health Care Medicare Advantage	$4.00

SENSITIVITY RML AEROBIC

Facility

$6.11

Hospital Charge Code	3008359
Hospital Revenue Code	306
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$5.19
Rate for Payer: Cash Price	$3.97
Rate for Payer: Community Health Alliance Commercial	$5.19
Rate for Payer: Priority Health Commercial	$4.28
Rate for Payer: Priority Health PPO	$4.28

SENSORY RE-INTEGRATION

Facility

$80.00

Hospital Charge Code	4300135
Hospital Revenue Code	430
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Community Health Alliance Commercial	$68.00
Rate for Payer: Priority Health Commercial	$56.00
Rate for Payer: Priority Health PPO	$56.00

SENSORY RE-INTEGRATION

Facility

$80.00

Hospital Charge Code	4300035
Hospital Revenue Code	430
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Community Health Alliance Commercial	$68.00
Rate for Payer: Priority Health Commercial	$56.00
Rate for Payer: Priority Health PPO	$56.00

SEROMA CATHETER

Facility

$108.00

Hospital Charge Code	27017970
Hospital Revenue Code	272
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$91.80
Rate for Payer: Cash Price	$70.20
Rate for Payer: Community Health Alliance Commercial	$91.80
Rate for Payer: Priority Health Commercial	$75.60
Rate for Payer: Priority Health PPO	$75.60

SEROQUEL

Facility

$58.00

Service Code	HCPCS G0480
Hospital Charge Code	3007375
Hospital Revenue Code	301
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$37.70
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$40.60
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

SEROTONIN

Facility

$12.22

Service Code	HCPCS 84260
Hospital Charge Code	3007380
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$32.53
Rate for Payer: BCBS BCN 65	$32.53
Rate for Payer: Blue Care Network Medicare Advantage	$32.53
Rate for Payer: Cash Price	$7.94
Rate for Payer: Cash Price	$7.94
Rate for Payer: Community Health Alliance Commercial	$10.39
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$32.53
Rate for Payer: Meridian Health Plan Medicare	$32.53
Rate for Payer: Priority Health Commercial	$8.55
Rate for Payer: Priority Health Medicaid	$32.53
Rate for Payer: Priority Health Medicare	$32.53
Rate for Payer: Priority Health PPO	$8.55
Rate for Payer: United Health Care Medicaid	$32.53
Rate for Payer: United Health Care Medicare Advantage	$14.31

SEROTONIN RELEASE ASSAY

Facility

$215.00

Hospital Charge Code	3101463
Hospital Revenue Code	300
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$182.75
Rate for Payer: Cash Price	$139.75
Rate for Payer: Community Health Alliance Commercial	$182.75
Rate for Payer: Priority Health Commercial	$150.50
Rate for Payer: Priority Health PPO	$150.50

SEROTONIN WHOLE BLOOD

Facility

$18.73

Hospital Charge Code	3101950
Hospital Revenue Code	300
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$15.92
Rate for Payer: Cash Price	$12.17
Rate for Payer: Community Health Alliance Commercial	$15.92
Rate for Payer: Priority Health Commercial	$13.11
Rate for Payer: Priority Health PPO	$13.11

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges