Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

SERTRALINE S/P

Facility

$64.00

Hospital Charge Code	3101399
Hospital Revenue Code	300
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$54.40
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health PPO	$44.80

SERUM PRETX DILUTION-R

Facility

$30.00

Hospital Charge Code	3100078
Hospital Revenue Code	300
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$25.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health PPO	$21.00

SERUM PRETX, DRUG INCUBATE-R

Facility

$83.00

Hospital Charge Code	3100075
Hospital Revenue Code	300
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$70.55
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health PPO	$58.10

SERUM PRETX, INHIBITOR INCUBAT

Facility

$50.00

Hospital Charge Code	3100077
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

SERUM PRETX, RC ABSORPT-R

Facility

$77.00

Hospital Charge Code	3100076
Hospital Revenue Code	300
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$65.45
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health PPO	$53.90

SERUM PROTEIN ELECTROPHORESIS

Facility

$67.00

Hospital Charge Code	3006921
Hospital Revenue Code	301
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$56.95
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health PPO	$46.90

SET,TISSOMAT SPRAY

Facility

$124.00

Hospital Charge Code	27266252
Hospital Revenue Code	272
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$105.40
Rate for Payer: Cash Price	$80.60
Rate for Payer: Community Health Alliance Commercial	$105.40
Rate for Payer: Priority Health Commercial	$86.80
Rate for Payer: Priority Health PPO	$86.80

SEX HORMONE BINDING GLOBULIN

Facility

$8.00

Service Code	HCPCS 84270
Hospital Charge Code	3007333
Hospital Revenue Code	301
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$22.82
Rate for Payer: BCBS BCN 65	$22.82
Rate for Payer: Blue Care Network Medicare Advantage	$22.82
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cash Price	$5.20
Rate for Payer: Community Health Alliance Commercial	$6.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$22.82
Rate for Payer: Meridian Health Plan Medicare	$22.82
Rate for Payer: Priority Health Commercial	$5.60
Rate for Payer: Priority Health Medicaid	$22.82
Rate for Payer: Priority Health Medicare	$22.82
Rate for Payer: Priority Health PPO	$5.60
Rate for Payer: United Health Care Medicaid	$22.82
Rate for Payer: United Health Care Medicare Advantage	$10.04

SGOT/AST

Facility

$39.00

Service Code	HCPCS 84450
Hospital Charge Code	3007400
Hospital Revenue Code	301
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$33.15
Rate for Payer: BCBS BCN 65	$5.44
Rate for Payer: Blue Care Network Medicare Advantage	$5.44
Rate for Payer: Cash Price	$25.35
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.44
Rate for Payer: Meridian Health Plan Medicare	$5.44
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health Medicaid	$5.44
Rate for Payer: Priority Health Medicare	$5.44
Rate for Payer: Priority Health PPO	$27.30
Rate for Payer: United Health Care Medicaid	$5.44
Rate for Payer: United Health Care Medicare Advantage	$2.39

SGPT/ALT

Facility

$33.00

Service Code	HCPCS 84460
Hospital Charge Code	3007420
Hospital Revenue Code	301
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$5.57
Rate for Payer: Blue Care Network Medicare Advantage	$5.57
Rate for Payer: Cash Price	$21.45
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.57
Rate for Payer: Meridian Health Plan Medicare	$5.57
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$5.57
Rate for Payer: Priority Health Medicare	$5.57
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$5.57
Rate for Payer: United Health Care Medicare Advantage	$2.45

SHARPLAN YAG SHARPLASE FIBER

Facility

$246.00

Hospital Charge Code	27015784
Hospital Revenue Code	272
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$209.10
Rate for Payer: Cash Price	$159.90
Rate for Payer: Community Health Alliance Commercial	$209.10
Rate for Payer: Priority Health Commercial	$172.20
Rate for Payer: Priority Health PPO	$172.20

SHAVE LESION <.6 CM

Facility

$177.00

Hospital Charge Code	5150758
Hospital Revenue Code	960
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$150.45
Rate for Payer: Cash Price	$115.05
Rate for Payer: Community Health Alliance Commercial	$150.45
Rate for Payer: Priority Health Commercial	$123.90
Rate for Payer: Priority Health PPO	$123.90

SHEATH

Facility

$256.00

Hospital Charge Code	27264157
Hospital Revenue Code	272
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$217.60
Rate for Payer: Cash Price	$166.40
Rate for Payer: Community Health Alliance Commercial	$217.60
Rate for Payer: Priority Health Commercial	$179.20
Rate for Payer: Priority Health PPO	$179.20

SHEATH

Facility

$47.00

Service Code	HCPCS C1894
Hospital Charge Code	27265106
Hospital Revenue Code	272
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$39.95
Rate for Payer: Cash Price	$30.55
Rate for Payer: Community Health Alliance Commercial	$39.95
Rate for Payer: Priority Health Commercial	$32.90
Rate for Payer: Priority Health PPO	$32.90

SHEATH #401-790M

Facility

$201.00

Service Code	HCPCS C1894
Hospital Charge Code	27264330
Hospital Revenue Code	272
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$170.85
Rate for Payer: Cash Price	$130.65
Rate for Payer: Community Health Alliance Commercial	$170.85
Rate for Payer: Priority Health Commercial	$140.70
Rate for Payer: Priority Health PPO	$140.70

SHEATH, 8.5FR X 11CM

Facility

$122.00

Service Code	HCPCS C1894
Hospital Charge Code	27061642
Hospital Revenue Code	272
Min. Negotiated Rate	$85.40
Max. Negotiated Rate	$103.70
Rate for Payer: Cash Price	$79.30
Rate for Payer: Community Health Alliance Commercial	$103.70
Rate for Payer: Priority Health Commercial	$85.40
Rate for Payer: Priority Health PPO	$85.40

SHEATH, 8FR X 11CM

Facility

$87.00

Service Code	HCPCS C1894
Hospital Charge Code	27061592
Hospital Revenue Code	272
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$73.95
Rate for Payer: Cash Price	$56.55
Rate for Payer: Community Health Alliance Commercial	$73.95
Rate for Payer: Priority Health Commercial	$60.90
Rate for Payer: Priority Health PPO	$60.90

SHIAA PLASMA

Facility

$10.00

Hospital Charge Code	3102014
Hospital Revenue Code	300
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health PPO	$7.00

SHIGITOX

Facility

$140.00

Hospital Charge Code	3003357
Hospital Revenue Code	306
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$119.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Community Health Alliance Commercial	$119.00
Rate for Payer: Priority Health Commercial	$98.00
Rate for Payer: Priority Health PPO	$98.00

SHILEY TRACHEOSTOMY TUBE

Facility

$158.00

Hospital Charge Code	27015214
Hospital Revenue Code	272
Min. Negotiated Rate	$110.60
Max. Negotiated Rate	$134.30
Rate for Payer: Cash Price	$102.70
Rate for Payer: Community Health Alliance Commercial	$134.30
Rate for Payer: Priority Health Commercial	$110.60
Rate for Payer: Priority Health PPO	$110.60

SHOE - POST ORDER

Facility

$51.00

Hospital Charge Code	27011239
Hospital Revenue Code	270
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

SHOULDER IMMOBILIZER

Facility

$47.00

Hospital Charge Code	27013193
Hospital Revenue Code	270
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$39.95
Rate for Payer: Cash Price	$30.55
Rate for Payer: Community Health Alliance Commercial	$39.95
Rate for Payer: Priority Health Commercial	$32.90
Rate for Payer: Priority Health PPO	$32.90

SHOULDER ORTHOSIS UNILATERAL

Facility

$111.00

Hospital Charge Code	27019752
Hospital Revenue Code	270
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$94.35
Rate for Payer: Cash Price	$72.15
Rate for Payer: Community Health Alliance Commercial	$94.35
Rate for Payer: Priority Health Commercial	$77.70
Rate for Payer: Priority Health PPO	$77.70

SHOULDER PULLEY, HOME RANGER

Facility

$33.00

Hospital Charge Code	27020974
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$28.05
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health PPO	$23.10

SHOULDER PULLEY,HOME RANGER 92

Facility

$58.00

Hospital Charge Code	27021758
Hospital Revenue Code	270
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$49.30
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health PPO	$40.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges