Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

SHOULDER PULLEY,HOME RANGER 93

Facility

$51.00

Hospital Charge Code	27021741
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 WRAP #SW9001

Facility

$176.00

Hospital Charge Code	27020677
Hospital Revenue Code	270
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$149.60
Rate for Payer: Cash Price	$114.40
Rate for Payer: Community Health Alliance Commercial	$149.60
Rate for Payer: Priority Health Commercial	$123.20
Rate for Payer: Priority Health PPO	$123.20

SHUNT - EXTERNAL CAROTID

Facility

$266.00

Hospital Charge Code	27013748
Hospital Revenue Code	278
Min. Negotiated Rate	$186.20
Max. Negotiated Rate	$226.10
Rate for Payer: Cash Price	$172.90
Rate for Payer: Community Health Alliance Commercial	$226.10
Rate for Payer: Priority Health Commercial	$186.20
Rate for Payer: Priority Health PPO	$186.20

SHUNT,JAVIT BYPASS

Facility

$251.00

Hospital Charge Code	27266187
Hospital Revenue Code	278
Min. Negotiated Rate	$175.70
Max. Negotiated Rate	$213.35
Rate for Payer: Cash Price	$163.15
Rate for Payer: Community Health Alliance Commercial	$213.35
Rate for Payer: Priority Health Commercial	$175.70
Rate for Payer: Priority Health PPO	$175.70

SHUNT, LOOP STYLE HEYER-SCHULT

Facility

$454.00

Hospital Charge Code	27019166
Hospital Revenue Code	278
Min. Negotiated Rate	$317.80
Max. Negotiated Rate	$385.90
Rate for Payer: Cash Price	$295.10
Rate for Payer: Community Health Alliance Commercial	$385.90
Rate for Payer: Priority Health Commercial	$317.80
Rate for Payer: Priority Health PPO	$317.80

SHUR - CLENS

Facility

$35.00

Hospital Charge Code	27016451
Hospital Revenue Code	270
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

SICKLE CELL SCREEN

Facility

$3.37

Service Code	HCPCS 85660
Hospital Charge Code	3007335
Hospital Revenue Code	305
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.79
Rate for Payer: BCBS BCN 65	$5.79
Rate for Payer: Blue Care Network Medicare Advantage	$5.79
Rate for Payer: Cash Price	$2.19
Rate for Payer: Cash Price	$2.19
Rate for Payer: Community Health Alliance Commercial	$2.86
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.79
Rate for Payer: Meridian Health Plan Medicare	$5.79
Rate for Payer: Priority Health Commercial	$2.36
Rate for Payer: Priority Health Medicaid	$5.79
Rate for Payer: Priority Health Medicare	$5.79
Rate for Payer: Priority Health PPO	$2.36
Rate for Payer: United Health Care Medicaid	$5.79
Rate for Payer: United Health Care Medicare Advantage	$2.55

SIGMOIDOSCOPY AND BIOPSY PC

Facility

$605.00

Hospital Charge Code	5150717
Hospital Revenue Code	960
Min. Negotiated Rate	$423.50
Max. Negotiated Rate	$514.25
Rate for Payer: Cash Price	$393.25
Rate for Payer: Community Health Alliance Commercial	$514.25
Rate for Payer: Priority Health Commercial	$423.50
Rate for Payer: Priority Health PPO	$423.50

SIGMOIDOSCOPY DIAGNOSTIC

Facility

$447.00

Hospital Charge Code	5150738
Hospital Revenue Code	960
Min. Negotiated Rate	$312.90
Max. Negotiated Rate	$379.95
Rate for Payer: Cash Price	$290.55
Rate for Payer: Community Health Alliance Commercial	$379.95
Rate for Payer: Priority Health Commercial	$312.90
Rate for Payer: Priority Health PPO	$312.90

SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$997.61

Service Code	CPT 45330
Hospital Revenue Code	360
Min. Negotiated Rate	$438.95
Max. Negotiated Rate	$997.61
Rate for Payer: BCBS BCN 65	$997.61
Rate for Payer: Blue Care Network Medicare Advantage	$997.61
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$997.61
Rate for Payer: Meridian Health Plan Medicare	$997.61
Rate for Payer: Priority Health Medicaid	$997.61
Rate for Payer: Priority Health Medicare	$997.61
Rate for Payer: United Health Care Medicaid	$997.61
Rate for Payer: United Health Care Medicare Advantage	$438.95

SIGMOIDOSCOPY W/SUBMUC INJ

Facility

$415.00

Hospital Charge Code	5150718
Hospital Revenue Code	960
Min. Negotiated Rate	$290.50
Max. Negotiated Rate	$352.75
Rate for Payer: Cash Price	$269.75
Rate for Payer: Community Health Alliance Commercial	$352.75
Rate for Payer: Priority Health Commercial	$290.50
Rate for Payer: Priority Health PPO	$290.50

SILASTIC IMPLANT

Facility

$525.00

Hospital Charge Code	27814092
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$446.25
Rate for Payer: Cash Price	$341.25
Rate for Payer: Community Health Alliance Commercial	$446.25
Rate for Payer: Priority Health Commercial	$367.50
Rate for Payer: Priority Health PPO	$367.50

SILASTIC IMPLANT

Facility

$525.00

Service Code	HCPCS C1776
Hospital Charge Code	27014092
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$446.25
Rate for Payer: Cash Price	$341.25
Rate for Payer: Community Health Alliance Commercial	$446.25
Rate for Payer: Priority Health Commercial	$367.50
Rate for Payer: Priority Health PPO	$367.50

SILASTIC NERVE CAP

Facility

$445.00

Hospital Charge Code	27015362
Hospital Revenue Code	272
Min. Negotiated Rate	$311.50
Max. Negotiated Rate	$378.25
Rate for Payer: Cash Price	$289.25
Rate for Payer: Community Health Alliance Commercial	$378.25
Rate for Payer: Priority Health Commercial	$311.50
Rate for Payer: Priority Health PPO	$311.50

SILICONE PLUG 0.5 DIA #3055

Facility

$163.00

Hospital Charge Code	27263030
Hospital Revenue Code	272
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$138.55
Rate for Payer: Cash Price	$105.95
Rate for Payer: Community Health Alliance Commercial	$138.55
Rate for Payer: Priority Health Commercial	$114.10
Rate for Payer: Priority Health PPO	$114.10

SILICONE TIES

Facility

$53.00

Hospital Charge Code	27061014
Hospital Revenue Code	270
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$45.05
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health PPO	$37.10

SIMPLE BILATERAL EPISTAXIS

Facility

$215.00

Hospital Charge Code	4500964
Hospital Revenue Code	450
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

SIMPLE SINGLE EPISTAXIS

Facility

$108.00

Hospital Charge Code	4500963
Hospital Revenue Code	450
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

SINEMET

Facility

$404.00

Hospital Charge Code	3010070
Hospital Revenue Code	301
Min. Negotiated Rate	$282.80
Max. Negotiated Rate	$343.40
Rate for Payer: Cash Price	$262.60
Rate for Payer: Community Health Alliance Commercial	$343.40
Rate for Payer: Priority Health Commercial	$282.80
Rate for Payer: Priority Health PPO	$282.80

SITU HYBRID 10-30 CELLS

Facility

$200.00

Hospital Charge Code	3100975
Hospital Revenue Code	310
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$170.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Community Health Alliance Commercial	$170.00
Rate for Payer: Priority Health Commercial	$140.00
Rate for Payer: Priority Health PPO	$140.00

SKIN SCRAPINGS SCABIES

Facility

$36.00

Hospital Charge Code	3007344
Hospital Revenue Code	306
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$30.60
Rate for Payer: Cash Price	$23.40
Rate for Payer: Community Health Alliance Commercial	$30.60
Rate for Payer: Priority Health Commercial	$25.20
Rate for Payer: Priority Health PPO	$25.20

SLING, ADVANTAGE SYSTEM

Facility

$1,817.00

Hospital Charge Code	26267425
Hospital Revenue Code	270
Min. Negotiated Rate	$1,271.90
Max. Negotiated Rate	$1,544.45
Rate for Payer: Cash Price	$1,181.05
Rate for Payer: Community Health Alliance Commercial	$1,544.45
Rate for Payer: Priority Health Commercial	$1,271.90
Rate for Payer: Priority Health PPO	$1,271.90

SLING, PEDIATRIC ARM

Facility

$19.00

Hospital Charge Code	27064603
Hospital Revenue Code	270
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$16.15
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health PPO	$13.30

SLING STRAP WITH FOAM -LARGE

Facility

$27.00

Hospital Charge Code	27024570
Hospital Revenue Code	270
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

SLING STRAP WITH FOAM - MEDIUM

Facility

$27.00

Hospital Charge Code	27024497
Hospital Revenue Code	270
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges