Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

SLING STRAP WITH FOAM - SMALL

Facility

$27.00

Hospital Charge Code	27024414
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/SWATHE

Facility

$29.00

Hospital Charge Code	27013201
Hospital Revenue Code	270
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$24.65
Rate for Payer: Cash Price	$18.85
Rate for Payer: Community Health Alliance Commercial	$24.65
Rate for Payer: Priority Health Commercial	$20.30
Rate for Payer: Priority Health PPO	$20.30

SLING SYSTEM,SPARC

Facility

$2,358.00

Service Code	HCPCS C1771
Hospital Charge Code	27867102
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.60
Max. Negotiated Rate	$2,004.30
Rate for Payer: Cash Price	$1,532.70
Rate for Payer: Community Health Alliance Commercial	$2,004.30
Rate for Payer: Priority Health Commercial	$1,650.60
Rate for Payer: Priority Health PPO	$1,650.60

SLING - W/ POCKET-ALL

Facility

$40.00

Hospital Charge Code	27011221
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

SLING,W/POCKET LARGE

Facility

$40.00

Hospital Charge Code	27011211
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

SLOTTED WHISKER

Facility

$565.00

Hospital Charge Code	27061576
Hospital Revenue Code	270
Min. Negotiated Rate	$395.50
Max. Negotiated Rate	$480.25
Rate for Payer: Cash Price	$367.25
Rate for Payer: Community Health Alliance Commercial	$480.25
Rate for Payer: Priority Health Commercial	$395.50
Rate for Payer: Priority Health PPO	$395.50

SMALL FRAGMENT SET

Facility

$203.00

Hospital Charge Code	27018978
Hospital Revenue Code	272
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$172.55
Rate for Payer: Cash Price	$131.95
Rate for Payer: Community Health Alliance Commercial	$172.55
Rate for Payer: Priority Health Commercial	$142.10
Rate for Payer: Priority Health PPO	$142.10

SMALL JOINT RESECTOR

Facility

$238.00

Hospital Charge Code	27061105
Hospital Revenue Code	272
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$202.30
Rate for Payer: Cash Price	$154.70
Rate for Payer: Community Health Alliance Commercial	$202.30
Rate for Payer: Priority Health Commercial	$166.60
Rate for Payer: Priority Health PPO	$166.60

SMART STENT

Facility

$4,651.00

Service Code	HCPCS C1876
Hospital Charge Code	27871543
Hospital Revenue Code	278
Min. Negotiated Rate	$3,255.70
Max. Negotiated Rate	$3,953.35
Rate for Payer: Cash Price	$3,023.15
Rate for Payer: Community Health Alliance Commercial	$3,953.35
Rate for Payer: Priority Health Commercial	$3,255.70
Rate for Payer: Priority Health PPO	$3,255.70

SMEAR EXAMINATION WITHOUT DIFF

Facility

$23.00

Service Code	HCPCS 85008
Hospital Charge Code	3007341
Hospital Revenue Code	305
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$19.55
Rate for Payer: BCBS BCN 65	$3.60
Rate for Payer: Blue Care Network Medicare Advantage	$3.60
Rate for Payer: Cash Price	$14.95
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.60
Rate for Payer: Meridian Health Plan Medicare	$3.60
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health Medicaid	$3.60
Rate for Payer: Priority Health Medicare	$3.60
Rate for Payer: Priority Health PPO	$16.10
Rate for Payer: United Health Care Medicaid	$3.60
Rate for Payer: United Health Care Medicare Advantage	$1.58

SMEAR FUNGAL

Facility

$29.00

Service Code	HCPCS 87210
Hospital Charge Code	3007343
Hospital Revenue Code	306
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$24.65
Rate for Payer: BCBS BCN 65	$6.11
Rate for Payer: Blue Care Network Medicare Advantage	$6.11
Rate for Payer: Cash Price	$18.85
Rate for Payer: Cash Price	$18.85
Rate for Payer: Community Health Alliance Commercial	$24.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.11
Rate for Payer: Meridian Health Plan Medicare	$6.11
Rate for Payer: Priority Health Commercial	$20.30
Rate for Payer: Priority Health Medicaid	$6.11
Rate for Payer: Priority Health Medicare	$6.11
Rate for Payer: Priority Health PPO	$20.30
Rate for Payer: United Health Care Medicaid	$6.11
Rate for Payer: United Health Care Medicare Advantage	$2.69

SMEAR MISC

Facility

$31.00

Service Code	HCPCS 87205
Hospital Charge Code	3007520
Hospital Revenue Code	306
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

SMITH LEMLI OPITZ SCREEN

Facility

$186.00

Hospital Charge Code	3100832
Hospital Revenue Code	301
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$158.10
Rate for Payer: Cash Price	$120.90
Rate for Payer: Community Health Alliance Commercial	$158.10
Rate for Payer: Priority Health Commercial	$130.20
Rate for Payer: Priority Health PPO	$130.20

SMITH RNP

Facility

$4.77

Hospital Charge Code	3101238
Hospital Revenue Code	301
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$4.05
Rate for Payer: Cash Price	$3.10
Rate for Payer: Community Health Alliance Commercial	$4.05
Rate for Payer: Priority Health Commercial	$3.34
Rate for Payer: Priority Health PPO	$3.34

SNARE ASSEMBLY, OVAL DISP

Facility

$184.00

Hospital Charge Code	27020537
Hospital Revenue Code	272
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$156.40
Rate for Payer: Cash Price	$119.60
Rate for Payer: Community Health Alliance Commercial	$156.40
Rate for Payer: Priority Health Commercial	$128.80
Rate for Payer: Priority Health PPO	$128.80

SNARE,CARR-LOCKE

Facility

$98.00

Hospital Charge Code	27262814
Hospital Revenue Code	272
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$83.30
Rate for Payer: Cash Price	$63.70
Rate for Payer: Community Health Alliance Commercial	$83.30
Rate for Payer: Priority Health Commercial	$68.60
Rate for Payer: Priority Health PPO	$68.60

SNARE, ELECTROSURGICAL-CRESENT

Facility

$92.00

Hospital Charge Code	27265742
Hospital Revenue Code	272
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$78.20
Rate for Payer: Cash Price	$59.80
Rate for Payer: Community Health Alliance Commercial	$78.20
Rate for Payer: Priority Health Commercial	$64.40
Rate for Payer: Priority Health PPO	$64.40

SNARE,POLYECTOMY

Facility

$78.00

Hospital Charge Code	27263317
Hospital Revenue Code	272
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health PPO	$54.60

SOD-1 GENE TESTING

Facility

$975.00

Hospital Charge Code	3101270
Hospital Revenue Code	301
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$828.75
Rate for Payer: Cash Price	$633.75
Rate for Payer: Community Health Alliance Commercial	$828.75
Rate for Payer: Priority Health Commercial	$682.50
Rate for Payer: Priority Health PPO	$682.50

SODIUM

Facility

$22.00

Service Code	HCPCS 84295
Hospital Charge Code	3007480
Hospital Revenue Code	301
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$18.70
Rate for Payer: BCBS BCN 65	$5.05
Rate for Payer: Blue Care Network Medicare Advantage	$5.05
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$14.30
Rate for Payer: Community Health Alliance Commercial	$18.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.05
Rate for Payer: Meridian Health Plan Medicare	$5.05
Rate for Payer: Priority Health Commercial	$15.40
Rate for Payer: Priority Health Medicaid	$5.05
Rate for Payer: Priority Health Medicare	$5.05
Rate for Payer: Priority Health PPO	$15.40
Rate for Payer: United Health Care Medicaid	$5.05
Rate for Payer: United Health Care Medicare Advantage	$2.22

SODIUM CHLORIDE 0.9% 1000ML IR

Facility

$48.45

Service Code	HCPCS J7030
Hospital Charge Code	2503333
Hospital Revenue Code	636
Min. Negotiated Rate	$33.91
Max. Negotiated Rate	$41.18
Rate for Payer: Cash Price	$31.49
Rate for Payer: Community Health Alliance Commercial	$41.18
Rate for Payer: Priority Health Commercial	$33.91
Rate for Payer: Priority Health PPO	$33.91

SODIUM CHLORIDE 0.9%M 250ML

Facility

$233.80

Service Code	HCPCS J7050
Hospital Charge Code	2510896
Hospital Revenue Code	636
Min. Negotiated Rate	$163.66
Max. Negotiated Rate	$198.73
Rate for Payer: Cash Price	$151.97
Rate for Payer: Community Health Alliance Commercial	$198.73
Rate for Payer: Priority Health Commercial	$163.66
Rate for Payer: Priority Health PPO	$163.66

SODIUM, STOOL

Facility

$43.45

Service Code	HCPCS 84302
Hospital Charge Code	3007490
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$36.93
Rate for Payer: BCBS BCN 65	$5.10
Rate for Payer: Blue Care Network Medicare Advantage	$5.10
Rate for Payer: Cash Price	$28.24
Rate for Payer: Cash Price	$28.24
Rate for Payer: Community Health Alliance Commercial	$36.93
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.10
Rate for Payer: Meridian Health Plan Medicare	$5.10
Rate for Payer: Priority Health Commercial	$30.41
Rate for Payer: Priority Health Medicaid	$5.10
Rate for Payer: Priority Health Medicare	$5.10
Rate for Payer: Priority Health PPO	$30.41
Rate for Payer: United Health Care Medicaid	$5.10
Rate for Payer: United Health Care Medicare Advantage	$2.25

SODIUM, URINE 24 HR

Facility

$2.00

Service Code	HCPCS 84300
Hospital Charge Code	3009110
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.31
Rate for Payer: BCBS BCN 65	$5.31
Rate for Payer: Blue Care Network Medicare Advantage	$5.31
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.31
Rate for Payer: Meridian Health Plan Medicare	$5.31
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health Medicaid	$5.31
Rate for Payer: Priority Health Medicare	$5.31
Rate for Payer: Priority Health PPO	$1.40
Rate for Payer: United Health Care Medicaid	$5.31
Rate for Payer: United Health Care Medicare Advantage	$2.34

SODIUM, URINE RANDOM

Facility

$2.00

Service Code	HCPCS 84300
Hospital Charge Code	3007500
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.31
Rate for Payer: BCBS BCN 65	$5.31
Rate for Payer: Blue Care Network Medicare Advantage	$5.31
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.31
Rate for Payer: Meridian Health Plan Medicare	$5.31
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health Medicaid	$5.31
Rate for Payer: Priority Health Medicare	$5.31
Rate for Payer: Priority Health PPO	$1.40
Rate for Payer: United Health Care Medicaid	$5.31
Rate for Payer: United Health Care Medicare Advantage	$2.34

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges