Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

SOEHENDRA STENT RETRIEVER

Facility

$414.00

Hospital Charge Code	27263558
Hospital Revenue Code	272
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$351.90
Rate for Payer: Cash Price	$269.10
Rate for Payer: Community Health Alliance Commercial	$351.90
Rate for Payer: Priority Health Commercial	$289.80
Rate for Payer: Priority Health PPO	$289.80

SOFTRANS(INTRAUTERINE PRES CAT

Facility

$141.00

Hospital Charge Code	27265551
Hospital Revenue Code	272
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$119.85
Rate for Payer: Cash Price	$91.65
Rate for Payer: Community Health Alliance Commercial	$119.85
Rate for Payer: Priority Health Commercial	$98.70
Rate for Payer: Priority Health PPO	$98.70

SOLID TUMER CULTURE

Facility

$431.00

Hospital Charge Code	3100617
Hospital Revenue Code	311
Min. Negotiated Rate	$301.70
Max. Negotiated Rate	$366.35
Rate for Payer: Cash Price	$280.15
Rate for Payer: Community Health Alliance Commercial	$366.35
Rate for Payer: Priority Health Commercial	$301.70
Rate for Payer: Priority Health PPO	$301.70

SOLO SITE GEL 3OZ TUBE

Facility

$31.00

Hospital Charge Code	27066807
Hospital Revenue Code	270
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$26.35
Rate for Payer: Cash Price	$20.15
Rate for Payer: Community Health Alliance Commercial	$26.35
Rate for Payer: Priority Health Commercial	$21.70
Rate for Payer: Priority Health PPO	$21.70

SOLUBLE LIVER AG/AB IgG

Facility

$141.75

Hospital Charge Code	3101803
Hospital Revenue Code	300
Min. Negotiated Rate	$99.22
Max. Negotiated Rate	$120.49
Rate for Payer: Cash Price	$92.14
Rate for Payer: Community Health Alliance Commercial	$120.49
Rate for Payer: Priority Health Commercial	$99.22
Rate for Payer: Priority Health PPO	$99.22

SOMATOMEDIN-C

Facility

$77.00

Service Code	HCPCS 84305
Hospital Charge Code	3007540
Hospital Revenue Code	301
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$65.45
Rate for Payer: BCBS BCN 65	$22.32
Rate for Payer: Blue Care Network Medicare Advantage	$22.32
Rate for Payer: Cash Price	$50.05
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$22.32
Rate for Payer: Meridian Health Plan Medicare	$22.32
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health Medicaid	$22.32
Rate for Payer: Priority Health Medicare	$22.32
Rate for Payer: Priority Health PPO	$53.90
Rate for Payer: United Health Care Medicaid	$22.32
Rate for Payer: United Health Care Medicare Advantage	$9.82

SOMATOMEDIN-C

Facility

$81.00

Service Code	HCPCS 84305
Hospital Charge Code	3007510
Hospital Revenue Code	301
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$68.85
Rate for Payer: BCBS BCN 65	$22.32
Rate for Payer: Blue Care Network Medicare Advantage	$22.32
Rate for Payer: Cash Price	$52.65
Rate for Payer: Cash Price	$52.65
Rate for Payer: Community Health Alliance Commercial	$68.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$22.32
Rate for Payer: Meridian Health Plan Medicare	$22.32
Rate for Payer: Priority Health Commercial	$56.70
Rate for Payer: Priority Health Medicaid	$22.32
Rate for Payer: Priority Health Medicare	$22.32
Rate for Payer: Priority Health PPO	$56.70
Rate for Payer: United Health Care Medicaid	$22.32
Rate for Payer: United Health Care Medicare Advantage	$9.82

SOMATOSTATIN

Facility

$365.00

Service Code	HCPCS 84307
Hospital Charge Code	3007550
Hospital Revenue Code	301
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$310.25
Rate for Payer: BCBS BCN 65	$19.19
Rate for Payer: Blue Care Network Medicare Advantage	$19.19
Rate for Payer: Cash Price	$237.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Community Health Alliance Commercial	$310.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.19
Rate for Payer: Meridian Health Plan Medicare	$19.19
Rate for Payer: Priority Health Commercial	$255.50
Rate for Payer: Priority Health Medicaid	$19.19
Rate for Payer: Priority Health Medicare	$19.19
Rate for Payer: Priority Health PPO	$255.50
Rate for Payer: United Health Care Medicaid	$19.19
Rate for Payer: United Health Care Medicare Advantage	$8.45

SONOHYSTERO UTERINE INJECTOR

Facility

$96.00

Hospital Charge Code	27261550
Hospital Revenue Code	272
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$81.60
Rate for Payer: Cash Price	$62.40
Rate for Payer: Community Health Alliance Commercial	$81.60
Rate for Payer: Priority Health Commercial	$67.20
Rate for Payer: Priority Health PPO	$67.20

SOULUABLE LIVER ANTIGEN

Facility

$56.00

Hospital Charge Code	3001090
Hospital Revenue Code	301
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

SOYBEAN IGG4

Facility

$26.00

Hospital Charge Code	3100728
Hospital Revenue Code	302
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

SPE

Facility

$77.00

Hospital Charge Code	3005662
Hospital Revenue Code	301
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

SPE-1

Facility

$3.98

Hospital Charge Code	3101648
Hospital Revenue Code	300
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$3.38
Rate for Payer: Cash Price	$2.59
Rate for Payer: Community Health Alliance Commercial	$3.38
Rate for Payer: Priority Health Commercial	$2.79
Rate for Payer: Priority Health PPO	$2.79

SPE-2

Facility

$3.98

Hospital Charge Code	3101649
Hospital Revenue Code	300
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$3.38
Rate for Payer: Cash Price	$2.59
Rate for Payer: Community Health Alliance Commercial	$3.38
Rate for Payer: Priority Health Commercial	$2.79
Rate for Payer: Priority Health PPO	$2.79

SPECIAL STAIN

Facility

$25.00

Hospital Charge Code	3004754
Hospital Revenue Code	306
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

SPECIAL STAIN GRP 1-PROF - KC

Facility

$25.21

Hospital Charge Code	3102685
Hospital Revenue Code	971
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$21.43
Rate for Payer: Cash Price	$16.39
Rate for Payer: Community Health Alliance Commercial	$21.43
Rate for Payer: Priority Health Commercial	$17.65
Rate for Payer: Priority Health PPO	$17.65

SPECIFIC GRAVITY O/T URINE

Facility

$3.08

Hospital Charge Code	3005518
Hospital Revenue Code	301
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.62
Rate for Payer: Cash Price	$2.00
Rate for Payer: Community Health Alliance Commercial	$2.62
Rate for Payer: Priority Health Commercial	$2.16
Rate for Payer: Priority Health PPO	$2.16

SPECIFIC GRAVITY, URINE

Facility

$24.00

Service Code	HCPCS 81003
Hospital Charge Code	3007580
Hospital Revenue Code	307
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$20.40
Rate for Payer: BCBS BCN 65	$2.36
Rate for Payer: Blue Care Network Medicare Advantage	$2.36
Rate for Payer: Cash Price	$15.60
Rate for Payer: Cash Price	$15.60
Rate for Payer: Community Health Alliance Commercial	$20.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2.36
Rate for Payer: Meridian Health Plan Medicare	$2.36
Rate for Payer: Priority Health Commercial	$16.80
Rate for Payer: Priority Health Medicaid	$2.36
Rate for Payer: Priority Health Medicare	$2.36
Rate for Payer: Priority Health PPO	$16.80
Rate for Payer: United Health Care Medicaid	$2.36
Rate for Payer: United Health Care Medicare Advantage	$1.04

SPECIMAN COLLECTION

Facility

$25.00

Service Code	HCPCS C9803
Hospital Charge Code	3101729
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

SPECIMEN CONCENTRATION

Facility

$15.00

Hospital Charge Code	30001540
Hospital Revenue Code	306
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

Spec-stain,GRP 1st

Facility

$29.97

Hospital Charge Code	31027480
Hospital Revenue Code	300
Min. Negotiated Rate	$20.98
Max. Negotiated Rate	$25.47
Rate for Payer: Cash Price	$19.48
Rate for Payer: Community Health Alliance Commercial	$25.47
Rate for Payer: Priority Health Commercial	$20.98
Rate for Payer: Priority Health PPO	$20.98

Spec-stain GRP 2nd

Facility

$29.97

Hospital Charge Code	31027481
Hospital Revenue Code	300
Min. Negotiated Rate	$20.98
Max. Negotiated Rate	$25.47
Rate for Payer: Cash Price	$19.48
Rate for Payer: Community Health Alliance Commercial	$25.47
Rate for Payer: Priority Health Commercial	$20.98
Rate for Payer: Priority Health PPO	$20.98

SPEECH THERAPY 92507 NO QUANT

Facility

$212.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	4400000
Hospital Revenue Code	441
Min. Negotiated Rate	$148.40
Max. Negotiated Rate	$180.20
Rate for Payer: Cash Price	$137.80
Rate for Payer: Community Health Alliance Commercial	$180.20
Rate for Payer: Priority Health Commercial	$148.40
Rate for Payer: Priority Health PPO	$148.40

SPERM CHECK POST OP

Facility

$45.00

Service Code	HCPCS 89321
Hospital Charge Code	3007600
Hospital Revenue Code	300
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$38.25
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.65
Rate for Payer: Meridian Health Plan Medicare	$12.65
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$31.50
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

SPHINCTEROTOME 20MM

Facility

$588.00

Hospital Charge Code	27024117
Hospital Revenue Code	272
Min. Negotiated Rate	$411.60
Max. Negotiated Rate	$499.80
Rate for Payer: Cash Price	$382.20
Rate for Payer: Community Health Alliance Commercial	$499.80
Rate for Payer: Priority Health Commercial	$411.60
Rate for Payer: Priority Health PPO	$411.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges