Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

SPHINCTEROTOME 30MM

Facility

$588.00

Hospital Charge Code	27024133
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

SPHINCTEROTOME, RAPID EXCHANGE

Facility

$910.00

Hospital Charge Code	27264009
Hospital Revenue Code	272
Min. Negotiated Rate	$637.00
Max. Negotiated Rate	$773.50
Rate for Payer: Cash Price	$591.50
Rate for Payer: Community Health Alliance Commercial	$773.50
Rate for Payer: Priority Health Commercial	$637.00
Rate for Payer: Priority Health PPO	$637.00

SPHINCTEROTOMES, WIRE GUIDED

Facility

$432.00

Hospital Charge Code	27263162
Hospital Revenue Code	272
Min. Negotiated Rate	$302.40
Max. Negotiated Rate	$367.20
Rate for Payer: Cash Price	$280.80
Rate for Payer: Community Health Alliance Commercial	$367.20
Rate for Payer: Priority Health Commercial	$302.40
Rate for Payer: Priority Health PPO	$302.40

SPHINCTEROTOME,TRIPLE LUMEN

Facility

$424.00

Hospital Charge Code	27262801
Hospital Revenue Code	272
Min. Negotiated Rate	$296.80
Max. Negotiated Rate	$360.40
Rate for Payer: Cash Price	$275.60
Rate for Payer: Community Health Alliance Commercial	$360.40
Rate for Payer: Priority Health Commercial	$296.80
Rate for Payer: Priority Health PPO	$296.80

SPHINCTERTOME, EXTRA LARGE

Facility

$730.00

Hospital Charge Code	27021030
Hospital Revenue Code	272
Min. Negotiated Rate	$511.00
Max. Negotiated Rate	$620.50
Rate for Payer: Cash Price	$474.50
Rate for Payer: Community Health Alliance Commercial	$620.50
Rate for Payer: Priority Health Commercial	$511.00
Rate for Payer: Priority Health PPO	$511.00

SPHINCTERTOME - MICROVASIVE

Facility

$677.00

Hospital Charge Code	27019265
Hospital Revenue Code	272
Min. Negotiated Rate	$473.90
Max. Negotiated Rate	$575.45
Rate for Payer: Cash Price	$440.05
Rate for Payer: Community Health Alliance Commercial	$575.45
Rate for Payer: Priority Health Commercial	$473.90
Rate for Payer: Priority Health PPO	$473.90

SPHINCTERTOME,NEEDLE KNIFE

Facility

$335.00

Hospital Charge Code	27022616
Hospital Revenue Code	272
Min. Negotiated Rate	$234.50
Max. Negotiated Rate	$284.75
Rate for Payer: Cash Price	$217.75
Rate for Payer: Community Health Alliance Commercial	$284.75
Rate for Payer: Priority Health Commercial	$234.50
Rate for Payer: Priority Health PPO	$234.50

SPHINCTERTOME, REVERSE BII

Facility

$393.00

Hospital Charge Code	27020859
Hospital Revenue Code	272
Min. Negotiated Rate	$275.10
Max. Negotiated Rate	$334.05
Rate for Payer: Cash Price	$255.45
Rate for Payer: Community Health Alliance Commercial	$334.05
Rate for Payer: Priority Health Commercial	$275.10
Rate for Payer: Priority Health PPO	$275.10

SPICA, FORMFIT THUMB

Facility

$69.00

Hospital Charge Code	27022566
Hospital Revenue Code	270
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$58.65
Rate for Payer: Cash Price	$44.85
Rate for Payer: Community Health Alliance Commercial	$58.65
Rate for Payer: Priority Health Commercial	$48.30
Rate for Payer: Priority Health PPO	$48.30

SPINAL ANES TRAY

Facility

$36.00

Hospital Charge Code	27268241
Hospital Revenue Code	272
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

Spinal Muscular Atrophy

Facility

$135.00

Hospital Charge Code	31027709
Hospital Revenue Code	300
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$114.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Community Health Alliance Commercial	$114.75
Rate for Payer: Priority Health Commercial	$94.50
Rate for Payer: Priority Health PPO	$94.50

SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;

Facility

$757.23

Service Code	CPT 62270
Hospital Revenue Code	360
Min. Negotiated Rate	$333.18
Max. Negotiated Rate	$757.23
Rate for Payer: BCBS BCN 65	$757.23
Rate for Payer: Blue Care Network Medicare Advantage	$757.23
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$757.23
Rate for Payer: Meridian Health Plan Medicare	$757.23
Rate for Payer: Priority Health Medicaid	$757.23
Rate for Payer: Priority Health Medicare	$757.23
Rate for Payer: United Health Care Medicaid	$757.23
Rate for Payer: United Health Care Medicare Advantage	$333.18

SPINCTERONE W/BALLOON

Facility

$1,252.00

Hospital Charge Code	27019273
Hospital Revenue Code	272
Min. Negotiated Rate	$876.40
Max. Negotiated Rate	$1,064.20
Rate for Payer: Cash Price	$813.80
Rate for Payer: Community Health Alliance Commercial	$1,064.20
Rate for Payer: Priority Health Commercial	$876.40
Rate for Payer: Priority Health PPO	$876.40

SPLINT,BURNHAM THUMB

Facility

$98.00

Hospital Charge Code	27061691
Hospital Revenue Code	270
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

SPLINT,CARPAL LOCK WRIST

Facility

$60.00

Hospital Charge Code	27021774
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

SPLINT,DAYTIMER WRIST

Facility

$56.00

Hospital Charge Code	27020743
Hospital Revenue Code	270
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

SPLINT,ELBOW HINGE W/WRENCH

Facility

$237.00

Hospital Charge Code	27061279
Hospital Revenue Code	270
Min. Negotiated Rate	$165.90
Max. Negotiated Rate	$201.45
Rate for Payer: Cash Price	$154.05
Rate for Payer: Community Health Alliance Commercial	$201.45
Rate for Payer: Priority Health Commercial	$165.90
Rate for Payer: Priority Health PPO	$165.90

SPLINT, FINGER FOAM/ALUM

Facility

$17.00

Hospital Charge Code	27020784
Hospital Revenue Code	270
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

SPLINT,FOREARM COLLES

Facility

$30.00

Hospital Charge Code	27020818
Hospital Revenue Code	270
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

SPLINT,GUTTER FOAM 7"

Facility

$17.00

Hospital Charge Code	27061089
Hospital Revenue Code	270
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

SPLINT,LIBERTY ONE

Facility

$53.00

Hospital Charge Code	27020867
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

SPLINT,LMB ACU-SPRING FINGER

Facility

$47.00

Hospital Charge Code	27062105
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

SPLINT, LMB WIRE FOAM

Facility

$60.00

Hospital Charge Code	27062182
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

SPLINT, PLANTAR FASCITIS

Facility

$112.00

Hospital Charge Code	27061931
Hospital Revenue Code	270
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$95.20
Rate for Payer: Cash Price	$72.80
Rate for Payer: Community Health Alliance Commercial	$95.20
Rate for Payer: Priority Health Commercial	$78.40
Rate for Payer: Priority Health PPO	$78.40

SPLINT,PROGRESS ELBOW HINGE

Facility

$366.00

Hospital Charge Code	27061337
Hospital Revenue Code	270
Min. Negotiated Rate	$256.20
Max. Negotiated Rate	$311.10
Rate for Payer: Cash Price	$237.90
Rate for Payer: Community Health Alliance Commercial	$311.10
Rate for Payer: Priority Health Commercial	$256.20
Rate for Payer: Priority Health PPO	$256.20

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges