Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

SPLINT, RESTING PAN MITT

Facility

$33.00

Hospital Charge Code	27019745
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

SPLINT, REVERSE FINGER KNUCKLE

Facility

$34.00

Hospital Charge Code	27019810
Hospital Revenue Code	270
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$28.90
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health PPO	$23.80

SPLINT,THUMB/SPICA (MED/LT)

Facility

$158.00

Hospital Charge Code	27066328
Hospital Revenue Code	270
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

SPLINT,TRACTION

Facility

$121.00

Hospital Charge Code	27060933
Hospital Revenue Code	270
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$102.85
Rate for Payer: Cash Price	$78.65
Rate for Payer: Community Health Alliance Commercial	$102.85
Rate for Payer: Priority Health Commercial	$84.70
Rate for Payer: Priority Health PPO	$84.70

SPRAY CATH

Facility

$243.00

Hospital Charge Code	27263676
Hospital Revenue Code	272
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$206.55
Rate for Payer: Cash Price	$157.95
Rate for Payer: Community Health Alliance Commercial	$206.55
Rate for Payer: Priority Health Commercial	$170.10
Rate for Payer: Priority Health PPO	$170.10

SPRING FINGER EXTENSION ASSIST

Facility

$44.00

Hospital Charge Code	27060470
Hospital Revenue Code	270
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

SPUTUM COLLECTION

Facility

$24.00

Service Code	HCPCS 94799
Hospital Charge Code	4600090
Hospital Revenue Code	300
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$138.03
Rate for Payer: BCBS BCN 65	$138.03
Rate for Payer: Blue Care Network Medicare Advantage	$138.03
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	$138.03
Rate for Payer: Meridian Health Plan Medicare	$138.03
Rate for Payer: Priority Health Commercial	$16.80
Rate for Payer: Priority Health Medicaid	$138.03
Rate for Payer: Priority Health Medicare	$138.03
Rate for Payer: Priority Health PPO	$16.80
Rate for Payer: United Health Care Medicaid	$138.03
Rate for Payer: United Health Care Medicare Advantage	$60.73

SQUAMOUS CELL CARCINOMA

Facility

$84.00

Service Code	HCPCS 86316
Hospital Charge Code	3007395
Hospital Revenue Code	302
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$71.40
Rate for Payer: BCBS BCN 65	$21.85
Rate for Payer: Blue Care Network Medicare Advantage	$21.85
Rate for Payer: Cash Price	$54.60
Rate for Payer: Cash Price	$54.60
Rate for Payer: Community Health Alliance Commercial	$71.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.85
Rate for Payer: Meridian Health Plan Medicare	$21.85
Rate for Payer: Priority Health Commercial	$58.80
Rate for Payer: Priority Health Medicaid	$21.85
Rate for Payer: Priority Health Medicare	$21.85
Rate for Payer: Priority Health PPO	$58.80
Rate for Payer: United Health Care Medicaid	$21.85
Rate for Payer: United Health Care Medicare Advantage	$9.61

SSA

Facility

$4.77

Service Code	HCPCS 86235
Hospital Charge Code	3007350
Hospital Revenue Code	302
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$18.83
Rate for Payer: BCBS BCN 65	$18.83
Rate for Payer: Blue Care Network Medicare Advantage	$18.83
Rate for Payer: Cash Price	$3.10
Rate for Payer: Cash Price	$3.10
Rate for Payer: Community Health Alliance Commercial	$4.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.83
Rate for Payer: Meridian Health Plan Medicare	$18.83
Rate for Payer: Priority Health Commercial	$3.34
Rate for Payer: Priority Health Medicaid	$18.83
Rate for Payer: Priority Health Medicare	$18.83
Rate for Payer: Priority Health PPO	$3.34
Rate for Payer: United Health Care Medicaid	$18.83
Rate for Payer: United Health Care Medicare Advantage	$8.28

SSB

Facility

$4.77

Service Code	HCPCS 86235
Hospital Charge Code	3007370
Hospital Revenue Code	302
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$18.83
Rate for Payer: BCBS BCN 65	$18.83
Rate for Payer: Blue Care Network Medicare Advantage	$18.83
Rate for Payer: Cash Price	$3.10
Rate for Payer: Cash Price	$3.10
Rate for Payer: Community Health Alliance Commercial	$4.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.83
Rate for Payer: Meridian Health Plan Medicare	$18.83
Rate for Payer: Priority Health Commercial	$3.34
Rate for Payer: Priority Health Medicaid	$18.83
Rate for Payer: Priority Health Medicare	$18.83
Rate for Payer: Priority Health PPO	$3.34
Rate for Payer: United Health Care Medicaid	$18.83
Rate for Payer: United Health Care Medicare Advantage	$8.28

SS GRP1-KC

Facility

$85.46

Hospital Charge Code	3102684
Hospital Revenue Code	300
Min. Negotiated Rate	$59.82
Max. Negotiated Rate	$72.64
Rate for Payer: Cash Price	$55.55
Rate for Payer: Community Health Alliance Commercial	$72.64
Rate for Payer: Priority Health Commercial	$59.82
Rate for Payer: Priority Health PPO	$59.82

SS MICRO ORGAN I TECH

Facility

$94.00

Service Code	HCPCS 88312
Hospital Charge Code	3100520
Hospital Revenue Code	310
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$79.90
Rate for Payer: BCBS BCN 65	$55.90
Rate for Payer: Blue Care Network Medicare Advantage	$55.90
Rate for Payer: Cash Price	$61.10
Rate for Payer: Cash Price	$61.10
Rate for Payer: Community Health Alliance Commercial	$79.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$55.90
Rate for Payer: Meridian Health Plan Medicare	$55.90
Rate for Payer: Priority Health Commercial	$65.80
Rate for Payer: Priority Health Medicaid	$55.90
Rate for Payer: Priority Health Medicare	$55.90
Rate for Payer: Priority Health PPO	$65.80
Rate for Payer: United Health Care Medicaid	$55.90
Rate for Payer: United Health Care Medicare Advantage	$24.60

STACHYBOTRYS CHARTARUM/ATR

Facility

$3.26

Hospital Charge Code	3100923
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

STAPLER,CURVED INTRALUMINARY

Facility

$1,438.00

Hospital Charge Code	27017443
Hospital Revenue Code	272
Min. Negotiated Rate	$1,006.60
Max. Negotiated Rate	$1,222.30
Rate for Payer: Cash Price	$934.70
Rate for Payer: Community Health Alliance Commercial	$1,222.30
Rate for Payer: Priority Health Commercial	$1,006.60
Rate for Payer: Priority Health PPO	$1,006.60

STAPLER, ENDO HERNIA

Facility

$832.00

Hospital Charge Code	27018424
Hospital Revenue Code	272
Min. Negotiated Rate	$582.40
Max. Negotiated Rate	$707.20
Rate for Payer: Cash Price	$540.80
Rate for Payer: Community Health Alliance Commercial	$707.20
Rate for Payer: Priority Health Commercial	$582.40
Rate for Payer: Priority Health PPO	$582.40

STAPLER, ENDO LINEAR CUTTER

Facility

$933.00

Hospital Charge Code	27267565
Hospital Revenue Code	272
Min. Negotiated Rate	$653.10
Max. Negotiated Rate	$793.05
Rate for Payer: Cash Price	$606.45
Rate for Payer: Community Health Alliance Commercial	$793.05
Rate for Payer: Priority Health Commercial	$653.10
Rate for Payer: Priority Health PPO	$653.10

STAPLER EXTRACTOR ETHICON

Facility

$34.00

Hospital Charge Code	27024646
Hospital Revenue Code	272
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$28.90
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health PPO	$23.80

STAPLER POWDERED LIDS, 15W

Facility

$1,069.00

Hospital Charge Code	27017434
Hospital Revenue Code	270
Min. Negotiated Rate	$748.30
Max. Negotiated Rate	$908.65
Rate for Payer: Cash Price	$694.85
Rate for Payer: Community Health Alliance Commercial	$908.65
Rate for Payer: Priority Health Commercial	$748.30
Rate for Payer: Priority Health PPO	$748.30

STATAK - TISSUE ATTACH DEVICE

Facility

$307.00

Hospital Charge Code	27018994
Hospital Revenue Code	272
Min. Negotiated Rate	$214.90
Max. Negotiated Rate	$260.95
Rate for Payer: Cash Price	$199.55
Rate for Payer: Community Health Alliance Commercial	$260.95
Rate for Payer: Priority Health Commercial	$214.90
Rate for Payer: Priority Health PPO	$214.90

STAY FUSE DISTAL IMPLANT 5.5

Facility

$812.00

Hospital Charge Code	27868761
Hospital Revenue Code	278
Min. Negotiated Rate	$568.40
Max. Negotiated Rate	$690.20
Rate for Payer: Cash Price	$527.80
Rate for Payer: Community Health Alliance Commercial	$690.20
Rate for Payer: Priority Health Commercial	$568.40
Rate for Payer: Priority Health PPO	$568.40

STAY FUSE DISTAL IMPLANT 6.5

Facility

$812.00

Hospital Charge Code	27868779
Hospital Revenue Code	278
Min. Negotiated Rate	$568.40
Max. Negotiated Rate	$690.20
Rate for Payer: Cash Price	$527.80
Rate for Payer: Community Health Alliance Commercial	$690.20
Rate for Payer: Priority Health Commercial	$568.40
Rate for Payer: Priority Health PPO	$568.40

STAY FUSE PROXIMAL IMPLANT 6.5

Facility

$812.00

Hospital Charge Code	27868753
Hospital Revenue Code	278
Min. Negotiated Rate	$568.40
Max. Negotiated Rate	$690.20
Rate for Payer: Cash Price	$527.80
Rate for Payer: Community Health Alliance Commercial	$690.20
Rate for Payer: Priority Health Commercial	$568.40
Rate for Payer: Priority Health PPO	$568.40

STEEL WIRE GUARD

Facility

$68.00

Hospital Charge Code	27018069
Hospital Revenue Code	270
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

STENT

Facility

$318.50

Hospital Charge Code	27267904
Hospital Revenue Code	278
Min. Negotiated Rate	$222.95
Max. Negotiated Rate	$270.73
Rate for Payer: Cash Price	$207.03
Rate for Payer: Community Health Alliance Commercial	$270.73
Rate for Payer: Priority Health Commercial	$222.95
Rate for Payer: Priority Health PPO	$222.95

STENT, 4FR BLACK SILICON

Facility

$524.00

Service Code	HCPCS C2617
Hospital Charge Code	27061147
Hospital Revenue Code	278
Min. Negotiated Rate	$366.80
Max. Negotiated Rate	$445.40
Rate for Payer: Cash Price	$340.60
Rate for Payer: Community Health Alliance Commercial	$445.40
Rate for Payer: Priority Health Commercial	$366.80
Rate for Payer: Priority Health PPO	$366.80

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges