Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ST LOUIS ENCEPHALITIS IGG

Facility

$28.75

Hospital Charge Code	3100758
Hospital Revenue Code	302
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$24.44
Rate for Payer: Cash Price	$18.69
Rate for Payer: Community Health Alliance Commercial	$24.44
Rate for Payer: Priority Health Commercial	$20.12
Rate for Payer: Priority Health PPO	$20.12

ST LOUIS ENCEPHALITIS IGM

Facility

$28.75

Hospital Charge Code	3100759
Hospital Revenue Code	302
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$24.44
Rate for Payer: Cash Price	$18.69
Rate for Payer: Community Health Alliance Commercial	$24.44
Rate for Payer: Priority Health Commercial	$20.12
Rate for Payer: Priority Health PPO	$20.12

STOCKING - A/E, KNEE HIGH

Facility

$31.00

Hospital Charge Code	27011213
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

STOCKING - A/E, THIGH HIGH

Facility

$59.00

Hospital Charge Code	27011205
Hospital Revenue Code	270
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$50.15
Rate for Payer: Cash Price	$38.35
Rate for Payer: Community Health Alliance Commercial	$50.15
Rate for Payer: Priority Health Commercial	$41.30
Rate for Payer: Priority Health PPO	$41.30

STOMATE 22 FR MEDIUM

Facility

$338.00

Hospital Charge Code	27017020
Hospital Revenue Code	270
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$287.30
Rate for Payer: Cash Price	$219.70
Rate for Payer: Community Health Alliance Commercial	$287.30
Rate for Payer: Priority Health Commercial	$236.60
Rate for Payer: Priority Health PPO	$236.60

STONE ANALYSIS

Facility

$11.05

Hospital Charge Code	3006557
Hospital Revenue Code	301
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$9.39
Rate for Payer: Cash Price	$7.18
Rate for Payer: Community Health Alliance Commercial	$9.39
Rate for Payer: Priority Health Commercial	$7.74
Rate for Payer: Priority Health PPO	$7.74

STONE BASKET

Facility

$814.00

Hospital Charge Code	27268548
Hospital Revenue Code	272
Min. Negotiated Rate	$569.80
Max. Negotiated Rate	$691.90
Rate for Payer: Cash Price	$529.10
Rate for Payer: Community Health Alliance Commercial	$691.90
Rate for Payer: Priority Health Commercial	$569.80
Rate for Payer: Priority Health PPO	$569.80

STONE EXTRACTOR

Facility

$230.00

Hospital Charge Code	27014837
Hospital Revenue Code	272
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$195.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Community Health Alliance Commercial	$195.50
Rate for Payer: Priority Health Commercial	$161.00
Rate for Payer: Priority Health PPO	$161.00

STONE EXTRACTOR (COOK)

Facility

$692.00

Hospital Charge Code	27061162
Hospital Revenue Code	272
Min. Negotiated Rate	$484.40
Max. Negotiated Rate	$588.20
Rate for Payer: Cash Price	$449.80
Rate for Payer: Community Health Alliance Commercial	$588.20
Rate for Payer: Priority Health Commercial	$484.40
Rate for Payer: Priority Health PPO	$484.40

STONE RETRIEVER-GEMINI

Facility

$742.00

Hospital Charge Code	27015198
Hospital Revenue Code	272
Min. Negotiated Rate	$519.40
Max. Negotiated Rate	$630.70
Rate for Payer: Cash Price	$482.30
Rate for Payer: Community Health Alliance Commercial	$630.70
Rate for Payer: Priority Health Commercial	$519.40
Rate for Payer: Priority Health PPO	$519.40

STONE RET TRICEP GRASP FORCEP

Facility

$699.00

Hospital Charge Code	27060669
Hospital Revenue Code	272
Min. Negotiated Rate	$489.30
Max. Negotiated Rate	$594.15
Rate for Payer: Cash Price	$454.35
Rate for Payer: Community Health Alliance Commercial	$594.15
Rate for Payer: Priority Health Commercial	$489.30
Rate for Payer: Priority Health PPO	$489.30

STOOL FOR FAT QUAL

Facility

$5.00

Service Code	HCPCS 82705
Hospital Charge Code	3007620
Hospital Revenue Code	301
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.36
Rate for Payer: BCBS BCN 65	$5.36
Rate for Payer: Blue Care Network Medicare Advantage	$5.36
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.36
Rate for Payer: Meridian Health Plan Medicare	$5.36
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$5.36
Rate for Payer: Priority Health Medicare	$5.36
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$5.36
Rate for Payer: United Health Care Medicare Advantage	$2.36

STOOL FOR FAT,QUANT

Facility

$12.22

Service Code	HCPCS 82710
Hospital Charge Code	3004140
Hospital Revenue Code	301
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$17.64
Rate for Payer: BCBS BCN 65	$17.64
Rate for Payer: Blue Care Network Medicare Advantage	$17.64
Rate for Payer: Cash Price	$7.94
Rate for Payer: Cash Price	$7.94
Rate for Payer: Community Health Alliance Commercial	$10.39
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.64
Rate for Payer: Meridian Health Plan Medicare	$17.64
Rate for Payer: Priority Health Commercial	$8.55
Rate for Payer: Priority Health Medicaid	$17.64
Rate for Payer: Priority Health Medicare	$17.64
Rate for Payer: Priority Health PPO	$8.55
Rate for Payer: United Health Care Medicaid	$17.64
Rate for Payer: United Health Care Medicare Advantage	$7.76

STOOL FOR POLYS

Facility

$23.00

Service Code	HCPCS 87205
Hospital Charge Code	3007640
Hospital Revenue Code	306
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$19.55
Rate for Payer: BCBS BCN 65	$4.48
Rate for Payer: Blue Care Network Medicare Advantage	$4.48
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	$4.48
Rate for Payer: Meridian Health Plan Medicare	$4.48
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health Medicaid	$4.48
Rate for Payer: Priority Health Medicare	$4.48
Rate for Payer: Priority Health PPO	$16.10
Rate for Payer: United Health Care Medicaid	$4.48
Rate for Payer: United Health Care Medicare Advantage	$1.97

STOOL FOR TRYPSIN

Facility

$133.00

Service Code	HCPCS 83519
Hospital Charge Code	3007645
Hospital Revenue Code	301
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$113.05
Rate for Payer: BCBS BCN 65	$19.32
Rate for Payer: Blue Care Network Medicare Advantage	$19.32
Rate for Payer: Cash Price	$86.45
Rate for Payer: Cash Price	$86.45
Rate for Payer: Community Health Alliance Commercial	$113.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.32
Rate for Payer: Meridian Health Plan Medicare	$19.32
Rate for Payer: Priority Health Commercial	$93.10
Rate for Payer: Priority Health Medicaid	$19.32
Rate for Payer: Priority Health Medicare	$19.32
Rate for Payer: Priority Health PPO	$93.10
Rate for Payer: United Health Care Medicaid	$19.32
Rate for Payer: United Health Care Medicare Advantage	$8.50

STRAIGHT 4-65-.035-19

Facility

$83.00

Service Code	HCPCS C1769
Hospital Charge Code	27022681
Hospital Revenue Code	272
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$70.55
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health PPO	$58.10

STRAP,CLAVICLE

Facility

$36.00

Hospital Charge Code	27021055
Hospital Revenue Code	270
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

STRAP - FOLEY CATHETER/LEG

Facility

$36.00

Hospital Charge Code	27011007
Hospital Revenue Code	270
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

STRAP,KNEE

Facility

$56.00

Hospital Charge Code	27021071
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

STRAP SLING

Facility

$23.00

Hospital Charge Code	27013243
Hospital Revenue Code	270
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

STRATASIS URETHRAL SLING

Facility

$1,363.00

Hospital Charge Code	27264926
Hospital Revenue Code	272
Min. Negotiated Rate	$954.10
Max. Negotiated Rate	$1,158.55
Rate for Payer: Cash Price	$885.95
Rate for Payer: Community Health Alliance Commercial	$1,158.55
Rate for Payer: Priority Health Commercial	$954.10
Rate for Payer: Priority Health PPO	$954.10

STREP PNEUMO ANTIGEN IN URINE

Facility

$86.00

Hospital Charge Code	3005287
Hospital Revenue Code	302
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$73.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Community Health Alliance Commercial	$73.10
Rate for Payer: Priority Health Commercial	$60.20
Rate for Payer: Priority Health PPO	$60.20

STREP PNEUMONIAE AG URINE

Facility

$55.00

Hospital Charge Code	3100922
Hospital Revenue Code	306
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$46.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health PPO	$38.50

STREP PNEUNO AG (MEN PANEL)

Facility

$50.00

Service Code	HCPCS 86403
Hospital Charge Code	3007390
Hospital Revenue Code	302
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$12.12
Rate for Payer: Blue Care Network Medicare Advantage	$12.12
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.12
Rate for Payer: Meridian Health Plan Medicare	$12.12
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$12.12
Rate for Payer: Priority Health Medicare	$12.12
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$12.12
Rate for Payer: United Health Care Medicare Advantage	$5.33

STREP SCREEN GROUP A

Facility

$40.00

Service Code	HCPCS 87880
Hospital Charge Code	3007720
Hospital Revenue Code	306
Min. Negotiated Rate	$7.64
Max. Negotiated Rate	$34.00
Rate for Payer: BCBS BCN 65	$17.36
Rate for Payer: Blue Care Network Medicare Advantage	$17.36
Rate for Payer: Cash Price	$26.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.36
Rate for Payer: Meridian Health Plan Medicare	$17.36
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health Medicaid	$17.36
Rate for Payer: Priority Health Medicare	$17.36
Rate for Payer: Priority Health PPO	$28.00
Rate for Payer: United Health Care Medicaid	$17.36
Rate for Payer: United Health Care Medicare Advantage	$7.64

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges