Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

STREP SCREEN GROUP A, BACK UP

Facility

$26.00

Service Code	HCPCS 87081
Hospital Charge Code	3007730
Hospital Revenue Code	306
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$22.10
Rate for Payer: BCBS BCN 65	$6.96
Rate for Payer: Blue Care Network Medicare Advantage	$6.96
Rate for Payer: Cash Price	$16.90
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.96
Rate for Payer: Meridian Health Plan Medicare	$6.96
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health Medicaid	$6.96
Rate for Payer: Priority Health Medicare	$6.96
Rate for Payer: Priority Health PPO	$18.20
Rate for Payer: United Health Care Medicaid	$6.96
Rate for Payer: United Health Care Medicare Advantage	$3.06

STREP SCREEN GROUP B

Facility

$53.00

Service Code	HCPCS 87899
Hospital Charge Code	3007740
Hospital Revenue Code	306
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$45.05
Rate for Payer: BCBS BCN 65	$16.87
Rate for Payer: Blue Care Network Medicare Advantage	$16.87
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.87
Rate for Payer: Meridian Health Plan Medicare	$16.87
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$16.87
Rate for Payer: Priority Health Medicare	$16.87
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$16.87
Rate for Payer: United Health Care Medicare Advantage	$7.42

STRESS TEST

Facility

$599.00

Service Code	HCPCS 93017
Hospital Charge Code	4820050
Hospital Revenue Code	482
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$509.15
Rate for Payer: BCBS BCN 65	$231.63
Rate for Payer: Blue Care Network Medicare Advantage	$231.63
Rate for Payer: Cash Price	$389.35
Rate for Payer: Cash Price	$389.35
Rate for Payer: Community Health Alliance Commercial	$509.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$231.63
Rate for Payer: Meridian Health Plan Medicare	$231.63
Rate for Payer: Priority Health Commercial	$419.30
Rate for Payer: Priority Health Medicaid	$231.63
Rate for Payer: Priority Health Medicare	$231.63
Rate for Payer: Priority Health PPO	$419.30
Rate for Payer: United Health Care Medicaid	$231.63
Rate for Payer: United Health Care Medicare Advantage	$101.92

STRIATED MUSCLE AB TITER

Facility

$57.50

Hospital Charge Code	3004918
Hospital Revenue Code	302
Min. Negotiated Rate	$40.25
Max. Negotiated Rate	$48.88
Rate for Payer: Cash Price	$37.38
Rate for Payer: Community Health Alliance Commercial	$48.88
Rate for Payer: Priority Health Commercial	$40.25
Rate for Payer: Priority Health PPO	$40.25

STRONGYLOIDES AB IgG ELISA

Facility

$39.25

Hospital Charge Code	3101394
Hospital Revenue Code	300
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$33.36
Rate for Payer: Cash Price	$25.51
Rate for Payer: Community Health Alliance Commercial	$33.36
Rate for Payer: Priority Health Commercial	$27.48
Rate for Payer: Priority Health PPO	$27.48

STRYKER BLADE LONG MED AGG

Facility

$51.94

Hospital Charge Code	27273201
Hospital Revenue Code	272
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$44.15
Rate for Payer: Cash Price	$33.76
Rate for Payer: Community Health Alliance Commercial	$44.15
Rate for Payer: Priority Health Commercial	$36.36
Rate for Payer: Priority Health PPO	$36.36

STYLET KIT

Facility

$266.00

Hospital Charge Code	27068464
Hospital Revenue Code	270
Min. Negotiated Rate	$186.20
Max. Negotiated Rate	$226.10
Rate for Payer: Cash Price	$172.90
Rate for Payer: Community Health Alliance Commercial	$226.10
Rate for Payer: Priority Health Commercial	$186.20
Rate for Payer: Priority Health PPO	$186.20

SUBCLAVIAN CATH 16 GA.

Facility

$176.00

Hospital Charge Code	27014654
Hospital Revenue Code	272
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$149.60
Rate for Payer: Cash Price	$114.40
Rate for Payer: Community Health Alliance Commercial	$149.60
Rate for Payer: Priority Health Commercial	$123.20
Rate for Payer: Priority Health PPO	$123.20

SUBTALAR ARTHROREISIS

Facility

$3,358.00

Service Code	HCPCS C1713
Hospital Charge Code	27874735
Hospital Revenue Code	278
Min. Negotiated Rate	$2,350.60
Max. Negotiated Rate	$2,854.30
Rate for Payer: Cash Price	$2,182.70
Rate for Payer: Community Health Alliance Commercial	$2,854.30
Rate for Payer: Priority Health Commercial	$2,350.60
Rate for Payer: Priority Health PPO	$2,350.60

SUBTELOMERE,FISH

Facility

$1,723.00

Hospital Charge Code	3100246
Hospital Revenue Code	310
Min. Negotiated Rate	$1,206.10
Max. Negotiated Rate	$1,464.55
Rate for Payer: Cash Price	$1,119.95
Rate for Payer: Community Health Alliance Commercial	$1,464.55
Rate for Payer: Priority Health Commercial	$1,206.10
Rate for Payer: Priority Health PPO	$1,206.10

SUCTION CANN 1200ML W/ TUBING

Facility

$23.00

Hospital Charge Code	27012682
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

SUCTION CANN 3000ML W/ TUBING

Facility

$21.00

Hospital Charge Code	27012674
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health PPO	$14.70

SUCTION CANNISTER/LID 1500ML

Facility

$19.00

Hospital Charge Code	27010827
Hospital Revenue Code	270
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$16.15
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health PPO	$13.30

SUCTION CANNISTER W/ TUBING

Facility

$21.00

Hospital Charge Code	27012013
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health PPO	$14.70

SUCTION CATH 14

Facility

$14.00

Hospital Charge Code	27013128
Hospital Revenue Code	270
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$11.90
Rate for Payer: Cash Price	$9.10
Rate for Payer: Community Health Alliance Commercial	$11.90
Rate for Payer: Priority Health Commercial	$9.80
Rate for Payer: Priority Health PPO	$9.80

SUCTION CURRETTES, 5MM FLEX

Facility

$21.00

Hospital Charge Code	27019612
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health PPO	$14.70

SUDDEN BLACK STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100530
Hospital Revenue Code	310
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

SUDS HIV

Facility

$40.00

Service Code	HCPCS 86701
Hospital Charge Code	3007650
Hospital Revenue Code	302
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$34.00
Rate for Payer: BCBS BCN 65	$9.33
Rate for Payer: Blue Care Network Medicare Advantage	$9.33
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	$9.33
Rate for Payer: Meridian Health Plan Medicare	$9.33
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health Medicaid	$9.33
Rate for Payer: Priority Health Medicare	$9.33
Rate for Payer: Priority Health PPO	$28.00
Rate for Payer: United Health Care Medicaid	$9.33
Rate for Payer: United Health Care Medicare Advantage	$4.11

SULFATE 24 HR URINE

Facility

$6.00

Hospital Charge Code	3101071
Hospital Revenue Code	300
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$5.10
Rate for Payer: Cash Price	$3.90
Rate for Payer: Community Health Alliance Commercial	$5.10
Rate for Payer: Priority Health Commercial	$4.20
Rate for Payer: Priority Health PPO	$4.20

SULFONYLUREA HYPOGLYCEMIC PAN

Facility

$137.00

Hospital Charge Code	3100609
Hospital Revenue Code	301
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$116.45
Rate for Payer: Cash Price	$89.05
Rate for Payer: Community Health Alliance Commercial	$116.45
Rate for Payer: Priority Health Commercial	$95.90
Rate for Payer: Priority Health PPO	$95.90

SUPER REVO, 5 MM

Facility

$835.00

Hospital Charge Code	27266435
Hospital Revenue Code	272
Min. Negotiated Rate	$584.50
Max. Negotiated Rate	$709.75
Rate for Payer: Cash Price	$542.75
Rate for Payer: Community Health Alliance Commercial	$709.75
Rate for Payer: Priority Health Commercial	$584.50
Rate for Payer: Priority Health PPO	$584.50

SUPER ROLL, MCKENZIE

Facility

$46.00

Hospital Charge Code	27021816
Hospital Revenue Code	270
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

SUPPORT,L/S

Facility

$115.00

Hospital Charge Code	27021907
Hospital Revenue Code	270
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$97.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Community Health Alliance Commercial	$97.75
Rate for Payer: Priority Health Commercial	$80.50
Rate for Payer: Priority Health PPO	$80.50

SUPPORT,SCROTAL

Facility

$24.00

Hospital Charge Code	27021568
Hospital Revenue Code	270
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$20.40
Rate for Payer: Cash Price	$15.60
Rate for Payer: Community Health Alliance Commercial	$20.40
Rate for Payer: Priority Health Commercial	$16.80
Rate for Payer: Priority Health PPO	$16.80

SUPRA TUBE & PLATE

Facility

$859.00

Hospital Charge Code	27014050
Hospital Revenue Code	278
Min. Negotiated Rate	$601.30
Max. Negotiated Rate	$730.15
Rate for Payer: Cash Price	$558.35
Rate for Payer: Community Health Alliance Commercial	$730.15
Rate for Payer: Priority Health Commercial	$601.30
Rate for Payer: Priority Health PPO	$601.30

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges