Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

EE-1

Facility

$27.95

Hospital Charge Code	3101477
Hospital Revenue Code	300
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$23.76
Rate for Payer: Cash Price	$18.17
Rate for Payer: Community Health Alliance Commercial	$23.76
Rate for Payer: Priority Health Commercial	$19.57
Rate for Payer: Priority Health PPO	$19.57

EE-2

Facility

$27.96

Hospital Charge Code	3101478
Hospital Revenue Code	300
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$23.77
Rate for Payer: Cash Price	$18.17
Rate for Payer: Community Health Alliance Commercial	$23.77
Rate for Payer: Priority Health Commercial	$19.57
Rate for Payer: Priority Health PPO	$19.57

EFFECT ELECTRODE

Facility

$674.00

Hospital Charge Code	27061509
Hospital Revenue Code	270
Min. Negotiated Rate	$471.80
Max. Negotiated Rate	$572.90
Rate for Payer: Cash Price	$438.10
Rate for Payer: Community Health Alliance Commercial	$572.90
Rate for Payer: Priority Health Commercial	$471.80
Rate for Payer: Priority Health PPO	$471.80

EGD BALLOON DIL ESOPH30 MM/>

Facility

$543.00

Hospital Charge Code	5150791
Hospital Revenue Code	960
Min. Negotiated Rate	$380.10
Max. Negotiated Rate	$461.55
Rate for Payer: Cash Price	$352.95
Rate for Payer: Community Health Alliance Commercial	$461.55
Rate for Payer: Priority Health Commercial	$380.10
Rate for Payer: Priority Health PPO	$380.10

EGD BIOPSY SINGLE/MULT P/C

Facility

$554.00

Hospital Charge Code	5150678
Hospital Revenue Code	960
Min. Negotiated Rate	$387.80
Max. Negotiated Rate	$470.90
Rate for Payer: Cash Price	$360.10
Rate for Payer: Community Health Alliance Commercial	$470.90
Rate for Payer: Priority Health Commercial	$387.80
Rate for Payer: Priority Health PPO	$387.80

EGD GUIDE WIRE INSERTION PC

Facility

$975.00

Hospital Charge Code	5150694
Hospital Revenue Code	960
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$828.75
Rate for Payer: Cash Price	$633.75
Rate for Payer: Community Health Alliance Commercial	$828.75
Rate for Payer: Priority Health Commercial	$682.50
Rate for Payer: Priority Health PPO	$682.50

EGD REMOVE FOREIGN BODY

Facility

$932.00

Hospital Charge Code	5150778
Hospital Revenue Code	960
Min. Negotiated Rate	$652.40
Max. Negotiated Rate	$792.20
Rate for Payer: Cash Price	$605.80
Rate for Payer: Community Health Alliance Commercial	$792.20
Rate for Payer: Priority Health Commercial	$652.40
Rate for Payer: Priority Health PPO	$652.40

EGD REMOVE LESION SNARE PC

Facility

$736.00

Hospital Charge Code	5150748
Hospital Revenue Code	960
Min. Negotiated Rate	$515.20
Max. Negotiated Rate	$625.60
Rate for Payer: Cash Price	$478.40
Rate for Payer: Community Health Alliance Commercial	$625.60
Rate for Payer: Priority Health Commercial	$515.20
Rate for Payer: Priority Health PPO	$515.20

EGD US FINE NEEDED BX/ASPIR PC

Facility

$554.00

Hospital Charge Code	5150692
Hospital Revenue Code	960
Min. Negotiated Rate	$387.80
Max. Negotiated Rate	$470.90
Rate for Payer: Cash Price	$360.10
Rate for Payer: Community Health Alliance Commercial	$470.90
Rate for Payer: Priority Health Commercial	$387.80
Rate for Payer: Priority Health PPO	$387.80

EGFR 1

Facility

$255.00

Hospital Charge Code	3101358
Hospital Revenue Code	310
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$216.75
Rate for Payer: Cash Price	$165.75
Rate for Payer: Community Health Alliance Commercial	$216.75
Rate for Payer: Priority Health Commercial	$178.50
Rate for Payer: Priority Health PPO	$178.50

EGFR 2

Facility

$255.00

Hospital Charge Code	3101359
Hospital Revenue Code	310
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$216.75
Rate for Payer: Cash Price	$165.75
Rate for Payer: Community Health Alliance Commercial	$216.75
Rate for Payer: Priority Health Commercial	$178.50
Rate for Payer: Priority Health PPO	$178.50

EGFR MICRODISSECTION MANUAL

Facility

$319.00

Hospital Charge Code	3100536
Hospital Revenue Code	310
Min. Negotiated Rate	$223.30
Max. Negotiated Rate	$271.15
Rate for Payer: Cash Price	$207.35
Rate for Payer: Community Health Alliance Commercial	$271.15
Rate for Payer: Priority Health Commercial	$223.30
Rate for Payer: Priority Health PPO	$223.30

EGFR PCR X

Facility

$661.00

Hospital Charge Code	3100535
Hospital Revenue Code	300
Min. Negotiated Rate	$462.70
Max. Negotiated Rate	$561.85
Rate for Payer: Cash Price	$429.65
Rate for Payer: Community Health Alliance Commercial	$561.85
Rate for Payer: Priority Health Commercial	$462.70
Rate for Payer: Priority Health PPO	$462.70

EGG WHITE IGG4

Facility

$26.00

Hospital Charge Code	3100725
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

EHDSP-1

Facility

$177.50

Hospital Charge Code	3102005
Hospital Revenue Code	300
Min. Negotiated Rate	$124.25
Max. Negotiated Rate	$150.88
Rate for Payer: Cash Price	$115.38
Rate for Payer: Community Health Alliance Commercial	$150.88
Rate for Payer: Priority Health Commercial	$124.25
Rate for Payer: Priority Health PPO	$124.25

EHDSP-2

Facility

$227.50

Hospital Charge Code	3102006
Hospital Revenue Code	300
Min. Negotiated Rate	$159.25
Max. Negotiated Rate	$193.38
Rate for Payer: Cash Price	$147.88
Rate for Payer: Community Health Alliance Commercial	$193.38
Rate for Payer: Priority Health Commercial	$159.25
Rate for Payer: Priority Health PPO	$159.25

EHDSP-3

Facility

$227.50

Hospital Charge Code	3102007
Hospital Revenue Code	300
Min. Negotiated Rate	$159.25
Max. Negotiated Rate	$193.38
Rate for Payer: Cash Price	$147.88
Rate for Payer: Community Health Alliance Commercial	$193.38
Rate for Payer: Priority Health Commercial	$159.25
Rate for Payer: Priority Health PPO	$159.25

EHDSP-4

Facility

$227.50

Hospital Charge Code	3102008
Hospital Revenue Code	300
Min. Negotiated Rate	$159.25
Max. Negotiated Rate	$193.38
Rate for Payer: Cash Price	$147.88
Rate for Payer: Community Health Alliance Commercial	$193.38
Rate for Payer: Priority Health Commercial	$159.25
Rate for Payer: Priority Health PPO	$159.25

EHDSP-5

Facility

$227.50

Hospital Charge Code	3102009
Hospital Revenue Code	300
Min. Negotiated Rate	$159.25
Max. Negotiated Rate	$193.38
Rate for Payer: Cash Price	$147.88
Rate for Payer: Community Health Alliance Commercial	$193.38
Rate for Payer: Priority Health Commercial	$159.25
Rate for Payer: Priority Health PPO	$159.25

EHDSP-6

Facility

$227.50

Hospital Charge Code	3102010
Hospital Revenue Code	300
Min. Negotiated Rate	$159.25
Max. Negotiated Rate	$193.38
Rate for Payer: Cash Price	$147.88
Rate for Payer: Community Health Alliance Commercial	$193.38
Rate for Payer: Priority Health Commercial	$159.25
Rate for Payer: Priority Health PPO	$159.25

EHLERS DAMLOS-LC

Facility

$896.00

Hospital Charge Code	31027436
Hospital Revenue Code	300
Min. Negotiated Rate	$627.20
Max. Negotiated Rate	$761.60
Rate for Payer: Cash Price	$582.40
Rate for Payer: Community Health Alliance Commercial	$761.60
Rate for Payer: Priority Health Commercial	$627.20
Rate for Payer: Priority Health PPO	$627.20

EHLERS DANLOS

Facility

$2,020.00

Hospital Charge Code	3102733
Hospital Revenue Code	300
Min. Negotiated Rate	$1,414.00
Max. Negotiated Rate	$1,717.00
Rate for Payer: Cash Price	$1,313.00
Rate for Payer: Community Health Alliance Commercial	$1,717.00
Rate for Payer: Priority Health Commercial	$1,414.00
Rate for Payer: Priority Health PPO	$1,414.00

EHLERSD-LC1

Facility

$1,010.00

Hospital Charge Code	3102734
Hospital Revenue Code	300
Min. Negotiated Rate	$707.00
Max. Negotiated Rate	$858.50
Rate for Payer: Cash Price	$656.50
Rate for Payer: Community Health Alliance Commercial	$858.50
Rate for Payer: Priority Health Commercial	$707.00
Rate for Payer: Priority Health PPO	$707.00

EHLERSD-LC2

Facility

$1,010.00

Hospital Charge Code	3102735
Hospital Revenue Code	300
Min. Negotiated Rate	$707.00
Max. Negotiated Rate	$858.50
Rate for Payer: Cash Price	$656.50
Rate for Payer: Community Health Alliance Commercial	$858.50
Rate for Payer: Priority Health Commercial	$707.00
Rate for Payer: Priority Health PPO	$707.00

EHRLICHIA CHAFFEENSIS AG IGG

Facility

$15.00

Hospital Charge Code	3100957
Hospital Revenue Code	302
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges