Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

EKG

Facility

$127.00

Service Code	HCPCS 93005
Hospital Charge Code	7300010
Hospital Revenue Code	730
Min. Negotiated Rate	$27.84
Max. Negotiated Rate	$107.95
Rate for Payer: BCBS BCN 65	$63.28
Rate for Payer: Blue Care Network Medicare Advantage	$63.28
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Community Health Alliance Commercial	$107.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$63.28
Rate for Payer: Meridian Health Plan Medicare	$63.28
Rate for Payer: Priority Health Commercial	$88.90
Rate for Payer: Priority Health Medicaid	$63.28
Rate for Payer: Priority Health Medicare	$63.28
Rate for Payer: Priority Health PPO	$88.90
Rate for Payer: United Health Care Medicaid	$63.28
Rate for Payer: United Health Care Medicare Advantage	$27.84

EKG - CARDIAC CLINIC

Facility

$127.00

Service Code	HCPCS 93005
Hospital Charge Code	7300050
Hospital Revenue Code	730
Min. Negotiated Rate	$27.84
Max. Negotiated Rate	$107.95
Rate for Payer: BCBS BCN 65	$63.28
Rate for Payer: Blue Care Network Medicare Advantage	$63.28
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Community Health Alliance Commercial	$107.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$63.28
Rate for Payer: Meridian Health Plan Medicare	$63.28
Rate for Payer: Priority Health Commercial	$88.90
Rate for Payer: Priority Health Medicaid	$63.28
Rate for Payer: Priority Health Medicare	$63.28
Rate for Payer: Priority Health PPO	$88.90
Rate for Payer: United Health Care Medicaid	$63.28
Rate for Payer: United Health Care Medicare Advantage	$27.84

EKG-ER

Facility

$127.00

Hospital Charge Code	7300041
Hospital Revenue Code	730
Min. Negotiated Rate	$88.90
Max. Negotiated Rate	$107.95
Rate for Payer: Cash Price	$82.55
Rate for Payer: Community Health Alliance Commercial	$107.95
Rate for Payer: Priority Health Commercial	$88.90
Rate for Payer: Priority Health PPO	$88.90

ELASTOGEL PACK, 12 X 12

Facility

$102.00

Hospital Charge Code	27019661
Hospital Revenue Code	270
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$86.70
Rate for Payer: Cash Price	$66.30
Rate for Payer: Community Health Alliance Commercial	$86.70
Rate for Payer: Priority Health Commercial	$71.40
Rate for Payer: Priority Health PPO	$71.40

ELASTOGEL WRAP 6 X 16

Facility

$65.00

Hospital Charge Code	27020594
Hospital Revenue Code	270
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

ELASTOGEL WRAP 6 X 24

Facility

$84.00

Hospital Charge Code	27021808
Hospital Revenue Code	270
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$71.40
Rate for Payer: Cash Price	$54.60
Rate for Payer: Community Health Alliance Commercial	$71.40
Rate for Payer: Priority Health Commercial	$58.80
Rate for Payer: Priority Health PPO	$58.80

ELASTOGEL WRAP 9 X 24

Facility

$102.00

Hospital Charge Code	27021535
Hospital Revenue Code	270
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$86.70
Rate for Payer: Cash Price	$66.30
Rate for Payer: Community Health Alliance Commercial	$86.70
Rate for Payer: Priority Health Commercial	$71.40
Rate for Payer: Priority Health PPO	$71.40

ELASTOGEL WRAP 9 X 30

Facility

$124.00

Hospital Charge Code	27020602
Hospital Revenue Code	270
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$105.40
Rate for Payer: Cash Price	$80.60
Rate for Payer: Community Health Alliance Commercial	$105.40
Rate for Payer: Priority Health Commercial	$86.80
Rate for Payer: Priority Health PPO	$86.80

ELBOW ORTHOSIS

Facility

$319.00

Hospital Charge Code	27061394
Hospital Revenue Code	270
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

ELBOW PROTECTOR W/AKTON (SM)

Facility

$70.00

Hospital Charge Code	27119513
Hospital Revenue Code	271
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

ELECTRICAL STIM - UNATTENDED

Facility

$142.00

Service Code	HCPCS 97014 GP
Hospital Charge Code	4200091
Hospital Revenue Code	420
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$120.70
Rate for Payer: Cash Price	$92.30
Rate for Payer: Community Health Alliance Commercial	$120.70
Rate for Payer: Priority Health Commercial	$99.40
Rate for Payer: Priority Health PPO	$99.40

ELECTRODE,ACROMIOPLASTY

Facility

$188.00

Hospital Charge Code	27021345
Hospital Revenue Code	270
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$159.80
Rate for Payer: Cash Price	$122.20
Rate for Payer: Community Health Alliance Commercial	$159.80
Rate for Payer: Priority Health Commercial	$131.60
Rate for Payer: Priority Health PPO	$131.60

ELECTRODE, FAST PATCH

Facility

$146.00

Hospital Charge Code	27020958
Hospital Revenue Code	270
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$124.10
Rate for Payer: Cash Price	$94.90
Rate for Payer: Community Health Alliance Commercial	$124.10
Rate for Payer: Priority Health Commercial	$102.20
Rate for Payer: Priority Health PPO	$102.20

ELECTRODE,HENLEY PHORESOR LG

Facility

$42.00

Hospital Charge Code	27019331
Hospital Revenue Code	270
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

ELECTRODE,HENLEY PHORESOR-STD

Facility

$31.00

Hospital Charge Code	27019349
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

ELECTRODE,IOGEL

Facility

$24.00

Hospital Charge Code	27061717
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

ELECTRODE L-HOOK 5MM X 32CM

Facility

$67.74

Hospital Charge Code	27284927
Hospital Revenue Code	272
Min. Negotiated Rate	$47.42
Max. Negotiated Rate	$57.58
Rate for Payer: Cash Price	$44.03
Rate for Payer: Community Health Alliance Commercial	$57.58
Rate for Payer: Priority Health Commercial	$47.42
Rate for Payer: Priority Health PPO	$47.42

ELECTRODE, NEUROLOGY

Facility

$113.00

Hospital Charge Code	27061840
Hospital Revenue Code	270
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$96.05
Rate for Payer: Cash Price	$73.45
Rate for Payer: Community Health Alliance Commercial	$96.05
Rate for Payer: Priority Health Commercial	$79.10
Rate for Payer: Priority Health PPO	$79.10

ELECTRODE, PACE/DEFIB/ECG

Facility

$65.00

Hospital Charge Code	27067136
Hospital Revenue Code	270
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

ELECTRODE, RE-PLY 1.5 x 2 OVAL

Facility

$21.00

Hospital Charge Code	27019703
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

ELECTROLYTE PANEL

Facility

$67.00

Service Code	HCPCS 80051
Hospital Charge Code	3004035
Hospital Revenue Code	301
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$56.95
Rate for Payer: BCBS BCN 65	$7.36
Rate for Payer: Blue Care Network Medicare Advantage	$7.36
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.36
Rate for Payer: Meridian Health Plan Medicare	$7.36
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health Medicaid	$7.36
Rate for Payer: Priority Health Medicare	$7.36
Rate for Payer: Priority Health PPO	$46.90
Rate for Payer: United Health Care Medicaid	$7.36
Rate for Payer: United Health Care Medicare Advantage	$3.24

ELECTROPHORESIS

Facility

$3.57

Hospital Charge Code	3100503
Hospital Revenue Code	301
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$3.03
Rate for Payer: Cash Price	$2.32
Rate for Payer: Community Health Alliance Commercial	$3.03
Rate for Payer: Priority Health Commercial	$2.50
Rate for Payer: Priority Health PPO	$2.50

ELECT STIM-UNATTEND WOUND CARE

Facility

$115.00

Service Code	HCPCS G0281
Hospital Charge Code	4200099
Hospital Revenue Code	420
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

ELLIK EVACUATOR

Facility

$29.00

Hospital Charge Code	27020347
Hospital Revenue Code	270
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$24.65
Rate for Payer: Cash Price	$18.85
Rate for Payer: Community Health Alliance Commercial	$24.65
Rate for Payer: Priority Health Commercial	$20.30
Rate for Payer: Priority Health PPO	$20.30

EMA IGA

Facility

$65.00

Hospital Charge Code	3000242
Hospital Revenue Code	310
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges