Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

EMR KIT

Facility

$676.00

Hospital Charge Code	27264900
Hospital Revenue Code	272
Min. Negotiated Rate	$473.20
Max. Negotiated Rate	$574.60
Rate for Payer: Cash Price	$439.40
Rate for Payer: Community Health Alliance Commercial	$574.60
Rate for Payer: Priority Health Commercial	$473.20
Rate for Payer: Priority Health PPO	$473.20

ENA

Facility

$322.00

Service Code	HCPCS 86235
Hospital Charge Code	3004050
Hospital Revenue Code	302
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$273.70
Rate for Payer: BCBS BCN 65	$18.83
Rate for Payer: Blue Care Network Medicare Advantage	$18.83
Rate for Payer: Cash Price	$209.30
Rate for Payer: Cash Price	$209.30
Rate for Payer: Community Health Alliance Commercial	$273.70
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	$225.40
Rate for Payer: Priority Health Medicaid	$18.83
Rate for Payer: Priority Health Medicare	$18.83
Rate for Payer: Priority Health PPO	$225.40
Rate for Payer: United Health Care Medicaid	$18.83
Rate for Payer: United Health Care Medicare Advantage	$8.28

ENA 1

Facility

$285.00

Service Code	HCPCS 86235
Hospital Charge Code	3004051
Hospital Revenue Code	302
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$242.25
Rate for Payer: BCBS BCN 65	$18.83
Rate for Payer: Blue Care Network Medicare Advantage	$18.83
Rate for Payer: Cash Price	$185.25
Rate for Payer: Cash Price	$185.25
Rate for Payer: Community Health Alliance Commercial	$242.25
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	$199.50
Rate for Payer: Priority Health Medicaid	$18.83
Rate for Payer: Priority Health Medicare	$18.83
Rate for Payer: Priority Health PPO	$199.50
Rate for Payer: United Health Care Medicaid	$18.83
Rate for Payer: United Health Care Medicare Advantage	$8.28

ENA ANY METHOD-MI2

Facility

$56.00

Hospital Charge Code	3100364
Hospital Revenue Code	300
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

ENA ANY METHOD SRP

Facility

$56.00

Hospital Charge Code	3100363
Hospital Revenue Code	300
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

END CAP

Facility

$257.00

Hospital Charge Code	27268217
Hospital Revenue Code	272
Min. Negotiated Rate	$179.90
Max. Negotiated Rate	$218.45
Rate for Payer: Cash Price	$167.05
Rate for Payer: Community Health Alliance Commercial	$218.45
Rate for Payer: Priority Health Commercial	$179.90
Rate for Payer: Priority Health PPO	$179.90

END CUTTER

Facility

$1,478.00

Hospital Charge Code	27265361
Hospital Revenue Code	272
Min. Negotiated Rate	$1,034.60
Max. Negotiated Rate	$1,256.30
Rate for Payer: Cash Price	$960.70
Rate for Payer: Community Health Alliance Commercial	$1,256.30
Rate for Payer: Priority Health Commercial	$1,034.60
Rate for Payer: Priority Health PPO	$1,034.60

ENDO, 3.5 RELOAD #XR60B

Facility

$234.00

Hospital Charge Code	27266088
Hospital Revenue Code	272
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$198.90
Rate for Payer: Cash Price	$152.10
Rate for Payer: Community Health Alliance Commercial	$198.90
Rate for Payer: Priority Health Commercial	$163.80
Rate for Payer: Priority Health PPO	$163.80

ENDO 4.8 THICK RELOAD #XR60G

Facility

$234.00

Hospital Charge Code	27266096
Hospital Revenue Code	272
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$198.90
Rate for Payer: Cash Price	$152.10
Rate for Payer: Community Health Alliance Commercial	$198.90
Rate for Payer: Priority Health Commercial	$163.80
Rate for Payer: Priority Health PPO	$163.80

ENDO BABCOCK BB10

Facility

$572.00

Hospital Charge Code	27018473
Hospital Revenue Code	270
Min. Negotiated Rate	$400.40
Max. Negotiated Rate	$486.20
Rate for Payer: Cash Price	$371.80
Rate for Payer: Community Health Alliance Commercial	$486.20
Rate for Payer: Priority Health Commercial	$400.40
Rate for Payer: Priority Health PPO	$400.40

ENDO CLIP APPLIER ER320

Facility

$528.00

Hospital Charge Code	27018028
Hospital Revenue Code	272
Min. Negotiated Rate	$369.60
Max. Negotiated Rate	$448.80
Rate for Payer: Cash Price	$343.20
Rate for Payer: Community Health Alliance Commercial	$448.80
Rate for Payer: Priority Health Commercial	$369.60
Rate for Payer: Priority Health PPO	$369.60

ENDOCLIP SURGIPORT

Facility

$666.00

Hospital Charge Code	27015776
Hospital Revenue Code	272
Min. Negotiated Rate	$466.20
Max. Negotiated Rate	$566.10
Rate for Payer: Cash Price	$432.90
Rate for Payer: Community Health Alliance Commercial	$566.10
Rate for Payer: Priority Health Commercial	$466.20
Rate for Payer: Priority Health PPO	$466.20

ENDO CLOT SIS

Facility

$60.80

Hospital Charge Code	27282342
Hospital Revenue Code	272
Min. Negotiated Rate	$42.56
Max. Negotiated Rate	$51.68
Rate for Payer: Cash Price	$39.52
Rate for Payer: Community Health Alliance Commercial	$51.68
Rate for Payer: Priority Health Commercial	$42.56
Rate for Payer: Priority Health PPO	$42.56

ENDO CURVED DISSECTOR DCD32

Facility

$402.00

Hospital Charge Code	27018333
Hospital Revenue Code	272
Min. Negotiated Rate	$281.40
Max. Negotiated Rate	$341.70
Rate for Payer: Cash Price	$261.30
Rate for Payer: Community Health Alliance Commercial	$341.70
Rate for Payer: Priority Health Commercial	$281.40
Rate for Payer: Priority Health PPO	$281.40

ENDO CUTTER RELOAD REG ERU35

Facility

$574.00

Hospital Charge Code	27018655
Hospital Revenue Code	272
Min. Negotiated Rate	$401.80
Max. Negotiated Rate	$487.90
Rate for Payer: Cash Price	$373.10
Rate for Payer: Community Health Alliance Commercial	$487.90
Rate for Payer: Priority Health Commercial	$401.80
Rate for Payer: Priority Health PPO	$401.80

ENDO CUTTER RELOAD VAS EVU35

Facility

$595.00

Hospital Charge Code	27018671
Hospital Revenue Code	272
Min. Negotiated Rate	$416.50
Max. Negotiated Rate	$505.75
Rate for Payer: Cash Price	$386.75
Rate for Payer: Community Health Alliance Commercial	$505.75
Rate for Payer: Priority Health Commercial	$416.50
Rate for Payer: Priority Health PPO	$416.50

ENDO GAUGE

Facility

$205.00

Hospital Charge Code	27017780
Hospital Revenue Code	270
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$174.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Community Health Alliance Commercial	$174.25
Rate for Payer: Priority Health Commercial	$143.50
Rate for Payer: Priority Health PPO	$143.50

ENDO GUIDE 300MM

Facility

$44.00

Hospital Charge Code	27016055
Hospital Revenue Code	272
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

ENDO,HERNIA STAPLER

Facility

$387.00

Hospital Charge Code	27020669
Hospital Revenue Code	272
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$328.95
Rate for Payer: Cash Price	$251.55
Rate for Payer: Community Health Alliance Commercial	$328.95
Rate for Payer: Priority Health Commercial	$270.90
Rate for Payer: Priority Health PPO	$270.90

ENDO JUDGE WOUND CLOSE DEVICE

Facility

$162.00

Hospital Charge Code	27017871
Hospital Revenue Code	272
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$137.70
Rate for Payer: Cash Price	$105.30
Rate for Payer: Community Health Alliance Commercial	$137.70
Rate for Payer: Priority Health Commercial	$113.40
Rate for Payer: Priority Health PPO	$113.40

ENDO LINEAR CUT 45MM EZ45B

Facility

$1,186.00

Hospital Charge Code	27019174
Hospital Revenue Code	272
Min. Negotiated Rate	$830.20
Max. Negotiated Rate	$1,008.10
Rate for Payer: Cash Price	$770.90
Rate for Payer: Community Health Alliance Commercial	$1,008.10
Rate for Payer: Priority Health Commercial	$830.20
Rate for Payer: Priority Health PPO	$830.20

ENDO LINEAR CUT RELOAD ERU60

Facility

$261.00

Hospital Charge Code	27017855
Hospital Revenue Code	272
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$221.85
Rate for Payer: Cash Price	$169.65
Rate for Payer: Community Health Alliance Commercial	$221.85
Rate for Payer: Priority Health Commercial	$182.70
Rate for Payer: Priority Health PPO	$182.70

ENDO LINEAR CUT RELOAD ZR45B

Facility

$574.00

Hospital Charge Code	27019182
Hospital Revenue Code	272
Min. Negotiated Rate	$401.80
Max. Negotiated Rate	$487.90
Rate for Payer: Cash Price	$373.10
Rate for Payer: Community Health Alliance Commercial	$487.90
Rate for Payer: Priority Health Commercial	$401.80
Rate for Payer: Priority Health PPO	$401.80

ENDO LINEAR CUTTER 45MM

Facility

$1,081.00

Hospital Charge Code	27265924
Hospital Revenue Code	272
Min. Negotiated Rate	$756.70
Max. Negotiated Rate	$918.85
Rate for Payer: Cash Price	$702.65
Rate for Payer: Community Health Alliance Commercial	$918.85
Rate for Payer: Priority Health Commercial	$756.70
Rate for Payer: Priority Health PPO	$756.70

ENDO LINEAR CUTTER 45MM

Facility

$1,398.00

Hospital Charge Code	27265874
Hospital Revenue Code	272
Min. Negotiated Rate	$978.60
Max. Negotiated Rate	$1,188.30
Rate for Payer: Cash Price	$908.70
Rate for Payer: Community Health Alliance Commercial	$1,188.30
Rate for Payer: Priority Health Commercial	$978.60
Rate for Payer: Priority Health PPO	$978.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges