Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ENDO LINEAR CUTTER REG EZ35B

Facility

$1,274.00

Hospital Charge Code	27018648
Hospital Revenue Code	272
Min. Negotiated Rate	$891.80
Max. Negotiated Rate	$1,082.90
Rate for Payer: Cash Price	$828.10
Rate for Payer: Community Health Alliance Commercial	$1,082.90
Rate for Payer: Priority Health Commercial	$891.80
Rate for Payer: Priority Health PPO	$891.80

ENDO LINEAR CUTTER VASC EZ35W

Facility

$1,127.00

Hospital Charge Code	27018663
Hospital Revenue Code	272
Min. Negotiated Rate	$788.90
Max. Negotiated Rate	$957.95
Rate for Payer: Cash Price	$732.55
Rate for Payer: Community Health Alliance Commercial	$957.95
Rate for Payer: Priority Health Commercial	$788.90
Rate for Payer: Priority Health PPO	$788.90

ENDO LINEAR STAPLER #TX60B

Facility

$487.00

Hospital Charge Code	27266070
Hospital Revenue Code	272
Min. Negotiated Rate	$340.90
Max. Negotiated Rate	$413.95
Rate for Payer: Cash Price	$316.55
Rate for Payer: Community Health Alliance Commercial	$413.95
Rate for Payer: Priority Health Commercial	$340.90
Rate for Payer: Priority Health PPO	$340.90

ENDO LINER CUTTER

Facility

$1,133.00

Hospital Charge Code	27061238
Hospital Revenue Code	272
Min. Negotiated Rate	$793.10
Max. Negotiated Rate	$963.05
Rate for Payer: Cash Price	$736.45
Rate for Payer: Community Health Alliance Commercial	$963.05
Rate for Payer: Priority Health Commercial	$793.10
Rate for Payer: Priority Health PPO	$793.10

ENDOLOOP

Facility

$75.00

Hospital Charge Code	27018341
Hospital Revenue Code	270
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

ENDO MOD ALLIS CLAMPS MBA10

Facility

$460.00

Hospital Charge Code	27017533
Hospital Revenue Code	272
Min. Negotiated Rate	$322.00
Max. Negotiated Rate	$391.00
Rate for Payer: Cash Price	$299.00
Rate for Payer: Community Health Alliance Commercial	$391.00
Rate for Payer: Priority Health Commercial	$322.00
Rate for Payer: Priority Health PPO	$322.00

ENDOMYSIAL ANTIBODY

Facility

$5.30

Service Code	HCPCS 86231
Hospital Charge Code	3004037
Hospital Revenue Code	302
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$12.69
Rate for Payer: BCBS BCN 65	$12.69
Rate for Payer: Blue Care Network Medicare Advantage	$12.69
Rate for Payer: Cash Price	$3.45
Rate for Payer: Cash Price	$3.45
Rate for Payer: Community Health Alliance Commercial	$4.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.69
Rate for Payer: Meridian Health Plan Medicare	$12.69
Rate for Payer: Priority Health Commercial	$3.71
Rate for Payer: Priority Health Medicaid	$12.69
Rate for Payer: Priority Health Medicare	$12.69
Rate for Payer: Priority Health PPO	$3.71
Rate for Payer: United Health Care Medicaid	$12.69
Rate for Payer: United Health Care Medicare Advantage	$5.59

ENDO RELOAD HEAVY WIRE TRH30

Facility

$140.00

Hospital Charge Code	27019141
Hospital Revenue Code	272
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$119.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Community Health Alliance Commercial	$119.00
Rate for Payer: Priority Health Commercial	$98.00
Rate for Payer: Priority Health PPO	$98.00

ENDO RELOAD, LINEAR CUTTER 45M

Facility

$454.00

Hospital Charge Code	27265882
Hospital Revenue Code	272
Min. Negotiated Rate	$317.80
Max. Negotiated Rate	$385.90
Rate for Payer: Cash Price	$295.10
Rate for Payer: Community Health Alliance Commercial	$385.90
Rate for Payer: Priority Health Commercial	$317.80
Rate for Payer: Priority Health PPO	$317.80

ENDO RELOAD VASCULAR TRV30

Facility

$143.00

Hospital Charge Code	27019125
Hospital Revenue Code	272
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$121.55
Rate for Payer: Cash Price	$92.95
Rate for Payer: Community Health Alliance Commercial	$121.55
Rate for Payer: Priority Health Commercial	$100.10
Rate for Payer: Priority Health PPO	$100.10

ENDOSCOPIC CARPAL TUNNEL KIT

Facility

$422.00

Hospital Charge Code	27022319
Hospital Revenue Code	270
Min. Negotiated Rate	$295.40
Max. Negotiated Rate	$358.70
Rate for Payer: Cash Price	$274.30
Rate for Payer: Community Health Alliance Commercial	$358.70
Rate for Payer: Priority Health Commercial	$295.40
Rate for Payer: Priority Health PPO	$295.40

ENDOSCOPIC CURVED DISSECTOR

Facility

$228.00

Hospital Charge Code	27017178
Hospital Revenue Code	272
Min. Negotiated Rate	$159.60
Max. Negotiated Rate	$193.80
Rate for Payer: Cash Price	$148.20
Rate for Payer: Community Health Alliance Commercial	$193.80
Rate for Payer: Priority Health Commercial	$159.60
Rate for Payer: Priority Health PPO	$159.60

ENDOSCOPIC INJ. NEEDLE

Facility

$353.00

Hospital Charge Code	27262166
Hospital Revenue Code	272
Min. Negotiated Rate	$247.10
Max. Negotiated Rate	$300.05
Rate for Payer: Cash Price	$229.45
Rate for Payer: Community Health Alliance Commercial	$300.05
Rate for Payer: Priority Health Commercial	$247.10
Rate for Payer: Priority Health PPO	$247.10

ENDOSCOPIC LINEAR CUT ELC60

Facility

$724.00

Hospital Charge Code	27017830
Hospital Revenue Code	272
Min. Negotiated Rate	$506.80
Max. Negotiated Rate	$615.40
Rate for Payer: Cash Price	$470.60
Rate for Payer: Community Health Alliance Commercial	$615.40
Rate for Payer: Priority Health Commercial	$506.80
Rate for Payer: Priority Health PPO	$506.80

ENDOSCOPIC OVERTUBE

Facility

$459.00

Hospital Charge Code	27261865
Hospital Revenue Code	272
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$390.15
Rate for Payer: Cash Price	$298.35
Rate for Payer: Community Health Alliance Commercial	$390.15
Rate for Payer: Priority Health Commercial	$321.30
Rate for Payer: Priority Health PPO	$321.30

ENDO STAPLER HEAVY WIRE TLH30

Facility

$290.00

Hospital Charge Code	27019133
Hospital Revenue Code	272
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$246.50
Rate for Payer: Cash Price	$188.50
Rate for Payer: Community Health Alliance Commercial	$246.50
Rate for Payer: Priority Health Commercial	$203.00
Rate for Payer: Priority Health PPO	$203.00

ENDO STAPLER VASCULAR TLV30

Facility

$319.00

Hospital Charge Code	27019117
Hospital Revenue Code	272
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

ENDOTRAC DISP BLADE SET

Facility

$440.00

Hospital Charge Code	27018861
Hospital Revenue Code	272
Min. Negotiated Rate	$308.00
Max. Negotiated Rate	$374.00
Rate for Payer: Cash Price	$286.00
Rate for Payer: Community Health Alliance Commercial	$374.00
Rate for Payer: Priority Health Commercial	$308.00
Rate for Payer: Priority Health PPO	$308.00

ENDOTRACHAEL TUBE, CUFFED

Facility

$21.00

Hospital Charge Code	27018630
Hospital Revenue Code	272
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

ENDOTRACHEAL TUBE HOLDER

Facility

$27.00

Hospital Charge Code	27060883
Hospital Revenue Code	272
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

ENDO TRACH TUBE 4.5MM

Facility

$24.00

Hospital Charge Code	27023333
Hospital Revenue Code	272
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

ENDO TROCAR SLEEVE

Facility

$19.60

Hospital Charge Code	27277079
Hospital Revenue Code	272
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$16.66
Rate for Payer: Cash Price	$12.74
Rate for Payer: Community Health Alliance Commercial	$16.66
Rate for Payer: Priority Health Commercial	$13.72
Rate for Payer: Priority Health PPO	$13.72

ENDO TUBE

Facility

$21.00

Hospital Charge Code	27017962
Hospital Revenue Code	272
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

ENDO TUBE - RAE, UNCUFFED

Facility

$51.00

Hospital Charge Code	27011387
Hospital Revenue Code	272
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

ENDO VASCULAR RELOAD #XR30V

Facility

$222.00

Hospital Charge Code	27266062
Hospital Revenue Code	272
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$188.70
Rate for Payer: Cash Price	$144.30
Rate for Payer: Community Health Alliance Commercial	$188.70
Rate for Payer: Priority Health Commercial	$155.40
Rate for Payer: Priority Health PPO	$155.40

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges