Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ENDO VASCULAR STAPLER #TX30V

Facility

$517.00

Hospital Charge Code	27266054
Hospital Revenue Code	272
Min. Negotiated Rate	$361.90
Max. Negotiated Rate	$439.45
Rate for Payer: Cash Price	$336.05
Rate for Payer: Community Health Alliance Commercial	$439.45
Rate for Payer: Priority Health Commercial	$361.90
Rate for Payer: Priority Health PPO	$361.90

ENPULSE PACEMAKER VVI

Facility

$15,312.00

Service Code	HCPCS C1786
Hospital Charge Code	27868662
Hospital Revenue Code	275
Min. Negotiated Rate	$10,718.40
Max. Negotiated Rate	$13,015.20
Rate for Payer: Cash Price	$9,952.80
Rate for Payer: Community Health Alliance Commercial	$13,015.20
Rate for Payer: Priority Health Commercial	$10,718.40
Rate for Payer: Priority Health PPO	$10,718.40

ENTAMOEB HIST GROUP AG EIA

Facility

$52.00

Hospital Charge Code	3100131
Hospital Revenue Code	300
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

ENTEROCLYSIS ADMIN KIT

Facility

$203.00

Hospital Charge Code	27262673
Hospital Revenue Code	272
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$172.55
Rate for Payer: Cash Price	$131.95
Rate for Payer: Community Health Alliance Commercial	$172.55
Rate for Payer: Priority Health Commercial	$142.10
Rate for Payer: Priority Health PPO	$142.10

ENTEROVIRUS BY RTPCR

Facility

$73.75

Hospital Charge Code	3001491
Hospital Revenue Code	306
Min. Negotiated Rate	$51.62
Max. Negotiated Rate	$62.69
Rate for Payer: Cash Price	$47.94
Rate for Payer: Community Health Alliance Commercial	$62.69
Rate for Payer: Priority Health Commercial	$51.62
Rate for Payer: Priority Health PPO	$51.62

ENTEROVIRUS PCR CSF

Facility

$570.00

Hospital Charge Code	3006553
Hospital Revenue Code	306
Min. Negotiated Rate	$399.00
Max. Negotiated Rate	$484.50
Rate for Payer: Cash Price	$370.50
Rate for Payer: Community Health Alliance Commercial	$484.50
Rate for Payer: Priority Health Commercial	$399.00
Rate for Payer: Priority Health PPO	$399.00

ENTEROVIRUS PCR FECES SWAB

Facility

$68.00

Hospital Charge Code	3100921
Hospital Revenue Code	306
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

ENTOMEBA HIST

Facility

$10.59

Service Code	HCPCS 86753
Hospital Charge Code	3004039
Hospital Revenue Code	302
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$13.01
Rate for Payer: BCBS BCN 65	$13.01
Rate for Payer: Blue Care Network Medicare Advantage	$13.01
Rate for Payer: Cash Price	$6.88
Rate for Payer: Cash Price	$6.88
Rate for Payer: Community Health Alliance Commercial	$9.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.01
Rate for Payer: Meridian Health Plan Medicare	$13.01
Rate for Payer: Priority Health Commercial	$7.41
Rate for Payer: Priority Health Medicaid	$13.01
Rate for Payer: Priority Health Medicare	$13.01
Rate for Payer: Priority Health PPO	$7.41
Rate for Payer: United Health Care Medicaid	$13.01
Rate for Payer: United Health Care Medicare Advantage	$5.72

ENZYME BIOTINIDASE DEF

Facility

$51.31

Hospital Charge Code	3102179
Hospital Revenue Code	300
Min. Negotiated Rate	$35.92
Max. Negotiated Rate	$43.61
Rate for Payer: Cash Price	$33.35
Rate for Payer: Community Health Alliance Commercial	$43.61
Rate for Payer: Priority Health Commercial	$35.92
Rate for Payer: Priority Health PPO	$35.92

ENZYME HISTOCHEMISTRY

Facility

$386.00

Hospital Charge Code	3004122
Hospital Revenue Code	312
Min. Negotiated Rate	$270.20
Max. Negotiated Rate	$328.10
Rate for Payer: Cash Price	$250.90
Rate for Payer: Community Health Alliance Commercial	$328.10
Rate for Payer: Priority Health Commercial	$270.20
Rate for Payer: Priority Health PPO	$270.20

EOSINOPHIL CATIONIC PROTEIN

Facility

$68.60

Hospital Charge Code	3101159
Hospital Revenue Code	300
Min. Negotiated Rate	$48.02
Max. Negotiated Rate	$58.31
Rate for Payer: Cash Price	$44.59
Rate for Payer: Community Health Alliance Commercial	$58.31
Rate for Payer: Priority Health Commercial	$48.02
Rate for Payer: Priority Health PPO	$48.02

EOSINOPHIL NASAL SMEAR

Facility

$33.00

Service Code	HCPCS 89190
Hospital Charge Code	3005061
Hospital Revenue Code	300
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$6.08
Rate for Payer: Blue Care Network Medicare Advantage	$6.08
Rate for Payer: Cash Price	$21.45
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.08
Rate for Payer: Meridian Health Plan Medicare	$6.08
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$6.08
Rate for Payer: Priority Health Medicare	$6.08
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$6.08
Rate for Payer: United Health Care Medicare Advantage	$2.67

EOSINOPHILS,URINE

Facility

$13.16

Service Code	HCPCS 87205
Hospital Charge Code	3005070
Hospital Revenue Code	305
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$11.19
Rate for Payer: BCBS BCN 65	$4.48
Rate for Payer: Blue Care Network Medicare Advantage	$4.48
Rate for Payer: Cash Price	$8.55
Rate for Payer: Cash Price	$8.55
Rate for Payer: Community Health Alliance Commercial	$11.19
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.48
Rate for Payer: Meridian Health Plan Medicare	$4.48
Rate for Payer: Priority Health Commercial	$9.21
Rate for Payer: Priority Health Medicaid	$4.48
Rate for Payer: Priority Health Medicare	$4.48
Rate for Payer: Priority Health PPO	$9.21
Rate for Payer: United Health Care Medicaid	$4.48
Rate for Payer: United Health Care Medicare Advantage	$1.97

EPC TRIPLE CARE CREAM 3.25OZ

Facility

$25.00

Hospital Charge Code	27066864
Hospital Revenue Code	270
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

EPICARDIAL LEAD

Facility

$1,754.00

Hospital Charge Code	27868654
Hospital Revenue Code	275
Min. Negotiated Rate	$1,227.80
Max. Negotiated Rate	$1,490.90
Rate for Payer: Cash Price	$1,140.10
Rate for Payer: Community Health Alliance Commercial	$1,490.90
Rate for Payer: Priority Health Commercial	$1,227.80
Rate for Payer: Priority Health PPO	$1,227.80

EPIDERMAL GROWTH FACTOR RECEP

Facility

$273.00

Hospital Charge Code	3003930
Hospital Revenue Code	301
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$232.05
Rate for Payer: Cash Price	$177.45
Rate for Payer: Community Health Alliance Commercial	$232.05
Rate for Payer: Priority Health Commercial	$191.10
Rate for Payer: Priority Health PPO	$191.10

EPSTEIN BARR -CAPSID VCA

Facility

$8.12

Service Code	HCPCS 86665
Hospital Charge Code	3004000
Hospital Revenue Code	302
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$19.05
Rate for Payer: BCBS BCN 65	$19.05
Rate for Payer: Blue Care Network Medicare Advantage	$19.05
Rate for Payer: Cash Price	$5.28
Rate for Payer: Cash Price	$5.28
Rate for Payer: Community Health Alliance Commercial	$6.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.05
Rate for Payer: Meridian Health Plan Medicare	$19.05
Rate for Payer: Priority Health Commercial	$5.68
Rate for Payer: Priority Health Medicaid	$19.05
Rate for Payer: Priority Health Medicare	$19.05
Rate for Payer: Priority Health PPO	$5.68
Rate for Payer: United Health Care Medicaid	$19.05
Rate for Payer: United Health Care Medicare Advantage	$8.38

EPSTEIN BARR EA

Facility

$13.95

Service Code	HCPCS 86663
Hospital Charge Code	3003980
Hospital Revenue Code	302
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$13.78
Rate for Payer: BCBS BCN 65	$13.78
Rate for Payer: Blue Care Network Medicare Advantage	$13.78
Rate for Payer: Cash Price	$9.07
Rate for Payer: Cash Price	$9.07
Rate for Payer: Community Health Alliance Commercial	$11.86
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.78
Rate for Payer: Meridian Health Plan Medicare	$13.78
Rate for Payer: Priority Health Commercial	$9.77
Rate for Payer: Priority Health Medicaid	$13.78
Rate for Payer: Priority Health Medicare	$13.78
Rate for Payer: Priority Health PPO	$9.77
Rate for Payer: United Health Care Medicaid	$13.78
Rate for Payer: United Health Care Medicare Advantage	$6.06

EPSTEIN BARR-EBNA

Facility

$8.12

Service Code	HCPCS 86664
Hospital Charge Code	3004020
Hospital Revenue Code	302
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$16.05
Rate for Payer: BCBS BCN 65	$16.05
Rate for Payer: Blue Care Network Medicare Advantage	$16.05
Rate for Payer: Cash Price	$5.28
Rate for Payer: Cash Price	$5.28
Rate for Payer: Community Health Alliance Commercial	$6.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.05
Rate for Payer: Meridian Health Plan Medicare	$16.05
Rate for Payer: Priority Health Commercial	$5.68
Rate for Payer: Priority Health Medicaid	$16.05
Rate for Payer: Priority Health Medicare	$16.05
Rate for Payer: Priority Health PPO	$5.68
Rate for Payer: United Health Care Medicaid	$16.05
Rate for Payer: United Health Care Medicare Advantage	$7.06

EQUALIZER AIR WALKER

Facility

$192.00

Hospital Charge Code	27021436
Hospital Revenue Code	270
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$124.80
Rate for Payer: Community Health Alliance Commercial	$163.20
Rate for Payer: Priority Health Commercial	$134.40
Rate for Payer: Priority Health PPO	$134.40

ERCP

Facility

$3,504.00

Hospital Charge Code	3600300
Hospital Revenue Code	360
Min. Negotiated Rate	$2,452.80
Max. Negotiated Rate	$2,978.40
Rate for Payer: Cash Price	$2,277.60
Rate for Payer: Community Health Alliance Commercial	$2,978.40
Rate for Payer: Priority Health Commercial	$2,452.80
Rate for Payer: Priority Health PPO	$2,452.80

ERCP CANNULA STANDARD TIP

Facility

$170.00

Hospital Charge Code	27016774
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$144.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Community Health Alliance Commercial	$144.50
Rate for Payer: Priority Health Commercial	$119.00
Rate for Payer: Priority Health PPO	$119.00

ERCP DUCT STENT PLACEMENT

Facility

$1,086.00

Hospital Charge Code	5150789
Hospital Revenue Code	960
Min. Negotiated Rate	$760.20
Max. Negotiated Rate	$923.10
Rate for Payer: Cash Price	$705.90
Rate for Payer: Community Health Alliance Commercial	$923.10
Rate for Payer: Priority Health Commercial	$760.20
Rate for Payer: Priority Health PPO	$760.20

ER CRITICAL PROCEDURE

Facility

$1,515.00

Hospital Charge Code	4500904
Hospital Revenue Code	450
Min. Negotiated Rate	$1,060.50
Max. Negotiated Rate	$1,287.75
Rate for Payer: Cash Price	$984.75
Rate for Payer: Community Health Alliance Commercial	$1,287.75
Rate for Payer: Priority Health Commercial	$1,060.50
Rate for Payer: Priority Health PPO	$1,060.50

ER-FOLEY CATH

Facility

$125.00

Hospital Charge Code	4500941
Hospital Revenue Code	450
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$106.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Community Health Alliance Commercial	$106.25
Rate for Payer: Priority Health Commercial	$87.50
Rate for Payer: Priority Health PPO	$87.50

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges