Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)

Facility

$972.96

Service Code	CPT 43247
Hospital Revenue Code	360
Min. Negotiated Rate	$428.10
Max. Negotiated Rate	$972.96
Rate for Payer: BCBS BCN 65	$972.96
Rate for Payer: Blue Care Network Medicare Advantage	$972.96
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$972.96
Rate for Payer: Meridian Health Plan Medicare	$972.96
Rate for Payer: Priority Health Medicaid	$972.96
Rate for Payer: Priority Health Medicare	$972.96
Rate for Payer: United Health Care Medicaid	$972.96
Rate for Payer: United Health Care Medicare Advantage	$428.10

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$2,058.49

Service Code	CPT 43251
Hospital Revenue Code	360
Min. Negotiated Rate	$905.74
Max. Negotiated Rate	$2,058.49
Rate for Payer: BCBS BCN 65	$2,058.49
Rate for Payer: Blue Care Network Medicare Advantage	$2,058.49
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,058.49
Rate for Payer: Meridian Health Plan Medicare	$2,058.49
Rate for Payer: Priority Health Medicaid	$2,058.49
Rate for Payer: Priority Health Medicare	$2,058.49
Rate for Payer: United Health Care Medicaid	$2,058.49
Rate for Payer: United Health Care Medicare Advantage	$905.74

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)

Facility

$2,058.49

Service Code	CPT 43249
Hospital Revenue Code	360
Min. Negotiated Rate	$905.74
Max. Negotiated Rate	$2,058.49
Rate for Payer: BCBS BCN 65	$2,058.49
Rate for Payer: Blue Care Network Medicare Advantage	$2,058.49
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,058.49
Rate for Payer: Meridian Health Plan Medicare	$2,058.49
Rate for Payer: Priority Health Medicaid	$2,058.49
Rate for Payer: Priority Health Medicare	$2,058.49
Rate for Payer: United Health Care Medicaid	$2,058.49
Rate for Payer: United Health Care Medicare Advantage	$905.74

ESOPH EGD DILATION <30 MM

Facility

$354.00

Hospital Charge Code	5150797
Hospital Revenue Code	960
Min. Negotiated Rate	$247.80
Max. Negotiated Rate	$300.90
Rate for Payer: Cash Price	$230.10
Rate for Payer: Community Health Alliance Commercial	$300.90
Rate for Payer: Priority Health Commercial	$247.80
Rate for Payer: Priority Health PPO	$247.80

ESR-LC

Facility

$2.02

Hospital Charge Code	31027471
Hospital Revenue Code	300
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.72
Rate for Payer: Cash Price	$1.31
Rate for Payer: Community Health Alliance Commercial	$1.72
Rate for Payer: Priority Health Commercial	$1.41
Rate for Payer: Priority Health PPO	$1.41

ESTABLISHED PATIENT BRIEF

Facility

$196.00

Service Code	HCPCS G0463
Hospital Charge Code	5150660
Hospital Revenue Code	510
Min. Negotiated Rate	$62.84
Max. Negotiated Rate	$166.60
Rate for Payer: BCBS BCN 65	$142.82
Rate for Payer: Blue Care Network Medicare Advantage	$142.82
Rate for Payer: Cash Price	$127.40
Rate for Payer: Cash Price	$127.40
Rate for Payer: Community Health Alliance Commercial	$166.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.82
Rate for Payer: Meridian Health Plan Medicare	$142.82
Rate for Payer: Priority Health Commercial	$137.20
Rate for Payer: Priority Health Medicaid	$142.82
Rate for Payer: Priority Health Medicare	$142.82
Rate for Payer: Priority Health PPO	$137.20
Rate for Payer: United Health Care Medicaid	$142.82
Rate for Payer: United Health Care Medicare Advantage	$62.84

ESTABLISHED PATIENT BRIEF PROF

Facility

$97.00

Hospital Charge Code	5150670
Hospital Revenue Code	960
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.05
Rate for Payer: Community Health Alliance Commercial	$82.45
Rate for Payer: Priority Health Commercial	$67.90
Rate for Payer: Priority Health PPO	$67.90

ESTABLISHED PATIENT COMPLEX

Facility

$355.00

Service Code	HCPCS G0463
Hospital Charge Code	5150664
Hospital Revenue Code	510
Min. Negotiated Rate	$62.84
Max. Negotiated Rate	$301.75
Rate for Payer: BCBS BCN 65	$142.82
Rate for Payer: Blue Care Network Medicare Advantage	$142.82
Rate for Payer: Cash Price	$230.75
Rate for Payer: Cash Price	$230.75
Rate for Payer: Community Health Alliance Commercial	$301.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.82
Rate for Payer: Meridian Health Plan Medicare	$142.82
Rate for Payer: Priority Health Commercial	$248.50
Rate for Payer: Priority Health Medicaid	$142.82
Rate for Payer: Priority Health Medicare	$142.82
Rate for Payer: Priority Health PPO	$248.50
Rate for Payer: United Health Care Medicaid	$142.82
Rate for Payer: United Health Care Medicare Advantage	$62.84

ESTABLISHED PATIENT COMPLEX PR

Facility

$194.00

Hospital Charge Code	5150674
Hospital Revenue Code	960
Min. Negotiated Rate	$135.80
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$126.10
Rate for Payer: Community Health Alliance Commercial	$164.90
Rate for Payer: Priority Health Commercial	$135.80
Rate for Payer: Priority Health PPO	$135.80

ESTABLISHED PATIENT EXTENDED

Facility

$285.00

Service Code	HCPCS G0463
Hospital Charge Code	5150663
Hospital Revenue Code	510
Min. Negotiated Rate	$62.84
Max. Negotiated Rate	$242.25
Rate for Payer: BCBS BCN 65	$142.82
Rate for Payer: Blue Care Network Medicare Advantage	$142.82
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	$142.82
Rate for Payer: Meridian Health Plan Medicare	$142.82
Rate for Payer: Priority Health Commercial	$199.50
Rate for Payer: Priority Health Medicaid	$142.82
Rate for Payer: Priority Health Medicare	$142.82
Rate for Payer: Priority Health PPO	$199.50
Rate for Payer: United Health Care Medicaid	$142.82
Rate for Payer: United Health Care Medicare Advantage	$62.84

ESTABLISHED PATIENT EXTEN PROF

Facility

$165.00

Hospital Charge Code	5150673
Hospital Revenue Code	960
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$140.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Community Health Alliance Commercial	$140.25
Rate for Payer: Priority Health Commercial	$115.50
Rate for Payer: Priority Health PPO	$115.50

ESTABLISHED PATIENT INTERMEDIA

Facility

$268.00

Service Code	HCPCS G0463
Hospital Charge Code	5150662
Hospital Revenue Code	510
Min. Negotiated Rate	$62.84
Max. Negotiated Rate	$227.80
Rate for Payer: BCBS BCN 65	$142.82
Rate for Payer: Blue Care Network Medicare Advantage	$142.82
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Community Health Alliance Commercial	$227.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.82
Rate for Payer: Meridian Health Plan Medicare	$142.82
Rate for Payer: Priority Health Commercial	$187.60
Rate for Payer: Priority Health Medicaid	$142.82
Rate for Payer: Priority Health Medicare	$142.82
Rate for Payer: Priority Health PPO	$187.60
Rate for Payer: United Health Care Medicaid	$142.82
Rate for Payer: United Health Care Medicare Advantage	$62.84

ESTABLISHED PATIENT INTER PROF

Facility

$148.00

Hospital Charge Code	5150672
Hospital Revenue Code	960
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$125.80
Rate for Payer: Cash Price	$96.20
Rate for Payer: Community Health Alliance Commercial	$125.80
Rate for Payer: Priority Health Commercial	$103.60
Rate for Payer: Priority Health PPO	$103.60

ESTABLISHED PATIENT LIMITED

Facility

$219.00

Service Code	HCPCS G0463
Hospital Charge Code	5150661
Hospital Revenue Code	510
Min. Negotiated Rate	$62.84
Max. Negotiated Rate	$186.15
Rate for Payer: BCBS BCN 65	$142.82
Rate for Payer: Blue Care Network Medicare Advantage	$142.82
Rate for Payer: Cash Price	$142.35
Rate for Payer: Cash Price	$142.35
Rate for Payer: Community Health Alliance Commercial	$186.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.82
Rate for Payer: Meridian Health Plan Medicare	$142.82
Rate for Payer: Priority Health Commercial	$153.30
Rate for Payer: Priority Health Medicaid	$142.82
Rate for Payer: Priority Health Medicare	$142.82
Rate for Payer: Priority Health PPO	$153.30
Rate for Payer: United Health Care Medicaid	$142.82
Rate for Payer: United Health Care Medicare Advantage	$62.84

ESTABLISHED PATIENT LIMIT PROF

Facility

$126.00

Hospital Charge Code	5150671
Hospital Revenue Code	960
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$107.10
Rate for Payer: Cash Price	$81.90
Rate for Payer: Community Health Alliance Commercial	$107.10
Rate for Payer: Priority Health Commercial	$88.20
Rate for Payer: Priority Health PPO	$88.20

E-STIM MANUAL EACH 15 MINUTES

Facility

$40.00

Service Code	HCPCS 97032 GP
Hospital Charge Code	4200095
Hospital Revenue Code	420
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

ESTRADIOL

Facility

$5.00

Service Code	HCPCS 82670
Hospital Charge Code	3004060
Hospital Revenue Code	301
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$29.34
Rate for Payer: BCBS BCN 65	$29.34
Rate for Payer: Blue Care Network Medicare Advantage	$29.34
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$29.34
Rate for Payer: Meridian Health Plan Medicare	$29.34
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$29.34
Rate for Payer: Priority Health Medicare	$29.34
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$29.34
Rate for Payer: United Health Care Medicare Advantage	$12.91

ESTRADIOL FREE-1

Facility

$16.80

Hospital Charge Code	3101539
Hospital Revenue Code	300
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$14.28
Rate for Payer: Cash Price	$10.92
Rate for Payer: Community Health Alliance Commercial	$14.28
Rate for Payer: Priority Health Commercial	$11.76
Rate for Payer: Priority Health PPO	$11.76

ESTRADIOL FREE-2

Facility

$16.80

Hospital Charge Code	3101540
Hospital Revenue Code	300
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$14.28
Rate for Payer: Cash Price	$10.92
Rate for Payer: Community Health Alliance Commercial	$14.28
Rate for Payer: Priority Health Commercial	$11.76
Rate for Payer: Priority Health PPO	$11.76

ESTRADIOL-ML

Facility

$110.00

Hospital Charge Code	3101284
Hospital Revenue Code	301
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$93.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Community Health Alliance Commercial	$93.50
Rate for Payer: Priority Health Commercial	$77.00
Rate for Payer: Priority Health PPO	$77.00

ESTRIOL

Facility

$6.00

Service Code	HCPCS 82677
Hospital Charge Code	3003381
Hospital Revenue Code	301
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$25.39
Rate for Payer: BCBS BCN 65	$25.39
Rate for Payer: Blue Care Network Medicare Advantage	$25.39
Rate for Payer: Cash Price	$3.90
Rate for Payer: Cash Price	$3.90
Rate for Payer: Community Health Alliance Commercial	$5.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$25.39
Rate for Payer: Meridian Health Plan Medicare	$25.39
Rate for Payer: Priority Health Commercial	$4.20
Rate for Payer: Priority Health Medicaid	$25.39
Rate for Payer: Priority Health Medicare	$25.39
Rate for Payer: Priority Health PPO	$4.20
Rate for Payer: United Health Care Medicaid	$25.39
Rate for Payer: United Health Care Medicare Advantage	$11.17

ESTROGEN FRACTIONATED

Facility

$50.00

Hospital Charge Code	3003425
Hospital Revenue Code	301
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

ESTROGEN LEVEL TOTAL

Facility

$83.00

Service Code	HCPCS 82672
Hospital Charge Code	3003421
Hospital Revenue Code	301
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$70.55
Rate for Payer: BCBS BCN 65	$22.79
Rate for Payer: Blue Care Network Medicare Advantage	$22.79
Rate for Payer: Cash Price	$53.95
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$22.79
Rate for Payer: Meridian Health Plan Medicare	$22.79
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health Medicaid	$22.79
Rate for Payer: Priority Health Medicare	$22.79
Rate for Payer: Priority Health PPO	$58.10
Rate for Payer: United Health Care Medicaid	$22.79
Rate for Payer: United Health Care Medicare Advantage	$10.03

ESTROGEN RECEPTOR ASS IHC

Facility

$108.10

Hospital Charge Code	3000391
Hospital Revenue Code	310
Min. Negotiated Rate	$75.67
Max. Negotiated Rate	$91.89
Rate for Payer: Cash Price	$70.27
Rate for Payer: Community Health Alliance Commercial	$91.89
Rate for Payer: Priority Health Commercial	$75.67
Rate for Payer: Priority Health PPO	$75.67

ESTROGEN TOTAL

Facility

$5.70

Hospital Charge Code	3101505
Hospital Revenue Code	300
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$4.84
Rate for Payer: Cash Price	$3.71
Rate for Payer: Community Health Alliance Commercial	$4.84
Rate for Payer: Priority Health Commercial	$3.99
Rate for Payer: Priority Health PPO	$3.99

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges