Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

GUIDEWIRE, SMOOTH (ZMS)

Facility

$287.00

Service Code	HCPCS C1769
Hospital Charge Code	27060891
Hospital Revenue Code	272
Min. Negotiated Rate	$200.90
Max. Negotiated Rate	$243.95
Rate for Payer: Cash Price	$186.55
Rate for Payer: Community Health Alliance Commercial	$243.95
Rate for Payer: Priority Health Commercial	$200.90
Rate for Payer: Priority Health PPO	$200.90

GUIDEWIRE,SUPERSTIFF

Facility

$459.00

Service Code	HCPCS C1769
Hospital Charge Code	27262060
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

GUIDEWIRE #TCMTNA-35-145-3-BH

Facility

$108.00

Service Code	HCPCS C1769
Hospital Charge Code	27014381
Hospital Revenue Code	272
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$91.80
Rate for Payer: Cash Price	$70.20
Rate for Payer: Community Health Alliance Commercial	$91.80
Rate for Payer: Priority Health Commercial	$75.60
Rate for Payer: Priority Health PPO	$75.60

GUIDEWIRE,TEFLON COATED STR

Facility

$44.00

Service Code	HCPCS C1769
Hospital Charge Code	27022657
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

GUIDE WIRE, THREADED 2.5MM

Facility

$102.00

Service Code	HCPCS C1769
Hospital Charge Code	27268209
Hospital Revenue Code	272
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

GUIDEWIRE, TRACER

Facility

$345.00

Service Code	HCPCS C1769
Hospital Charge Code	27262578
Hospital Revenue Code	272
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$293.25
Rate for Payer: Cash Price	$224.25
Rate for Payer: Community Health Alliance Commercial	$293.25
Rate for Payer: Priority Health Commercial	$241.50
Rate for Payer: Priority Health PPO	$241.50

GUIDEWIRE,TRACER HYBRID

Facility

$345.00

Service Code	HCPCS C1769
Hospital Charge Code	27262423
Hospital Revenue Code	272
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$293.25
Rate for Payer: Cash Price	$224.25
Rate for Payer: Community Health Alliance Commercial	$293.25
Rate for Payer: Priority Health Commercial	$241.50
Rate for Payer: Priority Health PPO	$241.50

GUIDEWIRE,TRACER METRO

Facility

$635.00

Service Code	HCPCS C1769
Hospital Charge Code	27264074
Hospital Revenue Code	272
Min. Negotiated Rate	$444.50
Max. Negotiated Rate	$539.75
Rate for Payer: Cash Price	$412.75
Rate for Payer: Community Health Alliance Commercial	$539.75
Rate for Payer: Priority Health Commercial	$444.50
Rate for Payer: Priority Health PPO	$444.50

GUIDEWIRE, TYPE C SOFT

Facility

$345.00

Service Code	HCPCS C1769
Hospital Charge Code	27017111
Hospital Revenue Code	272
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$293.25
Rate for Payer: Cash Price	$224.25
Rate for Payer: Community Health Alliance Commercial	$293.25
Rate for Payer: Priority Health Commercial	$241.50
Rate for Payer: Priority Health PPO	$241.50

GUIDEWIRE,ZEBRA #5168

Facility

$494.00

Service Code	HCPCS C1769
Hospital Charge Code	27019240
Hospital Revenue Code	272
Min. Negotiated Rate	$345.80
Max. Negotiated Rate	$419.90
Rate for Payer: Cash Price	$321.10
Rate for Payer: Community Health Alliance Commercial	$419.90
Rate for Payer: Priority Health Commercial	$345.80
Rate for Payer: Priority Health PPO	$345.80

GYMNIC BALL 55 CM

Facility

$40.00

Hospital Charge Code	27019844
Hospital Revenue Code	270
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

GYMNIC BALL 65 CM

Facility

$56.00

Hospital Charge Code	27020966
Hospital Revenue Code	270
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

GYNECARE, CATHETER

Facility

$1,976.00

Hospital Charge Code	27268456
Hospital Revenue Code	272
Min. Negotiated Rate	$1,383.20
Max. Negotiated Rate	$1,679.60
Rate for Payer: Cash Price	$1,284.40
Rate for Payer: Community Health Alliance Commercial	$1,679.60
Rate for Payer: Priority Health Commercial	$1,383.20
Rate for Payer: Priority Health PPO	$1,383.20

GYNECARE TVT EXACT

Facility

$3,086.00

Service Code	HCPCS C1771
Hospital Charge Code	27876813
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.20
Max. Negotiated Rate	$2,623.10
Rate for Payer: Cash Price	$2,005.90
Rate for Payer: Community Health Alliance Commercial	$2,623.10
Rate for Payer: Priority Health Commercial	$2,160.20
Rate for Payer: Priority Health PPO	$2,160.20

HALDOL

Facility

$13.03

Service Code	HCPCS 80173
Hospital Charge Code	3004980
Hospital Revenue Code	301
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$16.57
Rate for Payer: BCBS BCN 65	$16.57
Rate for Payer: Blue Care Network Medicare Advantage	$16.57
Rate for Payer: Cash Price	$8.47
Rate for Payer: Cash Price	$8.47
Rate for Payer: Community Health Alliance Commercial	$11.08
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.57
Rate for Payer: Meridian Health Plan Medicare	$16.57
Rate for Payer: Priority Health Commercial	$9.12
Rate for Payer: Priority Health Medicaid	$16.57
Rate for Payer: Priority Health Medicare	$16.57
Rate for Payer: Priority Health PPO	$9.12
Rate for Payer: United Health Care Medicaid	$16.57
Rate for Payer: United Health Care Medicare Advantage	$7.29

HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITH IMPLANT

Facility

$7,784.05

Service Code	CPT 28291
Hospital Revenue Code	360
Min. Negotiated Rate	$3,424.98
Max. Negotiated Rate	$7,784.05
Rate for Payer: BCBS BCN 65	$7,784.05
Rate for Payer: Blue Care Network Medicare Advantage	$7,784.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7,784.05
Rate for Payer: Meridian Health Plan Medicare	$7,784.05
Rate for Payer: Priority Health Medicaid	$7,784.05
Rate for Payer: Priority Health Medicare	$7,784.05
Rate for Payer: United Health Care Medicaid	$7,784.05
Rate for Payer: United Health Care Medicare Advantage	$3,424.98

HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITHOUT IMPLANT

Facility

$3,510.01

Service Code	CPT 28289
Hospital Revenue Code	360
Min. Negotiated Rate	$1,544.41
Max. Negotiated Rate	$3,510.01
Rate for Payer: BCBS BCN 65	$3,510.01
Rate for Payer: Blue Care Network Medicare Advantage	$3,510.01
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,510.01
Rate for Payer: Meridian Health Plan Medicare	$3,510.01
Rate for Payer: Priority Health Medicaid	$3,510.01
Rate for Payer: Priority Health Medicare	$3,510.01
Rate for Payer: United Health Care Medicaid	$3,510.01
Rate for Payer: United Health Care Medicare Advantage	$1,544.41

HAMMERTOE CORRECTION SYSTEM

Facility

$2,236.85

Service Code	HCPCS C1713
Hospital Charge Code	27885223
Hospital Revenue Code	278
Min. Negotiated Rate	$1,565.80
Max. Negotiated Rate	$1,901.32
Rate for Payer: Cash Price	$1,453.95
Rate for Payer: Community Health Alliance Commercial	$1,901.32
Rate for Payer: Priority Health Commercial	$1,565.80
Rate for Payer: Priority Health PPO	$1,565.80

HAPTOGLOBIN

Facility

$3.67

Service Code	HCPCS 83010
Hospital Charge Code	3005120
Hospital Revenue Code	301
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$13.21
Rate for Payer: BCBS BCN 65	$13.21
Rate for Payer: Blue Care Network Medicare Advantage	$13.21
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cash Price	$2.39
Rate for Payer: Community Health Alliance Commercial	$3.12
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.21
Rate for Payer: Meridian Health Plan Medicare	$13.21
Rate for Payer: Priority Health Commercial	$2.57
Rate for Payer: Priority Health Medicaid	$13.21
Rate for Payer: Priority Health Medicare	$13.21
Rate for Payer: Priority Health PPO	$2.57
Rate for Payer: United Health Care Medicaid	$13.21
Rate for Payer: United Health Care Medicare Advantage	$5.81

HARMONIC HANDLE

Facility

$1,549.00

Hospital Charge Code	27265940
Hospital Revenue Code	272
Min. Negotiated Rate	$1,084.30
Max. Negotiated Rate	$1,316.65
Rate for Payer: Cash Price	$1,006.85
Rate for Payer: Community Health Alliance Commercial	$1,316.65
Rate for Payer: Priority Health Commercial	$1,084.30
Rate for Payer: Priority Health PPO	$1,084.30

HARMONIC HANDLE SHARP/CURVED

Facility

$674.00

Hospital Charge Code	27265957
Hospital Revenue Code	272
Min. Negotiated Rate	$471.80
Max. Negotiated Rate	$572.90
Rate for Payer: Cash Price	$438.10
Rate for Payer: Community Health Alliance Commercial	$572.90
Rate for Payer: Priority Health Commercial	$471.80
Rate for Payer: Priority Health PPO	$471.80

HAZELNUT COMPONENT PROFILE

Facility

$36.00

Hospital Charge Code	3102611
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$30.60
Rate for Payer: Cash Price	$23.40
Rate for Payer: Community Health Alliance Commercial	$30.60
Rate for Payer: Priority Health Commercial	$25.20
Rate for Payer: Priority Health PPO	$25.20

HBSAG

Facility

$7.40

Hospital Charge Code	3101099
Hospital Revenue Code	302
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$6.29
Rate for Payer: Cash Price	$4.81
Rate for Payer: Community Health Alliance Commercial	$6.29
Rate for Payer: Priority Health Commercial	$5.18
Rate for Payer: Priority Health PPO	$5.18

HBV QUANT PCR

Facility

$73.31

Service Code	HCPCS 87517
Hospital Charge Code	3004985
Hospital Revenue Code	306
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$62.31
Rate for Payer: BCBS BCN 65	$44.98
Rate for Payer: Blue Care Network Medicare Advantage	$44.98
Rate for Payer: Cash Price	$47.65
Rate for Payer: Cash Price	$47.65
Rate for Payer: Community Health Alliance Commercial	$62.31
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$44.98
Rate for Payer: Meridian Health Plan Medicare	$44.98
Rate for Payer: Priority Health Commercial	$51.32
Rate for Payer: Priority Health Medicaid	$44.98
Rate for Payer: Priority Health Medicare	$44.98
Rate for Payer: Priority Health PPO	$51.32
Rate for Payer: United Health Care Medicaid	$44.98
Rate for Payer: United Health Care Medicare Advantage	$19.79

HBVS-1

Facility

$3.60

Hospital Charge Code	3102489
Hospital Revenue Code	300
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$3.06
Rate for Payer: Cash Price	$2.34
Rate for Payer: Community Health Alliance Commercial	$3.06
Rate for Payer: Priority Health Commercial	$2.52
Rate for Payer: Priority Health PPO	$2.52

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges