Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

KIT, CVP INSERTION

Facility

$92.00

Hospital Charge Code	27020222
Hospital Revenue Code	272
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$78.20
Rate for Payer: Cash Price	$59.80
Rate for Payer: Community Health Alliance Commercial	$78.20
Rate for Payer: Priority Health Commercial	$64.40
Rate for Payer: Priority Health PPO	$64.40

KIT, ENDO HERNIA - ETHICON

Facility

$1,428.00

Service Code	HCPCS C1781
Hospital Charge Code	27018036
Hospital Revenue Code	278
Min. Negotiated Rate	$999.60
Max. Negotiated Rate	$1,213.80
Rate for Payer: Cash Price	$928.20
Rate for Payer: Community Health Alliance Commercial	$1,213.80
Rate for Payer: Priority Health Commercial	$999.60
Rate for Payer: Priority Health PPO	$999.60

KIT, ENDOSCOPIC GYN FT050/FT06

Facility

$3,157.00

Hospital Charge Code	27017772
Hospital Revenue Code	272
Min. Negotiated Rate	$2,209.90
Max. Negotiated Rate	$2,683.45
Rate for Payer: Cash Price	$2,052.05
Rate for Payer: Community Health Alliance Commercial	$2,683.45
Rate for Payer: Priority Health Commercial	$2,209.90
Rate for Payer: Priority Health PPO	$2,209.90

KIT,ENDOSCOPIC LIGATOR 5 BAND

Facility

$234.00

Hospital Charge Code	27261857
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

KIT, ENTRISTAR GASTROSTOMY

Facility

$164.00

Hospital Charge Code	27265684
Hospital Revenue Code	272
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$139.40
Rate for Payer: Cash Price	$106.60
Rate for Payer: Community Health Alliance Commercial	$139.40
Rate for Payer: Priority Health Commercial	$114.80
Rate for Payer: Priority Health PPO	$114.80

KIT, FALOPE-RING BAND W/TROCAR

Facility

$365.00

Hospital Charge Code	27021675
Hospital Revenue Code	272
Min. Negotiated Rate	$255.50
Max. Negotiated Rate	$310.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Community Health Alliance Commercial	$310.25
Rate for Payer: Priority Health Commercial	$255.50
Rate for Payer: Priority Health PPO	$255.50

KIT, GASTRIC LAVAGE

Facility

$77.00

Hospital Charge Code	27013656
Hospital Revenue Code	272
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$65.45
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health PPO	$53.90

KIT, LAPAROSCOPIC

Facility

$1,588.00

Hospital Charge Code	27017954
Hospital Revenue Code	272
Min. Negotiated Rate	$1,111.60
Max. Negotiated Rate	$1,349.80
Rate for Payer: Cash Price	$1,032.20
Rate for Payer: Community Health Alliance Commercial	$1,349.80
Rate for Payer: Priority Health Commercial	$1,111.60
Rate for Payer: Priority Health PPO	$1,111.60

KIT, LAP/CHOLE ETHICON

Facility

$1,293.00

Hospital Charge Code	27024802
Hospital Revenue Code	272
Min. Negotiated Rate	$905.10
Max. Negotiated Rate	$1,099.05
Rate for Payer: Cash Price	$840.45
Rate for Payer: Community Health Alliance Commercial	$1,099.05
Rate for Payer: Priority Health Commercial	$905.10
Rate for Payer: Priority Health PPO	$905.10

KIT,LTA 360

Facility

$38.00

Hospital Charge Code	27263619
Hospital Revenue Code	272
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$32.30
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health PPO	$26.60

KIT, MILLER CARTRIDGE

Facility

$143.00

Hospital Charge Code	27060867
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

KIT, MULTI LUMEN CVC

Facility

$450.00

Hospital Charge Code	27018895
Hospital Revenue Code	272
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$382.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Community Health Alliance Commercial	$382.50
Rate for Payer: Priority Health Commercial	$315.00
Rate for Payer: Priority Health PPO	$315.00

KIT,NEONATAL SPECIALCATH

Facility

$19.00

Hospital Charge Code	27021451
Hospital Revenue Code	272
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$16.15
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health PPO	$13.30

KIT,PERCUTANEOUS LINGEMEN

Facility

$3,087.00

Hospital Charge Code	27266260
Hospital Revenue Code	272
Min. Negotiated Rate	$2,160.90
Max. Negotiated Rate	$2,623.95
Rate for Payer: Cash Price	$2,006.55
Rate for Payer: Community Health Alliance Commercial	$2,623.95
Rate for Payer: Priority Health Commercial	$2,160.90
Rate for Payer: Priority Health PPO	$2,160.90

KIT, PERCUT INTRO W/ SHEATH

Facility

$215.00

Hospital Charge Code	27011080
Hospital Revenue Code	272
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$182.75
Rate for Payer: Cash Price	$139.75
Rate for Payer: Community Health Alliance Commercial	$182.75
Rate for Payer: Priority Health Commercial	$150.50
Rate for Payer: Priority Health PPO	$150.50

KIT,QUINTON TENCKHOFF

Facility

$252.00

Hospital Charge Code	27266666
Hospital Revenue Code	272
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$214.20
Rate for Payer: Cash Price	$163.80
Rate for Payer: Community Health Alliance Commercial	$214.20
Rate for Payer: Priority Health Commercial	$176.40
Rate for Payer: Priority Health PPO	$176.40

KIT, RADIAL ARTERY CATH

Facility

$116.00

Hospital Charge Code	27017582
Hospital Revenue Code	272
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$98.60
Rate for Payer: Cash Price	$75.40
Rate for Payer: Community Health Alliance Commercial	$98.60
Rate for Payer: Priority Health Commercial	$81.20
Rate for Payer: Priority Health PPO	$81.20

KIT RECONSTRUCTION

Facility

$15.00

Hospital Charge Code	27264033
Hospital Revenue Code	272
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

KIT, SOAPSUDS ENEMA

Facility

$17.00

Hospital Charge Code	27010686
Hospital Revenue Code	270
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

KIT, STYLET 58CM

Facility

$116.00

Hospital Charge Code	27268563
Hospital Revenue Code	272
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$98.60
Rate for Payer: Cash Price	$75.40
Rate for Payer: Community Health Alliance Commercial	$98.60
Rate for Payer: Priority Health Commercial	$81.20
Rate for Payer: Priority Health PPO	$81.20

KIT, SUCTION, DELEE CATHETER

Facility

$15.00

Hospital Charge Code	27010975
Hospital Revenue Code	272
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

KIT,SUPRAPUBIC CATHETER 12 FR

Facility

$159.00

Service Code	HCPCS C2627
Hospital Charge Code	27060313
Hospital Revenue Code	272
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$135.15
Rate for Payer: Cash Price	$103.35
Rate for Payer: Community Health Alliance Commercial	$135.15
Rate for Payer: Priority Health Commercial	$111.30
Rate for Payer: Priority Health PPO	$111.30

KIT,SUPRAPUBIC CATHETER 14FR

Facility

$139.00

Service Code	HCPCS C2627
Hospital Charge Code	27060363
Hospital Revenue Code	272
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$118.15
Rate for Payer: Cash Price	$90.35
Rate for Payer: Community Health Alliance Commercial	$118.15
Rate for Payer: Priority Health Commercial	$97.30
Rate for Payer: Priority Health PPO	$97.30

KIT, SUTURE REMOVAL

Facility

$14.00

Hospital Charge Code	27011353
Hospital Revenue Code	272
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$11.90
Rate for Payer: Cash Price	$9.10
Rate for Payer: Community Health Alliance Commercial	$11.90
Rate for Payer: Priority Health Commercial	$9.80
Rate for Payer: Priority Health PPO	$9.80

KIT, THORACENTESIS,PLEURA SEAL

Facility

$228.00

Hospital Charge Code	27018820
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges