Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

SCREW, CORTICAL 3.5X14MM

Facility

$842.00

Service Code	HCPCS C1713
Hospital Charge Code	27872088
Hospital Revenue Code	278
Min. Negotiated Rate	$589.40
Max. Negotiated Rate	$715.70
Rate for Payer: Cash Price	$547.30
Rate for Payer: Community Health Alliance Commercial	$715.70
Rate for Payer: Priority Health Commercial	$589.40
Rate for Payer: Priority Health PPO	$589.40

SCREW, CORTICAL 4.5 36MM

Facility

$46.00

Service Code	HCPCS C1713
Hospital Charge Code	27868852
Hospital Revenue Code	278
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

SCREW, CORTICAL 4.5 X 32MM

Facility

$86.00

Service Code	HCPCS C1713
Hospital Charge Code	27868910
Hospital Revenue Code	278
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$73.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Community Health Alliance Commercial	$73.10
Rate for Payer: Priority Health Commercial	$60.20
Rate for Payer: Priority Health PPO	$60.20

SCREW,CORTICAL 5.5MM x 70MM

Facility

$481.00

Service Code	HCPCS C1713
Hospital Charge Code	27266021
Hospital Revenue Code	278
Min. Negotiated Rate	$336.70
Max. Negotiated Rate	$408.85
Rate for Payer: Cash Price	$312.65
Rate for Payer: Community Health Alliance Commercial	$408.85
Rate for Payer: Priority Health Commercial	$336.70
Rate for Payer: Priority Health PPO	$336.70

SCREW, CORTICAL BONE

Facility

$42.00

Service Code	HCPCS C1713
Hospital Charge Code	27024588
Hospital Revenue Code	278
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

SCREW,CROSS FULL TREADED

Facility

$510.00

Service Code	HCPCS C1713
Hospital Charge Code	27866393
Hospital Revenue Code	278
Min. Negotiated Rate	$357.00
Max. Negotiated Rate	$433.50
Rate for Payer: Cash Price	$331.50
Rate for Payer: Community Health Alliance Commercial	$433.50
Rate for Payer: Priority Health Commercial	$357.00
Rate for Payer: Priority Health PPO	$357.00

SCREW, GUARDSMAN

Facility

$431.00

Service Code	HCPCS C1713
Hospital Charge Code	27265346
Hospital Revenue Code	278
Min. Negotiated Rate	$301.70
Max. Negotiated Rate	$366.35
Rate for Payer: Cash Price	$280.15
Rate for Payer: Community Health Alliance Commercial	$366.35
Rate for Payer: Priority Health Commercial	$301.70
Rate for Payer: Priority Health PPO	$301.70

SCREW, GUARDSMAN 9 x 25

Facility

$592.00

Service Code	HCPCS C1713
Hospital Charge Code	27865189
Hospital Revenue Code	278
Min. Negotiated Rate	$414.40
Max. Negotiated Rate	$503.20
Rate for Payer: Cash Price	$384.80
Rate for Payer: Community Health Alliance Commercial	$503.20
Rate for Payer: Priority Health Commercial	$414.40
Rate for Payer: Priority Health PPO	$414.40

SCREW, JONES 4.5 x 40MM

Facility

$3,808.00

Service Code	HCPCS C1713
Hospital Charge Code	27868738
Hospital Revenue Code	278
Min. Negotiated Rate	$2,665.60
Max. Negotiated Rate	$3,236.80
Rate for Payer: Cash Price	$2,475.20
Rate for Payer: Community Health Alliance Commercial	$3,236.80
Rate for Payer: Priority Health Commercial	$2,665.60
Rate for Payer: Priority Health PPO	$2,665.60

SCREW, LAG

Facility

$602.00

Service Code	HCPCS C1713
Hospital Charge Code	27867599
Hospital Revenue Code	278
Min. Negotiated Rate	$421.40
Max. Negotiated Rate	$511.70
Rate for Payer: Cash Price	$391.30
Rate for Payer: Community Health Alliance Commercial	$511.70
Rate for Payer: Priority Health Commercial	$421.40
Rate for Payer: Priority Health PPO	$421.40

SCREW,LAG #3370-2-105

Facility

$1,183.00

Service Code	HCPCS C1713
Hospital Charge Code	27866567
Hospital Revenue Code	278
Min. Negotiated Rate	$828.10
Max. Negotiated Rate	$1,005.55
Rate for Payer: Cash Price	$768.95
Rate for Payer: Community Health Alliance Commercial	$1,005.55
Rate for Payer: Priority Health Commercial	$828.10
Rate for Payer: Priority Health PPO	$828.10

SCREW, LOCKING

Facility

$261.00

Service Code	HCPCS C1713
Hospital Charge Code	27872203
Hospital Revenue Code	278
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$221.85
Rate for Payer: Cash Price	$169.65
Rate for Payer: Community Health Alliance Commercial	$221.85
Rate for Payer: Priority Health Commercial	$182.70
Rate for Payer: Priority Health PPO	$182.70

SCREW,LOCKING 4.0MM/18MM

Facility

$412.00

Service Code	HCPCS C1713
Hospital Charge Code	27866922
Hospital Revenue Code	278
Min. Negotiated Rate	$288.40
Max. Negotiated Rate	$350.20
Rate for Payer: Cash Price	$267.80
Rate for Payer: Community Health Alliance Commercial	$350.20
Rate for Payer: Priority Health Commercial	$288.40
Rate for Payer: Priority Health PPO	$288.40

SCREW, LOCKING .40MM/34MM

Facility

$556.00

Service Code	HCPCS C1713
Hospital Charge Code	27866930
Hospital Revenue Code	278
Min. Negotiated Rate	$389.20
Max. Negotiated Rate	$472.60
Rate for Payer: Cash Price	$361.40
Rate for Payer: Community Health Alliance Commercial	$472.60
Rate for Payer: Priority Health Commercial	$389.20
Rate for Payer: Priority Health PPO	$389.20

SCREW, LOCKING 4.0MM/38MM

Facility

$412.00

Service Code	HCPCS C1713
Hospital Charge Code	27866948
Hospital Revenue Code	278
Min. Negotiated Rate	$288.40
Max. Negotiated Rate	$350.20
Rate for Payer: Cash Price	$267.80
Rate for Payer: Community Health Alliance Commercial	$350.20
Rate for Payer: Priority Health Commercial	$288.40
Rate for Payer: Priority Health PPO	$288.40

SCREW, LOCKING 5.0MM

Facility

$399.00

Service Code	HCPCS C1713
Hospital Charge Code	27868126
Hospital Revenue Code	278
Min. Negotiated Rate	$279.30
Max. Negotiated Rate	$339.15
Rate for Payer: Cash Price	$259.35
Rate for Payer: Community Health Alliance Commercial	$339.15
Rate for Payer: Priority Health Commercial	$279.30
Rate for Payer: Priority Health PPO	$279.30

SCREW, LOCKING 5.0 X 20MM

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	27867961
Hospital Revenue Code	278
Min. Negotiated Rate	$204.40
Max. Negotiated Rate	$248.20
Rate for Payer: Cash Price	$189.80
Rate for Payer: Community Health Alliance Commercial	$248.20
Rate for Payer: Priority Health Commercial	$204.40
Rate for Payer: Priority Health PPO	$204.40

SCREW, LOCKING 5.0 X 30MM

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	27867946
Hospital Revenue Code	278
Min. Negotiated Rate	$204.40
Max. Negotiated Rate	$248.20
Rate for Payer: Cash Price	$189.80
Rate for Payer: Community Health Alliance Commercial	$248.20
Rate for Payer: Priority Health Commercial	$204.40
Rate for Payer: Priority Health PPO	$204.40

SCREW, LOCKING 5.0 X 32MM

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	27867953
Hospital Revenue Code	278
Min. Negotiated Rate	$204.40
Max. Negotiated Rate	$248.20
Rate for Payer: Cash Price	$189.80
Rate for Payer: Community Health Alliance Commercial	$248.20
Rate for Payer: Priority Health Commercial	$204.40
Rate for Payer: Priority Health PPO	$204.40

SCREW, MULTIDIRECTION

Facility

$277.00

Service Code	HCPCS C1713
Hospital Charge Code	27872244
Hospital Revenue Code	278
Min. Negotiated Rate	$193.90
Max. Negotiated Rate	$235.45
Rate for Payer: Cash Price	$180.05
Rate for Payer: Community Health Alliance Commercial	$235.45
Rate for Payer: Priority Health Commercial	$193.90
Rate for Payer: Priority Health PPO	$193.90

SCREW, PERIARTICULAR 4.5x110MM

Facility

$92.00

Service Code	HCPCS C1713
Hospital Charge Code	27266203
Hospital Revenue Code	278
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

SCREW, SELF TAPPING

Facility

$74.00

Service Code	HCPCS C1713
Hospital Charge Code	27271880
Hospital Revenue Code	278
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$62.90
Rate for Payer: Cash Price	$48.10
Rate for Payer: Community Health Alliance Commercial	$62.90
Rate for Payer: Priority Health Commercial	$51.80
Rate for Payer: Priority Health PPO	$51.80

SCREW SET 08/27MM

Facility

$528.00

Service Code	HCPCS C1713
Hospital Charge Code	27866575
Hospital Revenue Code	278
Min. Negotiated Rate	$369.60
Max. Negotiated Rate	$448.80
Rate for Payer: Cash Price	$343.20
Rate for Payer: Community Health Alliance Commercial	$448.80
Rate for Payer: Priority Health Commercial	$369.60
Rate for Payer: Priority Health PPO	$369.60

SCREW, TALON COMPRESSION 26MM

Facility

$81.00

Service Code	HCPCS C1713
Hospital Charge Code	27267201
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$68.85
Rate for Payer: Cash Price	$52.65
Rate for Payer: Community Health Alliance Commercial	$68.85
Rate for Payer: Priority Health Commercial	$56.70
Rate for Payer: Priority Health PPO	$56.70

SCREW, TALON CORTICAL

Facility

$81.00

Service Code	HCPCS C1713
Hospital Charge Code	27267219
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$68.85
Rate for Payer: Cash Price	$52.65
Rate for Payer: Community Health Alliance Commercial	$68.85
Rate for Payer: Priority Health Commercial	$56.70
Rate for Payer: Priority Health PPO	$56.70

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges