Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

STENT, 7 X 4 X 120CM

Facility

$6,618.00

Service Code	HCPCS C1876
Hospital Charge Code	27267383
Hospital Revenue Code	278
Min. Negotiated Rate	$4,632.60
Max. Negotiated Rate	$5,625.30
Rate for Payer: Cash Price	$4,301.70
Rate for Payer: Community Health Alliance Commercial	$5,625.30
Rate for Payer: Priority Health Commercial	$4,632.60
Rate for Payer: Priority Health PPO	$4,632.60

STENT, 7 X 6 X 120CM

Facility

$6,618.00

Service Code	HCPCS C1876
Hospital Charge Code	27267390
Hospital Revenue Code	278
Min. Negotiated Rate	$4,632.60
Max. Negotiated Rate	$5,625.30
Rate for Payer: Cash Price	$4,301.70
Rate for Payer: Community Health Alliance Commercial	$5,625.30
Rate for Payer: Priority Health Commercial	$4,632.60
Rate for Payer: Priority Health PPO	$4,632.60

STENT, 7 X 8 X 120CM

Facility

$7,945.00

Hospital Charge Code	27267375
Hospital Revenue Code	278
Min. Negotiated Rate	$5,561.50
Max. Negotiated Rate	$6,753.25
Rate for Payer: Cash Price	$5,164.25
Rate for Payer: Community Health Alliance Commercial	$6,753.25
Rate for Payer: Priority Health Commercial	$5,561.50
Rate for Payer: Priority Health PPO	$5,561.50

STENT,ARTERIAL

Facility

$6,779.00

Hospital Charge Code	27263635
Hospital Revenue Code	278
Min. Negotiated Rate	$4,745.30
Max. Negotiated Rate	$5,762.15
Rate for Payer: Cash Price	$4,406.35
Rate for Payer: Community Health Alliance Commercial	$5,762.15
Rate for Payer: Priority Health Commercial	$4,745.30
Rate for Payer: Priority Health PPO	$4,745.30

STENT, BILIARY

Facility

$172.00

Service Code	HCPCS C2625
Hospital Charge Code	27263960
Hospital Revenue Code	278
Min. Negotiated Rate	$120.40
Max. Negotiated Rate	$146.20
Rate for Payer: Cash Price	$111.80
Rate for Payer: Community Health Alliance Commercial	$146.20
Rate for Payer: Priority Health Commercial	$120.40
Rate for Payer: Priority Health PPO	$120.40

STENT, BILIARY

Facility

$465.00

Service Code	HCPCS C2625
Hospital Charge Code	27262895
Hospital Revenue Code	278
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$395.25
Rate for Payer: Cash Price	$302.25
Rate for Payer: Community Health Alliance Commercial	$395.25
Rate for Payer: Priority Health Commercial	$325.50
Rate for Payer: Priority Health PPO	$325.50

STENT, BILIARY

Facility

$6,688.00

Hospital Charge Code	27262533
Hospital Revenue Code	278
Min. Negotiated Rate	$4,681.60
Max. Negotiated Rate	$5,684.80
Rate for Payer: Cash Price	$4,347.20
Rate for Payer: Community Health Alliance Commercial	$5,684.80
Rate for Payer: Priority Health Commercial	$4,681.60
Rate for Payer: Priority Health PPO	$4,681.60

STENT, BILIARY #43060

Facility

$6,823.00

Hospital Charge Code	27262549
Hospital Revenue Code	272
Min. Negotiated Rate	$4,776.10
Max. Negotiated Rate	$5,799.55
Rate for Payer: Cash Price	$4,434.95
Rate for Payer: Community Health Alliance Commercial	$5,799.55
Rate for Payer: Priority Health Commercial	$4,776.10
Rate for Payer: Priority Health PPO	$4,776.10

STENT BILIARY 6 X 150

Facility

$4,359.00

Service Code	HCPCS C1876
Hospital Charge Code	27876162
Hospital Revenue Code	278
Min. Negotiated Rate	$3,051.30
Max. Negotiated Rate	$3,705.15
Rate for Payer: Cash Price	$2,833.35
Rate for Payer: Community Health Alliance Commercial	$3,705.15
Rate for Payer: Priority Health Commercial	$3,051.30
Rate for Payer: Priority Health PPO	$3,051.30

STENT,BILIARY RAPID EXCHANGE

Facility

$510.00

Hospital Charge Code	27263985
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

STENT, COIL

Facility

$352.00

Hospital Charge Code	27015693
Hospital Revenue Code	278
Min. Negotiated Rate	$246.40
Max. Negotiated Rate	$299.20
Rate for Payer: Cash Price	$228.80
Rate for Payer: Community Health Alliance Commercial	$299.20
Rate for Payer: Priority Health Commercial	$246.40
Rate for Payer: Priority Health PPO	$246.40

STENT (CORDIS)

Facility

$5,458.00

Hospital Charge Code	27264207
Hospital Revenue Code	278
Min. Negotiated Rate	$3,820.60
Max. Negotiated Rate	$4,639.30
Rate for Payer: Cash Price	$3,547.70
Rate for Payer: Community Health Alliance Commercial	$4,639.30
Rate for Payer: Priority Health Commercial	$3,820.60
Rate for Payer: Priority Health PPO	$3,820.60

STENT,COTTON-HUIBREGTSE BILIAR

Facility

$444.00

Service Code	HCPCS C2625
Hospital Charge Code	27264637
Hospital Revenue Code	278
Min. Negotiated Rate	$310.80
Max. Negotiated Rate	$377.40
Rate for Payer: Cash Price	$288.60
Rate for Payer: Community Health Alliance Commercial	$377.40
Rate for Payer: Priority Health Commercial	$310.80
Rate for Payer: Priority Health PPO	$310.80

STENT,COTTON LEUNG BILIARY SET

Facility

$444.00

Hospital Charge Code	27264645
Hospital Revenue Code	278
Min. Negotiated Rate	$310.80
Max. Negotiated Rate	$377.40
Rate for Payer: Cash Price	$288.60
Rate for Payer: Community Health Alliance Commercial	$377.40
Rate for Payer: Priority Health Commercial	$310.80
Rate for Payer: Priority Health PPO	$310.80

STENT, DOUBLE-J URETERAL

Facility

$798.00

Service Code	HCPCS C2617
Hospital Charge Code	27018044
Hospital Revenue Code	278
Min. Negotiated Rate	$558.60
Max. Negotiated Rate	$678.30
Rate for Payer: Cash Price	$518.70
Rate for Payer: Community Health Alliance Commercial	$678.30
Rate for Payer: Priority Health Commercial	$558.60
Rate for Payer: Priority Health PPO	$558.60

STENT, ENDOPROSTHESIS WALL

Facility

$4,876.00

Hospital Charge Code	27061527
Hospital Revenue Code	278
Min. Negotiated Rate	$3,413.20
Max. Negotiated Rate	$4,144.60
Rate for Payer: Cash Price	$3,169.40
Rate for Payer: Community Health Alliance Commercial	$4,144.60
Rate for Payer: Priority Health Commercial	$3,413.20
Rate for Payer: Priority Health PPO	$3,413.20

STENT,ENTERAL/DUODENAL

Facility

$8,272.00

Hospital Charge Code	27262078
Hospital Revenue Code	278
Min. Negotiated Rate	$5,790.40
Max. Negotiated Rate	$7,031.20
Rate for Payer: Cash Price	$5,376.80
Rate for Payer: Community Health Alliance Commercial	$7,031.20
Rate for Payer: Priority Health Commercial	$5,790.40
Rate for Payer: Priority Health PPO	$5,790.40

STENT,ESOPHAGEAL

Facility

$6,232.00

Hospital Charge Code	27262379
Hospital Revenue Code	278
Min. Negotiated Rate	$4,362.40
Max. Negotiated Rate	$5,297.20
Rate for Payer: Cash Price	$4,050.80
Rate for Payer: Community Health Alliance Commercial	$5,297.20
Rate for Payer: Priority Health Commercial	$4,362.40
Rate for Payer: Priority Health PPO	$4,362.40

STENT, EZ

Facility

$3,855.00

Hospital Charge Code	27262407
Hospital Revenue Code	278
Min. Negotiated Rate	$2,698.50
Max. Negotiated Rate	$3,276.75
Rate for Payer: Cash Price	$2,505.75
Rate for Payer: Community Health Alliance Commercial	$3,276.75
Rate for Payer: Priority Health Commercial	$2,698.50
Rate for Payer: Priority Health PPO	$2,698.50

STENT GENESIS 18MM BILIARY

Facility

$4,215.00

Hospital Charge Code	27265890
Hospital Revenue Code	272
Min. Negotiated Rate	$2,950.50
Max. Negotiated Rate	$3,582.75
Rate for Payer: Cash Price	$2,739.75
Rate for Payer: Community Health Alliance Commercial	$3,582.75
Rate for Payer: Priority Health Commercial	$2,950.50
Rate for Payer: Priority Health PPO	$2,950.50

STENT,GREEN PANCREATIC

Facility

$188.00

Service Code	HCPCS C2625
Hospital Charge Code	27262594
Hospital Revenue Code	278
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$159.80
Rate for Payer: Cash Price	$122.20
Rate for Payer: Community Health Alliance Commercial	$159.80
Rate for Payer: Priority Health Commercial	$131.60
Rate for Payer: Priority Health PPO	$131.60

STENT, LUBRI-FLEX URETERAL

Facility

$823.00

Service Code	HCPCS C2625
Hospital Charge Code	27013805
Hospital Revenue Code	278
Min. Negotiated Rate	$576.10
Max. Negotiated Rate	$699.55
Rate for Payer: Cash Price	$534.95
Rate for Payer: Community Health Alliance Commercial	$699.55
Rate for Payer: Priority Health Commercial	$576.10
Rate for Payer: Priority Health PPO	$576.10

STENT,MEMOTHERM COLORECTAL

Facility

$6,347.00

Hospital Charge Code	27265825
Hospital Revenue Code	278
Min. Negotiated Rate	$4,442.90
Max. Negotiated Rate	$5,394.95
Rate for Payer: Cash Price	$4,125.55
Rate for Payer: Community Health Alliance Commercial	$5,394.95
Rate for Payer: Priority Health Commercial	$4,442.90
Rate for Payer: Priority Health PPO	$4,442.90

STENT, MICROVASIVE #3376

Facility

$393.00

Hospital Charge Code	27019299
Hospital Revenue Code	278
Min. Negotiated Rate	$275.10
Max. Negotiated Rate	$334.05
Rate for Payer: Cash Price	$255.45
Rate for Payer: Community Health Alliance Commercial	$334.05
Rate for Payer: Priority Health Commercial	$275.10
Rate for Payer: Priority Health PPO	$275.10

STENT, MULTI-FLO

Facility

$550.00

Hospital Charge Code	27018432
Hospital Revenue Code	278
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$467.50
Rate for Payer: Cash Price	$357.50
Rate for Payer: Community Health Alliance Commercial	$467.50
Rate for Payer: Priority Health Commercial	$385.00
Rate for Payer: Priority Health PPO	$385.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges