Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

STENT,OASIS-ONE ACTION

Facility

$243.00

Service Code	HCPCS C2625
Hospital Charge Code	27264256
Hospital Revenue Code	278
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$206.55
Rate for Payer: Cash Price	$157.95
Rate for Payer: Community Health Alliance Commercial	$206.55
Rate for Payer: Priority Health Commercial	$170.10
Rate for Payer: Priority Health PPO	$170.10

STENT,PALMEX

Facility

$5,192.00

Service Code	HCPCS C1725
Hospital Charge Code	27060800
Hospital Revenue Code	278
Min. Negotiated Rate	$3,634.40
Max. Negotiated Rate	$4,413.20
Rate for Payer: Cash Price	$3,374.80
Rate for Payer: Community Health Alliance Commercial	$4,413.20
Rate for Payer: Priority Health Commercial	$3,634.40
Rate for Payer: Priority Health PPO	$3,634.40

STENT,PANCREATIC

Facility

$188.00

Service Code	HCPCS C2625
Hospital Charge Code	27262982
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,PANCREATIC SET

Facility

$465.00

Service Code	HCPCS C2625
Hospital Charge Code	27262586
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, PERCUFLEX

Facility

$338.00

Hospital Charge Code	27060264
Hospital Revenue Code	278
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$287.30
Rate for Payer: Cash Price	$219.70
Rate for Payer: Community Health Alliance Commercial	$287.30
Rate for Payer: Priority Health Commercial	$236.60
Rate for Payer: Priority Health PPO	$236.60

STENT,PERCUFLEX TAIL PLUS

Facility

$438.00

Hospital Charge Code	27068001
Hospital Revenue Code	278
Min. Negotiated Rate	$306.60
Max. Negotiated Rate	$372.30
Rate for Payer: Cash Price	$284.70
Rate for Payer: Community Health Alliance Commercial	$372.30
Rate for Payer: Priority Health Commercial	$306.60
Rate for Payer: Priority Health PPO	$306.60

STENT, PERCUFLEX URETERAL

Facility

$557.00

Service Code	HCPCS C2617
Hospital Charge Code	27060594
Hospital Revenue Code	278
Min. Negotiated Rate	$389.90
Max. Negotiated Rate	$473.45
Rate for Payer: Cash Price	$362.05
Rate for Payer: Community Health Alliance Commercial	$473.45
Rate for Payer: Priority Health Commercial	$389.90
Rate for Payer: Priority Health PPO	$389.90

STENT, PERCUTANEOUS #410-126

Facility

$298.00

Hospital Charge Code	27265791
Hospital Revenue Code	272
Min. Negotiated Rate	$208.60
Max. Negotiated Rate	$253.30
Rate for Payer: Cash Price	$193.70
Rate for Payer: Community Health Alliance Commercial	$253.30
Rate for Payer: Priority Health Commercial	$208.60
Rate for Payer: Priority Health PPO	$208.60

STENT, PREMOUNTED

Facility

$5,872.00

Service Code	HCPCS C1876
Hospital Charge Code	27264140
Hospital Revenue Code	278
Min. Negotiated Rate	$4,110.40
Max. Negotiated Rate	$4,991.20
Rate for Payer: Cash Price	$3,816.80
Rate for Payer: Community Health Alliance Commercial	$4,991.20
Rate for Payer: Priority Health Commercial	$4,110.40
Rate for Payer: Priority Health PPO	$4,110.40

STENT, SILICONE UROGUIDE

Facility

$510.00

Hospital Charge Code	27016758
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, SMART BIL 80CM 8 X 060

Facility

$4,542.00

Service Code	HCPCS C1876
Hospital Charge Code	27267771
Hospital Revenue Code	278
Min. Negotiated Rate	$3,179.40
Max. Negotiated Rate	$3,860.70
Rate for Payer: Cash Price	$2,952.30
Rate for Payer: Community Health Alliance Commercial	$3,860.70
Rate for Payer: Priority Health Commercial	$3,179.40
Rate for Payer: Priority Health PPO	$3,179.40

STENT,URETERAL

Facility

$599.00

Service Code	HCPCS C2617
Hospital Charge Code	27014704
Hospital Revenue Code	278
Min. Negotiated Rate	$419.30
Max. Negotiated Rate	$509.15
Rate for Payer: Cash Price	$389.35
Rate for Payer: Community Health Alliance Commercial	$509.15
Rate for Payer: Priority Health Commercial	$419.30
Rate for Payer: Priority Health PPO	$419.30

STENT,URETERAL

Facility

$556.00

Hospital Charge Code	27814704
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

STENT, WALL

Facility

$5,420.00

Hospital Charge Code	27061832
Hospital Revenue Code	278
Min. Negotiated Rate	$3,794.00
Max. Negotiated Rate	$4,607.00
Rate for Payer: Cash Price	$3,523.00
Rate for Payer: Community Health Alliance Commercial	$4,607.00
Rate for Payer: Priority Health Commercial	$3,794.00
Rate for Payer: Priority Health PPO	$3,794.00

STERI-CATH, CLOSED SUCTION

Facility

$98.00

Hospital Charge Code	27018788
Hospital Revenue Code	270
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$83.30
Rate for Payer: Cash Price	$63.70
Rate for Payer: Community Health Alliance Commercial	$83.30
Rate for Payer: Priority Health Commercial	$68.60
Rate for Payer: Priority Health PPO	$68.60

STERILE KLING

Facility

$14.00

Hospital Charge Code	27011452
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

STERILE WATER 10 ML INJ

Facility

$26.78

Service Code	NDC 409488710
Hospital Charge Code	2500813
Hospital Revenue Code	250
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$22.76
Rate for Payer: Cash Price	$17.41
Rate for Payer: Community Health Alliance Commercial	$22.76
Rate for Payer: Priority Health Commercial	$18.75
Rate for Payer: Priority Health PPO	$18.75

STERLING END CUTTER

Facility

$201.00

Hospital Charge Code	27264371
Hospital Revenue Code	272
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$170.85
Rate for Payer: Cash Price	$130.65
Rate for Payer: Community Health Alliance Commercial	$170.85
Rate for Payer: Priority Health Commercial	$140.70
Rate for Payer: Priority Health PPO	$140.70

STIFFNECK COLLAR

Facility

$96.00

Hospital Charge Code	27018937
Hospital Revenue Code	270
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$81.60
Rate for Payer: Cash Price	$62.40
Rate for Payer: Community Health Alliance Commercial	$81.60
Rate for Payer: Priority Health Commercial	$67.20
Rate for Payer: Priority Health PPO	$67.20

STILLPOINT INDUCER

Facility

$36.00

Hospital Charge Code	27061212
Hospital Revenue Code	270
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

STIU HYDRIDIZATION EA ADDPROBE

Facility

$224.00

Hospital Charge Code	3000192
Hospital Revenue Code	310
Min. Negotiated Rate	$156.80
Max. Negotiated Rate	$190.40
Rate for Payer: Cash Price	$145.60
Rate for Payer: Community Health Alliance Commercial	$190.40
Rate for Payer: Priority Health Commercial	$156.80
Rate for Payer: Priority Health PPO	$156.80

STIU HYDRIDIZATION EA PROBE

Facility

$224.00

Hospital Charge Code	3000191
Hospital Revenue Code	310
Min. Negotiated Rate	$156.80
Max. Negotiated Rate	$190.40
Rate for Payer: Cash Price	$145.60
Rate for Payer: Community Health Alliance Commercial	$190.40
Rate for Payer: Priority Health Commercial	$156.80
Rate for Payer: Priority Health PPO	$156.80

STL-1-LC

Facility

$6.78

Hospital Charge Code	3102425
Hospital Revenue Code	300
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$5.76
Rate for Payer: Cash Price	$4.41
Rate for Payer: Community Health Alliance Commercial	$5.76
Rate for Payer: Priority Health Commercial	$4.75
Rate for Payer: Priority Health PPO	$4.75

STL-2-LC

Facility

$6.78

Hospital Charge Code	3102426
Hospital Revenue Code	300
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$5.76
Rate for Payer: Cash Price	$4.41
Rate for Payer: Community Health Alliance Commercial	$5.76
Rate for Payer: Priority Health Commercial	$4.75
Rate for Payer: Priority Health PPO	$4.75

STL-3-LC

Facility

$6.80

Hospital Charge Code	3102427
Hospital Revenue Code	300
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$5.78
Rate for Payer: Cash Price	$4.42
Rate for Payer: Community Health Alliance Commercial	$5.78
Rate for Payer: Priority Health Commercial	$4.76
Rate for Payer: Priority Health PPO	$4.76

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges