Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

TRAY, BONE MARROW

Facility

$120.00

Hospital Charge Code	27267573
Hospital Revenue Code	272
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Priority Health Commercial	$84.00
Rate for Payer: Priority Health PPO	$84.00

TRAY,BONE MARROW BIOPSY

Facility

$120.00

Hospital Charge Code	27263841
Hospital Revenue Code	272
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Priority Health Commercial	$84.00
Rate for Payer: Priority Health PPO	$84.00

TRAY, CATH 14 FR

Facility

$27.00

Hospital Charge Code	27010363
Hospital Revenue Code	272
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

TRAY - CENTRAL VENOUS

Facility

$395.00

Hospital Charge Code	27011114
Hospital Revenue Code	272
Min. Negotiated Rate	$276.50
Max. Negotiated Rate	$335.75
Rate for Payer: Cash Price	$256.75
Rate for Payer: Community Health Alliance Commercial	$335.75
Rate for Payer: Priority Health Commercial	$276.50
Rate for Payer: Priority Health PPO	$276.50

TRAY, EPIDURAL PERIFIX

Facility

$141.00

Hospital Charge Code	27264660
Hospital Revenue Code	272
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$119.85
Rate for Payer: Cash Price	$91.65
Rate for Payer: Community Health Alliance Commercial	$119.85
Rate for Payer: Priority Health Commercial	$98.70
Rate for Payer: Priority Health PPO	$98.70

TRAY - FOLEY, 16/5

Facility

$77.00

Hospital Charge Code	27010330
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

TRAY - FOLEY, 16/5, METER

Facility

$96.00

Hospital Charge Code	27010348
Hospital Revenue Code	272
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

TRAY - FOLEY IRRIGATION

Facility

$21.00

Hospital Charge Code	27010371
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health PPO	$14.70

TRAY - FOLEY, W/O CATH

Facility

$51.00

Hospital Charge Code	27010355
Hospital Revenue Code	272
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

TRAY,GASTRIC LAVAGE

Facility

$303.00

Hospital Charge Code	27263909
Hospital Revenue Code	272
Min. Negotiated Rate	$212.10
Max. Negotiated Rate	$257.55
Rate for Payer: Cash Price	$196.95
Rate for Payer: Community Health Alliance Commercial	$257.55
Rate for Payer: Priority Health Commercial	$212.10
Rate for Payer: Priority Health PPO	$212.10

TRAY - L.P., ADULT

Facility

$83.00

Hospital Charge Code	27011130
Hospital Revenue Code	272
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$70.55
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health PPO	$58.10

TRAY - L.P., INFANT

Facility

$81.00

Hospital Charge Code	27011122
Hospital Revenue Code	272
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

TRAY, NON-LATEX FOLEY 16FR

Facility

$35.00

Hospital Charge Code	27267250
Hospital Revenue Code	272
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

TRAY - PERITONEAL DIALYSIS

Facility

$119.00

Hospital Charge Code	27011148
Hospital Revenue Code	272
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$101.15
Rate for Payer: Cash Price	$77.35
Rate for Payer: Community Health Alliance Commercial	$101.15
Rate for Payer: Priority Health Commercial	$83.30
Rate for Payer: Priority Health PPO	$83.30

TRAY,PHEUMOTHORAX PROCEDURE

Facility

$260.00

Hospital Charge Code	27266765
Hospital Revenue Code	272
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$221.00
Rate for Payer: Cash Price	$169.00
Rate for Payer: Community Health Alliance Commercial	$221.00
Rate for Payer: Priority Health Commercial	$182.00
Rate for Payer: Priority Health PPO	$182.00

TRAY, PONSKY PULL P.E.G. 20FR

Facility

$320.00

Hospital Charge Code	27018358
Hospital Revenue Code	272
Min. Negotiated Rate	$224.00
Max. Negotiated Rate	$272.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Community Health Alliance Commercial	$272.00
Rate for Payer: Priority Health Commercial	$224.00
Rate for Payer: Priority Health PPO	$224.00

TRAY, SOFT TISSUE BIOPSY

Facility

$113.00

Hospital Charge Code	27263928
Hospital Revenue Code	272
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$96.05
Rate for Payer: Cash Price	$73.45
Rate for Payer: Community Health Alliance Commercial	$96.05
Rate for Payer: Priority Health Commercial	$79.10
Rate for Payer: Priority Health PPO	$79.10

TRAY - SPINAL ANESTHESIA

Facility

$126.00

Hospital Charge Code	27011759
Hospital Revenue Code	272
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$107.10
Rate for Payer: Cash Price	$81.90
Rate for Payer: Community Health Alliance Commercial	$107.10
Rate for Payer: Priority Health Commercial	$88.20
Rate for Payer: Priority Health PPO	$88.20

TRAY,SUCTION CATHETER 18FR

Facility

$14.00

Hospital Charge Code	27021642
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

TRAY - THORACETESIS

Facility

$164.00

Hospital Charge Code	27011155
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

TRAY,TURKEL LONG PARACENTESIS

Facility

$87.00

Hospital Charge Code	27265338
Hospital Revenue Code	272
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$73.95
Rate for Payer: Cash Price	$56.55
Rate for Payer: Community Health Alliance Commercial	$73.95
Rate for Payer: Priority Health Commercial	$60.90
Rate for Payer: Priority Health PPO	$60.90

TRAZODONE

Facility

$14.99

Service Code	HCPCS 80338
Hospital Charge Code	3008320
Hospital Revenue Code	301
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$12.74
Rate for Payer: Cash Price	$9.74
Rate for Payer: Community Health Alliance Commercial	$12.74
Rate for Payer: Priority Health Commercial	$10.49
Rate for Payer: Priority Health PPO	$10.49

TRB @ GENE REARRANGE AMPLIFY

Facility

$170.00

Hospital Charge Code	3100690
Hospital Revenue Code	300
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$144.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Community Health Alliance Commercial	$144.50
Rate for Payer: Priority Health Commercial	$119.00
Rate for Payer: Priority Health PPO	$119.00

TREATMENT OF ANAL FISSURE

Facility

$1,066.00

Hospital Charge Code	5150776
Hospital Revenue Code	960
Min. Negotiated Rate	$746.20
Max. Negotiated Rate	$906.10
Rate for Payer: Cash Price	$692.90
Rate for Payer: Community Health Alliance Commercial	$906.10
Rate for Payer: Priority Health Commercial	$746.20
Rate for Payer: Priority Health PPO	$746.20

Tree Allergan Panel

Facility

$39.12

Hospital Charge Code	31027580
Hospital Revenue Code	300
Min. Negotiated Rate	$27.38
Max. Negotiated Rate	$33.25
Rate for Payer: Cash Price	$25.43
Rate for Payer: Community Health Alliance Commercial	$33.25
Rate for Payer: Priority Health Commercial	$27.38
Rate for Payer: Priority Health PPO	$27.38

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges