Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

T-TUBE,DEAVER

Facility

$44.00

Hospital Charge Code	27021840
Hospital Revenue Code	272
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

TUBE, BLAKEMORE 4-LUMEN

Facility

$1,529.00

Hospital Charge Code	27262799
Hospital Revenue Code	272
Min. Negotiated Rate	$1,070.30
Max. Negotiated Rate	$1,299.65
Rate for Payer: Cash Price	$993.85
Rate for Payer: Community Health Alliance Commercial	$1,299.65
Rate for Payer: Priority Health Commercial	$1,070.30
Rate for Payer: Priority Health PPO	$1,070.30

TUBE,COLLAR BOBBIN

Facility

$66.00

Hospital Charge Code	27060818
Hospital Revenue Code	270
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$56.10
Rate for Payer: Cash Price	$42.90
Rate for Payer: Community Health Alliance Commercial	$56.10
Rate for Payer: Priority Health Commercial	$46.20
Rate for Payer: Priority Health PPO	$46.20

TUBE & ECT PLATE

Facility

$678.00

Service Code	HCPCS C1713
Hospital Charge Code	27013862
Hospital Revenue Code	278
Min. Negotiated Rate	$474.60
Max. Negotiated Rate	$576.30
Rate for Payer: Cash Price	$440.70
Rate for Payer: Community Health Alliance Commercial	$576.30
Rate for Payer: Priority Health Commercial	$474.60
Rate for Payer: Priority Health PPO	$474.60

TUBE & ECT PLATE

Facility

$678.00

Service Code	HCPCS C1713
Hospital Charge Code	27813862
Hospital Revenue Code	278
Min. Negotiated Rate	$474.60
Max. Negotiated Rate	$576.30
Rate for Payer: Cash Price	$440.70
Rate for Payer: Community Health Alliance Commercial	$576.30
Rate for Payer: Priority Health Commercial	$474.60
Rate for Payer: Priority Health PPO	$474.60

TUBE, ENDO CUFFED 6.5

Facility

$23.00

Hospital Charge Code	27017889
Hospital Revenue Code	272
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

TUBE, ENDO TRACH 6.0

Facility

$21.00

Hospital Charge Code	27017251
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

TUBE, ENDO TRACH 9.0

Facility

$21.00

Hospital Charge Code	27011445
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

TUBE, ENDO TRACH 9.5

Facility

$30.00

Hospital Charge Code	27017236
Hospital Revenue Code	272
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$25.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health PPO	$21.00

TUBE - ENDO TRACH,MURPHY,W/ADP

Facility

$21.00

Hospital Charge Code	27011932
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

TUBE, EXCHANGE 8MM

Facility

$622.00

Hospital Charge Code	27266526
Hospital Revenue Code	272
Min. Negotiated Rate	$435.40
Max. Negotiated Rate	$528.70
Rate for Payer: Cash Price	$404.30
Rate for Payer: Community Health Alliance Commercial	$528.70
Rate for Payer: Priority Health Commercial	$435.40
Rate for Payer: Priority Health PPO	$435.40

TUBE-FEEDING, XRAY OPAQUE

Facility

$15.00

Hospital Charge Code	27012732
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

TUBE-FEEDING, XRAY, WGTD

Facility

$92.00

Hospital Charge Code	27012740
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

TUBE, GASTROSTOMY 20FR/5CC

Facility

$180.00

Hospital Charge Code	27264728
Hospital Revenue Code	272
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$153.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Community Health Alliance Commercial	$153.00
Rate for Payer: Priority Health Commercial	$126.00
Rate for Payer: Priority Health PPO	$126.00

TUBE, LASER ET 7.0 #H-1484

Facility

$565.00

Hospital Charge Code	27263248
Hospital Revenue Code	272
Min. Negotiated Rate	$395.50
Max. Negotiated Rate	$480.25
Rate for Payer: Cash Price	$367.25
Rate for Payer: Community Health Alliance Commercial	$480.25
Rate for Payer: Priority Health Commercial	$395.50
Rate for Payer: Priority Health PPO	$395.50

TUBE PLATE - 12 HOLE

Facility

$931.00

Service Code	HCPCS C1713
Hospital Charge Code	27814019
Hospital Revenue Code	278
Min. Negotiated Rate	$651.70
Max. Negotiated Rate	$791.35
Rate for Payer: Cash Price	$605.15
Rate for Payer: Community Health Alliance Commercial	$791.35
Rate for Payer: Priority Health Commercial	$651.70
Rate for Payer: Priority Health PPO	$651.70

TUBE PLATE-12 HOLE

Facility

$931.00

Service Code	HCPCS C1713
Hospital Charge Code	27014019
Hospital Revenue Code	278
Min. Negotiated Rate	$651.70
Max. Negotiated Rate	$791.35
Rate for Payer: Cash Price	$605.15
Rate for Payer: Community Health Alliance Commercial	$791.35
Rate for Payer: Priority Health Commercial	$651.70
Rate for Payer: Priority Health PPO	$651.70

TUBE PLATE - 14 HOLE

Facility

$952.00

Service Code	HCPCS C1713
Hospital Charge Code	27814001
Hospital Revenue Code	278
Min. Negotiated Rate	$666.40
Max. Negotiated Rate	$809.20
Rate for Payer: Cash Price	$618.80
Rate for Payer: Community Health Alliance Commercial	$809.20
Rate for Payer: Priority Health Commercial	$666.40
Rate for Payer: Priority Health PPO	$666.40

TUBE PLATE-14 HOLE

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Charge Code	27014001
Hospital Revenue Code	278
Min. Negotiated Rate	$1,411.20
Max. Negotiated Rate	$1,713.60
Rate for Payer: Cash Price	$1,310.40
Rate for Payer: Community Health Alliance Commercial	$1,713.60
Rate for Payer: Priority Health Commercial	$1,411.20
Rate for Payer: Priority Health PPO	$1,411.20

TUBE PLATE - 6 OR 4 HOLE

Facility

$612.00

Service Code	HCPCS C1713
Hospital Charge Code	27814035
Hospital Revenue Code	278
Min. Negotiated Rate	$428.40
Max. Negotiated Rate	$520.20
Rate for Payer: Cash Price	$397.80
Rate for Payer: Community Health Alliance Commercial	$520.20
Rate for Payer: Priority Health Commercial	$428.40
Rate for Payer: Priority Health PPO	$428.40

TUBE PLATE - 6 OR 4 HOLE

Facility

$1,056.00

Service Code	HCPCS C1713
Hospital Charge Code	27014035
Hospital Revenue Code	278
Min. Negotiated Rate	$739.20
Max. Negotiated Rate	$897.60
Rate for Payer: Cash Price	$686.40
Rate for Payer: Community Health Alliance Commercial	$897.60
Rate for Payer: Priority Health Commercial	$739.20
Rate for Payer: Priority Health PPO	$739.20

TUBE PLATE - 8 HOLE

Facility

$857.00

Service Code	HCPCS C1713
Hospital Charge Code	27814027
Hospital Revenue Code	278
Min. Negotiated Rate	$599.90
Max. Negotiated Rate	$728.45
Rate for Payer: Cash Price	$557.05
Rate for Payer: Community Health Alliance Commercial	$728.45
Rate for Payer: Priority Health Commercial	$599.90
Rate for Payer: Priority Health PPO	$599.90

TUBE PLATE-8 HOLE

Facility

$1,489.00

Service Code	HCPCS C1713
Hospital Charge Code	27014027
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.30
Max. Negotiated Rate	$1,265.65
Rate for Payer: Cash Price	$967.85
Rate for Payer: Community Health Alliance Commercial	$1,265.65
Rate for Payer: Priority Health Commercial	$1,042.30
Rate for Payer: Priority Health PPO	$1,042.30

TUBE, PORTEX ENDO CUFFED 5.0

Facility

$23.00

Hospital Charge Code	27017244
Hospital Revenue Code	272
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

TUBE/PORTEX ENDO CUFFED 7.5

Facility

$23.00

Hospital Charge Code	27024018
Hospital Revenue Code	272
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges