Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CATHETER-FOLEY, 30CC

Facility

$36.00

Hospital Charge Code	27010306
Hospital Revenue Code	272
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

CATHETER-FOLEY, 30CC, 2-WAY

Facility

$34.00

Hospital Charge Code	270112692
Hospital Revenue Code	272
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$28.90
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health PPO	$23.80

CATHETER-FOLEY, 30CC, 3-WAY

Facility

$89.00

Hospital Charge Code	27011270
Hospital Revenue Code	272
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$75.65
Rate for Payer: Cash Price	$57.85
Rate for Payer: Community Health Alliance Commercial	$75.65
Rate for Payer: Priority Health Commercial	$62.30
Rate for Payer: Priority Health PPO	$62.30

CATHETER-FOLEY, 5CC

Facility

$33.00

Hospital Charge Code	27010298
Hospital Revenue Code	272
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$28.05
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health PPO	$23.10

CATHETER-FOLEY, 5CC, ALL SIZES

Facility

$45.00

Hospital Charge Code	27010553
Hospital Revenue Code	272
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

CATHETER-FOLEY, FEMALE

Facility

$63.00

Hospital Charge Code	27012427
Hospital Revenue Code	272
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$53.55
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health PPO	$44.10

CATHETER-FOLEY, IRRIG, 30C

Facility

$36.00

Hospital Charge Code	27010314
Hospital Revenue Code	272
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

CATHETER, FOLEY NON LATEX

Facility

$20.00

Hospital Charge Code	27261709
Hospital Revenue Code	272
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$17.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health PPO	$14.00

CATHETER-FOLEY, PEDI, 3CC

Facility

$36.00

Hospital Charge Code	27010280
Hospital Revenue Code	272
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

CATHETER,FOLEY,SILICOAT, 30

Facility

$44.00

Hospital Charge Code	27011262
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

CATHETER-FOLLEY, PEDIATRIC

Facility

$45.00

Hospital Charge Code	27012435
Hospital Revenue Code	272
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

CATHETER, GLO TIP ERCP

Facility

$188.00

Hospital Charge Code	27261949
Hospital Revenue Code	272
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

CATHETER GUIDING

Facility

$198.00

Service Code	HCPCS C1887
Hospital Charge Code	27268365
Hospital Revenue Code	272
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$168.30
Rate for Payer: Cash Price	$128.70
Rate for Payer: Community Health Alliance Commercial	$168.30
Rate for Payer: Priority Health Commercial	$138.60
Rate for Payer: Priority Health PPO	$138.60

CATHETER,GUIDING RENAL CURVE

Facility

$311.00

Service Code	HCPCS C1887
Hospital Charge Code	27266112
Hospital Revenue Code	272
Min. Negotiated Rate	$217.70
Max. Negotiated Rate	$264.35
Rate for Payer: Cash Price	$202.15
Rate for Payer: Community Health Alliance Commercial	$264.35
Rate for Payer: Priority Health Commercial	$217.70
Rate for Payer: Priority Health PPO	$217.70

CATHETER, HICKMAN 9.6FR

Facility

$314.00

Hospital Charge Code	27263741
Hospital Revenue Code	272
Min. Negotiated Rate	$219.80
Max. Negotiated Rate	$266.90
Rate for Payer: Cash Price	$204.10
Rate for Payer: Community Health Alliance Commercial	$266.90
Rate for Payer: Priority Health Commercial	$219.80
Rate for Payer: Priority Health PPO	$219.80

CATHETER, HICKMAN 9.6FR

Facility

$246.00

Hospital Charge Code	27024216
Hospital Revenue Code	272
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$209.10
Rate for Payer: Cash Price	$159.90
Rate for Payer: Community Health Alliance Commercial	$209.10
Rate for Payer: Priority Health Commercial	$172.20
Rate for Payer: Priority Health PPO	$172.20

CATHETER,INTRAUTERINE PRESSURE

Facility

$165.00

Hospital Charge Code	27261600
Hospital Revenue Code	272
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$140.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Community Health Alliance Commercial	$140.25
Rate for Payer: Priority Health Commercial	$115.50
Rate for Payer: Priority Health PPO	$115.50

CATHETER,INTRAUTERINE SENSOR

Facility

$141.00

Hospital Charge Code	27020529
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

CATHETER, JUPITER DILATION

Facility

$1,434.00

Hospital Charge Code	27265023
Hospital Revenue Code	272
Min. Negotiated Rate	$1,003.80
Max. Negotiated Rate	$1,218.90
Rate for Payer: Cash Price	$932.10
Rate for Payer: Community Health Alliance Commercial	$1,218.90
Rate for Payer: Priority Health Commercial	$1,003.80
Rate for Payer: Priority Health PPO	$1,003.80

CATHETER KIT FOR MORPHINE PUMP

Facility

$2,249.00

Hospital Charge Code	27862147
Hospital Revenue Code	272
Min. Negotiated Rate	$1,574.30
Max. Negotiated Rate	$1,911.65
Rate for Payer: Cash Price	$1,461.85
Rate for Payer: Community Health Alliance Commercial	$1,911.65
Rate for Payer: Priority Health Commercial	$1,574.30
Rate for Payer: Priority Health PPO	$1,574.30

CATHETER KIT-TROCAR

Facility

$257.00

Hospital Charge Code	27013763
Hospital Revenue Code	272
Min. Negotiated Rate	$179.90
Max. Negotiated Rate	$218.45
Rate for Payer: Cash Price	$167.05
Rate for Payer: Community Health Alliance Commercial	$218.45
Rate for Payer: Priority Health Commercial	$179.90
Rate for Payer: Priority Health PPO	$179.90

CATHETER, MEDIPORT INFUSION

Facility

$1,586.00

Service Code	HCPCS C1788
Hospital Charge Code	27266104
Hospital Revenue Code	278
Min. Negotiated Rate	$1,110.20
Max. Negotiated Rate	$1,348.10
Rate for Payer: Cash Price	$1,030.90
Rate for Payer: Community Health Alliance Commercial	$1,348.10
Rate for Payer: Priority Health Commercial	$1,110.20
Rate for Payer: Priority Health PPO	$1,110.20

CATHETER, MEDI-TECH DILATOR

Facility

$699.00

Hospital Charge Code	27024240
Hospital Revenue Code	272
Min. Negotiated Rate	$489.30
Max. Negotiated Rate	$594.15
Rate for Payer: Cash Price	$454.35
Rate for Payer: Community Health Alliance Commercial	$594.15
Rate for Payer: Priority Health Commercial	$489.30
Rate for Payer: Priority Health PPO	$489.30

CATHETER,MEWISSEN INFUSION

Facility

$367.00

Hospital Charge Code	27061808
Hospital Revenue Code	272
Min. Negotiated Rate	$256.90
Max. Negotiated Rate	$311.95
Rate for Payer: Cash Price	$238.55
Rate for Payer: Community Health Alliance Commercial	$311.95
Rate for Payer: Priority Health Commercial	$256.90
Rate for Payer: Priority Health PPO	$256.90

CATHETER OCCLUSION

Facility

$180.00

Service Code	HCPCS C2628
Hospital Charge Code	27015495
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges