Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CATHETER,ON-Q PAIN MGMT DBL

Facility

$730.00

Hospital Charge Code	27264108
Hospital Revenue Code	272
Min. Negotiated Rate	$511.00
Max. Negotiated Rate	$620.50
Rate for Payer: Cash Price	$474.50
Rate for Payer: Community Health Alliance Commercial	$620.50
Rate for Payer: Priority Health Commercial	$511.00
Rate for Payer: Priority Health PPO	$511.00

CATHETER,ON-Q PAIN MGMT SGL

Facility

$550.00

Hospital Charge Code	27264090
Hospital Revenue Code	272
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

CATHETER-OPER CHOLANGIOGRAM

Facility

$142.00

Hospital Charge Code	27010488
Hospital Revenue Code	270
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$120.70
Rate for Payer: Cash Price	$92.30
Rate for Payer: Community Health Alliance Commercial	$120.70
Rate for Payer: Priority Health Commercial	$99.40
Rate for Payer: Priority Health PPO	$99.40

CATHETER,PANCREATIC METAL

Facility

$158.00

Hospital Charge Code	27022673
Hospital Revenue Code	272
Min. Negotiated Rate	$110.60
Max. Negotiated Rate	$134.30
Rate for Payer: Cash Price	$102.70
Rate for Payer: Community Health Alliance Commercial	$134.30
Rate for Payer: Priority Health Commercial	$110.60
Rate for Payer: Priority Health PPO	$110.60

CATHETER,PUSHING

Facility

$120.00

Hospital Charge Code	27262655
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

CATHETER,ROUND TIP URET 4FR

Facility

$59.00

Hospital Charge Code	27020701
Hospital Revenue Code	272
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$50.15
Rate for Payer: Cash Price	$38.35
Rate for Payer: Community Health Alliance Commercial	$50.15
Rate for Payer: Priority Health Commercial	$41.30
Rate for Payer: Priority Health PPO	$41.30

CATHETER,S.E.A - PORT

Facility

$2,386.00

Hospital Charge Code	27861634
Hospital Revenue Code	272
Min. Negotiated Rate	$1,670.20
Max. Negotiated Rate	$2,028.10
Rate for Payer: Cash Price	$1,550.90
Rate for Payer: Community Health Alliance Commercial	$2,028.10
Rate for Payer: Priority Health Commercial	$1,670.20
Rate for Payer: Priority Health PPO	$1,670.20

CATHETER SET,CENTRAL VENOUS

Facility

$278.00

Service Code	HCPCS C1751
Hospital Charge Code	27263532
Hospital Revenue Code	272
Min. Negotiated Rate	$194.60
Max. Negotiated Rate	$236.30
Rate for Payer: Cash Price	$180.70
Rate for Payer: Community Health Alliance Commercial	$236.30
Rate for Payer: Priority Health Commercial	$194.60
Rate for Payer: Priority Health PPO	$194.60

CATHETER SET,PERCUTANEOUS SUP

Facility

$345.00

Hospital Charge Code	27219216
Hospital Revenue Code	272
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$293.25
Rate for Payer: Cash Price	$224.25
Rate for Payer: Community Health Alliance Commercial	$293.25
Rate for Payer: Priority Health Commercial	$241.50
Rate for Payer: Priority Health PPO	$241.50

CATHETER, SIM 1

Facility

$91.00

Hospital Charge Code	27015065
Hospital Revenue Code	272
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$77.35
Rate for Payer: Cash Price	$59.15
Rate for Payer: Community Health Alliance Commercial	$77.35
Rate for Payer: Priority Health Commercial	$63.70
Rate for Payer: Priority Health PPO	$63.70

CATHETER,SIM 3 5-100-.038-17

Facility

$83.00

Hospital Charge Code	27022764
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

CATHETER, SIMPLISTIC HEMOSTAT

Facility

$81.00

Hospital Charge Code	27019430
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

CATHETER,STRAIGHT #30-153

Facility

$83.00

Hospital Charge Code	27060735
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

CATHETER SUBCLAVIAN

Facility

$74.00

Hospital Charge Code	27012377
Hospital Revenue Code	272
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$62.90
Rate for Payer: Cash Price	$48.10
Rate for Payer: Community Health Alliance Commercial	$62.90
Rate for Payer: Priority Health Commercial	$51.80
Rate for Payer: Priority Health PPO	$51.80

CATHETER-SUCTION, CONTROL, 5/6

Facility

$14.00

Hospital Charge Code	27010439
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

CATHETER-SUCTION, DELEE TIP

Facility

$14.00

Hospital Charge Code	27010462
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

CATHETER-SUCTIONM TIP-TROL

Facility

$15.00

Hospital Charge Code	27010454
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

CATHETER-SUCTION, WHISTLE TIP

Facility

$15.00

Hospital Charge Code	27010447
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

CATHETER-SUCTION W/MUCUS TRAP

Facility

$25.00

Hospital Charge Code	27010843
Hospital Revenue Code	272
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

CATHETER, SUPRAPUBIC

Facility

$75.00

Service Code	HCPCS C2627
Hospital Charge Code	27266161
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

CATHETER,TEMPO SIM

Facility

$87.00

Hospital Charge Code	27262712
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

CATHETER,TENCKHOFF PERITONEAL

Facility

$319.00

Hospital Charge Code	27263764
Hospital Revenue Code	272
Min. Negotiated Rate	$223.30
Max. Negotiated Rate	$271.15
Rate for Payer: Cash Price	$207.35
Rate for Payer: Community Health Alliance Commercial	$271.15
Rate for Payer: Priority Health Commercial	$223.30
Rate for Payer: Priority Health PPO	$223.30

CATHETER, THERMODILUTION

Facility

$320.00

Hospital Charge Code	27013961
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

CATHETER, THERMODILUTION 4 LUM

Facility

$343.00

Hospital Charge Code	27018721
Hospital Revenue Code	272
Min. Negotiated Rate	$240.10
Max. Negotiated Rate	$291.55
Rate for Payer: Cash Price	$222.95
Rate for Payer: Community Health Alliance Commercial	$291.55
Rate for Payer: Priority Health Commercial	$240.10
Rate for Payer: Priority Health PPO	$240.10

CATHETER,THORACIC 32 F

Facility

$172.00

Hospital Charge Code	27263309
Hospital Revenue Code	272
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges