Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

GUANOACETIC ACID

Facility

$97.70

Hospital Charge Code	3101226
Hospital Revenue Code	301
Min. Negotiated Rate	$68.39
Max. Negotiated Rate	$83.05
Rate for Payer: Cash Price	$63.51
Rate for Payer: Community Health Alliance Commercial	$83.05
Rate for Payer: Priority Health Commercial	$68.39
Rate for Payer: Priority Health PPO	$68.39

GUARDSMAN 7 X 20

Facility

$592.00

Hospital Charge Code	27865155
Hospital Revenue Code	278
Min. Negotiated Rate	$414.40
Max. Negotiated Rate	$503.20
Rate for Payer: Cash Price	$384.80
Rate for Payer: Community Health Alliance Commercial	$503.20
Rate for Payer: Priority Health Commercial	$414.40
Rate for Payer: Priority Health PPO	$414.40

GUARDSMAN 9 x 20

Facility

$592.00

Hospital Charge Code	27865171
Hospital Revenue Code	278
Min. Negotiated Rate	$414.40
Max. Negotiated Rate	$503.20
Rate for Payer: Cash Price	$384.80
Rate for Payer: Community Health Alliance Commercial	$503.20
Rate for Payer: Priority Health Commercial	$414.40
Rate for Payer: Priority Health PPO	$414.40

GUIDE, DISP 119A #G011F

Facility

$33.00

Service Code	HCPCS C1769
Hospital Charge Code	27264835
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

GUIDE,INTRODUCER RDC-1 7FR

Facility

$294.00

Service Code	HCPCS C1769
Hospital Charge Code	27266278
Hospital Revenue Code	272
Min. Negotiated Rate	$205.80
Max. Negotiated Rate	$249.90
Rate for Payer: Cash Price	$191.10
Rate for Payer: Community Health Alliance Commercial	$249.90
Rate for Payer: Priority Health Commercial	$205.80
Rate for Payer: Priority Health PPO	$205.80

GUIDE PIN, 2.4MM X 230MM

Facility

$81.00

Hospital Charge Code	27267243
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

GUIDE PIN, THREADED

Facility

$490.00

Hospital Charge Code	27271632
Hospital Revenue Code	272
Min. Negotiated Rate	$343.00
Max. Negotiated Rate	$416.50
Rate for Payer: Cash Price	$318.50
Rate for Payer: Community Health Alliance Commercial	$416.50
Rate for Payer: Priority Health Commercial	$343.00
Rate for Payer: Priority Health PPO	$343.00

GUIDEWIRE

Facility

$209.00

Service Code	HCPCS C1769
Hospital Charge Code	27015115
Hospital Revenue Code	272
Min. Negotiated Rate	$146.30
Max. Negotiated Rate	$177.65
Rate for Payer: Cash Price	$135.85
Rate for Payer: Community Health Alliance Commercial	$177.65
Rate for Payer: Priority Health Commercial	$146.30
Rate for Payer: Priority Health PPO	$146.30

GUIDEWIRE

Facility

$628.00

Service Code	HCPCS C1769
Hospital Charge Code	27262121
Hospital Revenue Code	272
Min. Negotiated Rate	$439.60
Max. Negotiated Rate	$533.80
Rate for Payer: Cash Price	$408.20
Rate for Payer: Community Health Alliance Commercial	$533.80
Rate for Payer: Priority Health Commercial	$439.60
Rate for Payer: Priority Health PPO	$439.60

GUIDEWIRE .045

Facility

$36.75

Hospital Charge Code	27276938
Hospital Revenue Code	272
Min. Negotiated Rate	$25.73
Max. Negotiated Rate	$31.24
Rate for Payer: Cash Price	$23.89
Rate for Payer: Community Health Alliance Commercial	$31.24
Rate for Payer: Priority Health Commercial	$25.73
Rate for Payer: Priority Health PPO	$25.73

GUIDEWIRE,ACUJET INJ NEEDLE

Facility

$198.00

Service Code	HCPCS C1769
Hospital Charge Code	27262174
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

GUIDE WIRE, BALL TIP 03X800MM

Facility

$594.00

Service Code	HCPCS C1769
Hospital Charge Code	27866534
Hospital Revenue Code	272
Min. Negotiated Rate	$415.80
Max. Negotiated Rate	$504.90
Rate for Payer: Cash Price	$386.10
Rate for Payer: Community Health Alliance Commercial	$504.90
Rate for Payer: Priority Health Commercial	$415.80
Rate for Payer: Priority Health PPO	$415.80

GUIDEWIRE, BIOSCREW

Facility

$87.00

Hospital Charge Code	27264306
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

GUIDEWIRE, BIOSCREW HYPERFLEX

Facility

$84.00

Hospital Charge Code	27264538
Hospital Revenue Code	272
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$71.40
Rate for Payer: Cash Price	$54.60
Rate for Payer: Community Health Alliance Commercial	$71.40
Rate for Payer: Priority Health Commercial	$58.80
Rate for Payer: Priority Health PPO	$58.80

GUIDEWIRE, BULLET TIP (ZMS)

Facility

$287.00

Service Code	HCPCS C1769
Hospital Charge Code	27060909
Hospital Revenue Code	272
Min. Negotiated Rate	$200.90
Max. Negotiated Rate	$243.95
Rate for Payer: Cash Price	$186.55
Rate for Payer: Community Health Alliance Commercial	$243.95
Rate for Payer: Priority Health Commercial	$200.90
Rate for Payer: Priority Health PPO	$200.90

GUIDEWIRE, EXTENDABLE JAGWIRE

Facility

$1,360.00

Service Code	HCPCS C1769
Hospital Charge Code	27263993
Hospital Revenue Code	272
Min. Negotiated Rate	$952.00
Max. Negotiated Rate	$1,156.00
Rate for Payer: Cash Price	$884.00
Rate for Payer: Community Health Alliance Commercial	$1,156.00
Rate for Payer: Priority Health Commercial	$952.00
Rate for Payer: Priority Health PPO	$952.00

GUIDEWIRE, HYPERFLEX

Facility

$82.00

Service Code	HCPCS C1769
Hospital Charge Code	27264546
Hospital Revenue Code	272
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$69.70
Rate for Payer: Cash Price	$53.30
Rate for Payer: Community Health Alliance Commercial	$69.70
Rate for Payer: Priority Health Commercial	$57.40
Rate for Payer: Priority Health PPO	$57.40

GUIDEWIRE,JAGWIRE

Facility

$634.00

Service Code	HCPCS C1769
Hospital Charge Code	27263207
Hospital Revenue Code	272
Min. Negotiated Rate	$443.80
Max. Negotiated Rate	$538.90
Rate for Payer: Cash Price	$412.10
Rate for Payer: Community Health Alliance Commercial	$538.90
Rate for Payer: Priority Health Commercial	$443.80
Rate for Payer: Priority Health PPO	$443.80

GUIDEWIRE, PATHFINDER

Facility

$483.00

Service Code	HCPCS C1769
Hospital Charge Code	27061071
Hospital Revenue Code	272
Min. Negotiated Rate	$338.10
Max. Negotiated Rate	$410.55
Rate for Payer: Cash Price	$313.95
Rate for Payer: Community Health Alliance Commercial	$410.55
Rate for Payer: Priority Health Commercial	$338.10
Rate for Payer: Priority Health PPO	$338.10

GUIDEWIRE P.E.G. SYSTEM

Facility

$399.00

Service Code	HCPCS C1769
Hospital Charge Code	27018457
Hospital Revenue Code	272
Min. Negotiated Rate	$279.30
Max. Negotiated Rate	$339.15
Rate for Payer: Cash Price	$259.35
Rate for Payer: Community Health Alliance Commercial	$339.15
Rate for Payer: Priority Health Commercial	$279.30
Rate for Payer: Priority Health PPO	$279.30

GUIDEWIRE, PTFE COATED

Facility

$58.00

Service Code	HCPCS C1769
Hospital Charge Code	27060651
Hospital Revenue Code	272
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$49.30
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health PPO	$40.60

GUIDEWIRE,ROAD-RUNNER

Facility

$539.00

Service Code	HCPCS C1769
Hospital Charge Code	27261956
Hospital Revenue Code	272
Min. Negotiated Rate	$377.30
Max. Negotiated Rate	$458.15
Rate for Payer: Cash Price	$350.35
Rate for Payer: Community Health Alliance Commercial	$458.15
Rate for Payer: Priority Health Commercial	$377.30
Rate for Payer: Priority Health PPO	$377.30

GUIDEWIRE,ROADRUNNER

Facility

$132.00

Service Code	HCPCS C1769
Hospital Charge Code	27263780
Hospital Revenue Code	272
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$112.20
Rate for Payer: Cash Price	$85.80
Rate for Payer: Community Health Alliance Commercial	$112.20
Rate for Payer: Priority Health Commercial	$92.40
Rate for Payer: Priority Health PPO	$92.40

GUIDEWIRE, ROTABLATOR

Facility

$640.00

Service Code	HCPCS C1769
Hospital Charge Code	27061998
Hospital Revenue Code	272
Min. Negotiated Rate	$448.00
Max. Negotiated Rate	$544.00
Rate for Payer: Cash Price	$416.00
Rate for Payer: Community Health Alliance Commercial	$544.00
Rate for Payer: Priority Health Commercial	$448.00
Rate for Payer: Priority Health PPO	$448.00

GUIDEWIRE, SLIPCOAT

Facility

$74.00

Service Code	HCPCS C1769
Hospital Charge Code	27262842
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges