Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PNEUMO SEROTYPE 11A IGG PNX

Facility

$1.37

Hospital Charge Code	3101046
Hospital Revenue Code	300
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.89
Rate for Payer: Community Health Alliance Commercial	$1.16
Rate for Payer: Priority Health Commercial	$0.96
Rate for Payer: Priority Health PPO	$0.96

PNEUMO SEROTYPE 12F IGG PNX

Facility

$2.37

Hospital Charge Code	3101047
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 14 IGG P7 P13

Facility

$2.37

Hospital Charge Code	3101048
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 15B IGG PNX

Facility

$5.42

Hospital Charge Code	3101049
Hospital Revenue Code	300
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$4.61
Rate for Payer: Cash Price	$3.52
Rate for Payer: Community Health Alliance Commercial	$4.61
Rate for Payer: Priority Health Commercial	$3.79
Rate for Payer: Priority Health PPO	$3.79

PNEUMO SEROTYPE 18C IGG P7 P13

Facility

$2.37

Hospital Charge Code	3101051
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 19A IGG P13 PN

Facility

$5.42

Hospital Charge Code	3101052
Hospital Revenue Code	300
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$4.61
Rate for Payer: Cash Price	$3.52
Rate for Payer: Community Health Alliance Commercial	$4.61
Rate for Payer: Priority Health Commercial	$3.79
Rate for Payer: Priority Health PPO	$3.79

PNEUMO SEROTYPE 19F IGG P7 P13

Facility

$2.37

Hospital Charge Code	3101053
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 1 IGG P13

Facility

$2.37

Hospital Charge Code	3101035
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 20 IGG PNX

Facility

$1.37

Hospital Charge Code	3101054
Hospital Revenue Code	300
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.89
Rate for Payer: Community Health Alliance Commercial	$1.16
Rate for Payer: Priority Health Commercial	$0.96
Rate for Payer: Priority Health PPO	$0.96

PNEUMO SEROTYPE 22 IGG PNX

Facility

$5.39

Hospital Charge Code	3101055
Hospital Revenue Code	300
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$4.58
Rate for Payer: Cash Price	$3.50
Rate for Payer: Community Health Alliance Commercial	$4.58
Rate for Payer: Priority Health Commercial	$3.77
Rate for Payer: Priority Health PPO	$3.77

PNEUMO SEROTYPE 23 F IGG P7

Facility

$2.44

Hospital Charge Code	3101056
Hospital Revenue Code	300
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.07
Rate for Payer: Cash Price	$1.59
Rate for Payer: Community Health Alliance Commercial	$2.07
Rate for Payer: Priority Health Commercial	$1.71
Rate for Payer: Priority Health PPO	$1.71

PNEUMO SEROTYPE 33F IGG PNX

Facility

$2.57

Hospital Charge Code	3101057
Hospital Revenue Code	300
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.18
Rate for Payer: Cash Price	$1.67
Rate for Payer: Community Health Alliance Commercial	$2.18
Rate for Payer: Priority Health Commercial	$1.80
Rate for Payer: Priority Health PPO	$1.80

PNEUMO SEROTYPE 3 IGG P13

Facility

$2.37

Hospital Charge Code	3101036
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 3 IGG PNX

Facility

$1.37

Hospital Charge Code	3101037
Hospital Revenue Code	300
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.89
Rate for Payer: Community Health Alliance Commercial	$1.16
Rate for Payer: Priority Health Commercial	$0.96
Rate for Payer: Priority Health PPO	$0.96

PNEUMO SEROTYPE 4 IGG P7 P13 P

Facility

$2.37

Hospital Charge Code	3101038
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 5 IGG P13 PNX

Facility

$2.37

Hospital Charge Code	3101039
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 6B IGG P7 P13

Facility

$2.37

Hospital Charge Code	3101040
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 6B IGG PNX

Facility

$2.37

Hospital Charge Code	3101042
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 7F IGG P13

Facility

$2.37

Hospital Charge Code	3101041
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 8 IGG (PMX)

Facility

$14.17

Hospital Charge Code	3101382
Hospital Revenue Code	300
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$12.04
Rate for Payer: Cash Price	$9.21
Rate for Payer: Community Health Alliance Commercial	$12.04
Rate for Payer: Priority Health Commercial	$9.92
Rate for Payer: Priority Health PPO	$9.92

PNEUMO SEROTYPE 9N IGG PNX

Facility

$2.37

Hospital Charge Code	3101043
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMO SEROTYPE 9V IGG P7 P 13

Facility

$2.37

Hospital Charge Code	3101044
Hospital Revenue Code	300
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.54
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.66
Rate for Payer: Priority Health PPO	$1.66

PNEUMOTHORAX SET #C-TPT-100

Facility

$283.00

Hospital Charge Code	27267763
Hospital Revenue Code	272
Min. Negotiated Rate	$198.10
Max. Negotiated Rate	$240.55
Rate for Payer: Cash Price	$183.95
Rate for Payer: Community Health Alliance Commercial	$240.55
Rate for Payer: Priority Health Commercial	$198.10
Rate for Payer: Priority Health PPO	$198.10

PNH-1

Facility

$21.16

Hospital Charge Code	3101371
Hospital Revenue Code	310
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$17.99
Rate for Payer: Cash Price	$13.75
Rate for Payer: Community Health Alliance Commercial	$17.99
Rate for Payer: Priority Health Commercial	$14.81
Rate for Payer: Priority Health PPO	$14.81

PNH-2

Facility

$21.16

Hospital Charge Code	3101372
Hospital Revenue Code	310
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$17.99
Rate for Payer: Cash Price	$13.75
Rate for Payer: Community Health Alliance Commercial	$17.99
Rate for Payer: Priority Health Commercial	$14.81
Rate for Payer: Priority Health PPO	$14.81

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges