Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

COXIELLA BURNETII-1

Facility

$19.50

Hospital Charge Code	3101137
Hospital Revenue Code	302
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$16.57
Rate for Payer: Cash Price	$12.68
Rate for Payer: Community Health Alliance Commercial	$16.57
Rate for Payer: Priority Health Commercial	$13.65
Rate for Payer: Priority Health PPO	$13.65

COXIELLA BURNETII-2

Facility

$19.50

Hospital Charge Code	3101138
Hospital Revenue Code	302
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$16.57
Rate for Payer: Cash Price	$12.68
Rate for Payer: Community Health Alliance Commercial	$16.57
Rate for Payer: Priority Health Commercial	$13.65
Rate for Payer: Priority Health PPO	$13.65

COXIELLA BURNETII-3

Facility

$19.50

Hospital Charge Code	3101139
Hospital Revenue Code	302
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$16.57
Rate for Payer: Cash Price	$12.68
Rate for Payer: Community Health Alliance Commercial	$16.57
Rate for Payer: Priority Health Commercial	$13.65
Rate for Payer: Priority Health PPO	$13.65

COXIELLA BURNETII-4

Facility

$19.50

Hospital Charge Code	3101140
Hospital Revenue Code	302
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$16.57
Rate for Payer: Cash Price	$12.68
Rate for Payer: Community Health Alliance Commercial	$16.57
Rate for Payer: Priority Health Commercial	$13.65
Rate for Payer: Priority Health PPO	$13.65

COXIELLA BURNETII IGG/IGM-

Facility

$78.00

Hospital Charge Code	3101120
Hospital Revenue Code	302
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health PPO	$54.60

COXSACKIE A 9 VIRUS AB

Facility

$37.00

Hospital Charge Code	3101306
Hospital Revenue Code	302
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$31.45
Rate for Payer: Cash Price	$24.05
Rate for Payer: Community Health Alliance Commercial	$31.45
Rate for Payer: Priority Health Commercial	$25.90
Rate for Payer: Priority Health PPO	$25.90

COXSACKIE A IGG/IGM AB

Facility

$177.35

Hospital Charge Code	3002710
Hospital Revenue Code	302
Min. Negotiated Rate	$124.14
Max. Negotiated Rate	$150.75
Rate for Payer: Cash Price	$115.28
Rate for Payer: Community Health Alliance Commercial	$150.75
Rate for Payer: Priority Health Commercial	$124.14
Rate for Payer: Priority Health PPO	$124.14

COXSACKIE B

Facility

$4.75

Hospital Charge Code	3002802
Hospital Revenue Code	302
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.04
Rate for Payer: Cash Price	$3.09
Rate for Payer: Community Health Alliance Commercial	$4.04
Rate for Payer: Priority Health Commercial	$3.33
Rate for Payer: Priority Health PPO	$3.33

COXSACKIE VIRUS

Facility

$4.75

Hospital Charge Code	3002801
Hospital Revenue Code	302
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.04
Rate for Payer: Cash Price	$3.09
Rate for Payer: Community Health Alliance Commercial	$4.04
Rate for Payer: Priority Health Commercial	$3.33
Rate for Payer: Priority Health PPO	$3.33

COXSACKIE VIRUS

Facility

$4.75

Hospital Charge Code	3002804
Hospital Revenue Code	302
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.04
Rate for Payer: Cash Price	$3.09
Rate for Payer: Community Health Alliance Commercial	$4.04
Rate for Payer: Priority Health Commercial	$3.33
Rate for Payer: Priority Health PPO	$3.33

COXSACKIE VIRUS

Facility

$4.76

Hospital Charge Code	3002806
Hospital Revenue Code	302
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.05
Rate for Payer: Cash Price	$3.09
Rate for Payer: Community Health Alliance Commercial	$4.05
Rate for Payer: Priority Health Commercial	$3.33
Rate for Payer: Priority Health PPO	$3.33

COXSACKIE VIRUS

Facility

$4.75

Hospital Charge Code	3002805
Hospital Revenue Code	302
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.04
Rate for Payer: Cash Price	$3.09
Rate for Payer: Community Health Alliance Commercial	$4.04
Rate for Payer: Priority Health Commercial	$3.33
Rate for Payer: Priority Health PPO	$3.33

COXSACKIE VIRUS

Facility

$4.75

Hospital Charge Code	3002803
Hospital Revenue Code	302
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.04
Rate for Payer: Cash Price	$3.09
Rate for Payer: Community Health Alliance Commercial	$4.04
Rate for Payer: Priority Health Commercial	$3.33
Rate for Payer: Priority Health PPO	$3.33

COXSACKIE VIRUS IGG (A16)

Facility

$25.05

Hospital Charge Code	3002703
Hospital Revenue Code	302
Min. Negotiated Rate	$17.54
Max. Negotiated Rate	$21.29
Rate for Payer: Cash Price	$16.28
Rate for Payer: Community Health Alliance Commercial	$21.29
Rate for Payer: Priority Health Commercial	$17.54
Rate for Payer: Priority Health PPO	$17.54

COXSACKIE VIRUS IGG (A24)

Facility

$25.03

Hospital Charge Code	3002704
Hospital Revenue Code	302
Min. Negotiated Rate	$17.52
Max. Negotiated Rate	$21.28
Rate for Payer: Cash Price	$16.27
Rate for Payer: Community Health Alliance Commercial	$21.28
Rate for Payer: Priority Health Commercial	$17.52
Rate for Payer: Priority Health PPO	$17.52

COXSACKIE VIRUS IGG (A7)

Facility

$25.05

Hospital Charge Code	3002701
Hospital Revenue Code	302
Min. Negotiated Rate	$17.54
Max. Negotiated Rate	$21.29
Rate for Payer: Cash Price	$16.28
Rate for Payer: Community Health Alliance Commercial	$21.29
Rate for Payer: Priority Health Commercial	$17.54
Rate for Payer: Priority Health PPO	$17.54

COXSACKIE VIRUS IGG (A9)

Facility

$25.05

Hospital Charge Code	3002702
Hospital Revenue Code	302
Min. Negotiated Rate	$17.54
Max. Negotiated Rate	$21.29
Rate for Payer: Cash Price	$16.28
Rate for Payer: Community Health Alliance Commercial	$21.29
Rate for Payer: Priority Health Commercial	$17.54
Rate for Payer: Priority Health PPO	$17.54

COXSACKIE VIRUS IGM (A7)

Facility

$19.29

Hospital Charge Code	3002705
Hospital Revenue Code	302
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$16.40
Rate for Payer: Cash Price	$12.54
Rate for Payer: Community Health Alliance Commercial	$16.40
Rate for Payer: Priority Health Commercial	$13.50
Rate for Payer: Priority Health PPO	$13.50

COXSACKIE VIRUS IGM (A9)

Facility

$19.29

Hospital Charge Code	3002706
Hospital Revenue Code	302
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$16.40
Rate for Payer: Cash Price	$12.54
Rate for Payer: Community Health Alliance Commercial	$16.40
Rate for Payer: Priority Health Commercial	$13.50
Rate for Payer: Priority Health PPO	$13.50

COXSAKIE B

Facility

$28.51

Hospital Charge Code	3002810
Hospital Revenue Code	302
Min. Negotiated Rate	$19.96
Max. Negotiated Rate	$24.23
Rate for Payer: Cash Price	$18.53
Rate for Payer: Community Health Alliance Commercial	$24.23
Rate for Payer: Priority Health Commercial	$19.96
Rate for Payer: Priority Health PPO	$19.96

CP-1

Facility

$60.00

Hospital Charge Code	3101465
Hospital Revenue Code	300
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

CP-1

Facility

$26.15

Hospital Charge Code	3101518
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

CP-10

Facility

$26.15

Hospital Charge Code	3101527
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

CP-11

Facility

$26.15

Hospital Charge Code	3101528
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

CP-12

Facility

$26.15

Hospital Charge Code	3101529
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges