Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CQ E-STIM MANUAL EACH 15 MIN

Facility

$40.00

Hospital Charge Code	4200195
Hospital Revenue Code	420
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

CQ GAIT TRAINING 1-15 MIN

Facility

$52.00

Hospital Charge Code	4201141
Hospital Revenue Code	420
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

CQ ICE MASSAGE

Facility

$42.00

Hospital Charge Code	4200125
Hospital Revenue Code	420
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

CQ IONTOPHORESIS EACH 15 MIN

Facility

$53.00

Hospital Charge Code	4201180
Hospital Revenue Code	420
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$45.05
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health PPO	$37.10

CQ MANUAL THERAPY EACH 15 MIN

Facility

$71.00

Hospital Charge Code	4201230
Hospital Revenue Code	420
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$60.35
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health PPO	$49.70

CQ MASSAGE EACH 15 MINUTES

Facility

$99.00

Hospital Charge Code	4201240
Hospital Revenue Code	420
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$84.15
Rate for Payer: Cash Price	$64.35
Rate for Payer: Community Health Alliance Commercial	$84.15
Rate for Payer: Priority Health Commercial	$69.30
Rate for Payer: Priority Health PPO	$69.30

CQ NEUROMUSCULAR RE-ED 15 MIN

Facility

$86.00

Hospital Charge Code	4201250
Hospital Revenue Code	420
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$73.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Community Health Alliance Commercial	$73.10
Rate for Payer: Priority Health Commercial	$60.20
Rate for Payer: Priority Health PPO	$60.20

CQ ORTHOTIC FIT AND TRAINING

Facility

$120.00

Hospital Charge Code	4201371
Hospital Revenue Code	420
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

CQ PARAFFIN BATH

Facility

$56.00

Hospital Charge Code	4201290
Hospital Revenue Code	420
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

CQ PROSTHETIC FIT & TRAIN

Facility

$104.00

Hospital Charge Code	4201280
Hospital Revenue Code	420
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$88.40
Rate for Payer: Cash Price	$67.60
Rate for Payer: Community Health Alliance Commercial	$88.40
Rate for Payer: Priority Health Commercial	$72.80
Rate for Payer: Priority Health PPO	$72.80

CQ PROSTHETIC TRAINING

Facility

$104.00

Hospital Charge Code	4201374
Hospital Revenue Code	420
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$88.40
Rate for Payer: Cash Price	$67.60
Rate for Payer: Community Health Alliance Commercial	$88.40
Rate for Payer: Priority Health Commercial	$72.80
Rate for Payer: Priority Health PPO	$72.80

CQ THERAPEUTIC ACTIV 15 M

Facility

$104.00

Hospital Charge Code	4201400
Hospital Revenue Code	420
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$88.40
Rate for Payer: Cash Price	$67.60
Rate for Payer: Community Health Alliance Commercial	$88.40
Rate for Payer: Priority Health Commercial	$72.80
Rate for Payer: Priority Health PPO	$72.80

CQ THERAPEUTIC EXER 15 MIN

Facility

$95.00

Hospital Charge Code	4201390
Hospital Revenue Code	420
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$80.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
Rate for Payer: Priority Health Commercial	$66.50
Rate for Payer: Priority Health PPO	$66.50

CQ TRACTION MECHANICAL

Facility

$38.00

Hospital Charge Code	4201420
Hospital Revenue Code	420
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$32.30
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health PPO	$26.60

CQ ULTRASOUND EACH 15 MINUTES

Facility

$35.00

Hospital Charge Code	4201440
Hospital Revenue Code	420
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

CQ UNSPECIFIED THERAPEUTIC PRO

Facility

$128.00

Hospital Charge Code	4200112
Hospital Revenue Code	420
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$108.80
Rate for Payer: Cash Price	$83.20
Rate for Payer: Community Health Alliance Commercial	$108.80
Rate for Payer: Priority Health Commercial	$89.60
Rate for Payer: Priority Health PPO	$89.60

CQ WHEEL CHAIR MANAGEMENT

Facility

$86.00

Hospital Charge Code	4201472
Hospital Revenue Code	420
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$73.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Community Health Alliance Commercial	$73.10
Rate for Payer: Priority Health Commercial	$60.20
Rate for Payer: Priority Health PPO	$60.20

CQ WHIRLPOOL

Facility

$49.00

Hospital Charge Code	4201450
Hospital Revenue Code	420
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$41.65
Rate for Payer: Cash Price	$31.85
Rate for Payer: Community Health Alliance Commercial	$41.65
Rate for Payer: Priority Health Commercial	$34.30
Rate for Payer: Priority Health PPO	$34.30

CQ WORK CONDITIONADD'L HR

Facility

$93.00

Hospital Charge Code	4201500
Hospital Revenue Code	420
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$79.05
Rate for Payer: Cash Price	$60.45
Rate for Payer: Community Health Alliance Commercial	$79.05
Rate for Payer: Priority Health Commercial	$65.10
Rate for Payer: Priority Health PPO	$65.10

CQ WORK CONDITION FIRST 2 HRS

Facility

$185.00

Hospital Charge Code	4201490
Hospital Revenue Code	420
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$157.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Community Health Alliance Commercial	$157.25
Rate for Payer: Priority Health Commercial	$129.50
Rate for Payer: Priority Health PPO	$129.50

CQ WOUND CARE NON SELECT

Facility

$112.00

Hospital Charge Code	4200173
Hospital Revenue Code	420
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$95.20
Rate for Payer: Cash Price	$72.80
Rate for Payer: Community Health Alliance Commercial	$95.20
Rate for Payer: Priority Health Commercial	$78.40
Rate for Payer: Priority Health PPO	$78.40

CRAWFORD INTUBATION SET

Facility

$228.00

Hospital Charge Code	27060685
Hospital Revenue Code	272
Min. Negotiated Rate	$159.60
Max. Negotiated Rate	$193.80
Rate for Payer: Cash Price	$148.20
Rate for Payer: Community Health Alliance Commercial	$193.80
Rate for Payer: Priority Health Commercial	$159.60
Rate for Payer: Priority Health PPO	$159.60

CREAM,TRIPLE CARE ANTIFUNGAL

Facility

$23.00

Hospital Charge Code	27066849
Hospital Revenue Code	250
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

CREAT/CA URINE RATION

Facility

$67.00

Hospital Charge Code	3006524
Hospital Revenue Code	301
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$56.95
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health PPO	$46.90

CREAT CLE-LC

Facility

$5.65

Hospital Charge Code	3101075
Hospital Revenue Code	301
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$3.67
Rate for Payer: Community Health Alliance Commercial	$4.80
Rate for Payer: Priority Health Commercial	$3.96
Rate for Payer: Priority Health PPO	$3.96

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges