Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

AMYLASE

Facility

$3.67

Service Code	HCPCS 82150
Hospital Charge Code	3000700
Hospital Revenue Code	301
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$6.80
Rate for Payer: BCBS BCN 65	$6.80
Rate for Payer: Blue Care Network Medicare Advantage	$6.80
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cash Price	$2.39
Rate for Payer: Community Health Alliance Commercial	$3.12
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.80
Rate for Payer: Meridian Health Plan Medicare	$6.80
Rate for Payer: Priority Health Commercial	$2.57
Rate for Payer: Priority Health Medicaid	$6.80
Rate for Payer: Priority Health Medicare	$6.80
Rate for Payer: Priority Health PPO	$2.57
Rate for Payer: United Health Care Medicaid	$6.80
Rate for Payer: United Health Care Medicare Advantage	$2.99

AMYLASE ISOENYZME

Facility

$11.81

Service Code	HCPCS 82150
Hospital Charge Code	3000705
Hospital Revenue Code	301
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$10.04
Rate for Payer: BCBS BCN 65	$6.80
Rate for Payer: Blue Care Network Medicare Advantage	$6.80
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cash Price	$7.68
Rate for Payer: Community Health Alliance Commercial	$10.04
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.80
Rate for Payer: Meridian Health Plan Medicare	$6.80
Rate for Payer: Priority Health Commercial	$8.27
Rate for Payer: Priority Health Medicaid	$6.80
Rate for Payer: Priority Health Medicare	$6.80
Rate for Payer: Priority Health PPO	$8.27
Rate for Payer: United Health Care Medicaid	$6.80
Rate for Payer: United Health Care Medicare Advantage	$2.99

AMYLASE SBMF

Facility

$3.42

Hospital Charge Code	3101489
Hospital Revenue Code	300
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.22
Rate for Payer: Community Health Alliance Commercial	$2.91
Rate for Payer: Priority Health Commercial	$2.39
Rate for Payer: Priority Health PPO	$2.39

AMYLASE URINE

Facility

$3.72

Hospital Charge Code	3100161
Hospital Revenue Code	300
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$3.16
Rate for Payer: Cash Price	$2.42
Rate for Payer: Community Health Alliance Commercial	$3.16
Rate for Payer: Priority Health Commercial	$2.60
Rate for Payer: Priority Health PPO	$2.60

AN-1

Facility

$10.47

Service Code	HCPCS 87075
Hospital Charge Code	3003160
Hospital Revenue Code	306
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$9.94
Rate for Payer: BCBS BCN 65	$9.94
Rate for Payer: Blue Care Network Medicare Advantage	$9.94
Rate for Payer: Cash Price	$6.81
Rate for Payer: Cash Price	$6.81
Rate for Payer: Community Health Alliance Commercial	$8.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.94
Rate for Payer: Meridian Health Plan Medicare	$9.94
Rate for Payer: Priority Health Commercial	$7.33
Rate for Payer: Priority Health Medicaid	$9.94
Rate for Payer: Priority Health Medicare	$9.94
Rate for Payer: Priority Health PPO	$7.33
Rate for Payer: United Health Care Medicaid	$9.94
Rate for Payer: United Health Care Medicare Advantage	$4.38

AN-2

Facility

$10.50

Service Code	HCPCS 87205
Hospital Charge Code	3004960
Hospital Revenue Code	306
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$8.93
Rate for Payer: BCBS BCN 65	$4.48
Rate for Payer: Blue Care Network Medicare Advantage	$4.48
Rate for Payer: Cash Price	$6.83
Rate for Payer: Cash Price	$6.83
Rate for Payer: Community Health Alliance Commercial	$8.93
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.48
Rate for Payer: Meridian Health Plan Medicare	$4.48
Rate for Payer: Priority Health Commercial	$7.35
Rate for Payer: Priority Health Medicaid	$4.48
Rate for Payer: Priority Health Medicare	$4.48
Rate for Payer: Priority Health PPO	$7.35
Rate for Payer: United Health Care Medicaid	$4.48
Rate for Payer: United Health Care Medicare Advantage	$1.97

ANA-1

Facility

$6.56

Hospital Charge Code	3102556
Hospital Revenue Code	300
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.58
Rate for Payer: Cash Price	$4.26
Rate for Payer: Community Health Alliance Commercial	$5.58
Rate for Payer: Priority Health Commercial	$4.59
Rate for Payer: Priority Health PPO	$4.59

ANA-10

Facility

$6.56

Hospital Charge Code	3102549
Hospital Revenue Code	300
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.58
Rate for Payer: Cash Price	$4.26
Rate for Payer: Community Health Alliance Commercial	$5.58
Rate for Payer: Priority Health Commercial	$4.59
Rate for Payer: Priority Health PPO	$4.59

ANA-11

Facility

$6.65

Hospital Charge Code	3102550
Hospital Revenue Code	300
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$5.65
Rate for Payer: Cash Price	$4.32
Rate for Payer: Community Health Alliance Commercial	$5.65
Rate for Payer: Priority Health Commercial	$4.66
Rate for Payer: Priority Health PPO	$4.66

ANA-2

Facility

$6.56

Hospital Charge Code	3102541
Hospital Revenue Code	300
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.58
Rate for Payer: Cash Price	$4.26
Rate for Payer: Community Health Alliance Commercial	$5.58
Rate for Payer: Priority Health Commercial	$4.59
Rate for Payer: Priority Health PPO	$4.59

ANA-3

Facility

$6.56

Hospital Charge Code	3102542
Hospital Revenue Code	300
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.58
Rate for Payer: Cash Price	$4.26
Rate for Payer: Community Health Alliance Commercial	$5.58
Rate for Payer: Priority Health Commercial	$4.59
Rate for Payer: Priority Health PPO	$4.59

ANA-4

Facility

$6.56

Hospital Charge Code	3102543
Hospital Revenue Code	300
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.58
Rate for Payer: Cash Price	$4.26
Rate for Payer: Community Health Alliance Commercial	$5.58
Rate for Payer: Priority Health Commercial	$4.59
Rate for Payer: Priority Health PPO	$4.59

ANA-5

Facility

$6.56

Hospital Charge Code	3102544
Hospital Revenue Code	300
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.58
Rate for Payer: Cash Price	$4.26
Rate for Payer: Community Health Alliance Commercial	$5.58
Rate for Payer: Priority Health Commercial	$4.59
Rate for Payer: Priority Health PPO	$4.59

ANA-6

Facility

$6.56

Hospital Charge Code	3102545
Hospital Revenue Code	300
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.58
Rate for Payer: Cash Price	$4.26
Rate for Payer: Community Health Alliance Commercial	$5.58
Rate for Payer: Priority Health Commercial	$4.59
Rate for Payer: Priority Health PPO	$4.59

ANA-7

Facility

$6.56

Hospital Charge Code	3102546
Hospital Revenue Code	300
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.58
Rate for Payer: Cash Price	$4.26
Rate for Payer: Community Health Alliance Commercial	$5.58
Rate for Payer: Priority Health Commercial	$4.59
Rate for Payer: Priority Health PPO	$4.59

ANA-8

Facility

$6.56

Hospital Charge Code	3102547
Hospital Revenue Code	300
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.58
Rate for Payer: Cash Price	$4.26
Rate for Payer: Community Health Alliance Commercial	$5.58
Rate for Payer: Priority Health Commercial	$4.59
Rate for Payer: Priority Health PPO	$4.59

ANA-9

Facility

$6.56

Hospital Charge Code	3102548
Hospital Revenue Code	300
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.58
Rate for Payer: Cash Price	$4.26
Rate for Payer: Community Health Alliance Commercial	$5.58
Rate for Payer: Priority Health Commercial	$4.59
Rate for Payer: Priority Health PPO	$4.59

ANA/AER 1

Facility

$9.70

Hospital Charge Code	31027381
Hospital Revenue Code	300
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$8.24
Rate for Payer: Cash Price	$6.31
Rate for Payer: Community Health Alliance Commercial	$8.24
Rate for Payer: Priority Health Commercial	$6.79
Rate for Payer: Priority Health PPO	$6.79

ANA/AER 2

Facility

$9.70

Hospital Charge Code	31027382
Hospital Revenue Code	300
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$8.24
Rate for Payer: Cash Price	$6.31
Rate for Payer: Community Health Alliance Commercial	$8.24
Rate for Payer: Priority Health Commercial	$6.79
Rate for Payer: Priority Health PPO	$6.79

ANA/AER 3

Facility

$9.71

Hospital Charge Code	31027383
Hospital Revenue Code	300
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$8.25
Rate for Payer: Cash Price	$6.31
Rate for Payer: Community Health Alliance Commercial	$8.25
Rate for Payer: Priority Health Commercial	$6.80
Rate for Payer: Priority Health PPO	$6.80

ANA (ANTINUCLEAR ANTIBODIES)

Facility

$8.50

Service Code	HCPCS 86038
Hospital Charge Code	3001180
Hospital Revenue Code	302
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$12.69
Rate for Payer: BCBS BCN 65	$12.69
Rate for Payer: Blue Care Network Medicare Advantage	$12.69
Rate for Payer: Cash Price	$5.53
Rate for Payer: Cash Price	$5.53
Rate for Payer: Community Health Alliance Commercial	$7.22
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.69
Rate for Payer: Meridian Health Plan Medicare	$12.69
Rate for Payer: Priority Health Commercial	$5.95
Rate for Payer: Priority Health Medicaid	$12.69
Rate for Payer: Priority Health Medicare	$12.69
Rate for Payer: Priority Health PPO	$5.95
Rate for Payer: United Health Care Medicaid	$12.69
Rate for Payer: United Health Care Medicare Advantage	$5.59

ANA-BF

Facility

$33.09

Hospital Charge Code	3101296
Hospital Revenue Code	302
Min. Negotiated Rate	$23.16
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$21.51
Rate for Payer: Community Health Alliance Commercial	$28.13
Rate for Payer: Priority Health Commercial	$23.16
Rate for Payer: Priority Health PPO	$23.16

ANA COMP-10

Facility

$1.00

Hospital Charge Code	3102210
Hospital Revenue Code	300
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.85
Rate for Payer: Cash Price	$0.65
Rate for Payer: Community Health Alliance Commercial	$0.85
Rate for Payer: Priority Health Commercial	$0.70
Rate for Payer: Priority Health PPO	$0.70

ANA COMP-11

Facility

$1.99

Hospital Charge Code	3102211
Hospital Revenue Code	300
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.69
Rate for Payer: Cash Price	$1.29
Rate for Payer: Community Health Alliance Commercial	$1.69
Rate for Payer: Priority Health Commercial	$1.39
Rate for Payer: Priority Health PPO	$1.39

ANAEROBE ID ONLY

Facility

$24.44

Hospital Charge Code	3101972
Hospital Revenue Code	300
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$20.77
Rate for Payer: Cash Price	$15.89
Rate for Payer: Community Health Alliance Commercial	$20.77
Rate for Payer: Priority Health Commercial	$17.11
Rate for Payer: Priority Health PPO	$17.11

Sturgis Hospital Inc.

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All Charges