Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

HEP B DNA QUALITATIVE

Facility

$113.00

Hospital Charge Code	3005118
Hospital Revenue Code	306
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$96.05
Rate for Payer: Cash Price	$73.45
Rate for Payer: Community Health Alliance Commercial	$96.05
Rate for Payer: Priority Health Commercial	$79.10
Rate for Payer: Priority Health PPO	$79.10

HEPB SURFACE

Facility

$2.82

Hospital Charge Code	31027529
Hospital Revenue Code	300
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.83
Rate for Payer: Community Health Alliance Commercial	$2.40
Rate for Payer: Priority Health Commercial	$1.97
Rate for Payer: Priority Health PPO	$1.97

HEP C VIRUS GENOTYPE1/NS5A

Facility

$575.00

Hospital Charge Code	3101095
Hospital Revenue Code	300
Min. Negotiated Rate	$402.50
Max. Negotiated Rate	$488.75
Rate for Payer: Cash Price	$373.75
Rate for Payer: Community Health Alliance Commercial	$488.75
Rate for Payer: Priority Health Commercial	$402.50
Rate for Payer: Priority Health PPO	$402.50

HEP C VIRUS GENOTYPE 3NS5A

Facility

$686.00

Hospital Charge Code	3101635
Hospital Revenue Code	300
Min. Negotiated Rate	$480.20
Max. Negotiated Rate	$583.10
Rate for Payer: Cash Price	$445.90
Rate for Payer: Community Health Alliance Commercial	$583.10
Rate for Payer: Priority Health Commercial	$480.20
Rate for Payer: Priority Health PPO	$480.20

HEP C VIRUS GENOTYPE 3NS5A DRU

Facility

$343.00

Hospital Charge Code	3101637
Hospital Revenue Code	300
Min. Negotiated Rate	$240.10
Max. Negotiated Rate	$291.55
Rate for Payer: Cash Price	$222.95
Rate for Payer: Community Health Alliance Commercial	$291.55
Rate for Payer: Priority Health Commercial	$240.10
Rate for Payer: Priority Health PPO	$240.10

HEP C VIRUS GENOTYPE 3NS5A DRU

Facility

$343.00

Hospital Charge Code	3101636
Hospital Revenue Code	300
Min. Negotiated Rate	$240.10
Max. Negotiated Rate	$291.55
Rate for Payer: Cash Price	$222.95
Rate for Payer: Community Health Alliance Commercial	$291.55
Rate for Payer: Priority Health Commercial	$240.10
Rate for Payer: Priority Health PPO	$240.10

HEP C VIRUS NS5A-1

Facility

$205.00

Hospital Charge Code	3101509
Hospital Revenue Code	300
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$174.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Community Health Alliance Commercial	$174.25
Rate for Payer: Priority Health Commercial	$143.50
Rate for Payer: Priority Health PPO	$143.50

HEP C VIRUS NS5A-2

Facility

$205.00

Hospital Charge Code	3101510
Hospital Revenue Code	300
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$174.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Community Health Alliance Commercial	$174.25
Rate for Payer: Priority Health Commercial	$143.50
Rate for Payer: Priority Health PPO	$143.50

HEP E IGM-LC

Facility

$45.00

Hospital Charge Code	31027435
Hospital Revenue Code	300
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

HEP PANEL ACUTE W/REF TO HEP

Facility

$15.74

Hospital Charge Code	3101431
Hospital Revenue Code	300
Min. Negotiated Rate	$11.02
Max. Negotiated Rate	$13.38
Rate for Payer: Cash Price	$10.23
Rate for Payer: Community Health Alliance Commercial	$13.38
Rate for Payer: Priority Health Commercial	$11.02
Rate for Payer: Priority Health PPO	$11.02

HEPTIMAX

Facility

$508.00

Hospital Charge Code	3004148
Hospital Revenue Code	306
Min. Negotiated Rate	$355.60
Max. Negotiated Rate	$431.80
Rate for Payer: Cash Price	$330.20
Rate for Payer: Community Health Alliance Commercial	$431.80
Rate for Payer: Priority Health Commercial	$355.60
Rate for Payer: Priority Health PPO	$355.60

HER2(ERBB2) BY FISH PARAFFIN

Facility

$179.00

Hospital Charge Code	3100897
Hospital Revenue Code	319
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$152.15
Rate for Payer: Cash Price	$116.35
Rate for Payer: Community Health Alliance Commercial	$152.15
Rate for Payer: Priority Health Commercial	$125.30
Rate for Payer: Priority Health PPO	$125.30

HER2 (ERBBS) BY FISH PARRAFIN

Facility

$93.00

Hospital Charge Code	3100898
Hospital Revenue Code	301
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

HER2/NEU BY IHC HERCEPTTEST

Facility

$270.00

Hospital Charge Code	3100896
Hospital Revenue Code	310
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$229.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Community Health Alliance Commercial	$229.50
Rate for Payer: Priority Health Commercial	$189.00
Rate for Payer: Priority Health PPO	$189.00

HERNIA BALLOON,EXTRAPERITONEA

Facility

$374.00

Hospital Charge Code	27022608
Hospital Revenue Code	272
Min. Negotiated Rate	$261.80
Max. Negotiated Rate	$317.90
Rate for Payer: Cash Price	$243.10
Rate for Payer: Community Health Alliance Commercial	$317.90
Rate for Payer: Priority Health Commercial	$261.80
Rate for Payer: Priority Health PPO	$261.80

HERNIA IMPLANT MESH P/C

Facility

$785.00

Hospital Charge Code	5150690
Hospital Revenue Code	960
Min. Negotiated Rate	$549.50
Max. Negotiated Rate	$667.25
Rate for Payer: Cash Price	$510.25
Rate for Payer: Community Health Alliance Commercial	$667.25
Rate for Payer: Priority Health Commercial	$549.50
Rate for Payer: Priority Health PPO	$549.50

HERNIA INCIS/VENTRAL P/C

Facility

$2,350.00

Hospital Charge Code	5150689
Hospital Revenue Code	960
Min. Negotiated Rate	$1,645.00
Max. Negotiated Rate	$1,997.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Community Health Alliance Commercial	$1,997.50
Rate for Payer: Priority Health Commercial	$1,645.00
Rate for Payer: Priority Health PPO	$1,645.00

HERNIA PATCH, KUGEL MIDIFIED

Facility

$507.00

Service Code	HCPCS C1781
Hospital Charge Code	27268373
Hospital Revenue Code	278
Min. Negotiated Rate	$354.90
Max. Negotiated Rate	$430.95
Rate for Payer: Cash Price	$329.55
Rate for Payer: Community Health Alliance Commercial	$430.95
Rate for Payer: Priority Health Commercial	$354.90
Rate for Payer: Priority Health PPO	$354.90

HERNIA UNV >5 P/C

Facility

$2,078.00

Hospital Charge Code	5150691
Hospital Revenue Code	960
Min. Negotiated Rate	$1,454.60
Max. Negotiated Rate	$1,766.30
Rate for Payer: Cash Price	$1,350.70
Rate for Payer: Community Health Alliance Commercial	$1,766.30
Rate for Payer: Priority Health Commercial	$1,454.60
Rate for Payer: Priority Health PPO	$1,454.60

HEROIN METABOLITE URINE

Facility

$13.00

Service Code	HCPCS G6056
Hospital Charge Code	3100889
Hospital Revenue Code	300
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$11.05
Rate for Payer: Cash Price	$8.45
Rate for Payer: Community Health Alliance Commercial	$11.05
Rate for Payer: Priority Health Commercial	$9.10
Rate for Payer: Priority Health PPO	$9.10

HERPES 1&2 PCR CFS ONLY

Facility

$470.00

Hospital Charge Code	3000656
Hospital Revenue Code	306
Min. Negotiated Rate	$329.00
Max. Negotiated Rate	$399.50
Rate for Payer: Cash Price	$305.50
Rate for Payer: Community Health Alliance Commercial	$399.50
Rate for Payer: Priority Health Commercial	$329.00
Rate for Payer: Priority Health PPO	$329.00

HERPES ANTIBODY

Facility

$73.00

Service Code	HCPCS 86694
Hospital Charge Code	3000641
Hospital Revenue Code	302
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$62.05
Rate for Payer: BCBS BCN 65	$15.11
Rate for Payer: Blue Care Network Medicare Advantage	$15.11
Rate for Payer: Cash Price	$47.45
Rate for Payer: Cash Price	$47.45
Rate for Payer: Community Health Alliance Commercial	$62.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.11
Rate for Payer: Meridian Health Plan Medicare	$15.11
Rate for Payer: Priority Health Commercial	$51.10
Rate for Payer: Priority Health Medicaid	$15.11
Rate for Payer: Priority Health Medicare	$15.11
Rate for Payer: Priority Health PPO	$51.10
Rate for Payer: United Health Care Medicaid	$15.11
Rate for Payer: United Health Care Medicare Advantage	$6.65

HERPES ANTIBODY

Facility

$73.00

Hospital Charge Code	3000639
Hospital Revenue Code	302
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$62.05
Rate for Payer: Cash Price	$47.45
Rate for Payer: Community Health Alliance Commercial	$62.05
Rate for Payer: Priority Health Commercial	$51.10
Rate for Payer: Priority Health PPO	$51.10

HERPES ANTIBODY

Facility

$49.80

Hospital Charge Code	3000638
Hospital Revenue Code	302
Min. Negotiated Rate	$34.86
Max. Negotiated Rate	$42.33
Rate for Payer: Cash Price	$32.37
Rate for Payer: Community Health Alliance Commercial	$42.33
Rate for Payer: Priority Health Commercial	$34.86
Rate for Payer: Priority Health PPO	$34.86

HERPES ANTIBODY,TYPE 1,IgG IgM

Facility

$10.00

Service Code	HCPCS 86695
Hospital Charge Code	3000630
Hospital Revenue Code	302
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$13.85
Rate for Payer: BCBS BCN 65	$13.85
Rate for Payer: Blue Care Network Medicare Advantage	$13.85
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.85
Rate for Payer: Meridian Health Plan Medicare	$13.85
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health Medicaid	$13.85
Rate for Payer: Priority Health Medicare	$13.85
Rate for Payer: Priority Health PPO	$7.00
Rate for Payer: United Health Care Medicaid	$13.85
Rate for Payer: United Health Care Medicare Advantage	$6.09

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges