Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

HERPES ANTIBODY TYPE 2 IgG

Facility

$13.00

Hospital Charge Code	3100813
Hospital Revenue Code	302
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 ANTIBODY,TYPE 2 IgG IgM

Facility

$10.00

Service Code	HCPCS 86696
Hospital Charge Code	3000631
Hospital Revenue Code	302
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$20.32
Rate for Payer: BCBS BCN 65	$20.32
Rate for Payer: Blue Care Network Medicare Advantage	$20.32
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	$20.32
Rate for Payer: Meridian Health Plan Medicare	$20.32
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health Medicaid	$20.32
Rate for Payer: Priority Health Medicare	$20.32
Rate for Payer: Priority Health PPO	$7.00
Rate for Payer: United Health Care Medicaid	$20.32
Rate for Payer: United Health Care Medicare Advantage	$8.94

HERPES CONFIRMATION

Facility

$27.00

Hospital Charge Code	3000646
Hospital Revenue Code	306
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

HERPES I

Facility

$115.00

Service Code	HCPCS 86695
Hospital Charge Code	3000642
Hospital Revenue Code	302
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$97.75
Rate for Payer: BCBS BCN 65	$13.85
Rate for Payer: Blue Care Network Medicare Advantage	$13.85
Rate for Payer: Cash Price	$74.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Community Health Alliance Commercial	$97.75
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	$80.50
Rate for Payer: Priority Health Medicaid	$13.85
Rate for Payer: Priority Health Medicare	$13.85
Rate for Payer: Priority Health PPO	$80.50
Rate for Payer: United Health Care Medicaid	$13.85
Rate for Payer: United Health Care Medicare Advantage	$6.09

HERPES I BY PCR - CSF

Facility

$176.00

Service Code	HCPCS 87529
Hospital Charge Code	3000653
Hospital Revenue Code	306
Min. Negotiated Rate	$16.21
Max. Negotiated Rate	$149.60
Rate for Payer: BCBS BCN 65	$36.84
Rate for Payer: Blue Care Network Medicare Advantage	$36.84
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Community Health Alliance Commercial	$149.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$36.84
Rate for Payer: Meridian Health Plan Medicare	$36.84
Rate for Payer: Priority Health Commercial	$123.20
Rate for Payer: Priority Health Medicaid	$36.84
Rate for Payer: Priority Health Medicare	$36.84
Rate for Payer: Priority Health PPO	$123.20
Rate for Payer: United Health Care Medicaid	$36.84
Rate for Payer: United Health Care Medicare Advantage	$16.21

HERPES ID

Facility

$43.00

Service Code	HCPCS 87140
Hospital Charge Code	3000644
Hospital Revenue Code	306
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$36.55
Rate for Payer: BCBS BCN 65	$5.85
Rate for Payer: Blue Care Network Medicare Advantage	$5.85
Rate for Payer: Cash Price	$27.95
Rate for Payer: Cash Price	$27.95
Rate for Payer: Community Health Alliance Commercial	$36.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.85
Rate for Payer: Meridian Health Plan Medicare	$5.85
Rate for Payer: Priority Health Commercial	$30.10
Rate for Payer: Priority Health Medicaid	$5.85
Rate for Payer: Priority Health Medicare	$5.85
Rate for Payer: Priority Health PPO	$30.10
Rate for Payer: United Health Care Medicaid	$5.85
Rate for Payer: United Health Care Medicare Advantage	$2.57

HERPES IGG TYPE 1 SERUM

Facility

$22.00

Hospital Charge Code	3100918
Hospital Revenue Code	300
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$18.70
Rate for Payer: Cash Price	$14.30
Rate for Payer: Community Health Alliance Commercial	$18.70
Rate for Payer: Priority Health Commercial	$15.40
Rate for Payer: Priority Health PPO	$15.40

HERPES IGM TYPE 1

Facility

$15.00

Hospital Charge Code	3101610
Hospital Revenue Code	300
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

HERPES IGM TYPE 2

Facility

$15.00

Hospital Charge Code	3101611
Hospital Revenue Code	300
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

HERPES II BY PCR - CSF

Facility

$100.00

Service Code	HCPCS 87529
Hospital Charge Code	3000655
Hospital Revenue Code	306
Min. Negotiated Rate	$16.21
Max. Negotiated Rate	$85.00
Rate for Payer: BCBS BCN 65	$36.84
Rate for Payer: Blue Care Network Medicare Advantage	$36.84
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$36.84
Rate for Payer: Meridian Health Plan Medicare	$36.84
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health Medicaid	$36.84
Rate for Payer: Priority Health Medicare	$36.84
Rate for Payer: Priority Health PPO	$70.00
Rate for Payer: United Health Care Medicaid	$36.84
Rate for Payer: United Health Care Medicare Advantage	$16.21

HERPES SIMPLEX

Facility

$50.00

Hospital Charge Code	3000446
Hospital Revenue Code	302
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

HERPES SINPLEX

Facility

$50.00

Hospital Charge Code	3000447
Hospital Revenue Code	302
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

HERPES TITER

Facility

$20.00

Hospital Charge Code	3000330
Hospital Revenue Code	302
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$17.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health PPO	$14.00

HERPES TYPE 8 VIRUS

Facility

$197.20

Service Code	HCPCS 86790
Hospital Charge Code	3000650
Hospital Revenue Code	302
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$167.62
Rate for Payer: BCBS BCN 65	$13.52
Rate for Payer: Blue Care Network Medicare Advantage	$13.52
Rate for Payer: Cash Price	$128.18
Rate for Payer: Cash Price	$128.18
Rate for Payer: Community Health Alliance Commercial	$167.62
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.52
Rate for Payer: Meridian Health Plan Medicare	$13.52
Rate for Payer: Priority Health Commercial	$138.04
Rate for Payer: Priority Health Medicaid	$13.52
Rate for Payer: Priority Health Medicare	$13.52
Rate for Payer: Priority Health PPO	$138.04
Rate for Payer: United Health Care Medicaid	$13.52
Rate for Payer: United Health Care Medicare Advantage	$5.95

HERPES VIRUS 6 IgG

Facility

$71.68

Hospital Charge Code	3000362
Hospital Revenue Code	302
Min. Negotiated Rate	$50.18
Max. Negotiated Rate	$60.93
Rate for Payer: Cash Price	$46.59
Rate for Payer: Community Health Alliance Commercial	$60.93
Rate for Payer: Priority Health Commercial	$50.18
Rate for Payer: Priority Health PPO	$50.18

HER-z/neu

Facility

$212.00

Service Code	HCPCS 83950
Hospital Charge Code	3005261
Hospital Revenue Code	301
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$180.20
Rate for Payer: BCBS BCN 65	$67.63
Rate for Payer: Blue Care Network Medicare Advantage	$67.63
Rate for Payer: Cash Price	$137.80
Rate for Payer: Cash Price	$137.80
Rate for Payer: Community Health Alliance Commercial	$180.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$67.63
Rate for Payer: Meridian Health Plan Medicare	$67.63
Rate for Payer: Priority Health Commercial	$148.40
Rate for Payer: Priority Health Medicaid	$67.63
Rate for Payer: Priority Health Medicare	$67.63
Rate for Payer: Priority Health PPO	$148.40
Rate for Payer: United Health Care Medicaid	$67.63
Rate for Payer: United Health Care Medicare Advantage	$29.76

HER-Z/NEW 2

Facility

$93.00

Hospital Charge Code	3000193
Hospital Revenue Code	310
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

HEXAGONAL PHASE PHOSPHOLIPID

Facility

$21.99

Hospital Charge Code	3101157
Hospital Revenue Code	305
Min. Negotiated Rate	$15.39
Max. Negotiated Rate	$18.69
Rate for Payer: Cash Price	$14.29
Rate for Payer: Community Health Alliance Commercial	$18.69
Rate for Payer: Priority Health Commercial	$15.39
Rate for Payer: Priority Health PPO	$15.39

HEXAGONAL PHASE PHOSPHOLIPID

Facility

$33.72

Hospital Charge Code	3102063
Hospital Revenue Code	300
Min. Negotiated Rate	$23.60
Max. Negotiated Rate	$28.66
Rate for Payer: Cash Price	$21.92
Rate for Payer: Community Health Alliance Commercial	$28.66
Rate for Payer: Priority Health Commercial	$23.60
Rate for Payer: Priority Health PPO	$23.60

HFPP-1

Facility

$4.08

Hospital Charge Code	3102089
Hospital Revenue Code	300
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$3.47
Rate for Payer: Cash Price	$2.65
Rate for Payer: Community Health Alliance Commercial	$3.47
Rate for Payer: Priority Health Commercial	$2.86
Rate for Payer: Priority Health PPO	$2.86

HFPP-2

Facility

$4.08

Hospital Charge Code	3102090
Hospital Revenue Code	300
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$3.47
Rate for Payer: Cash Price	$2.65
Rate for Payer: Community Health Alliance Commercial	$3.47
Rate for Payer: Priority Health Commercial	$2.86
Rate for Payer: Priority Health PPO	$2.86

HFPP-3

Facility

$4.10

Hospital Charge Code	3102091
Hospital Revenue Code	300
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$3.48
Rate for Payer: Cash Price	$2.67
Rate for Payer: Community Health Alliance Commercial	$3.48
Rate for Payer: Priority Health Commercial	$2.87
Rate for Payer: Priority Health PPO	$2.87

HGB ELECTROPHORESIS

Facility

$9.16

Service Code	HCPCS 83020
Hospital Charge Code	3005280
Hospital Revenue Code	301
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.51
Rate for Payer: BCBS BCN 65	$13.51
Rate for Payer: Blue Care Network Medicare Advantage	$13.51
Rate for Payer: Cash Price	$5.95
Rate for Payer: Cash Price	$5.95
Rate for Payer: Community Health Alliance Commercial	$7.79
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.51
Rate for Payer: Meridian Health Plan Medicare	$13.51
Rate for Payer: Priority Health Commercial	$6.41
Rate for Payer: Priority Health Medicaid	$13.51
Rate for Payer: Priority Health Medicare	$13.51
Rate for Payer: Priority Health PPO	$6.41
Rate for Payer: United Health Care Medicaid	$13.51
Rate for Payer: United Health Care Medicare Advantage	$5.95

HH-1

Facility

$1.50

Hospital Charge Code	3101964
Hospital Revenue Code	300
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.27
Rate for Payer: Cash Price	$0.98
Rate for Payer: Community Health Alliance Commercial	$1.27
Rate for Payer: Priority Health Commercial	$1.05
Rate for Payer: Priority Health PPO	$1.05

HH-2

Facility

$1.50

Hospital Charge Code	3101965
Hospital Revenue Code	300
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.27
Rate for Payer: Cash Price	$0.98
Rate for Payer: Community Health Alliance Commercial	$1.27
Rate for Payer: Priority Health Commercial	$1.05
Rate for Payer: Priority Health PPO	$1.05

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges