Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

HIGH PRESSURE INFLATION GAUGE

Facility

$126.00

Hospital Charge Code	27014761
Hospital Revenue Code	270
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$107.10
Rate for Payer: Cash Price	$81.90
Rate for Payer: Community Health Alliance Commercial	$107.10
Rate for Payer: Priority Health Commercial	$88.20
Rate for Payer: Priority Health PPO	$88.20

HIGH PRESSURE INJECTION LINE

Facility

$21.00

Hospital Charge Code	27060131
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health PPO	$14.70

H.INFLUENZA AG (MEN PANEL)

Facility

$50.00

Service Code	HCPCS 86403
Hospital Charge Code	3005130
Hospital Revenue Code	302
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$12.12
Rate for Payer: Blue Care Network Medicare Advantage	$12.12
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.12
Rate for Payer: Meridian Health Plan Medicare	$12.12
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$12.12
Rate for Payer: Priority Health Medicare	$12.12
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$12.12
Rate for Payer: United Health Care Medicare Advantage	$5.33

H INLFU B IGG

Facility

$57.02

Hospital Charge Code	3100787
Hospital Revenue Code	300
Min. Negotiated Rate	$39.91
Max. Negotiated Rate	$48.47
Rate for Payer: Cash Price	$37.06
Rate for Payer: Community Health Alliance Commercial	$48.47
Rate for Payer: Priority Health Commercial	$39.91
Rate for Payer: Priority Health PPO	$39.91

HIP ABDUCTION WEDGE

Facility

$150.00

Hospital Charge Code	27062903
Hospital Revenue Code	270
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$127.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Community Health Alliance Commercial	$127.50
Rate for Payer: Priority Health Commercial	$105.00
Rate for Payer: Priority Health PPO	$105.00

HIP ORTHOSIS, ULTRAGUARD FS

Facility

$1,454.00

Hospital Charge Code	27061097
Hospital Revenue Code	270
Min. Negotiated Rate	$1,017.80
Max. Negotiated Rate	$1,235.90
Rate for Payer: Cash Price	$945.10
Rate for Payer: Community Health Alliance Commercial	$1,235.90
Rate for Payer: Priority Health Commercial	$1,017.80
Rate for Payer: Priority Health PPO	$1,017.80

HISTAMINE WHL BLD

Facility

$8.55

Hospital Charge Code	3102577
Hospital Revenue Code	300
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$7.27
Rate for Payer: Cash Price	$5.56
Rate for Payer: Community Health Alliance Commercial	$7.27
Rate for Payer: Priority Health Commercial	$5.99
Rate for Payer: Priority Health PPO	$5.99

HISTONE ANTIBODIES

Facility

$62.00

Service Code	HCPCS 83516
Hospital Charge Code	3005255
Hospital Revenue Code	301
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$52.70
Rate for Payer: BCBS BCN 65	$12.11
Rate for Payer: Blue Care Network Medicare Advantage	$12.11
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cash Price	$40.30
Rate for Payer: Community Health Alliance Commercial	$52.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.11
Rate for Payer: Meridian Health Plan Medicare	$12.11
Rate for Payer: Priority Health Commercial	$43.40
Rate for Payer: Priority Health Medicaid	$12.11
Rate for Payer: Priority Health Medicare	$12.11
Rate for Payer: Priority Health PPO	$43.40
Rate for Payer: United Health Care Medicaid	$12.11
Rate for Payer: United Health Care Medicare Advantage	$5.33

HISTONE ANTIBODY

Facility

$10.00

Hospital Charge Code	3101417
Hospital Revenue Code	300
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health PPO	$7.00

HISTOPLASMA AB BY IMMUNO

Facility

$14.78

Hospital Charge Code	3009412
Hospital Revenue Code	302
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$12.56
Rate for Payer: Cash Price	$9.61
Rate for Payer: Community Health Alliance Commercial	$12.56
Rate for Payer: Priority Health Commercial	$10.35
Rate for Payer: Priority Health PPO	$10.35

Histoplasma Ag Quant

Facility

$103.25

Hospital Charge Code	31027658
Hospital Revenue Code	300
Min. Negotiated Rate	$72.28
Max. Negotiated Rate	$87.76
Rate for Payer: Cash Price	$67.11
Rate for Payer: Community Health Alliance Commercial	$87.76
Rate for Payer: Priority Health Commercial	$72.28
Rate for Payer: Priority Health PPO	$72.28

HISTOPLASMA ANTIGEN URINE

Facility

$71.75

Hospital Charge Code	3102194
Hospital Revenue Code	300
Min. Negotiated Rate	$50.23
Max. Negotiated Rate	$60.99
Rate for Payer: Cash Price	$46.64
Rate for Payer: Community Health Alliance Commercial	$60.99
Rate for Payer: Priority Health Commercial	$50.23
Rate for Payer: Priority Health PPO	$50.23

HISTOPLASMA MYCELIAL CF

Facility

$19.66

Hospital Charge Code	3101680
Hospital Revenue Code	300
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$16.71
Rate for Payer: Cash Price	$12.78
Rate for Payer: Community Health Alliance Commercial	$16.71
Rate for Payer: Priority Health Commercial	$13.76
Rate for Payer: Priority Health PPO	$13.76

HISTOPLASMA YEAST CF

Facility

$19.68

Hospital Charge Code	3101681
Hospital Revenue Code	300
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$16.73
Rate for Payer: Cash Price	$12.79
Rate for Payer: Community Health Alliance Commercial	$16.73
Rate for Payer: Priority Health Commercial	$13.78
Rate for Payer: Priority Health PPO	$13.78

HISTOPLASMOSIS AG SERUM

Facility

$55.00

Hospital Charge Code	3000665
Hospital Revenue Code	306
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$46.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health PPO	$38.50

HISTOPLASMOSIS TO STATE

Facility

$402.00

Service Code	HCPCS 86698
Hospital Charge Code	3000661
Hospital Revenue Code	302
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$341.70
Rate for Payer: BCBS BCN 65	$14.48
Rate for Payer: Blue Care Network Medicare Advantage	$14.48
Rate for Payer: Cash Price	$261.30
Rate for Payer: Cash Price	$261.30
Rate for Payer: Community Health Alliance Commercial	$341.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.48
Rate for Payer: Meridian Health Plan Medicare	$14.48
Rate for Payer: Priority Health Commercial	$281.40
Rate for Payer: Priority Health Medicaid	$14.48
Rate for Payer: Priority Health Medicare	$14.48
Rate for Payer: Priority Health PPO	$281.40
Rate for Payer: United Health Care Medicaid	$14.48
Rate for Payer: United Health Care Medicare Advantage	$6.37

HIV-1

Facility

$37.95

Hospital Charge Code	3101331
Hospital Revenue Code	302
Min. Negotiated Rate	$26.57
Max. Negotiated Rate	$32.26
Rate for Payer: Cash Price	$24.67
Rate for Payer: Community Health Alliance Commercial	$32.26
Rate for Payer: Priority Health Commercial	$26.57
Rate for Payer: Priority Health PPO	$26.57

HIV- 1/2 AB AG

Facility

$40.00

Hospital Charge Code	3100892
Hospital Revenue Code	302
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

HIV-1 BY NUCLEIC ACID

Facility

$63.33

Hospital Charge Code	3000614
Hospital Revenue Code	306
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$53.83
Rate for Payer: Cash Price	$41.16
Rate for Payer: Community Health Alliance Commercial	$53.83
Rate for Payer: Priority Health Commercial	$44.33
Rate for Payer: Priority Health PPO	$44.33

HIV-1 GENOSURE-1

Facility

$132.50

Hospital Charge Code	3101639
Hospital Revenue Code	300
Min. Negotiated Rate	$92.75
Max. Negotiated Rate	$112.62
Rate for Payer: Cash Price	$86.13
Rate for Payer: Community Health Alliance Commercial	$112.62
Rate for Payer: Priority Health Commercial	$92.75
Rate for Payer: Priority Health PPO	$92.75

HIV-1 GENOSURE-2

Facility

$132.50

Hospital Charge Code	3101640
Hospital Revenue Code	300
Min. Negotiated Rate	$92.75
Max. Negotiated Rate	$112.62
Rate for Payer: Cash Price	$86.13
Rate for Payer: Community Health Alliance Commercial	$112.62
Rate for Payer: Priority Health Commercial	$92.75
Rate for Payer: Priority Health PPO	$92.75

HIV-1 W/ DRUG RESIS FIRST 10

Facility

$63.33

Hospital Charge Code	3000615
Hospital Revenue Code	306
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$53.83
Rate for Payer: Cash Price	$41.16
Rate for Payer: Community Health Alliance Commercial	$53.83
Rate for Payer: Priority Health Commercial	$44.33
Rate for Payer: Priority Health PPO	$44.33

HIV-2

Facility

$37.95

Hospital Charge Code	3101332
Hospital Revenue Code	302
Min. Negotiated Rate	$26.57
Max. Negotiated Rate	$32.26
Rate for Payer: Cash Price	$24.67
Rate for Payer: Community Health Alliance Commercial	$32.26
Rate for Payer: Priority Health Commercial	$26.57
Rate for Payer: Priority Health PPO	$26.57

HIV DNA PCR

Facility

$111.00

Hospital Charge Code	3001631
Hospital Revenue Code	306
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$94.35
Rate for Payer: Cash Price	$72.15
Rate for Payer: Community Health Alliance Commercial	$94.35
Rate for Payer: Priority Health Commercial	$77.70
Rate for Payer: Priority Health PPO	$77.70

HIV GENOTYPE

Facility

$265.00

Service Code	HCPCS 87901
Hospital Charge Code	3005271
Hospital Revenue Code	300
Min. Negotiated Rate	$118.94
Max. Negotiated Rate	$270.32
Rate for Payer: BCBS BCN 65	$270.32
Rate for Payer: Blue Care Network Medicare Advantage	$270.32
Rate for Payer: Cash Price	$172.25
Rate for Payer: Cash Price	$172.25
Rate for Payer: Community Health Alliance Commercial	$225.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$270.32
Rate for Payer: Meridian Health Plan Medicare	$270.32
Rate for Payer: Priority Health Commercial	$185.50
Rate for Payer: Priority Health Medicaid	$270.32
Rate for Payer: Priority Health Medicare	$270.32
Rate for Payer: Priority Health PPO	$185.50
Rate for Payer: United Health Care Medicaid	$270.32
Rate for Payer: United Health Care Medicare Advantage	$118.94

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges