Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

HIV-RNA BY PCR

Facility

$50.00

Service Code	HCPCS 87536
Hospital Charge Code	3001630
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$89.36
Rate for Payer: BCBS BCN 65	$89.36
Rate for Payer: Blue Care Network Medicare Advantage	$89.36
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	$89.36
Rate for Payer: Meridian Health Plan Medicare	$89.36
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$89.36
Rate for Payer: Priority Health Medicare	$89.36
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$89.36
Rate for Payer: United Health Care Medicare Advantage	$39.32

HIV TO STATE

Facility

$5.00

Service Code	HCPCS 87389
Hospital Charge Code	3001020
Hospital Revenue Code	302
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$25.28
Rate for Payer: BCBS BCN 65	$25.28
Rate for Payer: Blue Care Network Medicare Advantage	$25.28
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$25.28
Rate for Payer: Meridian Health Plan Medicare	$25.28
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$25.28
Rate for Payer: Priority Health Medicare	$25.28
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$25.28
Rate for Payer: United Health Care Medicare Advantage	$11.12

HLA-A29

Facility

$210.00

Service Code	HCPCS 86812
Hospital Charge Code	3005290
Hospital Revenue Code	302
Min. Negotiated Rate	$11.92
Max. Negotiated Rate	$178.50
Rate for Payer: BCBS BCN 65	$27.10
Rate for Payer: Blue Care Network Medicare Advantage	$27.10
Rate for Payer: Cash Price	$136.50
Rate for Payer: Cash Price	$136.50
Rate for Payer: Community Health Alliance Commercial	$178.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$27.10
Rate for Payer: Meridian Health Plan Medicare	$27.10
Rate for Payer: Priority Health Commercial	$147.00
Rate for Payer: Priority Health Medicaid	$27.10
Rate for Payer: Priority Health Medicare	$27.10
Rate for Payer: Priority Health PPO	$147.00
Rate for Payer: United Health Care Medicaid	$27.10
Rate for Payer: United Health Care Medicare Advantage	$11.92

HLA-A29 UVEITIS

Facility

$175.50

Hospital Charge Code	3102533
Hospital Revenue Code	300
Min. Negotiated Rate	$122.85
Max. Negotiated Rate	$149.18
Rate for Payer: Cash Price	$114.08
Rate for Payer: Community Health Alliance Commercial	$149.18
Rate for Payer: Priority Health Commercial	$122.85
Rate for Payer: Priority Health PPO	$122.85

HLA-A GENOTYPING

Facility

$316.03

Hospital Charge Code	3100607
Hospital Revenue Code	310
Min. Negotiated Rate	$221.22
Max. Negotiated Rate	$268.63
Rate for Payer: Cash Price	$205.42
Rate for Payer: Community Health Alliance Commercial	$268.63
Rate for Payer: Priority Health Commercial	$221.22
Rate for Payer: Priority Health PPO	$221.22

HLA-B27

Facility

$18.75

Service Code	HCPCS 81374
Hospital Charge Code	3005300
Hospital Revenue Code	302
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$78.05
Rate for Payer: BCBS BCN 65	$78.05
Rate for Payer: Blue Care Network Medicare Advantage	$78.05
Rate for Payer: Cash Price	$12.19
Rate for Payer: Cash Price	$12.19
Rate for Payer: Community Health Alliance Commercial	$15.94
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$78.05
Rate for Payer: Meridian Health Plan Medicare	$78.05
Rate for Payer: Priority Health Commercial	$13.12
Rate for Payer: Priority Health Medicaid	$78.05
Rate for Payer: Priority Health Medicare	$78.05
Rate for Payer: Priority Health PPO	$13.12
Rate for Payer: United Health Care Medicaid	$78.05
Rate for Payer: United Health Care Medicare Advantage	$34.34

HLA B3

Facility

$60.00

Hospital Charge Code	3005307
Hospital Revenue Code	302
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

HLA B*51 DISEASE ASSOC

Facility

$47.24

Hospital Charge Code	3102448
Hospital Revenue Code	300
Min. Negotiated Rate	$33.07
Max. Negotiated Rate	$40.15
Rate for Payer: Cash Price	$30.71
Rate for Payer: Community Health Alliance Commercial	$40.15
Rate for Payer: Priority Health Commercial	$33.07
Rate for Payer: Priority Health PPO	$33.07

HLA-B 5701 GENOTYPING

Facility

$120.00

Hospital Charge Code	3100176
Hospital Revenue Code	300
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

HLA-B GENOTYPING

Facility

$316.03

Hospital Charge Code	3100608
Hospital Revenue Code	310
Min. Negotiated Rate	$221.22
Max. Negotiated Rate	$268.63
Rate for Payer: Cash Price	$205.42
Rate for Payer: Community Health Alliance Commercial	$268.63
Rate for Payer: Priority Health Commercial	$221.22
Rate for Payer: Priority Health PPO	$221.22

HLA DR3

Facility

$60.00

Hospital Charge Code	3005309
Hospital Revenue Code	302
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

HLA-DRZ DQ1

Facility

$181.00

Service Code	HCPCS 86817
Hospital Charge Code	3005303
Hospital Revenue Code	302
Min. Negotiated Rate	$49.04
Max. Negotiated Rate	$153.85
Rate for Payer: BCBS BCN 65	$111.45
Rate for Payer: Blue Care Network Medicare Advantage	$111.45
Rate for Payer: Cash Price	$117.65
Rate for Payer: Cash Price	$117.65
Rate for Payer: Community Health Alliance Commercial	$153.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$111.45
Rate for Payer: Meridian Health Plan Medicare	$111.45
Rate for Payer: Priority Health Commercial	$126.70
Rate for Payer: Priority Health Medicaid	$111.45
Rate for Payer: Priority Health Medicare	$111.45
Rate for Payer: Priority Health PPO	$126.70
Rate for Payer: United Health Care Medicaid	$111.45
Rate for Payer: United Health Care Medicare Advantage	$49.04

HLA II TYPING 1 LOCUS LR DQ2

Facility

$202.00

Hospital Charge Code	3100815
Hospital Revenue Code	300
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$171.70
Rate for Payer: Cash Price	$131.30
Rate for Payer: Community Health Alliance Commercial	$171.70
Rate for Payer: Priority Health Commercial	$141.40
Rate for Payer: Priority Health PPO	$141.40

HLA II TYPING 1 LOCUS LR DQ8

Facility

$202.00

Hospital Charge Code	3100816
Hospital Revenue Code	300
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$171.70
Rate for Payer: Cash Price	$131.30
Rate for Payer: Community Health Alliance Commercial	$171.70
Rate for Payer: Priority Health Commercial	$141.40
Rate for Payer: Priority Health PPO	$141.40

HLA SURCHARGE

Facility

$175.00

Hospital Charge Code	3101320
Hospital Revenue Code	300
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$148.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Community Health Alliance Commercial	$148.75
Rate for Payer: Priority Health Commercial	$122.50
Rate for Payer: Priority Health PPO	$122.50

HLA TYPING

Facility

$575.00

Service Code	HCPCS 86813
Hospital Charge Code	3005305
Hospital Revenue Code	302
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$488.75
Rate for Payer: BCBS BCN 65	$60.90
Rate for Payer: Blue Care Network Medicare Advantage	$60.90
Rate for Payer: Cash Price	$373.75
Rate for Payer: Cash Price	$373.75
Rate for Payer: Community Health Alliance Commercial	$488.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$60.90
Rate for Payer: Meridian Health Plan Medicare	$60.90
Rate for Payer: Priority Health Commercial	$402.50
Rate for Payer: Priority Health Medicaid	$60.90
Rate for Payer: Priority Health Medicare	$60.90
Rate for Payer: Priority Health PPO	$402.50
Rate for Payer: United Health Care Medicaid	$60.90
Rate for Payer: United Health Care Medicare Advantage	$26.80

HMPP-1

Facility

$5.48

Hospital Charge Code	3102093
Hospital Revenue Code	300
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$4.66
Rate for Payer: Cash Price	$3.56
Rate for Payer: Community Health Alliance Commercial	$4.66
Rate for Payer: Priority Health Commercial	$3.84
Rate for Payer: Priority Health PPO	$3.84

HMPP-2

Facility

$5.48

Hospital Charge Code	3102094
Hospital Revenue Code	300
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$4.66
Rate for Payer: Cash Price	$3.56
Rate for Payer: Community Health Alliance Commercial	$4.66
Rate for Payer: Priority Health Commercial	$3.84
Rate for Payer: Priority Health PPO	$3.84

HMPP-3

Facility

$5.48

Hospital Charge Code	3102095
Hospital Revenue Code	300
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$4.66
Rate for Payer: Cash Price	$3.56
Rate for Payer: Community Health Alliance Commercial	$4.66
Rate for Payer: Priority Health Commercial	$3.84
Rate for Payer: Priority Health PPO	$3.84

HMPP-4

Facility

$5.48

Hospital Charge Code	3102096
Hospital Revenue Code	300
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$4.66
Rate for Payer: Cash Price	$3.56
Rate for Payer: Community Health Alliance Commercial	$4.66
Rate for Payer: Priority Health Commercial	$3.84
Rate for Payer: Priority Health PPO	$3.84

HMU-2

Facility

$1.66

Hospital Charge Code	3000711
Hospital Revenue Code	301
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.41
Rate for Payer: Cash Price	$1.08
Rate for Payer: Community Health Alliance Commercial	$1.41
Rate for Payer: Priority Health Commercial	$1.16
Rate for Payer: Priority Health PPO	$1.16

HMU-3

Facility

$1.66

Service Code	HCPCS 83825
Hospital Charge Code	3006010
Hospital Revenue Code	301
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$17.07
Rate for Payer: BCBS BCN 65	$17.07
Rate for Payer: Blue Care Network Medicare Advantage	$17.07
Rate for Payer: Cash Price	$1.08
Rate for Payer: Cash Price	$1.08
Rate for Payer: Community Health Alliance Commercial	$1.41
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.07
Rate for Payer: Meridian Health Plan Medicare	$17.07
Rate for Payer: Priority Health Commercial	$1.16
Rate for Payer: Priority Health Medicaid	$17.07
Rate for Payer: Priority Health Medicare	$17.07
Rate for Payer: Priority Health PPO	$1.16
Rate for Payer: United Health Care Medicaid	$17.07
Rate for Payer: United Health Care Medicare Advantage	$7.51

HMU-4

Facility

$1.68

Service Code	HCPCS 82570
Hospital Charge Code	3006523
Hospital Revenue Code	301
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$5.44
Rate for Payer: BCBS BCN 65	$5.44
Rate for Payer: Blue Care Network Medicare Advantage	$5.44
Rate for Payer: Cash Price	$1.09
Rate for Payer: Cash Price	$1.09
Rate for Payer: Community Health Alliance Commercial	$1.43
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.44
Rate for Payer: Meridian Health Plan Medicare	$5.44
Rate for Payer: Priority Health Commercial	$1.18
Rate for Payer: Priority Health Medicaid	$5.44
Rate for Payer: Priority Health Medicare	$5.44
Rate for Payer: Priority Health PPO	$1.18
Rate for Payer: United Health Care Medicaid	$5.44
Rate for Payer: United Health Care Medicare Advantage	$2.39

HMWB-1

Facility

$13.05

Hospital Charge Code	3102144
Hospital Revenue Code	300
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$11.09
Rate for Payer: Cash Price	$8.48
Rate for Payer: Community Health Alliance Commercial	$11.09
Rate for Payer: Priority Health Commercial	$9.13
Rate for Payer: Priority Health PPO	$9.13

HMWB-2

Facility

$13.05

Hospital Charge Code	3102145
Hospital Revenue Code	300
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$11.09
Rate for Payer: Cash Price	$8.48
Rate for Payer: Community Health Alliance Commercial	$11.09
Rate for Payer: Priority Health Commercial	$9.13
Rate for Payer: Priority Health PPO	$9.13

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges