Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

HPV APTIMA LB

Facility

$23.89

Hospital Charge Code	3101870
Hospital Revenue Code	300
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$20.31
Rate for Payer: Cash Price	$15.53
Rate for Payer: Community Health Alliance Commercial	$20.31
Rate for Payer: Priority Health Commercial	$16.72
Rate for Payer: Priority Health PPO	$16.72

HPVCOBAS 16/18

Facility

$38.75

Hospital Charge Code	3102356
Hospital Revenue Code	300
Min. Negotiated Rate	$27.12
Max. Negotiated Rate	$32.94
Rate for Payer: Cash Price	$25.19
Rate for Payer: Community Health Alliance Commercial	$32.94
Rate for Payer: Priority Health Commercial	$27.12
Rate for Payer: Priority Health PPO	$27.12

HPV GENOTYPES 16,18,45

Facility

$38.00

Hospital Charge Code	3102452
Hospital Revenue Code	311
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$32.30
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health PPO	$26.60

HPV HIGH RISK IN SITU PARAFIN

Facility

$287.50

Hospital Charge Code	3100812
Hospital Revenue Code	319
Min. Negotiated Rate	$201.25
Max. Negotiated Rate	$244.38
Rate for Payer: Cash Price	$186.88
Rate for Payer: Community Health Alliance Commercial	$244.38
Rate for Payer: Priority Health Commercial	$201.25
Rate for Payer: Priority Health PPO	$201.25

HPV LOW RISK IN SITU PARAFIN

Facility

$145.00

Hospital Charge Code	3100905
Hospital Revenue Code	319
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$123.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Community Health Alliance Commercial	$123.25
Rate for Payer: Priority Health Commercial	$101.50
Rate for Payer: Priority Health PPO	$101.50

H.PYLORI ANTIGEN, STOOL

Facility

$23.00

Service Code	HCPCS 87338
Hospital Charge Code	3005134
Hospital Revenue Code	302
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$19.55
Rate for Payer: BCBS BCN 65	$15.10
Rate for Payer: Blue Care Network Medicare Advantage	$15.10
Rate for Payer: Cash Price	$14.95
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.10
Rate for Payer: Meridian Health Plan Medicare	$15.10
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health Medicaid	$15.10
Rate for Payer: Priority Health Medicare	$15.10
Rate for Payer: Priority Health PPO	$16.10
Rate for Payer: United Health Care Medicaid	$15.10
Rate for Payer: United Health Care Medicare Advantage	$6.64

HPYLORI BREATH TEST ADULT

Facility

$20.00

Hospital Charge Code	3101415
Hospital Revenue Code	300
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

H PYLORI BREATH TEST PEDIATRIC

Facility

$150.00

Hospital Charge Code	3101409
Hospital Revenue Code	300
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

HS-2 IGG SUPPLEMENTAL TEST REF

Facility

$57.00

Hospital Charge Code	3101864
Hospital Revenue Code	300
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$48.45
Rate for Payer: Cash Price	$37.05
Rate for Payer: Community Health Alliance Commercial	$48.45
Rate for Payer: Priority Health Commercial	$39.90
Rate for Payer: Priority Health PPO	$39.90

HSPP-1

Facility

$8.50

Hospital Charge Code	3101629
Hospital Revenue Code	300
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$7.22
Rate for Payer: Cash Price	$5.53
Rate for Payer: Community Health Alliance Commercial	$7.22
Rate for Payer: Priority Health Commercial	$5.95
Rate for Payer: Priority Health PPO	$5.95

HSPP-2

Facility

$8.50

Hospital Charge Code	3101630
Hospital Revenue Code	300
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$7.22
Rate for Payer: Cash Price	$5.53
Rate for Payer: Community Health Alliance Commercial	$7.22
Rate for Payer: Priority Health Commercial	$5.95
Rate for Payer: Priority Health PPO	$5.95

HSPP-3

Facility

$8.50

Hospital Charge Code	3101631
Hospital Revenue Code	300
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$7.22
Rate for Payer: Cash Price	$5.53
Rate for Payer: Community Health Alliance Commercial	$7.22
Rate for Payer: Priority Health Commercial	$5.95
Rate for Payer: Priority Health PPO	$5.95

HSPP-4

Facility

$8.50

Hospital Charge Code	3101632
Hospital Revenue Code	300
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$7.22
Rate for Payer: Cash Price	$5.53
Rate for Payer: Community Health Alliance Commercial	$7.22
Rate for Payer: Priority Health Commercial	$5.95
Rate for Payer: Priority Health PPO	$5.95

HSPP-5

Facility

$8.50

Hospital Charge Code	3101633
Hospital Revenue Code	300
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$7.22
Rate for Payer: Cash Price	$5.53
Rate for Payer: Community Health Alliance Commercial	$7.22
Rate for Payer: Priority Health Commercial	$5.95
Rate for Payer: Priority Health PPO	$5.95

HSPP-6

Facility

$8.50

Hospital Charge Code	3101634
Hospital Revenue Code	300
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$7.22
Rate for Payer: Cash Price	$5.53
Rate for Payer: Community Health Alliance Commercial	$7.22
Rate for Payer: Priority Health Commercial	$5.95
Rate for Payer: Priority Health PPO	$5.95

HSU BY PCR TYPE I & II 1

Facility

$686.00

Service Code	HCPCS 87530
Hospital Charge Code	3005556
Hospital Revenue Code	306
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$583.10
Rate for Payer: BCBS BCN 65	$44.98
Rate for Payer: Blue Care Network Medicare Advantage	$44.98
Rate for Payer: Cash Price	$445.90
Rate for Payer: Cash Price	$445.90
Rate for Payer: Community Health Alliance Commercial	$583.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$44.98
Rate for Payer: Meridian Health Plan Medicare	$44.98
Rate for Payer: Priority Health Commercial	$480.20
Rate for Payer: Priority Health Medicaid	$44.98
Rate for Payer: Priority Health Medicare	$44.98
Rate for Payer: Priority Health PPO	$480.20
Rate for Payer: United Health Care Medicaid	$44.98
Rate for Payer: United Health Care Medicare Advantage	$19.79

HSU BY PCR TYPE I & II 2

Facility

$686.00

Service Code	HCPCS 87530
Hospital Charge Code	3005557
Hospital Revenue Code	306
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$583.10
Rate for Payer: BCBS BCN 65	$44.98
Rate for Payer: Blue Care Network Medicare Advantage	$44.98
Rate for Payer: Cash Price	$445.90
Rate for Payer: Cash Price	$445.90
Rate for Payer: Community Health Alliance Commercial	$583.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$44.98
Rate for Payer: Meridian Health Plan Medicare	$44.98
Rate for Payer: Priority Health Commercial	$480.20
Rate for Payer: Priority Health Medicaid	$44.98
Rate for Payer: Priority Health Medicare	$44.98
Rate for Payer: Priority Health PPO	$480.20
Rate for Payer: United Health Care Medicaid	$44.98
Rate for Payer: United Health Care Medicare Advantage	$19.79

HSV 1&2 GENOTYPING PCR CSF 2

Facility

$50.00

Hospital Charge Code	3101079
Hospital Revenue Code	306
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

HSV 1&2 GENOTYPING PCR OTHER

Facility

$101.00

Hospital Charge Code	3101077
Hospital Revenue Code	306
Min. Negotiated Rate	$70.70
Max. Negotiated Rate	$85.85
Rate for Payer: Cash Price	$65.65
Rate for Payer: Community Health Alliance Commercial	$85.85
Rate for Payer: Priority Health Commercial	$70.70
Rate for Payer: Priority Health PPO	$70.70

HSV-1 PCR CSF

Facility

$16.29

Hospital Charge Code	3102078
Hospital Revenue Code	300
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$13.85
Rate for Payer: Cash Price	$10.59
Rate for Payer: Community Health Alliance Commercial	$13.85
Rate for Payer: Priority Health Commercial	$11.40
Rate for Payer: Priority Health PPO	$11.40

HSV-2 IgG AB

Facility

$10.00

Service Code	HCPCS 86696
Hospital Charge Code	3000643
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

HSV-2 PCR CSF

Facility

$16.29

Hospital Charge Code	3102079
Hospital Revenue Code	300
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$13.85
Rate for Payer: Cash Price	$10.59
Rate for Payer: Community Health Alliance Commercial	$13.85
Rate for Payer: Priority Health Commercial	$11.40
Rate for Payer: Priority Health PPO	$11.40

HSV ANTIBODY

Facility

$86.00

Hospital Charge Code	3000442
Hospital Revenue Code	302
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$73.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Community Health Alliance Commercial	$73.10
Rate for Payer: Priority Health Commercial	$60.20
Rate for Payer: Priority Health PPO	$60.20

HSV BY PCR

Facility

$304.00

Service Code	HCPCS 87529
Hospital Charge Code	3000671
Hospital Revenue Code	306
Min. Negotiated Rate	$16.21
Max. Negotiated Rate	$258.40
Rate for Payer: BCBS BCN 65	$36.84
Rate for Payer: Blue Care Network Medicare Advantage	$36.84
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cash Price	$197.60
Rate for Payer: Community Health Alliance Commercial	$258.40
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	$212.80
Rate for Payer: Priority Health Medicaid	$36.84
Rate for Payer: Priority Health Medicare	$36.84
Rate for Payer: Priority Health PPO	$212.80
Rate for Payer: United Health Care Medicaid	$36.84
Rate for Payer: United Health Care Medicare Advantage	$16.21

HSV IGG-2

Facility

$7.85

Hospital Charge Code	3101861
Hospital Revenue Code	300
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$6.67
Rate for Payer: Cash Price	$5.10
Rate for Payer: Community Health Alliance Commercial	$6.67
Rate for Payer: Priority Health Commercial	$5.50
Rate for Payer: Priority Health PPO	$5.50

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges