Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

HSVIGM-1

Facility

$7.85

Hospital Charge Code	3101834
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

HSV PCR 1

Facility

$16.29

Hospital Charge Code	3101986
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 PCR 2

Facility

$16.29

Hospital Charge Code	3101987
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 PCR CSF

Facility

$32.58

Hospital Charge Code	3102077
Hospital Revenue Code	300
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$27.69
Rate for Payer: Cash Price	$21.18
Rate for Payer: Community Health Alliance Commercial	$27.69
Rate for Payer: Priority Health Commercial	$22.81
Rate for Payer: Priority Health PPO	$22.81

HSV-PCR-TISSUE

Facility

$190.00

Hospital Charge Code	3000014
Hospital Revenue Code	306
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$161.50
Rate for Payer: Cash Price	$123.50
Rate for Payer: Community Health Alliance Commercial	$161.50
Rate for Payer: Priority Health Commercial	$133.00
Rate for Payer: Priority Health PPO	$133.00

HSV SUPPLEMENTAL TEST

Facility

$57.00

Hospital Charge Code	3102065
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

HSV T 1&2 GENOTYPING PCR

Facility

$32.58

Hospital Charge Code	3005428
Hospital Revenue Code	306
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$27.69
Rate for Payer: Cash Price	$21.18
Rate for Payer: Community Health Alliance Commercial	$27.69
Rate for Payer: Priority Health Commercial	$22.81
Rate for Payer: Priority Health PPO	$22.81

HSV T 1&2 GENOTYPING PCR CSF 1

Facility

$50.00

Hospital Charge Code	3101078
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 T 1&2 GENOTYPING PCR PAP V

Facility

$100.00

Hospital Charge Code	3101081
Hospital Revenue Code	306
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$85.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health PPO	$70.00

HSV TYP 1

Facility

$25.00

Service Code	HCPCS 87140
Hospital Charge Code	3000645
Hospital Revenue Code	306
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$21.25
Rate for Payer: BCBS BCN 65	$5.85
Rate for Payer: Blue Care Network Medicare Advantage	$5.85
Rate for Payer: Cash Price	$16.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
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	$17.50
Rate for Payer: Priority Health Medicaid	$5.85
Rate for Payer: Priority Health Medicare	$5.85
Rate for Payer: Priority Health PPO	$17.50
Rate for Payer: United Health Care Medicaid	$5.85
Rate for Payer: United Health Care Medicare Advantage	$2.57

HSV TYP 2

Facility

$25.00

Hospital Charge Code	3101087
Hospital Revenue Code	306
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

HTLVI VIRUS

Facility

$18.00

Service Code	HCPCS 86790
Hospital Charge Code	3005310
Hospital Revenue Code	302
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$15.30
Rate for Payer: BCBS BCN 65	$13.52
Rate for Payer: Blue Care Network Medicare Advantage	$13.52
Rate for Payer: Cash Price	$11.70
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
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	$12.60
Rate for Payer: Priority Health Medicaid	$13.52
Rate for Payer: Priority Health Medicare	$13.52
Rate for Payer: Priority Health PPO	$12.60
Rate for Payer: United Health Care Medicaid	$13.52
Rate for Payer: United Health Care Medicare Advantage	$5.95

HTT GENE-LC

Facility

$286.00

Hospital Charge Code	31027440
Hospital Revenue Code	300
Min. Negotiated Rate	$200.20
Max. Negotiated Rate	$243.10
Rate for Payer: Cash Price	$185.90
Rate for Payer: Community Health Alliance Commercial	$243.10
Rate for Payer: Priority Health Commercial	$200.20
Rate for Payer: Priority Health PPO	$200.20

HUMAN EPIDIDYMIS PROTEIN 4

Facility

$180.00

Hospital Charge Code	3100625
Hospital Revenue Code	300
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$153.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Community Health Alliance Commercial	$153.00
Rate for Payer: Priority Health Commercial	$126.00
Rate for Payer: Priority Health PPO	$126.00

HUMAN ERYTHROCYTE AG PHENOTYPI

Facility

$50.00

Hospital Charge Code	3100952
Hospital Revenue Code	310
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

HUMAN GRANULOCYTIC IGG

Facility

$30.75

Hospital Charge Code	3100959
Hospital Revenue Code	302
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$26.14
Rate for Payer: Cash Price	$19.99
Rate for Payer: Community Health Alliance Commercial	$26.14
Rate for Payer: Priority Health Commercial	$21.52
Rate for Payer: Priority Health PPO	$21.52

HUMAN GRANULOCYTIC IGM

Facility

$30.75

Hospital Charge Code	3101163
Hospital Revenue Code	302
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$26.14
Rate for Payer: Cash Price	$19.99
Rate for Payer: Community Health Alliance Commercial	$26.14
Rate for Payer: Priority Health Commercial	$21.52
Rate for Payer: Priority Health PPO	$21.52

HUMAN GROWTH HORMONE

Facility

$7.94

Service Code	HCPCS 83003
Hospital Charge Code	3005320
Hospital Revenue Code	301
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$17.50
Rate for Payer: BCBS BCN 65	$17.50
Rate for Payer: Blue Care Network Medicare Advantage	$17.50
Rate for Payer: Cash Price	$5.16
Rate for Payer: Cash Price	$5.16
Rate for Payer: Community Health Alliance Commercial	$6.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.50
Rate for Payer: Meridian Health Plan Medicare	$17.50
Rate for Payer: Priority Health Commercial	$5.56
Rate for Payer: Priority Health Medicaid	$17.50
Rate for Payer: Priority Health Medicare	$17.50
Rate for Payer: Priority Health PPO	$5.56
Rate for Payer: United Health Care Medicaid	$17.50
Rate for Payer: United Health Care Medicare Advantage	$7.70

HUMAN MONOCYTIC AGG

Facility

$15.00

Service Code	HCPCS 86666
Hospital Charge Code	3004066
Hospital Revenue Code	302
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$12.75
Rate for Payer: BCBS BCN 65	$10.69
Rate for Payer: Blue Care Network Medicare Advantage	$10.69
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.69
Rate for Payer: Meridian Health Plan Medicare	$10.69
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$10.69
Rate for Payer: Priority Health Medicare	$10.69
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$10.69
Rate for Payer: United Health Care Medicare Advantage	$4.70

HUMAN MONOCYTIC IGM

Facility

$15.00

Service Code	HCPCS 86666
Hospital Charge Code	3004067
Hospital Revenue Code	302
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$12.75
Rate for Payer: BCBS BCN 65	$10.69
Rate for Payer: Blue Care Network Medicare Advantage	$10.69
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.69
Rate for Payer: Meridian Health Plan Medicare	$10.69
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$10.69
Rate for Payer: Priority Health Medicare	$10.69
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$10.69
Rate for Payer: United Health Care Medicare Advantage	$4.70

HUMAN PLACENTAL LACTOGEN

Facility

$112.40

Hospital Charge Code	3100793
Hospital Revenue Code	300
Min. Negotiated Rate	$78.68
Max. Negotiated Rate	$95.54
Rate for Payer: Cash Price	$73.06
Rate for Payer: Community Health Alliance Commercial	$95.54
Rate for Payer: Priority Health Commercial	$78.68
Rate for Payer: Priority Health PPO	$78.68

HVAP-1

Facility

$5.96

Hospital Charge Code	3102559
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HVAP-10

Facility

$5.96

Hospital Charge Code	3102568
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HVAP-11

Facility

$5.96

Hospital Charge Code	3102569
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HVAP-12

Facility

$6.01

Hospital Charge Code	3102570
Hospital Revenue Code	300
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$5.11
Rate for Payer: Cash Price	$3.91
Rate for Payer: Community Health Alliance Commercial	$5.11
Rate for Payer: Priority Health Commercial	$4.21
Rate for Payer: Priority Health PPO	$4.21

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges