Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

MITOCHONDRIAL (M2) AB

Facility

$5.29

Hospital Charge Code	3101441
Hospital Revenue Code	300
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$4.50
Rate for Payer: Cash Price	$3.44
Rate for Payer: Community Health Alliance Commercial	$4.50
Rate for Payer: Priority Health Commercial	$3.70
Rate for Payer: Priority Health PPO	$3.70

MITOCHONDRIAL M2 IGG

Facility

$11.00

Hospital Charge Code	3100866
Hospital Revenue Code	300
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$9.35
Rate for Payer: Cash Price	$7.15
Rate for Payer: Community Health Alliance Commercial	$9.35
Rate for Payer: Priority Health Commercial	$7.70
Rate for Payer: Priority Health PPO	$7.70

MITOCHONRIAL (M2) ANTIBODY

Facility

$5.95

Service Code	HCPCS 86381
Hospital Charge Code	3006950
Hospital Revenue Code	302
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$26.72
Rate for Payer: BCBS BCN 65	$26.72
Rate for Payer: Blue Care Network Medicare Advantage	$26.72
Rate for Payer: Cash Price	$3.87
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.06
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$26.72
Rate for Payer: Meridian Health Plan Medicare	$26.72
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health Medicaid	$26.72
Rate for Payer: Priority Health Medicare	$26.72
Rate for Payer: Priority Health PPO	$4.17
Rate for Payer: United Health Care Medicaid	$26.72
Rate for Payer: United Health Care Medicare Advantage	$11.76

MIXED CONN TISSUE DISEASE PANE

Facility

$14.31

Hospital Charge Code	3101617
Hospital Revenue Code	300
Min. Negotiated Rate	$10.02
Max. Negotiated Rate	$12.16
Rate for Payer: Cash Price	$9.30
Rate for Payer: Community Health Alliance Commercial	$12.16
Rate for Payer: Priority Health Commercial	$10.02
Rate for Payer: Priority Health PPO	$10.02

MIXING STUDIES PTT

Facility

$54.00

Service Code	HCPCS 85732
Hospital Charge Code	3006160
Hospital Revenue Code	305
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$45.90
Rate for Payer: BCBS BCN 65	$6.79
Rate for Payer: Blue Care Network Medicare Advantage	$6.79
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Community Health Alliance Commercial	$45.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.79
Rate for Payer: Meridian Health Plan Medicare	$6.79
Rate for Payer: Priority Health Commercial	$37.80
Rate for Payer: Priority Health Medicaid	$6.79
Rate for Payer: Priority Health Medicare	$6.79
Rate for Payer: Priority Health PPO	$37.80
Rate for Payer: United Health Care Medicaid	$6.79
Rate for Payer: United Health Care Medicare Advantage	$2.99

MM 3-1

Facility

$37.18

Hospital Charge Code	31027391
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-10

Facility

$37.18

Hospital Charge Code	31027400
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-11

Facility

$37.18

Hospital Charge Code	31027401
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-12

Facility

$37.18

Hospital Charge Code	31027402
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-13

Facility

$37.18

Hospital Charge Code	31027403
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-14

Facility

$37.18

Hospital Charge Code	31027404
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-15

Facility

$37.18

Hospital Charge Code	31027405
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-16

Facility

$37.30

Hospital Charge Code	31027406
Hospital Revenue Code	300
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$31.70
Rate for Payer: Cash Price	$24.25
Rate for Payer: Community Health Alliance Commercial	$31.70
Rate for Payer: Priority Health Commercial	$26.11
Rate for Payer: Priority Health PPO	$26.11

MM 3-2

Facility

$37.18

Hospital Charge Code	31027392
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-3

Facility

$37.18

Hospital Charge Code	31027393
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-4

Facility

$37.18

Hospital Charge Code	31027394
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-5

Facility

$37.18

Hospital Charge Code	31027395
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-6

Facility

$37.18

Hospital Charge Code	31027396
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-7

Facility

$37.18

Hospital Charge Code	31027397
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-8

Facility

$37.18

Hospital Charge Code	31027398
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MM 3-9

Facility

$37.18

Hospital Charge Code	31027399
Hospital Revenue Code	300
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$31.60
Rate for Payer: Cash Price	$24.17
Rate for Payer: Community Health Alliance Commercial	$31.60
Rate for Payer: Priority Health Commercial	$26.03
Rate for Payer: Priority Health PPO	$26.03

MMP-1

Facility

$68.00

Hospital Charge Code	3101183
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

MMP-10

Facility

$68.00

Hospital Charge Code	3101192
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

MMP-11

Facility

$68.00

Hospital Charge Code	3101193
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

MMP-12

Facility

$68.00

Hospital Charge Code	3101194
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges