Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ANTIBODY ID BLASTOMYCES

Facility

$63.00

Service Code	HCPCS 86612
Hospital Charge Code	3005057
Hospital Revenue Code	302
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$53.55
Rate for Payer: BCBS BCN 65	$13.54
Rate for Payer: Blue Care Network Medicare Advantage	$13.54
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.54
Rate for Payer: Meridian Health Plan Medicare	$13.54
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health Medicaid	$13.54
Rate for Payer: Priority Health Medicare	$13.54
Rate for Payer: Priority Health PPO	$44.10
Rate for Payer: United Health Care Medicaid	$13.54
Rate for Payer: United Health Care Medicare Advantage	$5.96

ANTIBODY ID COCCIDOIDES-CF

Facility

$18.00

Hospital Charge Code	3100518
Hospital Revenue Code	302
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$15.30
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health PPO	$12.60

ANTIBODY PANEL ID

Facility

$235.00

Service Code	HCPCS 86870
Hospital Charge Code	3000530
Hospital Revenue Code	300
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$384.52
Rate for Payer: BCBS BCN 65	$384.52
Rate for Payer: Blue Care Network Medicare Advantage	$384.52
Rate for Payer: Cash Price	$152.75
Rate for Payer: Cash Price	$152.75
Rate for Payer: Community Health Alliance Commercial	$199.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$384.52
Rate for Payer: Meridian Health Plan Medicare	$384.52
Rate for Payer: Priority Health Commercial	$164.50
Rate for Payer: Priority Health Medicaid	$384.52
Rate for Payer: Priority Health Medicare	$384.52
Rate for Payer: Priority Health PPO	$164.50
Rate for Payer: United Health Care Medicaid	$384.52
Rate for Payer: United Health Care Medicare Advantage	$169.19

ANTIBODY SCREEN

Facility

$74.00

Service Code	HCPCS 86850
Hospital Charge Code	3000460
Hospital Revenue Code	300
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$62.90
Rate for Payer: BCBS BCN 65	$10.26
Rate for Payer: Blue Care Network Medicare Advantage	$10.26
Rate for Payer: Cash Price	$48.10
Rate for Payer: Cash Price	$48.10
Rate for Payer: Community Health Alliance Commercial	$62.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.26
Rate for Payer: Meridian Health Plan Medicare	$10.26
Rate for Payer: Priority Health Commercial	$51.80
Rate for Payer: Priority Health Medicaid	$10.26
Rate for Payer: Priority Health Medicare	$10.26
Rate for Payer: Priority Health PPO	$51.80
Rate for Payer: United Health Care Medicaid	$10.26
Rate for Payer: United Health Care Medicare Advantage	$4.51

ANTIBODY SCREEN ADVANCED

Facility

$880.00

Service Code	HCPCS 86870
Hospital Charge Code	3000475
Hospital Revenue Code	300
Min. Negotiated Rate	$169.19
Max. Negotiated Rate	$748.00
Rate for Payer: BCBS BCN 65	$384.52
Rate for Payer: Blue Care Network Medicare Advantage	$384.52
Rate for Payer: Cash Price	$572.00
Rate for Payer: Cash Price	$572.00
Rate for Payer: Community Health Alliance Commercial	$748.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$384.52
Rate for Payer: Meridian Health Plan Medicare	$384.52
Rate for Payer: Priority Health Commercial	$616.00
Rate for Payer: Priority Health Medicaid	$384.52
Rate for Payer: Priority Health Medicare	$384.52
Rate for Payer: Priority Health PPO	$616.00
Rate for Payer: United Health Care Medicaid	$384.52
Rate for Payer: United Health Care Medicare Advantage	$169.19

ANTIBODY SCREEN BASIC

Facility

$277.00

Service Code	HCPCS 86870
Hospital Charge Code	3000470
Hospital Revenue Code	300
Min. Negotiated Rate	$169.19
Max. Negotiated Rate	$384.52
Rate for Payer: BCBS BCN 65	$384.52
Rate for Payer: Blue Care Network Medicare Advantage	$384.52
Rate for Payer: Cash Price	$180.05
Rate for Payer: Cash Price	$180.05
Rate for Payer: Community Health Alliance Commercial	$235.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$384.52
Rate for Payer: Meridian Health Plan Medicare	$384.52
Rate for Payer: Priority Health Commercial	$193.90
Rate for Payer: Priority Health Medicaid	$384.52
Rate for Payer: Priority Health Medicare	$384.52
Rate for Payer: Priority Health PPO	$193.90
Rate for Payer: United Health Care Medicaid	$384.52
Rate for Payer: United Health Care Medicare Advantage	$169.19

ANTIBODY SCREEN INTERMEDIATE

Facility

$427.00

Service Code	HCPCS 86870
Hospital Charge Code	3000465
Hospital Revenue Code	300
Min. Negotiated Rate	$169.19
Max. Negotiated Rate	$384.52
Rate for Payer: BCBS BCN 65	$384.52
Rate for Payer: Blue Care Network Medicare Advantage	$384.52
Rate for Payer: Cash Price	$277.55
Rate for Payer: Cash Price	$277.55
Rate for Payer: Community Health Alliance Commercial	$362.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$384.52
Rate for Payer: Meridian Health Plan Medicare	$384.52
Rate for Payer: Priority Health Commercial	$298.90
Rate for Payer: Priority Health Medicaid	$384.52
Rate for Payer: Priority Health Medicare	$384.52
Rate for Payer: Priority Health PPO	$298.90
Rate for Payer: United Health Care Medicaid	$384.52
Rate for Payer: United Health Care Medicare Advantage	$169.19

ANTIBODY TITER RH

Facility

$63.00

Service Code	HCPCS 86886
Hospital Charge Code	3005600
Hospital Revenue Code	300
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$53.55
Rate for Payer: BCBS BCN 65	$5.44
Rate for Payer: Blue Care Network Medicare Advantage	$5.44
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
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	$44.10
Rate for Payer: Priority Health Medicaid	$5.44
Rate for Payer: Priority Health Medicare	$5.44
Rate for Payer: Priority Health PPO	$44.10
Rate for Payer: United Health Care Medicaid	$5.44
Rate for Payer: United Health Care Medicare Advantage	$2.39

ANTIBODY TO ASPERGILLIS 1

Facility

$70.00

Service Code	HCPCS 86606
Hospital Charge Code	3005052
Hospital Revenue Code	302
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$59.50
Rate for Payer: BCBS BCN 65	$15.80
Rate for Payer: Blue Care Network Medicare Advantage	$15.80
Rate for Payer: Cash Price	$45.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.80
Rate for Payer: Meridian Health Plan Medicare	$15.80
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health Medicaid	$15.80
Rate for Payer: Priority Health Medicare	$15.80
Rate for Payer: Priority Health PPO	$49.00
Rate for Payer: United Health Care Medicaid	$15.80
Rate for Payer: United Health Care Medicare Advantage	$6.95

ANTI CARDIOLIPIN ANTIBODY

Facility

$95.00

Service Code	HCPCS 86147
Hospital Charge Code	3000940
Hospital Revenue Code	302
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$80.75
Rate for Payer: BCBS BCN 65	$26.72
Rate for Payer: Blue Care Network Medicare Advantage	$26.72
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
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	$66.50
Rate for Payer: Priority Health Medicaid	$26.72
Rate for Payer: Priority Health Medicare	$26.72
Rate for Payer: Priority Health PPO	$66.50
Rate for Payer: United Health Care Medicaid	$26.72
Rate for Payer: United Health Care Medicare Advantage	$11.76

ANTI CBIR1

Facility

$103.00

Hospital Charge Code	3000828
Hospital Revenue Code	301
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$87.55
Rate for Payer: Cash Price	$66.95
Rate for Payer: Community Health Alliance Commercial	$87.55
Rate for Payer: Priority Health Commercial	$72.10
Rate for Payer: Priority Health PPO	$72.10

ANTI-CCP

Facility

$45.00

Hospital Charge Code	31027531
Hospital Revenue Code	300
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

ANTI CENTROMERE

Facility

$17.00

Hospital Charge Code	3001945
Hospital Revenue Code	302
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

ANTI CENTROMERE

Facility

$40.00

Hospital Charge Code	3001947
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

ANTI CENTROMERE Ab

Facility

$15.00

Service Code	HCPCS 86255
Hospital Charge Code	3000945
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$12.75
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
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	$12.65
Rate for Payer: Meridian Health Plan Medicare	$12.65
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

ANTI-CHROMATIN-LC

Facility

$65.00

Hospital Charge Code	31027441
Hospital Revenue Code	300
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

ANTI-CYTOPLASMIC ANTIBODY

Facility

$181.00

Service Code	HCPCS 86021
Hospital Charge Code	3003061
Hospital Revenue Code	302
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$153.85
Rate for Payer: BCBS BCN 65	$15.80
Rate for Payer: Blue Care Network Medicare Advantage	$15.80
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	$15.80
Rate for Payer: Meridian Health Plan Medicare	$15.80
Rate for Payer: Priority Health Commercial	$126.70
Rate for Payer: Priority Health Medicaid	$15.80
Rate for Payer: Priority Health Medicare	$15.80
Rate for Payer: Priority Health PPO	$126.70
Rate for Payer: United Health Care Medicaid	$15.80
Rate for Payer: United Health Care Medicare Advantage	$6.95

ANTIDEPRESSANT SCREEN

Facility

$150.00

Hospital Charge Code	3000075
Hospital Revenue Code	301
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

ANTIDIURETIC HORMONE-ADH

Facility

$24.44

Service Code	HCPCS 84588
Hospital Charge Code	3001160
Hospital Revenue Code	301
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$35.64
Rate for Payer: BCBS BCN 65	$35.64
Rate for Payer: Blue Care Network Medicare Advantage	$35.64
Rate for Payer: Cash Price	$15.89
Rate for Payer: Cash Price	$15.89
Rate for Payer: Community Health Alliance Commercial	$20.77
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$35.64
Rate for Payer: Meridian Health Plan Medicare	$35.64
Rate for Payer: Priority Health Commercial	$17.11
Rate for Payer: Priority Health Medicaid	$35.64
Rate for Payer: Priority Health Medicare	$35.64
Rate for Payer: Priority Health PPO	$17.11
Rate for Payer: United Health Care Medicaid	$35.64
Rate for Payer: United Health Care Medicare Advantage	$15.68

ANTI DNA DOUBLE STRANDED

Facility

$5.70

Service Code	HCPCS 86225
Hospital Charge Code	3000920
Hospital Revenue Code	302
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$14.43
Rate for Payer: BCBS BCN 65	$14.43
Rate for Payer: Blue Care Network Medicare Advantage	$14.43
Rate for Payer: Cash Price	$3.71
Rate for Payer: Cash Price	$3.71
Rate for Payer: Community Health Alliance Commercial	$4.84
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.43
Rate for Payer: Meridian Health Plan Medicare	$14.43
Rate for Payer: Priority Health Commercial	$3.99
Rate for Payer: Priority Health Medicaid	$14.43
Rate for Payer: Priority Health Medicare	$14.43
Rate for Payer: Priority Health PPO	$3.99
Rate for Payer: United Health Care Medicaid	$14.43
Rate for Payer: United Health Care Medicare Advantage	$6.35

ANTI DNASE B

Facility

$14.66

Service Code	HCPCS 86215
Hospital Charge Code	3000924
Hospital Revenue Code	302
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$13.91
Rate for Payer: BCBS BCN 65	$13.91
Rate for Payer: Blue Care Network Medicare Advantage	$13.91
Rate for Payer: Cash Price	$9.53
Rate for Payer: Cash Price	$9.53
Rate for Payer: Community Health Alliance Commercial	$12.46
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.91
Rate for Payer: Meridian Health Plan Medicare	$13.91
Rate for Payer: Priority Health Commercial	$10.26
Rate for Payer: Priority Health Medicaid	$13.91
Rate for Payer: Priority Health Medicare	$13.91
Rate for Payer: Priority Health PPO	$10.26
Rate for Payer: United Health Care Medicaid	$13.91
Rate for Payer: United Health Care Medicare Advantage	$6.12

ANTI EPIDERMAL ANTIBODY

Facility

$20.36

Hospital Charge Code	3000990
Hospital Revenue Code	302
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$17.31
Rate for Payer: Cash Price	$13.23
Rate for Payer: Community Health Alliance Commercial	$17.31
Rate for Payer: Priority Health Commercial	$14.25
Rate for Payer: Priority Health PPO	$14.25

ANTI EPIDERMAL ANTIBODY 1

Facility

$140.00

Hospital Charge Code	3000991
Hospital Revenue Code	302
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$119.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Community Health Alliance Commercial	$119.00
Rate for Payer: Priority Health Commercial	$98.00
Rate for Payer: Priority Health PPO	$98.00

ANTI EPIDERMAL ANTIBODY 2

Facility

$140.00

Service Code	HCPCS 88350
Hospital Charge Code	3000992
Hospital Revenue Code	302
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$119.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Community Health Alliance Commercial	$119.00
Rate for Payer: Priority Health Commercial	$98.00
Rate for Payer: Priority Health PPO	$98.00

ANTI EPIDERMAL ANTIBODY 3

Facility

$140.00

Hospital Charge Code	3100990
Hospital Revenue Code	319
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$119.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Community Health Alliance Commercial	$119.00
Rate for Payer: Priority Health Commercial	$98.00
Rate for Payer: Priority Health PPO	$98.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges