Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ANTI EPIDERMAL ANTIBODY 4

Facility

$140.00

Hospital Charge Code	3100991
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

ANTI EPIDERMAL ANTIBODY 5

Facility

$140.00

Hospital Charge Code	3101063
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

ANTI EPIDERMAL ANTIBODY 6

Facility

$140.00

Hospital Charge Code	3101064
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

ANTIGLIAD-1

Facility

$3.67

Hospital Charge Code	3102208
Hospital Revenue Code	300
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$3.12
Rate for Payer: Cash Price	$2.39
Rate for Payer: Community Health Alliance Commercial	$3.12
Rate for Payer: Priority Health Commercial	$2.57
Rate for Payer: Priority Health PPO	$2.57

ANTIGLIAD-2

Facility

$3.67

Hospital Charge Code	3102209
Hospital Revenue Code	300
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$3.12
Rate for Payer: Cash Price	$2.39
Rate for Payer: Community Health Alliance Commercial	$3.12
Rate for Payer: Priority Health Commercial	$2.57
Rate for Payer: Priority Health PPO	$2.57

ANTIGRANULOCYTE ANTIBODY

Facility

$222.00

Service Code	HCPCS 86021
Hospital Charge Code	3000535
Hospital Revenue Code	302
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$188.70
Rate for Payer: BCBS BCN 65	$15.80
Rate for Payer: Blue Care Network Medicare Advantage	$15.80
Rate for Payer: Cash Price	$144.30
Rate for Payer: Cash Price	$144.30
Rate for Payer: Community Health Alliance Commercial	$188.70
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	$155.40
Rate for Payer: Priority Health Medicaid	$15.80
Rate for Payer: Priority Health Medicare	$15.80
Rate for Payer: Priority Health PPO	$155.40
Rate for Payer: United Health Care Medicaid	$15.80
Rate for Payer: United Health Care Medicare Advantage	$6.95

ANTI-HMGCR AB (RDL)

Facility

$90.00

Hospital Charge Code	3102087
Hospital Revenue Code	300
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$76.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Community Health Alliance Commercial	$76.50
Rate for Payer: Priority Health Commercial	$63.00
Rate for Payer: Priority Health PPO	$63.00

ANTI-HU

Facility

$209.00

Service Code	HCPCS 86255
Hospital Charge Code	3003710
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$177.65
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$135.85
Rate for Payer: Cash Price	$135.85
Rate for Payer: Community Health Alliance Commercial	$177.65
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	$146.30
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$146.30
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

ANTI-JO AB-LC

Facility

$65.00

Hospital Charge Code	31027370
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

ANTIMICROSOMAL ANTIBODY

Facility

$4.89

Service Code	HCPCS 86376
Hospital Charge Code	3003121
Hospital Revenue Code	302
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$15.28
Rate for Payer: BCBS BCN 65	$15.28
Rate for Payer: Blue Care Network Medicare Advantage	$15.28
Rate for Payer: Cash Price	$3.18
Rate for Payer: Cash Price	$3.18
Rate for Payer: Community Health Alliance Commercial	$4.16
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.28
Rate for Payer: Meridian Health Plan Medicare	$15.28
Rate for Payer: Priority Health Commercial	$3.42
Rate for Payer: Priority Health Medicaid	$15.28
Rate for Payer: Priority Health Medicare	$15.28
Rate for Payer: Priority Health PPO	$3.42
Rate for Payer: United Health Care Medicaid	$15.28
Rate for Payer: United Health Care Medicare Advantage	$6.72

ANTI-MICROSOMAL LIVER/KIDNEY

Facility

$12.49

Service Code	HCPCS 86376
Hospital Charge Code	3003713
Hospital Revenue Code	302
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$15.28
Rate for Payer: BCBS BCN 65	$15.28
Rate for Payer: Blue Care Network Medicare Advantage	$15.28
Rate for Payer: Cash Price	$8.12
Rate for Payer: Cash Price	$8.12
Rate for Payer: Community Health Alliance Commercial	$10.62
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.28
Rate for Payer: Meridian Health Plan Medicare	$15.28
Rate for Payer: Priority Health Commercial	$8.74
Rate for Payer: Priority Health Medicaid	$15.28
Rate for Payer: Priority Health Medicare	$15.28
Rate for Payer: Priority Health PPO	$8.74
Rate for Payer: United Health Care Medicaid	$15.28
Rate for Payer: United Health Care Medicare Advantage	$6.72

ANTI MITOCHONRIAL ANTIBODY

Facility

$47.00

Service Code	HCPCS 86255
Hospital Charge Code	3000950
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$39.95
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$30.55
Rate for Payer: Cash Price	$30.55
Rate for Payer: Community Health Alliance Commercial	$39.95
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	$32.90
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$32.90
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

Anti-MOG Spinal

Facility

$522.50

Hospital Charge Code	31027710
Hospital Revenue Code	300
Min. Negotiated Rate	$365.75
Max. Negotiated Rate	$444.12
Rate for Payer: Cash Price	$339.63
Rate for Payer: Community Health Alliance Commercial	$444.12
Rate for Payer: Priority Health Commercial	$365.75
Rate for Payer: Priority Health PPO	$365.75

ANTI-NEURONAL NUCLEAR ANTIBODY

Facility

$65.00

Service Code	HCPCS 86255
Hospital Charge Code	3003725
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$55.25
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
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	$45.50
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$45.50
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

ANTI NEUTROPHIL ANTIBODY

Facility

$170.00

Hospital Charge Code	3000147
Hospital Revenue Code	302
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$144.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Community Health Alliance Commercial	$144.50
Rate for Payer: Priority Health Commercial	$119.00
Rate for Payer: Priority Health PPO	$119.00

ANTI OMPC IGA

Facility

$103.00

Hospital Charge Code	3000827
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

ANTIPHOSPHOLIPID ANTI IGG IGM

Facility

$113.00

Service Code	HCPCS 86148
Hospital Charge Code	3000519
Hospital Revenue Code	302
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$96.05
Rate for Payer: BCBS BCN 65	$16.87
Rate for Payer: Blue Care Network Medicare Advantage	$16.87
Rate for Payer: Cash Price	$73.45
Rate for Payer: Cash Price	$73.45
Rate for Payer: Community Health Alliance Commercial	$96.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.87
Rate for Payer: Meridian Health Plan Medicare	$16.87
Rate for Payer: Priority Health Commercial	$79.10
Rate for Payer: Priority Health Medicaid	$16.87
Rate for Payer: Priority Health Medicare	$16.87
Rate for Payer: Priority Health PPO	$79.10
Rate for Payer: United Health Care Medicaid	$16.87
Rate for Payer: United Health Care Medicare Advantage	$7.42

ANTI-PM/POLYMGOCITIS SERUM

Facility

$66.00

Service Code	HCPCS 86235
Hospital Charge Code	3001150
Hospital Revenue Code	302
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$56.10
Rate for Payer: BCBS BCN 65	$18.83
Rate for Payer: Blue Care Network Medicare Advantage	$18.83
Rate for Payer: Cash Price	$42.90
Rate for Payer: Cash Price	$42.90
Rate for Payer: Community Health Alliance Commercial	$56.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.83
Rate for Payer: Meridian Health Plan Medicare	$18.83
Rate for Payer: Priority Health Commercial	$46.20
Rate for Payer: Priority Health Medicaid	$18.83
Rate for Payer: Priority Health Medicare	$18.83
Rate for Payer: Priority Health PPO	$46.20
Rate for Payer: United Health Care Medicaid	$18.83
Rate for Payer: United Health Care Medicare Advantage	$8.28

ANTI-RETICULIN

Facility

$3.67

Service Code	HCPCS 86255
Hospital Charge Code	3002931
Hospital Revenue Code	302
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$12.65
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cash Price	$2.39
Rate for Payer: Community Health Alliance Commercial	$3.12
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	$2.57
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$2.57
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

ANTI-RNP

Facility

$1.00

Service Code	HCPCS 86235
Hospital Charge Code	3003072
Hospital Revenue Code	302
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$18.83
Rate for Payer: BCBS BCN 65	$18.83
Rate for Payer: Blue Care Network Medicare Advantage	$18.83
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.65
Rate for Payer: Community Health Alliance Commercial	$0.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.83
Rate for Payer: Meridian Health Plan Medicare	$18.83
Rate for Payer: Priority Health Commercial	$0.70
Rate for Payer: Priority Health Medicaid	$18.83
Rate for Payer: Priority Health Medicare	$18.83
Rate for Payer: Priority Health PPO	$0.70
Rate for Payer: United Health Care Medicaid	$18.83
Rate for Payer: United Health Care Medicare Advantage	$8.28

ANTI-SACCHAROMYCES CERVISIAE

Facility

$68.00

Hospital Charge Code	3100524
Hospital Revenue Code	302
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

ANTI-SACCHAROMYCES CERVISIAE

Facility

$5.00

Hospital Charge Code	3002915
Hospital Revenue Code	302
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$4.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health PPO	$3.50

ANTI-SMITH

Facility

$4.77

Service Code	HCPCS 86235
Hospital Charge Code	3003071
Hospital Revenue Code	302
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$18.83
Rate for Payer: BCBS BCN 65	$18.83
Rate for Payer: Blue Care Network Medicare Advantage	$18.83
Rate for Payer: Cash Price	$3.10
Rate for Payer: Cash Price	$3.10
Rate for Payer: Community Health Alliance Commercial	$4.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.83
Rate for Payer: Meridian Health Plan Medicare	$18.83
Rate for Payer: Priority Health Commercial	$3.34
Rate for Payer: Priority Health Medicaid	$18.83
Rate for Payer: Priority Health Medicare	$18.83
Rate for Payer: Priority Health PPO	$3.34
Rate for Payer: United Health Care Medicaid	$18.83
Rate for Payer: United Health Care Medicare Advantage	$8.28

ANTI SMOOTH MUSCLE ANTIBODY

Facility

$61.00

Service Code	HCPCS 86255
Hospital Charge Code	3000970
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$51.85
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Community Health Alliance Commercial	$51.85
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	$42.70
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$42.70
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

ANTI-SP-100 AB (RDL)-LC

Facility

$95.00

Hospital Charge Code	3102673
Hospital Revenue Code	300
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$80.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
Rate for Payer: Priority Health Commercial	$66.50
Rate for Payer: Priority Health PPO	$66.50

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges