Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

X AMA IFA WITH REFLUX TO 11 MA

Facility

$72.25

Hospital Charge Code	3102555
Hospital Revenue Code	300
Min. Negotiated Rate	$50.58
Max. Negotiated Rate	$61.41
Rate for Payer: Cash Price	$46.96
Rate for Payer: Community Health Alliance Commercial	$61.41
Rate for Payer: Priority Health Commercial	$50.58
Rate for Payer: Priority Health PPO	$50.58

XAMPHETAMINE QUANT URINE

Facility

$35.00

Hospital Charge Code	3101335
Hospital Revenue Code	310
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

X AMPH/METH/MDMA.MDA WB

Facility

$33.00

Hospital Charge Code	3102107
Hospital Revenue Code	300
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$28.05
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health PPO	$23.10

X AMYLASE ISOENZYNE

Facility

$23.62

Hospital Charge Code	3102101
Hospital Revenue Code	300
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$20.08
Rate for Payer: Cash Price	$15.35
Rate for Payer: Community Health Alliance Commercial	$20.08
Rate for Payer: Priority Health Commercial	$16.53
Rate for Payer: Priority Health PPO	$16.53

X ANA COMP PLUS PROFILE

Facility

$88.11

Hospital Charge Code	3100012
Hospital Revenue Code	302
Min. Negotiated Rate	$61.68
Max. Negotiated Rate	$74.89
Rate for Payer: Cash Price	$57.27
Rate for Payer: Community Health Alliance Commercial	$74.89
Rate for Payer: Priority Health Commercial	$61.68
Rate for Payer: Priority Health PPO	$61.68

X ANA NEG REFLEX

Facility

$133.50

Hospital Charge Code	3102636
Hospital Revenue Code	300
Min. Negotiated Rate	$93.45
Max. Negotiated Rate	$113.47
Rate for Payer: Cash Price	$86.78
Rate for Payer: Community Health Alliance Commercial	$113.47
Rate for Payer: Priority Health Commercial	$93.45
Rate for Payer: Priority Health PPO	$93.45

X ANA POS REFLEX

Facility

$910.00

Hospital Charge Code	3102594
Hospital Revenue Code	300
Min. Negotiated Rate	$637.00
Max. Negotiated Rate	$773.50
Rate for Payer: Cash Price	$591.50
Rate for Payer: Community Health Alliance Commercial	$773.50
Rate for Payer: Priority Health Commercial	$637.00
Rate for Payer: Priority Health PPO	$637.00

XANAX (ALPRAZOLAM)

Facility

$28.00

Service Code	HCPCS G0480
Hospital Charge Code	3008951
Hospital Revenue Code	301
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$19.60
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

X ANCA

Facility

$31.80

Hospital Charge Code	3101672
Hospital Revenue Code	300
Min. Negotiated Rate	$22.26
Max. Negotiated Rate	$27.03
Rate for Payer: Cash Price	$20.67
Rate for Payer: Community Health Alliance Commercial	$27.03
Rate for Payer: Priority Health Commercial	$22.26
Rate for Payer: Priority Health PPO	$22.26

X ANCA

Facility

$7.41

Hospital Charge Code	3101668
Hospital Revenue Code	300
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$6.30
Rate for Payer: Cash Price	$4.82
Rate for Payer: Community Health Alliance Commercial	$6.30
Rate for Payer: Priority Health Commercial	$5.19
Rate for Payer: Priority Health PPO	$5.19

X ANCA W/REFLUX MPO/PR3

Facility

$22.00

Hospital Charge Code	3102152
Hospital Revenue Code	300
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$18.70
Rate for Payer: Cash Price	$14.30
Rate for Payer: Community Health Alliance Commercial	$18.70
Rate for Payer: Priority Health Commercial	$15.40
Rate for Payer: Priority Health PPO	$15.40

XANTHINE

Facility

$50.00

Hospital Charge Code	3100841
Hospital Revenue Code	300
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

X ANTIDEPRESSANE DRUG PANEL, U

Facility

$67.75

Hospital Charge Code	3101673
Hospital Revenue Code	300
Min. Negotiated Rate	$47.42
Max. Negotiated Rate	$57.59
Rate for Payer: Cash Price	$44.04
Rate for Payer: Community Health Alliance Commercial	$57.59
Rate for Payer: Priority Health Commercial	$47.42
Rate for Payer: Priority Health PPO	$47.42

X ANTIGLIAD

Facility

$7.34

Hospital Charge Code	3000915
Hospital Revenue Code	301
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$6.24
Rate for Payer: Cash Price	$4.77
Rate for Payer: Community Health Alliance Commercial	$6.24
Rate for Payer: Priority Health Commercial	$5.14
Rate for Payer: Priority Health PPO	$5.14

X ANTI-SMOOTH MUSCLE/MITOCHOND

Facility

$11.24

Hospital Charge Code	3101806
Hospital Revenue Code	300
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$9.55
Rate for Payer: Cash Price	$7.31
Rate for Payer: Community Health Alliance Commercial	$9.55
Rate for Payer: Priority Health Commercial	$7.87
Rate for Payer: Priority Health PPO	$7.87

X APCR AT3 FUNC CARD

Facility

$977.50

Hospital Charge Code	3101979
Hospital Revenue Code	300
Min. Negotiated Rate	$684.25
Max. Negotiated Rate	$830.88
Rate for Payer: Cash Price	$635.38
Rate for Payer: Community Health Alliance Commercial	$830.88
Rate for Payer: Priority Health Commercial	$684.25
Rate for Payer: Priority Health PPO	$684.25

X APO A1+B+RATIO

Facility

$12.72

Hospital Charge Code	3102674
Hospital Revenue Code	300
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$10.81
Rate for Payer: Cash Price	$8.27
Rate for Payer: Community Health Alliance Commercial	$10.81
Rate for Payer: Priority Health Commercial	$8.90
Rate for Payer: Priority Health PPO	$8.90

X AQUAPORIN 4 REC AB IGG W/RE

Facility

$375.00

Hospital Charge Code	3102354
Hospital Revenue Code	300
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$318.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Community Health Alliance Commercial	$318.75
Rate for Payer: Priority Health Commercial	$262.50
Rate for Payer: Priority Health PPO	$262.50

X ARBOVIRUS IGG & IGM ANTIBODI

Facility

$230.00

Hospital Charge Code	3100762
Hospital Revenue Code	302
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$195.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Community Health Alliance Commercial	$195.50
Rate for Payer: Priority Health Commercial	$161.00
Rate for Payer: Priority Health PPO	$161.00

X ARBOVIRUS IGG/IGM CSF

Facility

$270.00

Hospital Charge Code	3102053
Hospital Revenue Code	300
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$229.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Community Health Alliance Commercial	$229.50
Rate for Payer: Priority Health Commercial	$189.00
Rate for Payer: Priority Health PPO	$189.00

X ARSENIC URINE

Facility

$10.00

Hospital Charge Code	3102176
Hospital Revenue Code	300
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health PPO	$7.00

X ARTHRITIC PROFILE

Facility

$322.00

Hospital Charge Code	3008990
Hospital Revenue Code	302
Min. Negotiated Rate	$225.40
Max. Negotiated Rate	$273.70
Rate for Payer: Cash Price	$209.30
Rate for Payer: Community Health Alliance Commercial	$273.70
Rate for Payer: Priority Health Commercial	$225.40
Rate for Payer: Priority Health PPO	$225.40

X ASPERGILLUS AB

Facility

$13.60

Hospital Charge Code	3101944
Hospital Revenue Code	300
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$11.56
Rate for Payer: Cash Price	$8.84
Rate for Payer: Community Health Alliance Commercial	$11.56
Rate for Payer: Priority Health Commercial	$9.52
Rate for Payer: Priority Health PPO	$9.52

X ASPIRIN RESISTANCE

Facility

$97.00

Hospital Charge Code	3100763
Hospital Revenue Code	301
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.05
Rate for Payer: Community Health Alliance Commercial	$82.45
Rate for Payer: Priority Health Commercial	$67.90
Rate for Payer: Priority Health PPO	$67.90

X BABESIA MICROTOTI IGG/IGM

Facility

$14.10

Hospital Charge Code	3101606
Hospital Revenue Code	300
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$11.98
Rate for Payer: Cash Price	$9.17
Rate for Payer: Community Health Alliance Commercial	$11.98
Rate for Payer: Priority Health Commercial	$9.87
Rate for Payer: Priority Health PPO	$9.87

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges