Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

X FLOW MARKER X 3

Facility

$30.36

Hospital Charge Code	3101871
Hospital Revenue Code	300
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$25.81
Rate for Payer: Cash Price	$19.73
Rate for Payer: Community Health Alliance Commercial	$25.81
Rate for Payer: Priority Health Commercial	$21.25
Rate for Payer: Priority Health PPO	$21.25

X FLOW MARKER X 5

Facility

$50.60

Hospital Charge Code	3101872
Hospital Revenue Code	300
Min. Negotiated Rate	$35.42
Max. Negotiated Rate	$43.01
Rate for Payer: Cash Price	$32.89
Rate for Payer: Community Health Alliance Commercial	$43.01
Rate for Payer: Priority Health Commercial	$35.42
Rate for Payer: Priority Health PPO	$35.42

X FLU A/B W/REFLEX TO QUAL PCR

Facility

$83.40

Hospital Charge Code	3101207
Hospital Revenue Code	306
Min. Negotiated Rate	$58.38
Max. Negotiated Rate	$70.89
Rate for Payer: Cash Price	$54.21
Rate for Payer: Community Health Alliance Commercial	$70.89
Rate for Payer: Priority Health Commercial	$58.38
Rate for Payer: Priority Health PPO	$58.38

X FOLATE RBS

Facility

$5.10

Hospital Charge Code	3101837
Hospital Revenue Code	300
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$4.33
Rate for Payer: Cash Price	$3.32
Rate for Payer: Community Health Alliance Commercial	$4.33
Rate for Payer: Priority Health Commercial	$3.57
Rate for Payer: Priority Health PPO	$3.57

X FOOD PROFILE VIII IGG4

Facility

$156.00

Hospital Charge Code	3100730
Hospital Revenue Code	302
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$132.60
Rate for Payer: Cash Price	$101.40
Rate for Payer: Community Health Alliance Commercial	$132.60
Rate for Payer: Priority Health Commercial	$109.20
Rate for Payer: Priority Health PPO	$109.20

X FRANCISSELLA TULARENSIS AB

Facility

$79.15

Hospital Charge Code	3002548
Hospital Revenue Code	302
Min. Negotiated Rate	$55.41
Max. Negotiated Rate	$67.28
Rate for Payer: Cash Price	$51.45
Rate for Payer: Community Health Alliance Commercial	$67.28
Rate for Payer: Priority Health Commercial	$55.41
Rate for Payer: Priority Health PPO	$55.41

X FREE AND TOTAL INSULIN

Facility

$9.77

Hospital Charge Code	3102334
Hospital Revenue Code	300
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$8.30
Rate for Payer: Cash Price	$6.35
Rate for Payer: Community Health Alliance Commercial	$8.30
Rate for Payer: Priority Health Commercial	$6.84
Rate for Payer: Priority Health PPO	$6.84

X FUNG AB DID

Facility

$25.82

Hospital Charge Code	3102069
Hospital Revenue Code	300
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$21.95
Rate for Payer: Cash Price	$16.78
Rate for Payer: Community Health Alliance Commercial	$21.95
Rate for Payer: Priority Health Commercial	$18.07
Rate for Payer: Priority Health PPO	$18.07

X FUNGAL AB BY CF/EIA W REFLUX

Facility

$110.00

Hospital Charge Code	3101678
Hospital Revenue Code	300
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$93.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Community Health Alliance Commercial	$93.50
Rate for Payer: Priority Health Commercial	$77.00
Rate for Payer: Priority Health PPO	$77.00

X FUNGAL ANTIBODIES ID SERUM

Facility

$280.00

Hospital Charge Code	3100863
Hospital Revenue Code	302
Min. Negotiated Rate	$196.00
Max. Negotiated Rate	$238.00
Rate for Payer: Cash Price	$182.00
Rate for Payer: Community Health Alliance Commercial	$238.00
Rate for Payer: Priority Health Commercial	$196.00
Rate for Payer: Priority Health PPO	$196.00

X GANGLIOSIDE AB

Facility

$108.00

Hospital Charge Code	3101251
Hospital Revenue Code	300
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$91.80
Rate for Payer: Cash Price	$70.20
Rate for Payer: Community Health Alliance Commercial	$91.80
Rate for Payer: Priority Health Commercial	$75.60
Rate for Payer: Priority Health PPO	$75.60

X GAUCHER DISEASE ENZYME

Facility

$210.00

Hospital Charge Code	3102517
Hospital Revenue Code	300
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$178.50
Rate for Payer: Cash Price	$136.50
Rate for Payer: Community Health Alliance Commercial	$178.50
Rate for Payer: Priority Health Commercial	$147.00
Rate for Payer: Priority Health PPO	$147.00

X GLUCOSE G PHOSPHATE DEHYDROG

Facility

$6.00

Hospital Charge Code	3102074
Hospital Revenue Code	300
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$5.10
Rate for Payer: Cash Price	$3.90
Rate for Payer: Community Health Alliance Commercial	$5.10
Rate for Payer: Priority Health Commercial	$4.20
Rate for Payer: Priority Health PPO	$4.20

X HBV SCREENING % DIAGNOSIS

Facility

$10.81

Hospital Charge Code	3102488
Hospital Revenue Code	300
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$9.19
Rate for Payer: Cash Price	$7.03
Rate for Payer: Community Health Alliance Commercial	$9.19
Rate for Payer: Priority Health Commercial	$7.57
Rate for Payer: Priority Health PPO	$7.57

X HEAVY METALS SCREEN BLOOD

Facility

$52.18

Hospital Charge Code	3005020
Hospital Revenue Code	301
Min. Negotiated Rate	$36.53
Max. Negotiated Rate	$44.35
Rate for Payer: Cash Price	$33.92
Rate for Payer: Community Health Alliance Commercial	$44.35
Rate for Payer: Priority Health Commercial	$36.53
Rate for Payer: Priority Health PPO	$36.53

X HELICOBACTER PYLORI

Facility

$17.31

Hospital Charge Code	3100794
Hospital Revenue Code	300
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$14.71
Rate for Payer: Cash Price	$11.25
Rate for Payer: Community Health Alliance Commercial	$14.71
Rate for Payer: Priority Health Commercial	$12.12
Rate for Payer: Priority Health PPO	$12.12

X HEMACHROMATOSIS GENE ANALYSI

Facility

$61.09

Hospital Charge Code	3005127
Hospital Revenue Code	301
Min. Negotiated Rate	$42.76
Max. Negotiated Rate	$51.93
Rate for Payer: Cash Price	$39.71
Rate for Payer: Community Health Alliance Commercial	$51.93
Rate for Payer: Priority Health Commercial	$42.76
Rate for Payer: Priority Health PPO	$42.76

X HEP C VIRUS NS5A DRUG RESIS

Facility

$410.00

Hospital Charge Code	3101508
Hospital Revenue Code	300
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$348.50
Rate for Payer: Cash Price	$266.50
Rate for Payer: Community Health Alliance Commercial	$348.50
Rate for Payer: Priority Health Commercial	$287.00
Rate for Payer: Priority Health PPO	$287.00

XHER2 (ERBB2) BY FISH PARRAFIN

Facility

$94.00

Hospital Charge Code	3100852
Hospital Revenue Code	301
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$79.90
Rate for Payer: Cash Price	$61.10
Rate for Payer: Community Health Alliance Commercial	$79.90
Rate for Payer: Priority Health Commercial	$65.80
Rate for Payer: Priority Health PPO	$65.80

X HEREDITARY SPEROCYTOSISIS EV

Facility

$285.00

Hospital Charge Code	3100948
Hospital Revenue Code	309
Min. Negotiated Rate	$199.50
Max. Negotiated Rate	$242.25
Rate for Payer: Cash Price	$185.25
Rate for Payer: Community Health Alliance Commercial	$242.25
Rate for Payer: Priority Health Commercial	$199.50
Rate for Payer: Priority Health PPO	$199.50

X HERPES ANTIBODY, IgG

Facility

$15.00

Hospital Charge Code	3000635
Hospital Revenue Code	302
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

X HERPES ANTIBODY, IgM

Facility

$82.00

Hospital Charge Code	3000636
Hospital Revenue Code	302
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$69.70
Rate for Payer: Cash Price	$53.30
Rate for Payer: Community Health Alliance Commercial	$69.70
Rate for Payer: Priority Health Commercial	$57.40
Rate for Payer: Priority Health PPO	$57.40

X HERPES IGG AND IGM 1,2

Facility

$179.00

Hospital Charge Code	3100851
Hospital Revenue Code	302
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$152.15
Rate for Payer: Cash Price	$116.35
Rate for Payer: Community Health Alliance Commercial	$152.15
Rate for Payer: Priority Health Commercial	$125.30
Rate for Payer: Priority Health PPO	$125.30

X HERPES IGM 1 AND 2

Facility

$30.00

Hospital Charge Code	3101609
Hospital Revenue Code	300
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$25.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health PPO	$21.00

X HGB/HCT-LC

Facility

$3.00

Hospital Charge Code	3101963
Hospital Revenue Code	300
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.55
Rate for Payer: Cash Price	$1.95
Rate for Payer: Community Health Alliance Commercial	$2.55
Rate for Payer: Priority Health Commercial	$2.10
Rate for Payer: Priority Health PPO	$2.10

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges