Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

X HISTOPLASMA CAPSULATION AB

Facility

$41.50

Hospital Charge Code	3009416
Hospital Revenue Code	302
Min. Negotiated Rate	$29.05
Max. Negotiated Rate	$35.27
Rate for Payer: Cash Price	$26.98
Rate for Payer: Community Health Alliance Commercial	$35.27
Rate for Payer: Priority Health Commercial	$29.05
Rate for Payer: Priority Health PPO	$29.05

X HIV-1 AND 2 AB DIFF W/REF

Facility

$75.90

Hospital Charge Code	3101330
Hospital Revenue Code	302
Min. Negotiated Rate	$53.13
Max. Negotiated Rate	$64.52
Rate for Payer: Cash Price	$49.34
Rate for Payer: Community Health Alliance Commercial	$64.52
Rate for Payer: Priority Health Commercial	$53.13
Rate for Payer: Priority Health PPO	$53.13

X HIV-1 GENOSURE (R) MG GENOTY

Facility

$265.00

Hospital Charge Code	3101638
Hospital Revenue Code	300
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$225.25
Rate for Payer: Cash Price	$172.25
Rate for Payer: Community Health Alliance Commercial	$225.25
Rate for Payer: Priority Health Commercial	$185.50
Rate for Payer: Priority Health PPO	$185.50

X HIV PHENOTYPE

Facility

$718.00

Hospital Charge Code	3000814
Hospital Revenue Code	306
Min. Negotiated Rate	$502.60
Max. Negotiated Rate	$610.30
Rate for Payer: Cash Price	$466.70
Rate for Payer: Community Health Alliance Commercial	$610.30
Rate for Payer: Priority Health Commercial	$502.60
Rate for Payer: Priority Health PPO	$502.60

X HLA II TYPING 1 LOCUS LR

Facility

$404.00

Hospital Charge Code	3100817
Hospital Revenue Code	300
Min. Negotiated Rate	$282.80
Max. Negotiated Rate	$343.40
Rate for Payer: Cash Price	$262.60
Rate for Payer: Community Health Alliance Commercial	$343.40
Rate for Payer: Priority Health Commercial	$282.80
Rate for Payer: Priority Health PPO	$282.80

X HLON MITOCHONRIAL DISORDERS

Facility

$4,894.76

Hospital Charge Code	3101443
Hospital Revenue Code	300
Min. Negotiated Rate	$3,426.33
Max. Negotiated Rate	$4,160.55
Rate for Payer: Cash Price	$3,181.59
Rate for Payer: Community Health Alliance Commercial	$4,160.55
Rate for Payer: Priority Health Commercial	$3,426.33
Rate for Payer: Priority Health PPO	$3,426.33

X HRT FEMALE POST PELLET

Facility

$12.26

Hospital Charge Code	3102097
Hospital Revenue Code	300
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$10.42
Rate for Payer: Cash Price	$7.97
Rate for Payer: Community Health Alliance Commercial	$10.42
Rate for Payer: Priority Health Commercial	$8.58
Rate for Payer: Priority Health PPO	$8.58

X HRT MALE POST PELLET

Facility

$21.92

Hospital Charge Code	3102092
Hospital Revenue Code	300
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$18.63
Rate for Payer: Cash Price	$14.25
Rate for Payer: Community Health Alliance Commercial	$18.63
Rate for Payer: Priority Health Commercial	$15.34
Rate for Payer: Priority Health PPO	$15.34

X HSV IGM + HSV1 IFF

Facility

$15.70

Hospital Charge Code	3101833
Hospital Revenue Code	300
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$13.35
Rate for Payer: Cash Price	$10.21
Rate for Payer: Community Health Alliance Commercial	$13.35
Rate for Payer: Priority Health Commercial	$10.99
Rate for Payer: Priority Health PPO	$10.99

X HUMAN GRANULOCYTIC EHRLICHI

Facility

$61.50

Hospital Charge Code	3101605
Hospital Revenue Code	300
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$52.27
Rate for Payer: Cash Price	$39.98
Rate for Payer: Community Health Alliance Commercial	$52.27
Rate for Payer: Priority Health Commercial	$43.05
Rate for Payer: Priority Health PPO	$43.05

X HUMAN MONOCYTIC ERLICHIOSIS

Facility

$30.00

Hospital Charge Code	3004065
Hospital Revenue Code	305
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 HYMENOPTRA VENOM ALLERGY PRO

Facility

$71.57

Hospital Charge Code	3102558
Hospital Revenue Code	300
Min. Negotiated Rate	$50.10
Max. Negotiated Rate	$60.83
Rate for Payer: Cash Price	$46.52
Rate for Payer: Community Health Alliance Commercial	$60.83
Rate for Payer: Priority Health Commercial	$50.10
Rate for Payer: Priority Health PPO	$50.10

X HYPERSENSITIVITY PNEUMONITIT

Facility

$125.00

Hospital Charge Code	3101628
Hospital Revenue Code	300
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$106.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Community Health Alliance Commercial	$106.25
Rate for Payer: Priority Health Commercial	$87.50
Rate for Payer: Priority Health PPO	$87.50

X ID&SUSCUR

Facility

$37.58

Hospital Charge Code	3101953
Hospital Revenue Code	300
Min. Negotiated Rate	$26.31
Max. Negotiated Rate	$31.94
Rate for Payer: Cash Price	$24.43
Rate for Payer: Community Health Alliance Commercial	$31.94
Rate for Payer: Priority Health Commercial	$26.31
Rate for Payer: Priority Health PPO	$26.31

X IFE REFLEX

Facility

$9.36

Hospital Charge Code	3101856
Hospital Revenue Code	300
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$7.96
Rate for Payer: Cash Price	$6.08
Rate for Payer: Community Health Alliance Commercial	$7.96
Rate for Payer: Priority Health Commercial	$6.55
Rate for Payer: Priority Health PPO	$6.55

X IGA SUBCLASSES 1&2

Facility

$29.82

Hospital Charge Code	3101234
Hospital Revenue Code	301
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$25.35
Rate for Payer: Cash Price	$19.38
Rate for Payer: Community Health Alliance Commercial	$25.35
Rate for Payer: Priority Health Commercial	$20.87
Rate for Payer: Priority Health PPO	$20.87

X IGG SUBCLASSES

Facility

$22.56

Hospital Charge Code	3101988
Hospital Revenue Code	300
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$19.18
Rate for Payer: Cash Price	$14.66
Rate for Payer: Community Health Alliance Commercial	$19.18
Rate for Payer: Priority Health Commercial	$15.79
Rate for Payer: Priority Health PPO	$15.79

X IgG SYN RATE CSF

Facility

$22.13

Hospital Charge Code	3100001
Hospital Revenue Code	301
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$18.81
Rate for Payer: Cash Price	$14.38
Rate for Payer: Community Health Alliance Commercial	$18.81
Rate for Payer: Priority Health Commercial	$15.49
Rate for Payer: Priority Health PPO	$15.49

X IGH/BCL2t(14;18)TRANSLOCATI

Facility

$94.00

Hospital Charge Code	3100844
Hospital Revenue Code	310
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 IGP APTIMA HPV

Facility

$42.00

Hospital Charge Code	3101868
Hospital Revenue Code	300
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

X IMMUNOCAP GI PROFILE

Facility

$680.00

Hospital Charge Code	3100697
Hospital Revenue Code	300
Min. Negotiated Rate	$476.00
Max. Negotiated Rate	$578.00
Rate for Payer: Cash Price	$442.00
Rate for Payer: Community Health Alliance Commercial	$578.00
Rate for Payer: Priority Health Commercial	$476.00
Rate for Payer: Priority Health PPO	$476.00

X IMMUNOFIXATION

Facility

$12.00

Hospital Charge Code	3101807
Hospital Revenue Code	300
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$10.20
Rate for Payer: Cash Price	$7.80
Rate for Payer: Community Health Alliance Commercial	$10.20
Rate for Payer: Priority Health Commercial	$8.40
Rate for Payer: Priority Health PPO	$8.40

X INFLAMMATORY BOWEL DIS PROFI

Facility

$17.41

Hospital Charge Code	3101793
Hospital Revenue Code	300
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$14.80
Rate for Payer: Cash Price	$11.32
Rate for Payer: Community Health Alliance Commercial	$14.80
Rate for Payer: Priority Health Commercial	$12.19
Rate for Payer: Priority Health PPO	$12.19

X INFLIXIMAB & ANTI INFLIXIMAB

Facility

$180.00

Hospital Charge Code	3102336
Hospital Revenue Code	300
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$153.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Community Health Alliance Commercial	$153.00
Rate for Payer: Priority Health Commercial	$126.00
Rate for Payer: Priority Health PPO	$126.00

X INFLIXIMAB IFX ACTIVITY

Facility

$340.00

Hospital Charge Code	3100928
Hospital Revenue Code	309
Min. Negotiated Rate	$238.00
Max. Negotiated Rate	$289.00
Rate for Payer: Cash Price	$221.00
Rate for Payer: Community Health Alliance Commercial	$289.00
Rate for Payer: Priority Health Commercial	$238.00
Rate for Payer: Priority Health PPO	$238.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges