Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

X INFLUENZA A AND B SERUM

Facility

$14.10

Hospital Charge Code	3101568
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

X IRON AND TIBS

Facility

$4.07

Hospital Charge Code	3102018
Hospital Revenue Code	300
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$2.65
Rate for Payer: Community Health Alliance Commercial	$3.46
Rate for Payer: Priority Health Commercial	$2.85
Rate for Payer: Priority Health PPO	$2.85

X ISOLATED DYSTONIA EVALUATION

Facility

$1,250.00

Hospital Charge Code	3102367
Hospital Revenue Code	300
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$1,062.50
Rate for Payer: Cash Price	$812.50
Rate for Payer: Community Health Alliance Commercial	$1,062.50
Rate for Payer: Priority Health Commercial	$875.00
Rate for Payer: Priority Health PPO	$875.00

XKAPPA/LAMBDA FR LT CH (URINE)

Facility

$28.00

Hospital Charge Code	3101650
Hospital Revenue Code	300
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

XKAPPA/LAMLODA FR LT CHAI(SER)

Facility

$19.00

Hospital Charge Code	3009886
Hospital Revenue Code	301
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$16.15
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health PPO	$13.30

X KIDNEY STONE URINE COMB W/SA

Facility

$90.00

Hospital Charge Code	3101072
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

XKRAS MUTATION DETECTION BY

Facility

$395.00

Hospital Charge Code	3101349
Hospital Revenue Code	310
Min. Negotiated Rate	$276.50
Max. Negotiated Rate	$335.75
Rate for Payer: Cash Price	$256.75
Rate for Payer: Community Health Alliance Commercial	$335.75
Rate for Payer: Priority Health Commercial	$276.50
Rate for Payer: Priority Health PPO	$276.50

X KRASS BRAF

Facility

$1,450.00

Hospital Charge Code	3100676
Hospital Revenue Code	310
Min. Negotiated Rate	$1,015.00
Max. Negotiated Rate	$1,232.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Community Health Alliance Commercial	$1,232.50
Rate for Payer: Priority Health Commercial	$1,015.00
Rate for Payer: Priority Health PPO	$1,015.00

XLD ISOENZYMES

Facility

$6.07

Hospital Charge Code	3101811
Hospital Revenue Code	300
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$5.16
Rate for Payer: Cash Price	$3.95
Rate for Payer: Community Health Alliance Commercial	$5.16
Rate for Payer: Priority Health Commercial	$4.25
Rate for Payer: Priority Health PPO	$4.25

X LEAD URINE

Facility

$3.65

Hospital Charge Code	3102385
Hospital Revenue Code	300
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.10
Rate for Payer: Cash Price	$2.37
Rate for Payer: Community Health Alliance Commercial	$3.10
Rate for Payer: Priority Health Commercial	$2.56
Rate for Payer: Priority Health PPO	$2.56

X LEG SP PCR

Facility

$185.00

Hospital Charge Code	3102386
Hospital Revenue Code	300
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$157.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Community Health Alliance Commercial	$157.25
Rate for Payer: Priority Health Commercial	$129.50
Rate for Payer: Priority Health PPO	$129.50

X LIPOPROTEIN B/A RATIO

Facility

$67.00

Hospital Charge Code	3100553
Hospital Revenue Code	301
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$56.95
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health PPO	$46.90

X LIVER FIBROSIS FIBROMETER

Facility

$135.00

Hospital Charge Code	3101297
Hospital Revenue Code	301
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$114.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Community Health Alliance Commercial	$114.75
Rate for Payer: Priority Health Commercial	$94.50
Rate for Payer: Priority Health PPO	$94.50

X LUEKOCYTE LYSOSOMOL ENZYME

Facility

$264.00

Hospital Charge Code	3100887
Hospital Revenue Code	301
Min. Negotiated Rate	$184.80
Max. Negotiated Rate	$224.40
Rate for Payer: Cash Price	$171.60
Rate for Payer: Community Health Alliance Commercial	$224.40
Rate for Payer: Priority Health Commercial	$184.80
Rate for Payer: Priority Health PPO	$184.80

XLUNG CANCER LID PANEL W/KRAS

Facility

$1,095.00

Hospital Charge Code	3101363
Hospital Revenue Code	310
Min. Negotiated Rate	$766.50
Max. Negotiated Rate	$930.75
Rate for Payer: Cash Price	$711.75
Rate for Payer: Community Health Alliance Commercial	$930.75
Rate for Payer: Priority Health Commercial	$766.50
Rate for Payer: Priority Health PPO	$766.50

X LUPUS ANTICOAGULANT

Facility

$45.00

Hospital Charge Code	3101457
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

X LUPUS COMP PANEL

Facility

$53.23

Hospital Charge Code	3100599
Hospital Revenue Code	302
Min. Negotiated Rate	$37.26
Max. Negotiated Rate	$45.25
Rate for Payer: Cash Price	$34.60
Rate for Payer: Community Health Alliance Commercial	$45.25
Rate for Payer: Priority Health Commercial	$37.26
Rate for Payer: Priority Health PPO	$37.26

X LUPUS PANEL BASIC

Facility

$43.69

Hospital Charge Code	3101575
Hospital Revenue Code	300
Min. Negotiated Rate	$30.58
Max. Negotiated Rate	$37.14
Rate for Payer: Cash Price	$28.40
Rate for Payer: Community Health Alliance Commercial	$37.14
Rate for Payer: Priority Health Commercial	$30.58
Rate for Payer: Priority Health PPO	$30.58

X LYM AB CSF-LC

Facility

$103.00

Hospital Charge Code	3102098
Hospital Revenue Code	300
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

X LYME IGG/IGM REFLEX

Facility

$15.00

Hospital Charge Code	3102223
Hospital Revenue Code	300
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 LYM GB IGG IGM

Facility

$15.80

Hospital Charge Code	3100722
Hospital Revenue Code	302
Min. Negotiated Rate	$11.06
Max. Negotiated Rate	$13.43
Rate for Payer: Cash Price	$10.27
Rate for Payer: Community Health Alliance Commercial	$13.43
Rate for Payer: Priority Health Commercial	$11.06
Rate for Payer: Priority Health PPO	$11.06

X MICROABLUMIN SBMF

Facility

$5.26

Hospital Charge Code	3101141
Hospital Revenue Code	301
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$4.47
Rate for Payer: Cash Price	$3.42
Rate for Payer: Community Health Alliance Commercial	$4.47
Rate for Payer: Priority Health Commercial	$3.68
Rate for Payer: Priority Health PPO	$3.68

XMICROSATELLITE INSTABILITY PC

Facility

$300.00

Hospital Charge Code	3101342
Hospital Revenue Code	310
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$255.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Community Health Alliance Commercial	$255.00
Rate for Payer: Priority Health Commercial	$210.00
Rate for Payer: Priority Health PPO	$210.00

X MITOCHONDRIAL GENOME SEQ & D

Facility

$834.75

Hospital Charge Code	3102503
Hospital Revenue Code	300
Min. Negotiated Rate	$584.33
Max. Negotiated Rate	$709.54
Rate for Payer: Cash Price	$542.59
Rate for Payer: Community Health Alliance Commercial	$709.54
Rate for Payer: Priority Health Commercial	$584.33
Rate for Payer: Priority Health PPO	$584.33

X MMR BY IHC

Facility

$410.00

Hospital Charge Code	3100977
Hospital Revenue Code	310
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges