Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

X MPO/PR3

Facility

$26.22

Hospital Charge Code	3102156
Hospital Revenue Code	300
Min. Negotiated Rate	$18.35
Max. Negotiated Rate	$22.29
Rate for Payer: Cash Price	$17.04
Rate for Payer: Community Health Alliance Commercial	$22.29
Rate for Payer: Priority Health Commercial	$18.35
Rate for Payer: Priority Health PPO	$18.35

XMRAS MUTATION DET PYROSEQUENC

Facility

$395.00

Hospital Charge Code	3101360
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-MSH2 GENE SEQ

Facility

$1,053.00

Hospital Charge Code	3100933
Hospital Revenue Code	309
Min. Negotiated Rate	$737.10
Max. Negotiated Rate	$895.05
Rate for Payer: Cash Price	$684.45
Rate for Payer: Community Health Alliance Commercial	$895.05
Rate for Payer: Priority Health Commercial	$737.10
Rate for Payer: Priority Health PPO	$737.10

X MULTIPLE MYELOMA PANEL

Facility

$816.00

Hospital Charge Code	3101182
Hospital Revenue Code	310
Min. Negotiated Rate	$571.20
Max. Negotiated Rate	$693.60
Rate for Payer: Cash Price	$530.40
Rate for Payer: Community Health Alliance Commercial	$693.60
Rate for Payer: Priority Health Commercial	$571.20
Rate for Payer: Priority Health PPO	$571.20

X MULTIPLE SCLEROSIS PANEL

Facility

$49.74

Hospital Charge Code	3006110
Hospital Revenue Code	301
Min. Negotiated Rate	$34.82
Max. Negotiated Rate	$42.28
Rate for Payer: Cash Price	$32.33
Rate for Payer: Community Health Alliance Commercial	$42.28
Rate for Payer: Priority Health Commercial	$34.82
Rate for Payer: Priority Health PPO	$34.82

X MYCOPLASMA, PNEU IGG/IGM ABS

Facility

$11.40

Hospital Charge Code	3101830
Hospital Revenue Code	300
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$9.69
Rate for Payer: Cash Price	$7.41
Rate for Payer: Community Health Alliance Commercial	$9.69
Rate for Payer: Priority Health Commercial	$7.98
Rate for Payer: Priority Health PPO	$7.98

X MYCOPLASMA PROFILE-GENT UR

Facility

$50.00

Hospital Charge Code	3102031
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 MYEL

Facility

$48.76

Hospital Charge Code	3102124
Hospital Revenue Code	300
Min. Negotiated Rate	$34.13
Max. Negotiated Rate	$41.45
Rate for Payer: Cash Price	$31.69
Rate for Payer: Community Health Alliance Commercial	$41.45
Rate for Payer: Priority Health Commercial	$34.13
Rate for Payer: Priority Health PPO	$34.13

XMYELIN ANTIBODIES,IgA,IgG,IgM

Facility

$232.00

Hospital Charge Code	3005205
Hospital Revenue Code	301
Min. Negotiated Rate	$162.40
Max. Negotiated Rate	$197.20
Rate for Payer: Cash Price	$150.80
Rate for Payer: Community Health Alliance Commercial	$197.20
Rate for Payer: Priority Health Commercial	$162.40
Rate for Payer: Priority Health PPO	$162.40

X MYELOMA PANEL

Facility

$339.00

Hospital Charge Code	3006230
Hospital Revenue Code	302
Min. Negotiated Rate	$237.30
Max. Negotiated Rate	$288.15
Rate for Payer: Cash Price	$220.35
Rate for Payer: Community Health Alliance Commercial	$288.15
Rate for Payer: Priority Health Commercial	$237.30
Rate for Payer: Priority Health PPO	$237.30

X MYOSITIS PANEL

Facility

$19.43

Hospital Charge Code	3102013
Hospital Revenue Code	300
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$16.52
Rate for Payer: Cash Price	$12.63
Rate for Payer: Community Health Alliance Commercial	$16.52
Rate for Payer: Priority Health Commercial	$13.60
Rate for Payer: Priority Health PPO	$13.60

X MYSOLINE-PRIMIDONE INC

Facility

$10.88

Hospital Charge Code	3101820
Hospital Revenue Code	300
Min. Negotiated Rate	$7.62
Max. Negotiated Rate	$9.25
Rate for Payer: Cash Price	$7.07
Rate for Payer: Community Health Alliance Commercial	$9.25
Rate for Payer: Priority Health Commercial	$7.62
Rate for Payer: Priority Health PPO	$7.62

X NASH FIBROSURE

Facility

$250.00

Hospital Charge Code	3102171
Hospital Revenue Code	300
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$212.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Community Health Alliance Commercial	$212.50
Rate for Payer: Priority Health Commercial	$175.00
Rate for Payer: Priority Health PPO	$175.00

X NM CISTERNOGRAM

Facility

$1,008.00

Hospital Charge Code	3400310
Hospital Revenue Code	340
Min. Negotiated Rate	$705.60
Max. Negotiated Rate	$856.80
Rate for Payer: Cash Price	$655.20
Rate for Payer: Community Health Alliance Commercial	$856.80
Rate for Payer: Priority Health Commercial	$705.60
Rate for Payer: Priority Health PPO	$705.60

X NMEN TEIR IGG

Facility

$297.00

Hospital Charge Code	3102393
Hospital Revenue Code	300
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$252.45
Rate for Payer: Cash Price	$193.05
Rate for Payer: Community Health Alliance Commercial	$252.45
Rate for Payer: Priority Health Commercial	$207.90
Rate for Payer: Priority Health PPO	$207.90

X NM MYOCARDIUM STRESS/REST

Facility

$3,626.00

Hospital Charge Code	3400215
Hospital Revenue Code	340
Min. Negotiated Rate	$2,538.20
Max. Negotiated Rate	$3,082.10
Rate for Payer: Cash Price	$2,356.90
Rate for Payer: Community Health Alliance Commercial	$3,082.10
Rate for Payer: Priority Health Commercial	$2,538.20
Rate for Payer: Priority Health PPO	$2,538.20

X NMR LIPOPROFILE

Facility

$137.00

Hospital Charge Code	3100717
Hospital Revenue Code	301
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$116.45
Rate for Payer: Cash Price	$89.05
Rate for Payer: Community Health Alliance Commercial	$116.45
Rate for Payer: Priority Health Commercial	$95.90
Rate for Payer: Priority Health PPO	$95.90

X NMR LIPOROTEIN W/ INSULIN

Facility

$32.61

Hospital Charge Code	3101486
Hospital Revenue Code	300
Min. Negotiated Rate	$22.83
Max. Negotiated Rate	$27.72
Rate for Payer: Cash Price	$21.20
Rate for Payer: Community Health Alliance Commercial	$27.72
Rate for Payer: Priority Health Commercial	$22.83
Rate for Payer: Priority Health PPO	$22.83

X NM SENTINEL NODE IMAGING

Facility

$2,001.00

Hospital Charge Code	3400265
Hospital Revenue Code	340
Min. Negotiated Rate	$1,400.70
Max. Negotiated Rate	$1,700.85
Rate for Payer: Cash Price	$1,300.65
Rate for Payer: Community Health Alliance Commercial	$1,700.85
Rate for Payer: Priority Health Commercial	$1,400.70
Rate for Payer: Priority Health PPO	$1,400.70

X NTX URINE

Facility

$16.29

Hospital Charge Code	3101781
Hospital Revenue Code	300
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$13.85
Rate for Payer: Cash Price	$10.59
Rate for Payer: Community Health Alliance Commercial	$13.85
Rate for Payer: Priority Health Commercial	$11.40
Rate for Payer: Priority Health PPO	$11.40

X OPIATE/OXYCODONE CONF URINE

Facility

$170.00

Hospital Charge Code	3101777
Hospital Revenue Code	300
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

X OPIATES/OPIOIDS SCREEN URIN

Facility

$20.00

Hospital Charge Code	3100873
Hospital Revenue Code	301
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$17.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health PPO	$14.00

XOPIATES QUANT S/P

Facility

$50.00

Hospital Charge Code	3101353
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 O&P TRAVELERS

Facility

$8.75

Hospital Charge Code	3102120
Hospital Revenue Code	300
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$7.44
Rate for Payer: Cash Price	$5.69
Rate for Payer: Community Health Alliance Commercial	$7.44
Rate for Payer: Priority Health Commercial	$6.12
Rate for Payer: Priority Health PPO	$6.12

X OVA AND PARASTIE BF-SMBF

Facility

$19.50

Hospital Charge Code	3101264
Hospital Revenue Code	306
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$16.57
Rate for Payer: Cash Price	$12.68
Rate for Payer: Community Health Alliance Commercial	$16.57
Rate for Payer: Priority Health Commercial	$13.65
Rate for Payer: Priority Health PPO	$13.65

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges