Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

X PAP DIAGNOSTIC/HPV

Facility

$67.50

Hospital Charge Code	3101620
Hospital Revenue Code	311
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$57.38
Rate for Payer: Cash Price	$43.88
Rate for Payer: Community Health Alliance Commercial	$57.38
Rate for Payer: Priority Health Commercial	$47.25
Rate for Payer: Priority Health PPO	$47.25

X PAP SCREENING/HPV

Facility

$67.50

Hospital Charge Code	3101621
Hospital Revenue Code	311
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$57.38
Rate for Payer: Cash Price	$43.88
Rate for Payer: Community Health Alliance Commercial	$57.38
Rate for Payer: Priority Health Commercial	$47.25
Rate for Payer: Priority Health PPO	$47.25

X PARANEOPLASTIC

Facility

$900.00

Hospital Charge Code	3102130
Hospital Revenue Code	300
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$765.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Community Health Alliance Commercial	$765.00
Rate for Payer: Priority Health Commercial	$630.00
Rate for Payer: Priority Health PPO	$630.00

XPARANEOPLASTIC AUTO AB EVAL

Facility

$565.00

Hospital Charge Code	3101180
Hospital Revenue Code	301
Min. Negotiated Rate	$395.50
Max. Negotiated Rate	$480.25
Rate for Payer: Cash Price	$367.25
Rate for Payer: Community Health Alliance Commercial	$480.25
Rate for Payer: Priority Health Commercial	$395.50
Rate for Payer: Priority Health PPO	$395.50

X PARANEPLASTIC PROFILE 1

Facility

$831.75

Hospital Charge Code	3102399
Hospital Revenue Code	300
Min. Negotiated Rate	$582.23
Max. Negotiated Rate	$706.99
Rate for Payer: Cash Price	$540.64
Rate for Payer: Community Health Alliance Commercial	$706.99
Rate for Payer: Priority Health Commercial	$582.23
Rate for Payer: Priority Health PPO	$582.23

X PARASITE STAIN MODIFIED ACID

Facility

$43.00

Hospital Charge Code	3100734
Hospital Revenue Code	306
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$36.55
Rate for Payer: Cash Price	$27.95
Rate for Payer: Community Health Alliance Commercial	$36.55
Rate for Payer: Priority Health Commercial	$30.10
Rate for Payer: Priority Health PPO	$30.10

XPAROXYSMAL NOCTURNAL HEMOGLO

Facility

$148.13

Hospital Charge Code	3101370
Hospital Revenue Code	310
Min. Negotiated Rate	$103.69
Max. Negotiated Rate	$125.91
Rate for Payer: Cash Price	$96.28
Rate for Payer: Community Health Alliance Commercial	$125.91
Rate for Payer: Priority Health Commercial	$103.69
Rate for Payer: Priority Health PPO	$103.69

X PAROXYSMAL NOCTURNAL HGBURIA

Facility

$645.00

Hospital Charge Code	3100736
Hospital Revenue Code	310
Min. Negotiated Rate	$451.50
Max. Negotiated Rate	$548.25
Rate for Payer: Cash Price	$419.25
Rate for Payer: Community Health Alliance Commercial	$548.25
Rate for Payer: Priority Health Commercial	$451.50
Rate for Payer: Priority Health PPO	$451.50

XPARVOVIRUS B19 IGG/IGM

Facility

$22.80

Hospital Charge Code	3101391
Hospital Revenue Code	300
Min. Negotiated Rate	$15.96
Max. Negotiated Rate	$19.38
Rate for Payer: Cash Price	$14.82
Rate for Payer: Community Health Alliance Commercial	$19.38
Rate for Payer: Priority Health Commercial	$15.96
Rate for Payer: Priority Health PPO	$15.96

X PHA DT < 7 YEARS 5 ML VIAL

Facility

$263.89

Service Code	HCPCS 90702
Hospital Charge Code	2505087
Hospital Revenue Code	636
Min. Negotiated Rate	$184.72
Max. Negotiated Rate	$224.31
Rate for Payer: Cash Price	$171.53
Rate for Payer: Community Health Alliance Commercial	$224.31
Rate for Payer: Priority Health Commercial	$184.72
Rate for Payer: Priority Health PPO	$184.72

X PHENOSENSE GT

Facility

$950.00

Hospital Charge Code	3000624
Hospital Revenue Code	306
Min. Negotiated Rate	$665.00
Max. Negotiated Rate	$807.50
Rate for Payer: Cash Price	$617.50
Rate for Payer: Community Health Alliance Commercial	$807.50
Rate for Payer: Priority Health Commercial	$665.00
Rate for Payer: Priority Health PPO	$665.00

X PHOSPHYTIDAL AB IGG/IGM/IGA

Facility

$19.50

Hospital Charge Code	3101426
Hospital Revenue Code	300
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

X PMEUMANT AB I6

Facility

$81.70

Hospital Charge Code	3102036
Hospital Revenue Code	300
Min. Negotiated Rate	$57.19
Max. Negotiated Rate	$69.44
Rate for Payer: Cash Price	$53.11
Rate for Payer: Community Health Alliance Commercial	$69.44
Rate for Payer: Priority Health Commercial	$57.19
Rate for Payer: Priority Health PPO	$57.19

X PNEUMANT 14

Facility

$48.10

Hospital Charge Code	3101383
Hospital Revenue Code	300
Min. Negotiated Rate	$33.67
Max. Negotiated Rate	$40.88
Rate for Payer: Cash Price	$31.27
Rate for Payer: Community Health Alliance Commercial	$40.88
Rate for Payer: Priority Health Commercial	$33.67
Rate for Payer: Priority Health PPO	$33.67

X PROMETHEUS ANSER VOZ

Facility

$125.00

Hospital Charge Code	3101541
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 PROM IBD sgi DIAGNOSTIC

Facility

$552.00

Hospital Charge Code	3101549
Hospital Revenue Code	310
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$469.20
Rate for Payer: Cash Price	$358.80
Rate for Payer: Community Health Alliance Commercial	$469.20
Rate for Payer: Priority Health Commercial	$386.40
Rate for Payer: Priority Health PPO	$386.40

X PROSTATE BIOPSY 12 SPECIMEN

Facility

$201.12

Hospital Charge Code	3101212
Hospital Revenue Code	310
Min. Negotiated Rate	$140.78
Max. Negotiated Rate	$170.95
Rate for Payer: Cash Price	$130.73
Rate for Payer: Community Health Alliance Commercial	$170.95
Rate for Payer: Priority Health Commercial	$140.78
Rate for Payer: Priority Health PPO	$140.78

X PROSTHETIC JOINT INFECTION

Facility

$58.68

Hospital Charge Code	3101261
Hospital Revenue Code	300
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$49.88
Rate for Payer: Cash Price	$38.14
Rate for Payer: Community Health Alliance Commercial	$49.88
Rate for Payer: Priority Health Commercial	$41.08
Rate for Payer: Priority Health PPO	$41.08

X PROTEIN/CREATININE RATIO RAN

Facility

$4.25

Hospital Charge Code	3002885
Hospital Revenue Code	301
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$3.61
Rate for Payer: Cash Price	$2.76
Rate for Payer: Community Health Alliance Commercial	$3.61
Rate for Payer: Priority Health Commercial	$2.98
Rate for Payer: Priority Health PPO	$2.98

X PROTEIN S ANTIGEN

Facility

$32.00

Hospital Charge Code	3101600
Hospital Revenue Code	300
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$20.80
Rate for Payer: Community Health Alliance Commercial	$27.20
Rate for Payer: Priority Health Commercial	$22.40
Rate for Payer: Priority Health PPO	$22.40

XPSEUDOCHOLINESTERASE WITH DIB

Facility

$7.60

Hospital Charge Code	3002666
Hospital Revenue Code	301
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$6.46
Rate for Payer: Cash Price	$4.94
Rate for Payer: Community Health Alliance Commercial	$6.46
Rate for Payer: Priority Health Commercial	$5.32
Rate for Payer: Priority Health PPO	$5.32

X PTH N TERMINAL

Facility

$8.05

Hospital Charge Code	3101828
Hospital Revenue Code	300
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$6.84
Rate for Payer: Cash Price	$5.23
Rate for Payer: Community Health Alliance Commercial	$6.84
Rate for Payer: Priority Health Commercial	$5.63
Rate for Payer: Priority Health PPO	$5.63

X PTN/DIL FREE AND TOTAL LC

Facility

$15.70

Hospital Charge Code	3102692
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 Q FEVER AB

Facility

$112.00

Hospital Charge Code	3002715
Hospital Revenue Code	302
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$95.20
Rate for Payer: Cash Price	$72.80
Rate for Payer: Community Health Alliance Commercial	$95.20
Rate for Payer: Priority Health Commercial	$78.40
Rate for Payer: Priority Health PPO	$78.40

XR ABDOMEN 1 VIEW (KUB)

Facility

$155.00

Service Code	HCPCS 74018
Hospital Charge Code	3200011
Hospital Revenue Code	320
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$131.75
Rate for Payer: BCBS BCN 65	$93.36
Rate for Payer: Blue Care Network Medicare Advantage	$93.36
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Community Health Alliance Commercial	$131.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$93.36
Rate for Payer: Meridian Health Plan Medicare	$93.36
Rate for Payer: Priority Health Commercial	$108.50
Rate for Payer: Priority Health Medicaid	$93.36
Rate for Payer: Priority Health Medicare	$93.36
Rate for Payer: Priority Health PPO	$108.50
Rate for Payer: United Health Care Medicaid	$93.36
Rate for Payer: United Health Care Medicare Advantage	$41.08

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges