Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

XR VENOGRAM EXTREMITY/UNI L.

Facility

$1,379.00

Service Code	HCPCS 75820
Hospital Charge Code	3201021
Hospital Revenue Code	320
Min. Negotiated Rate	$743.01
Max. Negotiated Rate	$1,688.66
Rate for Payer: BCBS BCN 65	$1,688.66
Rate for Payer: Blue Care Network Medicare Advantage	$1,688.66
Rate for Payer: Cash Price	$896.35
Rate for Payer: Cash Price	$896.35
Rate for Payer: Community Health Alliance Commercial	$1,172.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,688.66
Rate for Payer: Meridian Health Plan Medicare	$1,688.66
Rate for Payer: Priority Health Commercial	$965.30
Rate for Payer: Priority Health Medicaid	$1,688.66
Rate for Payer: Priority Health Medicare	$1,688.66
Rate for Payer: Priority Health PPO	$965.30
Rate for Payer: United Health Care Medicaid	$1,688.66
Rate for Payer: United Health Care Medicare Advantage	$743.01

XR VENOGRAM EXTREMITY/UNI R.

Facility

$1,281.00

Service Code	HCPCS 75820
Hospital Charge Code	3201020
Hospital Revenue Code	320
Min. Negotiated Rate	$743.01
Max. Negotiated Rate	$1,688.66
Rate for Payer: BCBS BCN 65	$1,688.66
Rate for Payer: Blue Care Network Medicare Advantage	$1,688.66
Rate for Payer: Cash Price	$832.65
Rate for Payer: Cash Price	$832.65
Rate for Payer: Community Health Alliance Commercial	$1,088.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,688.66
Rate for Payer: Meridian Health Plan Medicare	$1,688.66
Rate for Payer: Priority Health Commercial	$896.70
Rate for Payer: Priority Health Medicaid	$1,688.66
Rate for Payer: Priority Health Medicare	$1,688.66
Rate for Payer: Priority Health PPO	$896.70
Rate for Payer: United Health Care Medicaid	$1,688.66
Rate for Payer: United Health Care Medicare Advantage	$743.01

XR WRIST LT, 2 VIEWS

Facility

$154.00

Service Code	HCPCS 73100 LT
Hospital Charge Code	3200891
Hospital Revenue Code	320
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$130.90
Rate for Payer: Cash Price	$100.10
Rate for Payer: Community Health Alliance Commercial	$130.90
Rate for Payer: Priority Health Commercial	$107.80
Rate for Payer: Priority Health PPO	$107.80

XR WRIST LT, MIN 3 VIEWS

Facility

$186.00

Service Code	HCPCS 73110 LT
Hospital Charge Code	3200893
Hospital Revenue Code	320
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$158.10
Rate for Payer: Cash Price	$120.90
Rate for Payer: Community Health Alliance Commercial	$158.10
Rate for Payer: Priority Health Commercial	$130.20
Rate for Payer: Priority Health PPO	$130.20

XR WRIST RT, 2 VIEW

Facility

$154.00

Service Code	HCPCS 73100 RT
Hospital Charge Code	3200890
Hospital Revenue Code	320
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$130.90
Rate for Payer: Cash Price	$100.10
Rate for Payer: Community Health Alliance Commercial	$130.90
Rate for Payer: Priority Health Commercial	$107.80
Rate for Payer: Priority Health PPO	$107.80

XR WRIST RT, MIN 3 VIEWS

Facility

$186.00

Service Code	HCPCS 73110 RT
Hospital Charge Code	3200892
Hospital Revenue Code	320
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$158.10
Rate for Payer: Cash Price	$120.90
Rate for Payer: Community Health Alliance Commercial	$158.10
Rate for Payer: Priority Health Commercial	$130.20
Rate for Payer: Priority Health PPO	$130.20

XSACCHARMYCES CEREVISIA AB IGG

Facility

$43.00

Hospital Charge Code	3101384
Hospital Revenue Code	302
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

X SACCHAROMYCES CERVISIAE PANE

Facility

$10.00

Hospital Charge Code	3102103
Hospital Revenue Code	300
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health PPO	$7.00

X SALIVARY CORTISOL X 2

Facility

$61.90

Hospital Charge Code	3102508
Hospital Revenue Code	300
Min. Negotiated Rate	$43.33
Max. Negotiated Rate	$52.62
Rate for Payer: Cash Price	$40.24
Rate for Payer: Community Health Alliance Commercial	$52.62
Rate for Payer: Priority Health Commercial	$43.33
Rate for Payer: Priority Health PPO	$43.33

X SALIVARY CORTISOL X 3

Facility

$92.85

Hospital Charge Code	3102511
Hospital Revenue Code	300
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$78.92
Rate for Payer: Cash Price	$60.35
Rate for Payer: Community Health Alliance Commercial	$78.92
Rate for Payer: Priority Health Commercial	$65.00
Rate for Payer: Priority Health PPO	$65.00

X SALIVARY CORTISOL X 4

Facility

$123.80

Hospital Charge Code	3102513
Hospital Revenue Code	300
Min. Negotiated Rate	$86.66
Max. Negotiated Rate	$105.23
Rate for Payer: Cash Price	$80.47
Rate for Payer: Community Health Alliance Commercial	$105.23
Rate for Payer: Priority Health Commercial	$86.66
Rate for Payer: Priority Health PPO	$86.66

X SJORGENS

Facility

$9.54

Hospital Charge Code	3007345
Hospital Revenue Code	302
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$8.11
Rate for Payer: Cash Price	$6.20
Rate for Payer: Community Health Alliance Commercial	$8.11
Rate for Payer: Priority Health Commercial	$6.68
Rate for Payer: Priority Health PPO	$6.68

X SPE REFLEX MONOCLONAL PROTE

Facility

$7.96

Hospital Charge Code	3101647
Hospital Revenue Code	300
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$6.77
Rate for Payer: Cash Price	$5.17
Rate for Payer: Community Health Alliance Commercial	$6.77
Rate for Payer: Priority Health Commercial	$5.57
Rate for Payer: Priority Health PPO	$5.57

X SPINE IGG 23 STEREOTYPES

Facility

$489.00

Hospital Charge Code	3100555
Hospital Revenue Code	300
Min. Negotiated Rate	$342.30
Max. Negotiated Rate	$415.65
Rate for Payer: Cash Price	$317.85
Rate for Payer: Community Health Alliance Commercial	$415.65
Rate for Payer: Priority Health Commercial	$342.30
Rate for Payer: Priority Health PPO	$342.30

X STREPTOCOCCUS PENUMONIAE AB

Facility

$62.95

Hospital Charge Code	3101034
Hospital Revenue Code	300
Min. Negotiated Rate	$44.06
Max. Negotiated Rate	$53.51
Rate for Payer: Cash Price	$40.92
Rate for Payer: Community Health Alliance Commercial	$53.51
Rate for Payer: Priority Health Commercial	$44.06
Rate for Payer: Priority Health PPO	$44.06

X STREPTOCOCCUS PNEUMONIAE AB

Facility

$48.75

Hospital Charge Code	3101058
Hospital Revenue Code	300
Min. Negotiated Rate	$34.12
Max. Negotiated Rate	$41.44
Rate for Payer: Cash Price	$31.69
Rate for Payer: Community Health Alliance Commercial	$41.44
Rate for Payer: Priority Health Commercial	$34.12
Rate for Payer: Priority Health PPO	$34.12

X SULFATIDE ANTIBODIES

Facility

$595.00

Hospital Charge Code	3102409
Hospital Revenue Code	300
Min. Negotiated Rate	$416.50
Max. Negotiated Rate	$505.75
Rate for Payer: Cash Price	$386.75
Rate for Payer: Community Health Alliance Commercial	$505.75
Rate for Payer: Priority Health Commercial	$416.50
Rate for Payer: Priority Health PPO	$416.50

X TCA QUANT SERUM

Facility

$100.00

Hospital Charge Code	3102469
Hospital Revenue Code	300
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$85.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health PPO	$70.00

X TCELL BCELL FLOW

Facility

$397.00

Hospital Charge Code	3100818
Hospital Revenue Code	302
Min. Negotiated Rate	$277.90
Max. Negotiated Rate	$337.45
Rate for Payer: Cash Price	$258.05
Rate for Payer: Community Health Alliance Commercial	$337.45
Rate for Payer: Priority Health Commercial	$277.90
Rate for Payer: Priority Health PPO	$277.90

X T-CELLS CD4/CD8 FLOW CYTO

Facility

$155.00

Hospital Charge Code	3100749
Hospital Revenue Code	300
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$131.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Community Health Alliance Commercial	$131.75
Rate for Payer: Priority Health Commercial	$108.50
Rate for Payer: Priority Health PPO	$108.50

X TCELLS FLOW BLOOD

Facility

$69.23

Hospital Charge Code	3100980
Hospital Revenue Code	302
Min. Negotiated Rate	$48.46
Max. Negotiated Rate	$58.85
Rate for Payer: Cash Price	$45.00
Rate for Payer: Community Health Alliance Commercial	$58.85
Rate for Payer: Priority Health Commercial	$48.46
Rate for Payer: Priority Health PPO	$48.46

XTEST FREE CALC & TOTAL ELCIA

Facility

$10.51

Hospital Charge Code	3101093
Hospital Revenue Code	301
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$8.93
Rate for Payer: Cash Price	$6.83
Rate for Payer: Community Health Alliance Commercial	$8.93
Rate for Payer: Priority Health Commercial	$7.36
Rate for Payer: Priority Health PPO	$7.36

X TESTOSTERONE,BIOAVAILABLE

Facility

$185.00

Hospital Charge Code	3007830
Hospital Revenue Code	301
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 TESTOSTERONE, FREE AND TOTAL

Facility

$198.00

Hospital Charge Code	3100956
Hospital Revenue Code	301
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$168.30
Rate for Payer: Cash Price	$128.70
Rate for Payer: Community Health Alliance Commercial	$168.30
Rate for Payer: Priority Health Commercial	$138.60
Rate for Payer: Priority Health PPO	$138.60

X TESTOSTERONE FREE PROFILE

Facility

$24.94

Hospital Charge Code	3101472
Hospital Revenue Code	300
Min. Negotiated Rate	$17.46
Max. Negotiated Rate	$21.20
Rate for Payer: Cash Price	$16.21
Rate for Payer: Community Health Alliance Commercial	$21.20
Rate for Payer: Priority Health Commercial	$17.46
Rate for Payer: Priority Health PPO	$17.46

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges