Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CCND1/IGHt(11;14)FISH TISSUE

Facility

$405.00

Hospital Charge Code	3100909
Hospital Revenue Code	319
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$344.25
Rate for Payer: Cash Price	$263.25
Rate for Payer: Community Health Alliance Commercial	$344.25
Rate for Payer: Priority Health Commercial	$283.50
Rate for Payer: Priority Health PPO	$283.50

CCND1/IgH TRANSLOCATION BY FIS

Facility

$357.00

Hospital Charge Code	3100124
Hospital Revenue Code	310
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$303.45
Rate for Payer: Cash Price	$232.05
Rate for Payer: Community Health Alliance Commercial	$303.45
Rate for Payer: Priority Health Commercial	$249.90
Rate for Payer: Priority Health PPO	$249.90

CD16 MONONUCLEAR CELL AG

Facility

$50.00

Hospital Charge Code	3101022
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

CD20-1

Facility

$132.50

Hospital Charge Code	31027656
Hospital Revenue Code	300
Min. Negotiated Rate	$92.75
Max. Negotiated Rate	$112.62
Rate for Payer: Cash Price	$86.13
Rate for Payer: Community Health Alliance Commercial	$112.62
Rate for Payer: Priority Health Commercial	$92.75
Rate for Payer: Priority Health PPO	$92.75

CD20-2

Facility

$132.50

Hospital Charge Code	31027657
Hospital Revenue Code	300
Min. Negotiated Rate	$92.75
Max. Negotiated Rate	$112.62
Rate for Payer: Cash Price	$86.13
Rate for Payer: Community Health Alliance Commercial	$112.62
Rate for Payer: Priority Health Commercial	$92.75
Rate for Payer: Priority Health PPO	$92.75

CD3 T-CELLS

Facility

$52.00

Hospital Charge Code	3100750
Hospital Revenue Code	300
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

CD-4/CD-8

Facility

$16.29

Service Code	HCPCS 86360
Hospital Charge Code	3002060
Hospital Revenue Code	302
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$49.33
Rate for Payer: BCBS BCN 65	$49.33
Rate for Payer: Blue Care Network Medicare Advantage	$49.33
Rate for Payer: Cash Price	$10.59
Rate for Payer: Cash Price	$10.59
Rate for Payer: Community Health Alliance Commercial	$13.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$49.33
Rate for Payer: Meridian Health Plan Medicare	$49.33
Rate for Payer: Priority Health Commercial	$11.40
Rate for Payer: Priority Health Medicaid	$49.33
Rate for Payer: Priority Health Medicare	$49.33
Rate for Payer: Priority Health PPO	$11.40
Rate for Payer: United Health Care Medicaid	$49.33
Rate for Payer: United Health Care Medicare Advantage	$21.70

CD 4 COUNT

Facility

$24.44

Service Code	HCPCS 86361
Hospital Charge Code	3002070
Hospital Revenue Code	302
Min. Negotiated Rate	$12.37
Max. Negotiated Rate	$28.12
Rate for Payer: BCBS BCN 65	$28.12
Rate for Payer: Blue Care Network Medicare Advantage	$28.12
Rate for Payer: Cash Price	$15.89
Rate for Payer: Cash Price	$15.89
Rate for Payer: Community Health Alliance Commercial	$20.77
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$28.12
Rate for Payer: Meridian Health Plan Medicare	$28.12
Rate for Payer: Priority Health Commercial	$17.11
Rate for Payer: Priority Health Medicaid	$28.12
Rate for Payer: Priority Health Medicare	$28.12
Rate for Payer: Priority Health PPO	$17.11
Rate for Payer: United Health Care Medicaid	$28.12
Rate for Payer: United Health Care Medicare Advantage	$12.37

CD4 HELPER CELLS

Facility

$52.00

Hospital Charge Code	3100751
Hospital Revenue Code	300
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

CD56 MONONUCLEAR CELL AG

Facility

$50.00

Hospital Charge Code	3101023
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

CD 57

Facility

$91.25

Hospital Charge Code	3101161
Hospital Revenue Code	300
Min. Negotiated Rate	$63.88
Max. Negotiated Rate	$77.56
Rate for Payer: Cash Price	$59.31
Rate for Payer: Community Health Alliance Commercial	$77.56
Rate for Payer: Priority Health Commercial	$63.88
Rate for Payer: Priority Health PPO	$63.88

CD57-1

Facility

$42.50

Hospital Charge Code	3102455
Hospital Revenue Code	300
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$36.12
Rate for Payer: Cash Price	$27.63
Rate for Payer: Community Health Alliance Commercial	$36.12
Rate for Payer: Priority Health Commercial	$29.75
Rate for Payer: Priority Health PPO	$29.75

CD57-2

Facility

$42.50

Hospital Charge Code	3102456
Hospital Revenue Code	300
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$36.12
Rate for Payer: Cash Price	$27.63
Rate for Payer: Community Health Alliance Commercial	$36.12
Rate for Payer: Priority Health Commercial	$29.75
Rate for Payer: Priority Health PPO	$29.75

CD57 MONONUCLEAR CELL AG

Facility

$50.00

Hospital Charge Code	3101021
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

CD5 MONONUCLEAR CELL AG

Facility

$50.00

Hospital Charge Code	3101018
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

CD5 MONONUCLEAR CELL AG

Facility

$50.00

Hospital Charge Code	3101019
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

CD7 MONONUCLEAR CELL AG

Facility

$50.00

Hospital Charge Code	3101020
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

CD8 SUPRESSOR CELLS

Facility

$52.00

Hospital Charge Code	3100752
Hospital Revenue Code	300
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

CDIFF TOXIN GENE NAA

Facility

$78.00

Hospital Charge Code	3100768
Hospital Revenue Code	306
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health PPO	$54.60

C-DIFF TOXIN GENE NAA-SBMF

Facility

$57.00

Hospital Charge Code	3101152
Hospital Revenue Code	306
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$48.45
Rate for Payer: Cash Price	$37.05
Rate for Payer: Community Health Alliance Commercial	$48.45
Rate for Payer: Priority Health Commercial	$39.90
Rate for Payer: Priority Health PPO	$39.90

C DIFF TOXINS A&B

Facility

$8.23

Hospital Charge Code	3101439
Hospital Revenue Code	306
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$7.00
Rate for Payer: Cash Price	$5.35
Rate for Payer: Community Health Alliance Commercial	$7.00
Rate for Payer: Priority Health Commercial	$5.76
Rate for Payer: Priority Health PPO	$5.76

C.D.I.S. TUBING

Facility

$209.00

Hospital Charge Code	27017079
Hospital Revenue Code	270
Min. Negotiated Rate	$146.30
Max. Negotiated Rate	$177.65
Rate for Payer: Cash Price	$135.85
Rate for Payer: Community Health Alliance Commercial	$177.65
Rate for Payer: Priority Health Commercial	$146.30
Rate for Payer: Priority Health PPO	$146.30

CDP-1

Facility

$3.60

Hospital Charge Code	3100834
Hospital Revenue Code	301
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$3.06
Rate for Payer: Cash Price	$2.34
Rate for Payer: Community Health Alliance Commercial	$3.06
Rate for Payer: Priority Health Commercial	$2.52
Rate for Payer: Priority Health PPO	$2.52

CDP-2

Facility

$3.60

Hospital Charge Code	3100835
Hospital Revenue Code	301
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$3.06
Rate for Payer: Cash Price	$2.34
Rate for Payer: Community Health Alliance Commercial	$3.06
Rate for Payer: Priority Health Commercial	$2.52
Rate for Payer: Priority Health PPO	$2.52

CDS-1

Facility

$15.73

Hospital Charge Code	3101272
Hospital Revenue Code	301
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$13.37
Rate for Payer: Cash Price	$10.22
Rate for Payer: Community Health Alliance Commercial	$13.37
Rate for Payer: Priority Health Commercial	$11.01
Rate for Payer: Priority Health PPO	$11.01

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges