Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CHLAMYDIA AND GC GENPROBE

Facility

$135.00

Hospital Charge Code	3008421
Hospital Revenue Code	306
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

CHLAMYDIA AND GC GENPROBE URIN

Facility

$135.00

Hospital Charge Code	3006276
Hospital Revenue Code	306
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

CHLAMYDIA BY MAA

Facility

$12.00

Hospital Charge Code	3101503
Hospital Revenue Code	306
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$10.20
Rate for Payer: Cash Price	$7.80
Rate for Payer: Community Health Alliance Commercial	$10.20
Rate for Payer: Priority Health Commercial	$8.40
Rate for Payer: Priority Health PPO	$8.40

CHLAMYDIA GEN PROBE SWAB,RML

Facility

$63.00

Service Code	HCPCS 87491
Hospital Charge Code	3008420
Hospital Revenue Code	306
Min. Negotiated Rate	$16.21
Max. Negotiated Rate	$53.55
Rate for Payer: BCBS BCN 65	$36.84
Rate for Payer: Blue Care Network Medicare Advantage	$36.84
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$36.84
Rate for Payer: Meridian Health Plan Medicare	$36.84
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health Medicaid	$36.84
Rate for Payer: Priority Health Medicare	$36.84
Rate for Payer: Priority Health PPO	$44.10
Rate for Payer: United Health Care Medicaid	$36.84
Rate for Payer: United Health Care Medicare Advantage	$16.21

CHLAMYDIA OIA,STURGIS

Facility

$58.00

Service Code	HCPCS 87810
Hospital Charge Code	3003000
Hospital Revenue Code	306
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$49.30
Rate for Payer: BCBS BCN 65	$37.05
Rate for Payer: Blue Care Network Medicare Advantage	$37.05
Rate for Payer: Cash Price	$37.70
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$37.05
Rate for Payer: Meridian Health Plan Medicare	$37.05
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health Medicaid	$37.05
Rate for Payer: Priority Health Medicare	$37.05
Rate for Payer: Priority Health PPO	$40.60
Rate for Payer: United Health Care Medicaid	$37.05
Rate for Payer: United Health Care Medicare Advantage	$16.30

CHLAMYDIA TRACHOMATIS:AMPLIFIE

Facility

$63.00

Service Code	HCPCS 87491
Hospital Charge Code	3006275
Hospital Revenue Code	306
Min. Negotiated Rate	$16.21
Max. Negotiated Rate	$53.55
Rate for Payer: BCBS BCN 65	$36.84
Rate for Payer: Blue Care Network Medicare Advantage	$36.84
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$36.84
Rate for Payer: Meridian Health Plan Medicare	$36.84
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health Medicaid	$36.84
Rate for Payer: Priority Health Medicare	$36.84
Rate for Payer: Priority Health PPO	$44.10
Rate for Payer: United Health Care Medicaid	$36.84
Rate for Payer: United Health Care Medicare Advantage	$16.21

CHLAYMYDIA ANTIBODY, SERUM

Facility

$76.00

Service Code	HCPCS 86631
Hospital Charge Code	3003040
Hospital Revenue Code	302
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$64.60
Rate for Payer: BCBS BCN 65	$12.41
Rate for Payer: Blue Care Network Medicare Advantage	$12.41
Rate for Payer: Cash Price	$49.40
Rate for Payer: Cash Price	$49.40
Rate for Payer: Community Health Alliance Commercial	$64.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.41
Rate for Payer: Meridian Health Plan Medicare	$12.41
Rate for Payer: Priority Health Commercial	$53.20
Rate for Payer: Priority Health Medicaid	$12.41
Rate for Payer: Priority Health Medicare	$12.41
Rate for Payer: Priority Health PPO	$53.20
Rate for Payer: United Health Care Medicaid	$12.41
Rate for Payer: United Health Care Medicare Advantage	$5.46

CHL-GC-GEN THIN PREP

Facility

$20.00

Hospital Charge Code	3007657
Hospital Revenue Code	971
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

CHL/GC NAA SWAB-1

Facility

$9.00

Hospital Charge Code	3101585
Hospital Revenue Code	306
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$7.65
Rate for Payer: Cash Price	$5.85
Rate for Payer: Community Health Alliance Commercial	$7.65
Rate for Payer: Priority Health Commercial	$6.30
Rate for Payer: Priority Health PPO	$6.30

CHL/GC NAA SWAB-2

Facility

$9.00

Hospital Charge Code	3101586
Hospital Revenue Code	306
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$7.65
Rate for Payer: Cash Price	$5.85
Rate for Payer: Community Health Alliance Commercial	$7.65
Rate for Payer: Priority Health Commercial	$6.30
Rate for Payer: Priority Health PPO	$6.30

CHL/GC NAA THINPREP-1

Facility

$10.00

Hospital Charge Code	3101588
Hospital Revenue Code	306
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

CHL-GC NAA THINPREP-2

Facility

$10.00

Hospital Charge Code	3101589
Hospital Revenue Code	306
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

CHL/GC NAA URINE-1

Facility

$10.00

Hospital Charge Code	3101591
Hospital Revenue Code	306
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

CHL/GC NAA URINE-2

Facility

$10.00

Hospital Charge Code	3101592
Hospital Revenue Code	306
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

CHL NAA SWAB

Facility

$9.00

Hospital Charge Code	3101593
Hospital Revenue Code	306
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$7.65
Rate for Payer: Cash Price	$5.85
Rate for Payer: Community Health Alliance Commercial	$7.65
Rate for Payer: Priority Health Commercial	$6.30
Rate for Payer: Priority Health PPO	$6.30

CHL NAA THINPREP

Facility

$12.00

Hospital Charge Code	3101594
Hospital Revenue Code	306
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$10.20
Rate for Payer: Cash Price	$7.80
Rate for Payer: Community Health Alliance Commercial	$10.20
Rate for Payer: Priority Health Commercial	$8.40
Rate for Payer: Priority Health PPO	$8.40

CHL NAA URINE

Facility

$12.00

Hospital Charge Code	3101595
Hospital Revenue Code	306
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$10.20
Rate for Payer: Cash Price	$7.80
Rate for Payer: Community Health Alliance Commercial	$10.20
Rate for Payer: Priority Health Commercial	$8.40
Rate for Payer: Priority Health PPO	$8.40

CHLORAMPHENICOL

Facility

$84.00

Service Code	HCPCS 82415
Hospital Charge Code	3002287
Hospital Revenue Code	301
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$71.40
Rate for Payer: BCBS BCN 65	$13.30
Rate for Payer: Blue Care Network Medicare Advantage	$13.30
Rate for Payer: Cash Price	$54.60
Rate for Payer: Cash Price	$54.60
Rate for Payer: Community Health Alliance Commercial	$71.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.30
Rate for Payer: Meridian Health Plan Medicare	$13.30
Rate for Payer: Priority Health Commercial	$58.80
Rate for Payer: Priority Health Medicaid	$13.30
Rate for Payer: Priority Health Medicare	$13.30
Rate for Payer: Priority Health PPO	$58.80
Rate for Payer: United Health Care Medicaid	$13.30
Rate for Payer: United Health Care Medicare Advantage	$5.85

CHLORIDE

Facility

$24.00

Service Code	HCPCS 82435
Hospital Charge Code	3002180
Hospital Revenue Code	301
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$20.40
Rate for Payer: BCBS BCN 65	$4.83
Rate for Payer: Blue Care Network Medicare Advantage	$4.83
Rate for Payer: Cash Price	$15.60
Rate for Payer: Cash Price	$15.60
Rate for Payer: Community Health Alliance Commercial	$20.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.83
Rate for Payer: Meridian Health Plan Medicare	$4.83
Rate for Payer: Priority Health Commercial	$16.80
Rate for Payer: Priority Health Medicaid	$4.83
Rate for Payer: Priority Health Medicare	$4.83
Rate for Payer: Priority Health PPO	$16.80
Rate for Payer: United Health Care Medicaid	$4.83
Rate for Payer: United Health Care Medicare Advantage	$2.13

CHLORIDE, URINE

Facility

$2.00

Service Code	HCPCS 82436
Hospital Charge Code	3002220
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$6.04
Rate for Payer: BCBS BCN 65	$6.04
Rate for Payer: Blue Care Network Medicare Advantage	$6.04
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.04
Rate for Payer: Meridian Health Plan Medicare	$6.04
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health Medicaid	$6.04
Rate for Payer: Priority Health Medicare	$6.04
Rate for Payer: Priority Health PPO	$1.40
Rate for Payer: United Health Care Medicaid	$6.04
Rate for Payer: United Health Care Medicare Advantage	$2.66

CHLORIDE,URINE RANDOM

Facility

$2.00

Service Code	HCPCS 82436
Hospital Charge Code	3002221
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$6.04
Rate for Payer: BCBS BCN 65	$6.04
Rate for Payer: Blue Care Network Medicare Advantage	$6.04
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.04
Rate for Payer: Meridian Health Plan Medicare	$6.04
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health Medicaid	$6.04
Rate for Payer: Priority Health Medicare	$6.04
Rate for Payer: Priority Health PPO	$1.40
Rate for Payer: United Health Care Medicaid	$6.04
Rate for Payer: United Health Care Medicare Advantage	$2.66

CHL-P

Facility

$9.00

Hospital Charge Code	3102161
Hospital Revenue Code	300
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$7.65
Rate for Payer: Cash Price	$5.85
Rate for Payer: Community Health Alliance Commercial	$7.65
Rate for Payer: Priority Health Commercial	$6.30
Rate for Payer: Priority Health PPO	$6.30

CHL PNEUMONIA PCR

Facility

$73.75

Hospital Charge Code	3101007
Hospital Revenue Code	306
Min. Negotiated Rate	$51.62
Max. Negotiated Rate	$62.69
Rate for Payer: Cash Price	$47.94
Rate for Payer: Community Health Alliance Commercial	$62.69
Rate for Payer: Priority Health Commercial	$51.62
Rate for Payer: Priority Health PPO	$51.62

CHOL BODY FLUID

Facility

$35.35

Hospital Charge Code	3100973
Hospital Revenue Code	300
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$30.05
Rate for Payer: Cash Price	$22.98
Rate for Payer: Community Health Alliance Commercial	$30.05
Rate for Payer: Priority Health Commercial	$24.75
Rate for Payer: Priority Health PPO	$24.75

CHOLESTEROL

Facility

$28.00

Service Code	HCPCS 82465
Hospital Charge Code	3002280
Hospital Revenue Code	301
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$23.80
Rate for Payer: BCBS BCN 65	$4.57
Rate for Payer: Blue Care Network Medicare Advantage	$4.57
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.57
Rate for Payer: Meridian Health Plan Medicare	$4.57
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health Medicaid	$4.57
Rate for Payer: Priority Health Medicare	$4.57
Rate for Payer: Priority Health PPO	$19.60
Rate for Payer: United Health Care Medicaid	$4.57
Rate for Payer: United Health Care Medicare Advantage	$2.01

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges