Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

DNA PLOIDY ANALYSIS

Facility

$245.00

Service Code	HCPCS 88182 26
Hospital Charge Code	9710600
Hospital Revenue Code	310
Min. Negotiated Rate	$171.50
Max. Negotiated Rate	$208.25
Rate for Payer: Cash Price	$159.25
Rate for Payer: Community Health Alliance Commercial	$208.25
Rate for Payer: Priority Health Commercial	$171.50
Rate for Payer: Priority Health PPO	$171.50

DNA PROBE EACH

Facility

$71.00

Hospital Charge Code	3000179
Hospital Revenue Code	310
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$60.35
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health PPO	$49.70

DNA PROBE EACH

Facility

$77.00

Hospital Charge Code	3100024
Hospital Revenue Code	310
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$65.45
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health PPO	$53.90

DNA PROBE EACH

Facility

$77.00

Hospital Charge Code	3100025
Hospital Revenue Code	310
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$65.45
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health PPO	$53.90

DNA PROBE EACH

Facility

$71.00

Hospital Charge Code	3000174
Hospital Revenue Code	310
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$60.35
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health PPO	$49.70

DNA PROBE EACH-1

Facility

$28.00

Hospital Charge Code	3100351
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-10

Facility

$28.00

Hospital Charge Code	3100186
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-11

Facility

$28.00

Hospital Charge Code	3100187
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-12

Facility

$28.00

Hospital Charge Code	3100188
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-13

Facility

$28.00

Hospital Charge Code	3100189
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-14

Facility

$28.00

Hospital Charge Code	3100191
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-15

Facility

$28.00

Hospital Charge Code	3100192
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-16

Facility

$28.00

Hospital Charge Code	3100193
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-17

Facility

$28.00

Hospital Charge Code	3100194
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-18

Facility

$28.00

Hospital Charge Code	3100196
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-19

Facility

$28.00

Hospital Charge Code	3100197
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-2

Facility

$28.00

Hospital Charge Code	3100177
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-20

Facility

$28.00

Hospital Charge Code	3100198
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-21

Facility

$28.00

Hospital Charge Code	3100199
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-22

Facility

$28.00

Hospital Charge Code	3100201
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-23

Facility

$28.00

Hospital Charge Code	3100202
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-24

Facility

$28.00

Hospital Charge Code	3100203
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-25

Facility

$28.00

Hospital Charge Code	3100204
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-26

Facility

$28.00

Hospital Charge Code	3100205
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-27

Facility

$28.00

Hospital Charge Code	3100206
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges