Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

EACH ADDITIONAL DRUG TEST

Facility

$105.00

Hospital Charge Code	3000823
Hospital Revenue Code	306
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

EACH ADDITIONAL DRUG TEST

Facility

$105.00

Hospital Charge Code	3000818
Hospital Revenue Code	306
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

EACH ADDITIONAL DRUG TEST

Facility

$105.00

Hospital Charge Code	3000835
Hospital Revenue Code	306
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

EACH ADDITIONAL DRUG TEST

Facility

$105.00

Hospital Charge Code	3000816
Hospital Revenue Code	306
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

EACH ADDITIONAL DRUG TEST

Facility

$105.00

Hospital Charge Code	3000819
Hospital Revenue Code	306
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

EACH ADDITIONAL DRUG TEST

Facility

$105.00

Hospital Charge Code	3000820
Hospital Revenue Code	306
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

EACH ADD'L MARKER

Facility

$224.00

Hospital Charge Code	3006222
Hospital Revenue Code	311
Min. Negotiated Rate	$156.80
Max. Negotiated Rate	$190.40
Rate for Payer: Cash Price	$145.60
Rate for Payer: Community Health Alliance Commercial	$190.40
Rate for Payer: Priority Health Commercial	$156.80
Rate for Payer: Priority Health PPO	$156.80

EASTERN EQUINE ENCEPHALITIS IG

Facility

$28.75

Hospital Charge Code	3100756
Hospital Revenue Code	302
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$24.44
Rate for Payer: Cash Price	$18.69
Rate for Payer: Community Health Alliance Commercial	$24.44
Rate for Payer: Priority Health Commercial	$20.12
Rate for Payer: Priority Health PPO	$20.12

EASTERN EQUINE ENCEPHALITIS IG

Facility

$28.75

Hospital Charge Code	3100757
Hospital Revenue Code	302
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$24.44
Rate for Payer: Cash Price	$18.69
Rate for Payer: Community Health Alliance Commercial	$24.44
Rate for Payer: Priority Health Commercial	$20.12
Rate for Payer: Priority Health PPO	$20.12

EBS VCA IgG ANTIBODY

Facility

$62.00

Hospital Charge Code	3100019
Hospital Revenue Code	302
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$52.70
Rate for Payer: Cash Price	$40.30
Rate for Payer: Community Health Alliance Commercial	$52.70
Rate for Payer: Priority Health Commercial	$43.40
Rate for Payer: Priority Health PPO	$43.40

EBV-4

Facility

$8.13

Hospital Charge Code	3101389
Hospital Revenue Code	300
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$6.91
Rate for Payer: Cash Price	$5.28
Rate for Payer: Community Health Alliance Commercial	$6.91
Rate for Payer: Priority Health Commercial	$5.69
Rate for Payer: Priority Health PPO	$5.69

EBV BY PCR

Facility

$55.00

Hospital Charge Code	3000013
Hospital Revenue Code	306
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$46.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health PPO	$38.50

EBV BY PCR CSF

Facility

$55.00

Hospital Charge Code	3007163
Hospital Revenue Code	306
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$46.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health PPO	$38.50

E-B VIRUS, VCA (IgM)

Facility

$64.00

Service Code	HCPCS 86665
Hospital Charge Code	3003950
Hospital Revenue Code	302
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$54.40
Rate for Payer: BCBS BCN 65	$19.05
Rate for Payer: Blue Care Network Medicare Advantage	$19.05
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.05
Rate for Payer: Meridian Health Plan Medicare	$19.05
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health Medicaid	$19.05
Rate for Payer: Priority Health Medicare	$19.05
Rate for Payer: Priority Health PPO	$44.80
Rate for Payer: United Health Care Medicaid	$19.05
Rate for Payer: United Health Care Medicare Advantage	$8.38

ECHOVIRUS

Facility

$142.00

Hospital Charge Code	3003970
Hospital Revenue Code	302
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$120.70
Rate for Payer: Cash Price	$92.30
Rate for Payer: Community Health Alliance Commercial	$120.70
Rate for Payer: Priority Health Commercial	$99.40
Rate for Payer: Priority Health PPO	$99.40

ECOLI, SORB NEG, H70157 TYPING

Facility

$65.00

Service Code	HCPCS 87147
Hospital Charge Code	3008480
Hospital Revenue Code	306
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$55.25
Rate for Payer: BCBS BCN 65	$5.44
Rate for Payer: Blue Care Network Medicare Advantage	$5.44
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.44
Rate for Payer: Meridian Health Plan Medicare	$5.44
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health Medicaid	$5.44
Rate for Payer: Priority Health Medicare	$5.44
Rate for Payer: Priority Health PPO	$45.50
Rate for Payer: United Health Care Medicaid	$5.44
Rate for Payer: United Health Care Medicare Advantage	$2.39

EC OPERATING INST.KIT

Facility

$1,000.00

Hospital Charge Code	27016329
Hospital Revenue Code	270
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$850.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Community Health Alliance Commercial	$850.00
Rate for Payer: Priority Health Commercial	$700.00
Rate for Payer: Priority Health PPO	$700.00

ECT PLATE SMALL 3 HOLE

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	27815297
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$88.40
Rate for Payer: Cash Price	$67.60
Rate for Payer: Community Health Alliance Commercial	$88.40
Rate for Payer: Priority Health Commercial	$72.80
Rate for Payer: Priority Health PPO	$72.80

ECT PLATE SMALL 3 HOLE

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	27015297
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$88.40
Rate for Payer: Cash Price	$67.60
Rate for Payer: Community Health Alliance Commercial	$88.40
Rate for Payer: Priority Health Commercial	$72.80
Rate for Payer: Priority Health PPO	$72.80

ECT PLATE SMALL 4 HOLE

Facility

$115.00

Service Code	HCPCS C1713
Hospital Charge Code	27815289
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$97.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Community Health Alliance Commercial	$97.75
Rate for Payer: Priority Health Commercial	$80.50
Rate for Payer: Priority Health PPO	$80.50

ECT PLATE SMALL 4 HOLE

Facility

$115.00

Service Code	HCPCS C1713
Hospital Charge Code	27015289
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$97.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Community Health Alliance Commercial	$97.75
Rate for Payer: Priority Health Commercial	$80.50
Rate for Payer: Priority Health PPO	$80.50

EDEMA GLOVE

Facility

$17.00

Hospital Charge Code	27019778
Hospital Revenue Code	270
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

EDT 1

Facility

$298.00

Hospital Charge Code	31027437
Hospital Revenue Code	300
Min. Negotiated Rate	$208.60
Max. Negotiated Rate	$253.30
Rate for Payer: Cash Price	$193.70
Rate for Payer: Community Health Alliance Commercial	$253.30
Rate for Payer: Priority Health Commercial	$208.60
Rate for Payer: Priority Health PPO	$208.60

EDT 2

Facility

$299.00

Hospital Charge Code	31027438
Hospital Revenue Code	300
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$254.15
Rate for Payer: Cash Price	$194.35
Rate for Payer: Community Health Alliance Commercial	$254.15
Rate for Payer: Priority Health Commercial	$209.30
Rate for Payer: Priority Health PPO	$209.30

EDT 3

Facility

$299.00

Hospital Charge Code	31027439
Hospital Revenue Code	300
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$254.15
Rate for Payer: Cash Price	$194.35
Rate for Payer: Community Health Alliance Commercial	$254.15
Rate for Payer: Priority Health Commercial	$209.30
Rate for Payer: Priority Health PPO	$209.30

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges