Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

HEPATITIS A ANTIBODY IgM

Facility

$4.70

Service Code	HCPCS 86709
Hospital Charge Code	3005140
Hospital Revenue Code	302
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$11.82
Rate for Payer: BCBS BCN 65	$11.82
Rate for Payer: Blue Care Network Medicare Advantage	$11.82
Rate for Payer: Cash Price	$3.06
Rate for Payer: Cash Price	$3.06
Rate for Payer: Community Health Alliance Commercial	$4.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$11.82
Rate for Payer: Meridian Health Plan Medicare	$11.82
Rate for Payer: Priority Health Commercial	$3.29
Rate for Payer: Priority Health Medicaid	$11.82
Rate for Payer: Priority Health Medicare	$11.82
Rate for Payer: Priority Health PPO	$3.29
Rate for Payer: United Health Care Medicaid	$11.82
Rate for Payer: United Health Care Medicare Advantage	$5.20

HEPATITIS A ANTIBODY IgM-ML

Facility

$76.00

Hospital Charge Code	3101287
Hospital Revenue Code	302
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$64.60
Rate for Payer: Cash Price	$49.40
Rate for Payer: Community Health Alliance Commercial	$64.60
Rate for Payer: Priority Health Commercial	$53.20
Rate for Payer: Priority Health PPO	$53.20

HEPATITIS A ANTIBODY TOTAL

Facility

$5.00

Service Code	HCPCS 86708
Hospital Charge Code	3005139
Hospital Revenue Code	302
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$13.01
Rate for Payer: BCBS BCN 65	$13.01
Rate for Payer: Blue Care Network Medicare Advantage	$13.01
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.01
Rate for Payer: Meridian Health Plan Medicare	$13.01
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$13.01
Rate for Payer: Priority Health Medicare	$13.01
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$13.01
Rate for Payer: United Health Care Medicare Advantage	$5.72

HEPATITIS B CORE, 1GM

Facility

$3.50

Service Code	HCPCS 86705
Hospital Charge Code	3005150
Hospital Revenue Code	302
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$12.36
Rate for Payer: BCBS BCN 65	$12.36
Rate for Payer: Blue Care Network Medicare Advantage	$12.36
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cash Price	$2.28
Rate for Payer: Community Health Alliance Commercial	$2.98
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.36
Rate for Payer: Meridian Health Plan Medicare	$12.36
Rate for Payer: Priority Health Commercial	$2.45
Rate for Payer: Priority Health Medicaid	$12.36
Rate for Payer: Priority Health Medicare	$12.36
Rate for Payer: Priority Health PPO	$2.45
Rate for Payer: United Health Care Medicaid	$12.36
Rate for Payer: United Health Care Medicare Advantage	$5.44

HEPATITIS B CORE ANTIBODY

Facility

$5.00

Service Code	HCPCS 86704
Hospital Charge Code	3005160
Hospital Revenue Code	302
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$12.65
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.65
Rate for Payer: Meridian Health Plan Medicare	$12.65
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

HEPATITIS B CORE ANTIBODY-ML

Facility

$75.00

Hospital Charge Code	3101280
Hospital Revenue Code	302
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

HEPATITIS B DNA

Facility

$443.00

Service Code	HCPCS 87517
Hospital Charge Code	3005162
Hospital Revenue Code	306
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$376.55
Rate for Payer: BCBS BCN 65	$44.98
Rate for Payer: Blue Care Network Medicare Advantage	$44.98
Rate for Payer: Cash Price	$287.95
Rate for Payer: Cash Price	$287.95
Rate for Payer: Community Health Alliance Commercial	$376.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$44.98
Rate for Payer: Meridian Health Plan Medicare	$44.98
Rate for Payer: Priority Health Commercial	$310.10
Rate for Payer: Priority Health Medicaid	$44.98
Rate for Payer: Priority Health Medicare	$44.98
Rate for Payer: Priority Health PPO	$310.10
Rate for Payer: United Health Care Medicaid	$44.98
Rate for Payer: United Health Care Medicare Advantage	$19.79

HEPATITIS Be ANTIBODY

Facility

$29.00

Service Code	HCPCS 86707
Hospital Charge Code	3005165
Hospital Revenue Code	302
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$24.65
Rate for Payer: BCBS BCN 65	$12.15
Rate for Payer: Blue Care Network Medicare Advantage	$12.15
Rate for Payer: Cash Price	$18.85
Rate for Payer: Cash Price	$18.85
Rate for Payer: Community Health Alliance Commercial	$24.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.15
Rate for Payer: Meridian Health Plan Medicare	$12.15
Rate for Payer: Priority Health Commercial	$20.30
Rate for Payer: Priority Health Medicaid	$12.15
Rate for Payer: Priority Health Medicare	$12.15
Rate for Payer: Priority Health PPO	$20.30
Rate for Payer: United Health Care Medicaid	$12.15
Rate for Payer: United Health Care Medicare Advantage	$5.35

HEPATITIS Be ANTIGEN

Facility

$2.35

Service Code	HCPCS 83516
Hospital Charge Code	3005170
Hospital Revenue Code	306
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$12.11
Rate for Payer: BCBS BCN 65	$12.11
Rate for Payer: Blue Care Network Medicare Advantage	$12.11
Rate for Payer: Cash Price	$1.53
Rate for Payer: Cash Price	$1.53
Rate for Payer: Community Health Alliance Commercial	$2.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.11
Rate for Payer: Meridian Health Plan Medicare	$12.11
Rate for Payer: Priority Health Commercial	$1.65
Rate for Payer: Priority Health Medicaid	$12.11
Rate for Payer: Priority Health Medicare	$12.11
Rate for Payer: Priority Health PPO	$1.65
Rate for Payer: United Health Care Medicaid	$12.11
Rate for Payer: United Health Care Medicare Advantage	$5.33

HEPATITIS B ENVELOPE AB-ML

Facility

$75.00

Hospital Charge Code	3101281
Hospital Revenue Code	302
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

HEPATITIS B ORE,1GM-ML

Facility

$85.00

Hospital Charge Code	3101288
Hospital Revenue Code	302
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$72.25
Rate for Payer: Cash Price	$55.25
Rate for Payer: Community Health Alliance Commercial	$72.25
Rate for Payer: Priority Health Commercial	$59.50
Rate for Payer: Priority Health PPO	$59.50

HEPATITIS B SURFACE ANTIBODY

Facility

$5.00

Service Code	HCPCS G0499
Hospital Charge Code	3005180
Hospital Revenue Code	302
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$29.68
Rate for Payer: BCBS BCN 65	$29.68
Rate for Payer: Blue Care Network Medicare Advantage	$29.68
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$29.68
Rate for Payer: Meridian Health Plan Medicare	$29.68
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$29.68
Rate for Payer: Priority Health Medicare	$29.68
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$29.68
Rate for Payer: United Health Care Medicare Advantage	$13.06

HEPATITIS B SURF ANTIGEN-HAA

Facility

$2.35

Hospital Charge Code	3005200
Hospital Revenue Code	302
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.00
Rate for Payer: Cash Price	$1.53
Rate for Payer: Community Health Alliance Commercial	$2.00
Rate for Payer: Priority Health Commercial	$1.65
Rate for Payer: Priority Health PPO	$1.65

HEPATITIS B VIRUS VACCINE

Facility

$300.50

Service Code	NDC 58160082152
Hospital Charge Code	2505659
Hospital Revenue Code	636
Min. Negotiated Rate	$210.35
Max. Negotiated Rate	$255.43
Rate for Payer: Cash Price	$195.33
Rate for Payer: Community Health Alliance Commercial	$255.43
Rate for Payer: Priority Health Commercial	$210.35
Rate for Payer: Priority Health PPO	$210.35

HEPATITIS C-ANTIBODY

Facility

$5.19

Service Code	HCPCS 86803
Hospital Charge Code	3005240
Hospital Revenue Code	302
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$14.98
Rate for Payer: BCBS BCN 65	$14.98
Rate for Payer: Blue Care Network Medicare Advantage	$14.98
Rate for Payer: Cash Price	$3.37
Rate for Payer: Cash Price	$3.37
Rate for Payer: Community Health Alliance Commercial	$4.41
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.98
Rate for Payer: Meridian Health Plan Medicare	$14.98
Rate for Payer: Priority Health Commercial	$3.63
Rate for Payer: Priority Health Medicaid	$14.98
Rate for Payer: Priority Health Medicare	$14.98
Rate for Payer: Priority Health PPO	$3.63
Rate for Payer: United Health Care Medicaid	$14.98
Rate for Payer: United Health Care Medicare Advantage	$6.59

HEPATITIS C ANTIBODY-ML

Facility

$110.00

Hospital Charge Code	3101283
Hospital Revenue Code	302
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$93.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Community Health Alliance Commercial	$93.50
Rate for Payer: Priority Health Commercial	$77.00
Rate for Payer: Priority Health PPO	$77.00

HEPATITIS C-DNA OR RNA

Facility

$547.00

Hospital Charge Code	3100258
Hospital Revenue Code	300
Min. Negotiated Rate	$382.90
Max. Negotiated Rate	$464.95
Rate for Payer: Cash Price	$355.55
Rate for Payer: Community Health Alliance Commercial	$464.95
Rate for Payer: Priority Health Commercial	$382.90
Rate for Payer: Priority Health PPO	$382.90

HEPATITIS C FIBROSURE

Facility

$90.00

Hospital Charge Code	3101780
Hospital Revenue Code	300
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$76.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Community Health Alliance Commercial	$76.50
Rate for Payer: Priority Health Commercial	$63.00
Rate for Payer: Priority Health PPO	$63.00

HEPATITIS C-RIBA

Facility

$134.00

Service Code	HCPCS 86804
Hospital Charge Code	3000621
Hospital Revenue Code	302
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$113.90
Rate for Payer: BCBS BCN 65	$16.26
Rate for Payer: Blue Care Network Medicare Advantage	$16.26
Rate for Payer: Cash Price	$87.10
Rate for Payer: Cash Price	$87.10
Rate for Payer: Community Health Alliance Commercial	$113.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.26
Rate for Payer: Meridian Health Plan Medicare	$16.26
Rate for Payer: Priority Health Commercial	$93.80
Rate for Payer: Priority Health Medicaid	$16.26
Rate for Payer: Priority Health Medicare	$16.26
Rate for Payer: Priority Health PPO	$93.80
Rate for Payer: United Health Care Medicaid	$16.26
Rate for Payer: United Health Care Medicare Advantage	$7.16

HEPATITIS C-RNA RT-PCR (QUAL)

Facility

$54.57

Service Code	HCPCS 87521
Hospital Charge Code	3005141
Hospital Revenue Code	306
Min. Negotiated Rate	$16.21
Max. Negotiated Rate	$46.38
Rate for Payer: BCBS BCN 65	$36.84
Rate for Payer: Blue Care Network Medicare Advantage	$36.84
Rate for Payer: Cash Price	$35.47
Rate for Payer: Cash Price	$35.47
Rate for Payer: Community Health Alliance Commercial	$46.38
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	$38.20
Rate for Payer: Priority Health Medicaid	$36.84
Rate for Payer: Priority Health Medicare	$36.84
Rate for Payer: Priority Health PPO	$38.20
Rate for Payer: United Health Care Medicaid	$36.84
Rate for Payer: United Health Care Medicare Advantage	$16.21

HEPATITIS C (VIRAL LOAD) QUANT

Facility

$150.00

Service Code	HCPCS 87522
Hospital Charge Code	3005248
Hospital Revenue Code	306
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$127.50
Rate for Payer: BCBS BCN 65	$44.98
Rate for Payer: Blue Care Network Medicare Advantage	$44.98
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Community Health Alliance Commercial	$127.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$44.98
Rate for Payer: Meridian Health Plan Medicare	$44.98
Rate for Payer: Priority Health Commercial	$105.00
Rate for Payer: Priority Health Medicaid	$44.98
Rate for Payer: Priority Health Medicare	$44.98
Rate for Payer: Priority Health PPO	$105.00
Rate for Payer: United Health Care Medicaid	$44.98
Rate for Payer: United Health Care Medicare Advantage	$19.79

HEPATITIS C VIRUS GENOTYPE

Facility

$79.00

Hospital Charge Code	3100906
Hospital Revenue Code	309
Min. Negotiated Rate	$55.30
Max. Negotiated Rate	$67.15
Rate for Payer: Cash Price	$51.35
Rate for Payer: Community Health Alliance Commercial	$67.15
Rate for Payer: Priority Health Commercial	$55.30
Rate for Payer: Priority Health PPO	$55.30

HEPATITIS D VIRUS

Facility

$40.00

Hospital Charge Code	3102062
Hospital Revenue Code	300
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

HEPATITIS E IgM ANTIBODY

Facility

$65.25

Service Code	HCPCS 86790
Hospital Charge Code	3005249
Hospital Revenue Code	302
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$55.46
Rate for Payer: BCBS BCN 65	$13.52
Rate for Payer: Blue Care Network Medicare Advantage	$13.52
Rate for Payer: Cash Price	$42.41
Rate for Payer: Cash Price	$42.41
Rate for Payer: Community Health Alliance Commercial	$55.46
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.52
Rate for Payer: Meridian Health Plan Medicare	$13.52
Rate for Payer: Priority Health Commercial	$45.67
Rate for Payer: Priority Health Medicaid	$13.52
Rate for Payer: Priority Health Medicare	$13.52
Rate for Payer: Priority Health PPO	$45.67
Rate for Payer: United Health Care Medicaid	$13.52
Rate for Payer: United Health Care Medicare Advantage	$5.95

HEPATITIS PANEL,ACUTE

Facility

$15.74

Service Code	HCPCS 80074
Hospital Charge Code	3009040
Hospital Revenue Code	302
Min. Negotiated Rate	$11.02
Max. Negotiated Rate	$50.01
Rate for Payer: BCBS BCN 65	$50.01
Rate for Payer: Blue Care Network Medicare Advantage	$50.01
Rate for Payer: Cash Price	$10.23
Rate for Payer: Cash Price	$10.23
Rate for Payer: Community Health Alliance Commercial	$13.38
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$50.01
Rate for Payer: Meridian Health Plan Medicare	$50.01
Rate for Payer: Priority Health Commercial	$11.02
Rate for Payer: Priority Health Medicaid	$50.01
Rate for Payer: Priority Health Medicare	$50.01
Rate for Payer: Priority Health PPO	$11.02
Rate for Payer: United Health Care Medicaid	$50.01
Rate for Payer: United Health Care Medicare Advantage	$22.01

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges