Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

NICOTINE AND MET QUANT URINE

Facility

$15.00

Service Code	HCPCS G0480
Hospital Charge Code	3100917
Hospital Revenue Code	309
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

NITROGLYCERIN 20,000 MCG/250 M

Facility

$112.58

Service Code	NDC 338104702
Hospital Charge Code	2501301
Hospital Revenue Code	250
Min. Negotiated Rate	$78.81
Max. Negotiated Rate	$95.69
Rate for Payer: Cash Price	$73.18
Rate for Payer: Community Health Alliance Commercial	$95.69
Rate for Payer: Priority Health Commercial	$78.81
Rate for Payer: Priority Health PPO	$78.81

NK CELLS

Facility

$91.25

Hospital Charge Code	3101162
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

NM ABSCESS LOC GALLIUM

Facility

$2,864.00

Service Code	HCPCS 78805
Hospital Charge Code	3400010
Hospital Revenue Code	340
Min. Negotiated Rate	$2,004.80
Max. Negotiated Rate	$2,434.40
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Community Health Alliance Commercial	$2,434.40
Rate for Payer: Priority Health Commercial	$2,004.80
Rate for Payer: Priority Health PPO	$2,004.80

NM BILIARY PATENCY W EF

Facility

$942.00

Hospital Charge Code	3400330
Hospital Revenue Code	340
Min. Negotiated Rate	$659.40
Max. Negotiated Rate	$800.70
Rate for Payer: Cash Price	$612.30
Rate for Payer: Community Health Alliance Commercial	$800.70
Rate for Payer: Priority Health Commercial	$659.40
Rate for Payer: Priority Health PPO	$659.40

NM BILIARY PATENCY W EF

Facility

$1,064.00

Hospital Charge Code	3400331
Hospital Revenue Code	340
Min. Negotiated Rate	$744.80
Max. Negotiated Rate	$904.40
Rate for Payer: Cash Price	$691.60
Rate for Payer: Community Health Alliance Commercial	$904.40
Rate for Payer: Priority Health Commercial	$744.80
Rate for Payer: Priority Health PPO	$744.80

NM BILIARY PAT. W0 EF

Facility

$942.00

Hospital Charge Code	3400320
Hospital Revenue Code	340
Min. Negotiated Rate	$659.40
Max. Negotiated Rate	$800.70
Rate for Payer: Cash Price	$612.30
Rate for Payer: Community Health Alliance Commercial	$800.70
Rate for Payer: Priority Health Commercial	$659.40
Rate for Payer: Priority Health PPO	$659.40

NM BILIARY PAT. WO EF

Facility

$942.00

Hospital Charge Code	3400321
Hospital Revenue Code	340
Min. Negotiated Rate	$659.40
Max. Negotiated Rate	$800.70
Rate for Payer: Cash Price	$612.30
Rate for Payer: Community Health Alliance Commercial	$800.70
Rate for Payer: Priority Health Commercial	$659.40
Rate for Payer: Priority Health PPO	$659.40

NM BLEEDING SCAN

Facility

$627.00

Service Code	HCPCS 78278
Hospital Charge Code	3400030
Hospital Revenue Code	340
Min. Negotiated Rate	$188.69
Max. Negotiated Rate	$532.95
Rate for Payer: BCBS BCN 65	$428.85
Rate for Payer: Blue Care Network Medicare Advantage	$428.85
Rate for Payer: Cash Price	$407.55
Rate for Payer: Cash Price	$407.55
Rate for Payer: Community Health Alliance Commercial	$532.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$428.85
Rate for Payer: Meridian Health Plan Medicare	$428.85
Rate for Payer: Priority Health Commercial	$438.90
Rate for Payer: Priority Health Medicaid	$428.85
Rate for Payer: Priority Health Medicare	$428.85
Rate for Payer: Priority Health PPO	$438.90
Rate for Payer: United Health Care Medicaid	$428.85
Rate for Payer: United Health Care Medicare Advantage	$188.69

NM BONE IMAGING 3 PHASE

Facility

$986.00

Service Code	HCPCS 78315
Hospital Charge Code	3400040
Hospital Revenue Code	340
Min. Negotiated Rate	$188.69
Max. Negotiated Rate	$838.10
Rate for Payer: BCBS BCN 65	$428.85
Rate for Payer: Blue Care Network Medicare Advantage	$428.85
Rate for Payer: Cash Price	$640.90
Rate for Payer: Cash Price	$640.90
Rate for Payer: Community Health Alliance Commercial	$838.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$428.85
Rate for Payer: Meridian Health Plan Medicare	$428.85
Rate for Payer: Priority Health Commercial	$690.20
Rate for Payer: Priority Health Medicaid	$428.85
Rate for Payer: Priority Health Medicare	$428.85
Rate for Payer: Priority Health PPO	$690.20
Rate for Payer: United Health Care Medicaid	$428.85
Rate for Payer: United Health Care Medicare Advantage	$188.69

NM BONE IMAGING WHOLE BODY

Facility

$862.00

Service Code	HCPCS 78306
Hospital Charge Code	3400050
Hospital Revenue Code	340
Min. Negotiated Rate	$188.69
Max. Negotiated Rate	$732.70
Rate for Payer: BCBS BCN 65	$428.85
Rate for Payer: Blue Care Network Medicare Advantage	$428.85
Rate for Payer: Cash Price	$560.30
Rate for Payer: Cash Price	$560.30
Rate for Payer: Community Health Alliance Commercial	$732.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$428.85
Rate for Payer: Meridian Health Plan Medicare	$428.85
Rate for Payer: Priority Health Commercial	$603.40
Rate for Payer: Priority Health Medicaid	$428.85
Rate for Payer: Priority Health Medicare	$428.85
Rate for Payer: Priority Health PPO	$603.40
Rate for Payer: United Health Care Medicaid	$428.85
Rate for Payer: United Health Care Medicare Advantage	$188.69

NM BONE SCAN MULTIPLE AREAS

Facility

$807.00

Service Code	HCPCS 78305
Hospital Charge Code	3400065
Hospital Revenue Code	340
Min. Negotiated Rate	$188.69
Max. Negotiated Rate	$685.95
Rate for Payer: BCBS BCN 65	$428.85
Rate for Payer: Blue Care Network Medicare Advantage	$428.85
Rate for Payer: Cash Price	$524.55
Rate for Payer: Cash Price	$524.55
Rate for Payer: Community Health Alliance Commercial	$685.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$428.85
Rate for Payer: Meridian Health Plan Medicare	$428.85
Rate for Payer: Priority Health Commercial	$564.90
Rate for Payer: Priority Health Medicaid	$428.85
Rate for Payer: Priority Health Medicare	$428.85
Rate for Payer: Priority Health PPO	$564.90
Rate for Payer: United Health Care Medicaid	$428.85
Rate for Payer: United Health Care Medicare Advantage	$188.69

NM BONE SCAN ONE AREA

Facility

$862.00

Service Code	HCPCS 78300
Hospital Charge Code	3400066
Hospital Revenue Code	340
Min. Negotiated Rate	$188.69
Max. Negotiated Rate	$732.70
Rate for Payer: BCBS BCN 65	$428.85
Rate for Payer: Blue Care Network Medicare Advantage	$428.85
Rate for Payer: Cash Price	$560.30
Rate for Payer: Cash Price	$560.30
Rate for Payer: Community Health Alliance Commercial	$732.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$428.85
Rate for Payer: Meridian Health Plan Medicare	$428.85
Rate for Payer: Priority Health Commercial	$603.40
Rate for Payer: Priority Health Medicaid	$428.85
Rate for Payer: Priority Health Medicare	$428.85
Rate for Payer: Priority Health PPO	$603.40
Rate for Payer: United Health Care Medicaid	$428.85
Rate for Payer: United Health Care Medicare Advantage	$188.69

NM BRAIN SCAN W FLOW STUDY

Facility

$896.00

Service Code	HCPCS 78606
Hospital Charge Code	3400080
Hospital Revenue Code	340
Min. Negotiated Rate	$256.29
Max. Negotiated Rate	$761.60
Rate for Payer: BCBS BCN 65	$582.47
Rate for Payer: Blue Care Network Medicare Advantage	$582.47
Rate for Payer: Cash Price	$582.40
Rate for Payer: Cash Price	$582.40
Rate for Payer: Community Health Alliance Commercial	$761.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$582.47
Rate for Payer: Meridian Health Plan Medicare	$582.47
Rate for Payer: Priority Health Commercial	$627.20
Rate for Payer: Priority Health Medicaid	$582.47
Rate for Payer: Priority Health Medicare	$582.47
Rate for Payer: Priority Health PPO	$627.20
Rate for Payer: United Health Care Medicaid	$582.47
Rate for Payer: United Health Care Medicare Advantage	$256.29

NM CISTERNOGRAM

Facility

$2,864.00

Service Code	HCPCS 78451
Hospital Charge Code	3400308
Hospital Revenue Code	340
Min. Negotiated Rate	$611.08
Max. Negotiated Rate	$2,434.40
Rate for Payer: BCBS BCN 65	$1,388.82
Rate for Payer: Blue Care Network Medicare Advantage	$1,388.82
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Community Health Alliance Commercial	$2,434.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,388.82
Rate for Payer: Meridian Health Plan Medicare	$1,388.82
Rate for Payer: Priority Health Commercial	$2,004.80
Rate for Payer: Priority Health Medicaid	$1,388.82
Rate for Payer: Priority Health Medicare	$1,388.82
Rate for Payer: Priority Health PPO	$2,004.80
Rate for Payer: United Health Care Medicaid	$1,388.82
Rate for Payer: United Health Care Medicare Advantage	$611.08

NMDA RECEPTOR IGG

Facility

$195.00

Hospital Charge Code	3100919
Hospital Revenue Code	300
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$165.75
Rate for Payer: Cash Price	$126.75
Rate for Payer: Community Health Alliance Commercial	$165.75
Rate for Payer: Priority Health Commercial	$136.50
Rate for Payer: Priority Health PPO	$136.50

NMDA RECEPTOR -IGG TITER

Facility

$126.00

Hospital Charge Code	3100920
Hospital Revenue Code	300
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$107.10
Rate for Payer: Cash Price	$81.90
Rate for Payer: Community Health Alliance Commercial	$107.10
Rate for Payer: Priority Health Commercial	$88.20
Rate for Payer: Priority Health PPO	$88.20

NM DEEP VEIN THROMBOSIS

Facility

$1,141.00

Service Code	HCPCS 78457
Hospital Charge Code	3400346
Hospital Revenue Code	340
Min. Negotiated Rate	$256.29
Max. Negotiated Rate	$969.85
Rate for Payer: BCBS BCN 65	$582.47
Rate for Payer: Blue Care Network Medicare Advantage	$582.47
Rate for Payer: Cash Price	$741.65
Rate for Payer: Cash Price	$741.65
Rate for Payer: Community Health Alliance Commercial	$969.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$582.47
Rate for Payer: Meridian Health Plan Medicare	$582.47
Rate for Payer: Priority Health Commercial	$798.70
Rate for Payer: Priority Health Medicaid	$582.47
Rate for Payer: Priority Health Medicare	$582.47
Rate for Payer: Priority Health PPO	$798.70
Rate for Payer: United Health Care Medicaid	$582.47
Rate for Payer: United Health Care Medicare Advantage	$256.29

NMEN A AB

Facility

$70.00

Hospital Charge Code	3100612
Hospital Revenue Code	309
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

N. MEN ACYW135 AG (MEN PANEL)

Facility

$50.00

Service Code	HCPCS 86403
Hospital Charge Code	3006170
Hospital Revenue Code	302
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$12.12
Rate for Payer: Blue Care Network Medicare Advantage	$12.12
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.12
Rate for Payer: Meridian Health Plan Medicare	$12.12
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$12.12
Rate for Payer: Priority Health Medicare	$12.12
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$12.12
Rate for Payer: United Health Care Medicare Advantage	$5.33

NMEN C AB

Facility

$70.00

Hospital Charge Code	3100613
Hospital Revenue Code	309
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

NMEN IGG ANTIBODIES

Facility

$277.00

Hospital Charge Code	3100616
Hospital Revenue Code	309
Min. Negotiated Rate	$193.90
Max. Negotiated Rate	$235.45
Rate for Payer: Cash Price	$180.05
Rate for Payer: Community Health Alliance Commercial	$235.45
Rate for Payer: Priority Health Commercial	$193.90
Rate for Payer: Priority Health PPO	$193.90

N. MENINGITIS B AG (MEN PANEL)

Facility

$50.00

Service Code	HCPCS 86403
Hospital Charge Code	3006175
Hospital Revenue Code	302
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$12.12
Rate for Payer: Blue Care Network Medicare Advantage	$12.12
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.12
Rate for Payer: Meridian Health Plan Medicare	$12.12
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$12.12
Rate for Payer: Priority Health Medicare	$12.12
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$12.12
Rate for Payer: United Health Care Medicare Advantage	$5.33

NMEN W135 AB

Facility

$70.00

Hospital Charge Code	3100614
Hospital Revenue Code	309
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

NMEN Y AB

Facility

$70.00

Hospital Charge Code	3100615
Hospital Revenue Code	309
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges