Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

NOROVIRUS

Facility

$134.00

Hospital Charge Code	3001047
Hospital Revenue Code	306
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$113.90
Rate for Payer: Cash Price	$87.10
Rate for Payer: Community Health Alliance Commercial	$113.90
Rate for Payer: Priority Health Commercial	$93.80
Rate for Payer: Priority Health PPO	$93.80

NOROVIRUS

Facility

$134.00

Hospital Charge Code	3001048
Hospital Revenue Code	306
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$113.90
Rate for Payer: Cash Price	$87.10
Rate for Payer: Community Health Alliance Commercial	$113.90
Rate for Payer: Priority Health Commercial	$93.80
Rate for Payer: Priority Health PPO	$93.80

NOROVIRUS

Facility

$182.00

Hospital Charge Code	3001049
Hospital Revenue Code	306
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$154.70
Rate for Payer: Cash Price	$118.30
Rate for Payer: Community Health Alliance Commercial	$154.70
Rate for Payer: Priority Health Commercial	$127.40
Rate for Payer: Priority Health PPO	$127.40

NORTRIPTYLINE (AVENTYL)

Facility

$63.00

Service Code	HCPCS G0480
Hospital Charge Code	3006340
Hospital Revenue Code	301
Min. Negotiated Rate	$44.10
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	$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	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$44.10
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

NOVASURE

Facility

$2,446.00

Hospital Charge Code	27268076
Hospital Revenue Code	272
Min. Negotiated Rate	$1,712.20
Max. Negotiated Rate	$2,079.10
Rate for Payer: Cash Price	$1,589.90
Rate for Payer: Community Health Alliance Commercial	$2,079.10
Rate for Payer: Priority Health Commercial	$1,712.20
Rate for Payer: Priority Health PPO	$1,712.20

NP-1

Facility

$5.70

Hospital Charge Code	3101831
Hospital Revenue Code	300
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$4.84
Rate for Payer: Cash Price	$3.71
Rate for Payer: Community Health Alliance Commercial	$4.84
Rate for Payer: Priority Health Commercial	$3.99
Rate for Payer: Priority Health PPO	$3.99

NRAS 1

Facility

$197.50

Hospital Charge Code	3101361
Hospital Revenue Code	310
Min. Negotiated Rate	$138.25
Max. Negotiated Rate	$167.88
Rate for Payer: Cash Price	$128.38
Rate for Payer: Community Health Alliance Commercial	$167.88
Rate for Payer: Priority Health Commercial	$138.25
Rate for Payer: Priority Health PPO	$138.25

NRAS 2

Facility

$197.50

Hospital Charge Code	3101362
Hospital Revenue Code	310
Min. Negotiated Rate	$138.25
Max. Negotiated Rate	$167.88
Rate for Payer: Cash Price	$128.38
Rate for Payer: Community Health Alliance Commercial	$167.88
Rate for Payer: Priority Health Commercial	$138.25
Rate for Payer: Priority Health PPO	$138.25

NSNA

Facility

$103.00

Hospital Charge Code	3000829
Hospital Revenue Code	301
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$87.55
Rate for Payer: Cash Price	$66.95
Rate for Payer: Community Health Alliance Commercial	$87.55
Rate for Payer: Priority Health Commercial	$72.10
Rate for Payer: Priority Health PPO	$72.10

N TELOPEPTIDES SERUM

Facility

$26.88

Hospital Charge Code	3102002
Hospital Revenue Code	300
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$22.85
Rate for Payer: Cash Price	$17.47
Rate for Payer: Community Health Alliance Commercial	$22.85
Rate for Payer: Priority Health Commercial	$18.82
Rate for Payer: Priority Health PPO	$18.82

N-TELOPEPTIDE,URINE

Facility

$121.00

Service Code	HCPCS 82523
Hospital Charge Code	3006350
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$102.85
Rate for Payer: BCBS BCN 65	$19.61
Rate for Payer: Blue Care Network Medicare Advantage	$19.61
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Community Health Alliance Commercial	$102.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.61
Rate for Payer: Meridian Health Plan Medicare	$19.61
Rate for Payer: Priority Health Commercial	$84.70
Rate for Payer: Priority Health Medicaid	$19.61
Rate for Payer: Priority Health Medicare	$19.61
Rate for Payer: Priority Health PPO	$84.70
Rate for Payer: United Health Care Medicaid	$19.61
Rate for Payer: United Health Care Medicare Advantage	$8.63

NTX URINE-1

Facility

$8.14

Hospital Charge Code	3101782
Hospital Revenue Code	300
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$6.92
Rate for Payer: Cash Price	$5.29
Rate for Payer: Community Health Alliance Commercial	$6.92
Rate for Payer: Priority Health Commercial	$5.70
Rate for Payer: Priority Health PPO	$5.70

NTX URINE-2

Facility

$18.15

Hospital Charge Code	3101783
Hospital Revenue Code	300
Min. Negotiated Rate	$12.71
Max. Negotiated Rate	$15.43
Rate for Payer: Cash Price	$11.80
Rate for Payer: Community Health Alliance Commercial	$15.43
Rate for Payer: Priority Health Commercial	$12.71
Rate for Payer: Priority Health PPO	$12.71

NUCLEOTIDASE-5

Facility

$4.89

Service Code	HCPCS 83915
Hospital Charge Code	3000120
Hospital Revenue Code	301
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$11.71
Rate for Payer: BCBS BCN 65	$11.71
Rate for Payer: Blue Care Network Medicare Advantage	$11.71
Rate for Payer: Cash Price	$3.18
Rate for Payer: Cash Price	$3.18
Rate for Payer: Community Health Alliance Commercial	$4.16
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$11.71
Rate for Payer: Meridian Health Plan Medicare	$11.71
Rate for Payer: Priority Health Commercial	$3.42
Rate for Payer: Priority Health Medicaid	$11.71
Rate for Payer: Priority Health Medicare	$11.71
Rate for Payer: Priority Health PPO	$3.42
Rate for Payer: United Health Care Medicaid	$11.71
Rate for Payer: United Health Care Medicare Advantage	$5.15

NUGAUZE 1/2 IODOPHOR

Facility

$34.00

Hospital Charge Code	27012294
Hospital Revenue Code	270
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$28.90
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health PPO	$23.80

NUGAUZE 1/2 PLAIN

Facility

$27.00

Hospital Charge Code	27012310
Hospital Revenue Code	270
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

NUGAUZE 1 IODOPHOR

Facility

$38.00

Hospital Charge Code	27012278
Hospital Revenue Code	270
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$32.30
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health PPO	$26.60

NUGAUZE 1 PLAIN

Facility

$34.00

Hospital Charge Code	27012302
Hospital Revenue Code	270
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$28.90
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health PPO	$23.80

NUGAUZE 2 IODOPHOR

Facility

$53.00

Hospital Charge Code	27012286
Hospital Revenue Code	270
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$45.05
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health PPO	$37.10

NUGUAZE 2 PLAIN

Facility

$45.00

Hospital Charge Code	27012328
Hospital Revenue Code	270
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

NXGEN

Facility

$20.00

Hospital Charge Code	3101066
Hospital Revenue Code	310
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

O214-IGE

Facility

$3.26

Hospital Charge Code	31027693
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

OA-1

Facility

$5.50

Hospital Charge Code	3102529
Hospital Revenue Code	300
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$4.67
Rate for Payer: Cash Price	$3.58
Rate for Payer: Community Health Alliance Commercial	$4.67
Rate for Payer: Priority Health Commercial	$3.85
Rate for Payer: Priority Health PPO	$3.85

OA-2

Facility

$5.50

Hospital Charge Code	3102530
Hospital Revenue Code	300
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$4.67
Rate for Payer: Cash Price	$3.58
Rate for Payer: Community Health Alliance Commercial	$4.67
Rate for Payer: Priority Health Commercial	$3.85
Rate for Payer: Priority Health PPO	$3.85

OBTRYX URETHRAL SLING

Facility

$2,782.00

Service Code	HCPCS C1771
Hospital Charge Code	27271872
Hospital Revenue Code	278
Min. Negotiated Rate	$1,947.40
Max. Negotiated Rate	$2,364.70
Rate for Payer: Cash Price	$1,808.30
Rate for Payer: Community Health Alliance Commercial	$2,364.70
Rate for Payer: Priority Health Commercial	$1,947.40
Rate for Payer: Priority Health PPO	$1,947.40

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges