Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

T3 FREE DIALYSIS

Facility

$60.00

Hospital Charge Code	31027530
Hospital Revenue Code	300
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

T3 REVERSE

Facility

$5.70

Service Code	HCPCS 84482
Hospital Charge Code	3008255
Hospital Revenue Code	301
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$16.55
Rate for Payer: BCBS BCN 65	$16.55
Rate for Payer: Blue Care Network Medicare Advantage	$16.55
Rate for Payer: Cash Price	$3.71
Rate for Payer: Cash Price	$3.71
Rate for Payer: Community Health Alliance Commercial	$4.84
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.55
Rate for Payer: Meridian Health Plan Medicare	$16.55
Rate for Payer: Priority Health Commercial	$3.99
Rate for Payer: Priority Health Medicaid	$16.55
Rate for Payer: Priority Health Medicare	$16.55
Rate for Payer: Priority Health PPO	$3.99
Rate for Payer: United Health Care Medicaid	$16.55
Rate for Payer: United Health Care Medicare Advantage	$7.28

T3 RIA

Facility

$3.67

Service Code	HCPCS 84480
Hospital Charge Code	3008260
Hospital Revenue Code	301
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$14.89
Rate for Payer: BCBS BCN 65	$14.89
Rate for Payer: Blue Care Network Medicare Advantage	$14.89
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cash Price	$2.39
Rate for Payer: Community Health Alliance Commercial	$3.12
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.89
Rate for Payer: Meridian Health Plan Medicare	$14.89
Rate for Payer: Priority Health Commercial	$2.57
Rate for Payer: Priority Health Medicaid	$14.89
Rate for Payer: Priority Health Medicare	$14.89
Rate for Payer: Priority Health PPO	$2.57
Rate for Payer: United Health Care Medicaid	$14.89
Rate for Payer: United Health Care Medicare Advantage	$6.55

T3 UPTAKE

Facility

$2.25

Service Code	HCPCS 84479
Hospital Charge Code	3007800
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$6.79
Rate for Payer: BCBS BCN 65	$6.79
Rate for Payer: Blue Care Network Medicare Advantage	$6.79
Rate for Payer: Cash Price	$1.46
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.91
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.79
Rate for Payer: Meridian Health Plan Medicare	$6.79
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health Medicaid	$6.79
Rate for Payer: Priority Health Medicare	$6.79
Rate for Payer: Priority Health PPO	$1.57
Rate for Payer: United Health Care Medicaid	$6.79
Rate for Payer: United Health Care Medicare Advantage	$2.99

T4 EXEC

Facility

$33.00

Hospital Charge Code	3008021
Hospital Revenue Code	301
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$28.05
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health PPO	$23.10

T-4 LC

Facility

$2.25

Hospital Charge Code	3101850
Hospital Revenue Code	300
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.91
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.91
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health PPO	$1.57

T-4/THYROXINE

Facility

$48.00

Service Code	HCPCS 84436
Hospital Charge Code	3008020
Hospital Revenue Code	301
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$40.80
Rate for Payer: BCBS BCN 65	$7.21
Rate for Payer: Blue Care Network Medicare Advantage	$7.21
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Community Health Alliance Commercial	$40.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.21
Rate for Payer: Meridian Health Plan Medicare	$7.21
Rate for Payer: Priority Health Commercial	$33.60
Rate for Payer: Priority Health Medicaid	$7.21
Rate for Payer: Priority Health Medicare	$7.21
Rate for Payer: Priority Health PPO	$33.60
Rate for Payer: United Health Care Medicaid	$7.21
Rate for Payer: United Health Care Medicare Advantage	$3.17

TA-1

Facility

$41.21

Hospital Charge Code	3000333
Hospital Revenue Code	300
Min. Negotiated Rate	$28.85
Max. Negotiated Rate	$35.03
Rate for Payer: Cash Price	$26.79
Rate for Payer: Community Health Alliance Commercial	$35.03
Rate for Payer: Priority Health Commercial	$28.85
Rate for Payer: Priority Health PPO	$28.85

TA-2

Facility

$41.22

Hospital Charge Code	3000334
Hospital Revenue Code	300
Min. Negotiated Rate	$28.85
Max. Negotiated Rate	$35.04
Rate for Payer: Cash Price	$26.79
Rate for Payer: Community Health Alliance Commercial	$35.04
Rate for Payer: Priority Health Commercial	$28.85
Rate for Payer: Priority Health PPO	$28.85

TACROLIMUS - RML

Facility

$20.40

Service Code	HCPCS 80197
Hospital Charge Code	3007805
Hospital Revenue Code	301
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$17.34
Rate for Payer: BCBS BCN 65	$14.42
Rate for Payer: Blue Care Network Medicare Advantage	$14.42
Rate for Payer: Cash Price	$13.26
Rate for Payer: Cash Price	$13.26
Rate for Payer: Community Health Alliance Commercial	$17.34
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.42
Rate for Payer: Meridian Health Plan Medicare	$14.42
Rate for Payer: Priority Health Commercial	$14.28
Rate for Payer: Priority Health Medicaid	$14.42
Rate for Payer: Priority Health Medicare	$14.42
Rate for Payer: Priority Health PPO	$14.28
Rate for Payer: United Health Care Medicaid	$14.42
Rate for Payer: United Health Care Medicare Advantage	$6.34

TAMOXIFEN LEVEL

Facility

$329.00

Service Code	HCPCS 80299
Hospital Charge Code	3009090
Hospital Revenue Code	300
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$279.65
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$213.85
Rate for Payer: Cash Price	$213.85
Rate for Payer: Community Health Alliance Commercial	$279.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.57
Rate for Payer: Meridian Health Plan Medicare	$19.57
Rate for Payer: Priority Health Commercial	$230.30
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$230.30
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

TAPENTADOL METABOLITE URINE

Facility

$69.00

Hospital Charge Code	3101105
Hospital Revenue Code	309
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$58.65
Rate for Payer: Cash Price	$44.85
Rate for Payer: Community Health Alliance Commercial	$58.65
Rate for Payer: Priority Health Commercial	$48.30
Rate for Payer: Priority Health PPO	$48.30

TAPENTADOL UR SCRN W REF TO QU

Facility

$32.50

Hospital Charge Code	3101104
Hospital Revenue Code	309
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$27.62
Rate for Payer: Cash Price	$21.13
Rate for Payer: Community Health Alliance Commercial	$27.62
Rate for Payer: Priority Health Commercial	$22.75
Rate for Payer: Priority Health PPO	$22.75

TAPERTOME #3282

Facility

$768.00

Hospital Charge Code	27262551
Hospital Revenue Code	272
Min. Negotiated Rate	$537.60
Max. Negotiated Rate	$652.80
Rate for Payer: Cash Price	$499.20
Rate for Payer: Community Health Alliance Commercial	$652.80
Rate for Payer: Priority Health Commercial	$537.60
Rate for Payer: Priority Health PPO	$537.60

TAU 217-LC

Facility

$179.00

Hospital Charge Code	31027492
Hospital Revenue Code	300
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$152.15
Rate for Payer: Cash Price	$116.35
Rate for Payer: Community Health Alliance Commercial	$152.15
Rate for Payer: Priority Health Commercial	$125.30
Rate for Payer: Priority Health PPO	$125.30

TAY-SACHS-BIOCHEMICAL SERUM

Facility

$22.48

Hospital Charge Code	3006885
Hospital Revenue Code	301
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$19.11
Rate for Payer: Cash Price	$14.61
Rate for Payer: Community Health Alliance Commercial	$19.11
Rate for Payer: Priority Health Commercial	$15.74
Rate for Payer: Priority Health PPO	$15.74

TB-1

Facility

$24.21

Hospital Charge Code	3102016
Hospital Revenue Code	300
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$20.58
Rate for Payer: Cash Price	$15.74
Rate for Payer: Community Health Alliance Commercial	$20.58
Rate for Payer: Priority Health Commercial	$16.95
Rate for Payer: Priority Health PPO	$16.95

TB-2

Facility

$24.21

Hospital Charge Code	3102017
Hospital Revenue Code	300
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$20.58
Rate for Payer: Cash Price	$15.74
Rate for Payer: Community Health Alliance Commercial	$20.58
Rate for Payer: Priority Health Commercial	$16.95
Rate for Payer: Priority Health PPO	$16.95

TB BLOOD CULTURE

Facility

$85.52

Hospital Charge Code	3002444
Hospital Revenue Code	306
Min. Negotiated Rate	$59.86
Max. Negotiated Rate	$72.69
Rate for Payer: Cash Price	$55.59
Rate for Payer: Community Health Alliance Commercial	$72.69
Rate for Payer: Priority Health Commercial	$59.86
Rate for Payer: Priority Health PPO	$59.86

TB GOLD

Facility

$52.00

Hospital Charge Code	3000431
Hospital Revenue Code	300
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

TB GOLD PLUS

Facility

$34.00

Hospital Charge Code	3101244
Hospital Revenue Code	300
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

TB-GOLD QUANTIFERON

Facility

$396.00

Hospital Charge Code	3008850
Hospital Revenue Code	302
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$336.60
Rate for Payer: Cash Price	$257.40
Rate for Payer: Community Health Alliance Commercial	$336.60
Rate for Payer: Priority Health Commercial	$277.20
Rate for Payer: Priority Health PPO	$277.20

TBL-1

Facility

$26.23

Hospital Charge Code	31027651
Hospital Revenue Code	300
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$22.30
Rate for Payer: Cash Price	$17.05
Rate for Payer: Community Health Alliance Commercial	$22.30
Rate for Payer: Priority Health Commercial	$18.36
Rate for Payer: Priority Health PPO	$18.36

TBL-2

Facility

$26.23

Hospital Charge Code	31027652
Hospital Revenue Code	300
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$22.30
Rate for Payer: Cash Price	$17.05
Rate for Payer: Community Health Alliance Commercial	$22.30
Rate for Payer: Priority Health Commercial	$18.36
Rate for Payer: Priority Health PPO	$18.36

TBL-3

Facility

$26.23

Hospital Charge Code	31027653
Hospital Revenue Code	300
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$22.30
Rate for Payer: Cash Price	$17.05
Rate for Payer: Community Health Alliance Commercial	$22.30
Rate for Payer: Priority Health Commercial	$18.36
Rate for Payer: Priority Health PPO	$18.36

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges