Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

TBL-4

Facility

$26.22

Hospital Charge Code	31027654
Hospital Revenue Code	300
Min. Negotiated Rate	$18.35
Max. Negotiated Rate	$22.29
Rate for Payer: Cash Price	$17.04
Rate for Payer: Community Health Alliance Commercial	$22.29
Rate for Payer: Priority Health Commercial	$18.35
Rate for Payer: Priority Health PPO	$18.35

T&B LYMPH PANEL TOTAL

Facility

$104.91

Hospital Charge Code	31027650
Hospital Revenue Code	300
Min. Negotiated Rate	$73.44
Max. Negotiated Rate	$89.17
Rate for Payer: Cash Price	$68.19
Rate for Payer: Community Health Alliance Commercial	$89.17
Rate for Payer: Priority Health Commercial	$73.44
Rate for Payer: Priority Health PPO	$73.44

TC-1

Facility

$11.50

Hospital Charge Code	3102433
Hospital Revenue Code	300
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$9.78
Rate for Payer: Cash Price	$7.48
Rate for Payer: Community Health Alliance Commercial	$9.78
Rate for Payer: Priority Health Commercial	$8.05
Rate for Payer: Priority Health PPO	$8.05

TC1-LC

Facility

$10.82

Hospital Charge Code	3102687
Hospital Revenue Code	300
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$9.20
Rate for Payer: Cash Price	$7.03
Rate for Payer: Community Health Alliance Commercial	$9.20
Rate for Payer: Priority Health Commercial	$7.57
Rate for Payer: Priority Health PPO	$7.57

TC-2

Facility

$6.31

Hospital Charge Code	3102462
Hospital Revenue Code	300
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$5.36
Rate for Payer: Cash Price	$4.10
Rate for Payer: Community Health Alliance Commercial	$5.36
Rate for Payer: Priority Health Commercial	$4.42
Rate for Payer: Priority Health PPO	$4.42

TC2-LC

Facility

$10.82

Hospital Charge Code	3102688
Hospital Revenue Code	300
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$9.20
Rate for Payer: Cash Price	$7.03
Rate for Payer: Community Health Alliance Commercial	$9.20
Rate for Payer: Priority Health Commercial	$7.57
Rate for Payer: Priority Health PPO	$7.57

TC3-LC

Facility

$10.83

Hospital Charge Code	3102689
Hospital Revenue Code	300
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$9.21
Rate for Payer: Cash Price	$7.04
Rate for Payer: Community Health Alliance Commercial	$9.21
Rate for Payer: Priority Health Commercial	$7.58
Rate for Payer: Priority Health PPO	$7.58

TCAQS-1

Facility

$42.50

Hospital Charge Code	3102470
Hospital Revenue Code	300
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$36.12
Rate for Payer: Cash Price	$27.63
Rate for Payer: Community Health Alliance Commercial	$36.12
Rate for Payer: Priority Health Commercial	$29.75
Rate for Payer: Priority Health PPO	$29.75

TCAQS-2

Facility

$15.00

Service Code	HCPCS G0480
Hospital Charge Code	3100704
Hospital Revenue Code	300
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

TCAQS-3

Facility

$42.50

Hospital Charge Code	3102471
Hospital Revenue Code	300
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$36.12
Rate for Payer: Cash Price	$27.63
Rate for Payer: Community Health Alliance Commercial	$36.12
Rate for Payer: Priority Health Commercial	$29.75
Rate for Payer: Priority Health PPO	$29.75

TCA SCREEN (SERUM)

Facility

$9.74

Service Code	HCPCS 80337
Hospital Charge Code	3006868
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$8.28
Rate for Payer: Cash Price	$6.33
Rate for Payer: Community Health Alliance Commercial	$8.28
Rate for Payer: Priority Health Commercial	$6.82
Rate for Payer: Priority Health PPO	$6.82

TC BONE MARROW BIOPSY EXAM

Facility

$53.00

Hospital Charge Code	3100950
Hospital Revenue Code	310
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

TC BONE MARROW CLOT EXAM

Facility

$53.00

Hospital Charge Code	3100949
Hospital Revenue Code	310
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

TC Cish 1st SGL-SBMF

Facility

$126.01

Hospital Charge Code	3102698
Hospital Revenue Code	300
Min. Negotiated Rate	$88.21
Max. Negotiated Rate	$107.11
Rate for Payer: Cash Price	$81.91
Rate for Payer: Community Health Alliance Commercial	$107.11
Rate for Payer: Priority Health Commercial	$88.21
Rate for Payer: Priority Health PPO	$88.21

TC Cish 1st SGL-SBMF

Facility

$112.84

Hospital Charge Code	3102699
Hospital Revenue Code	300
Min. Negotiated Rate	$78.99
Max. Negotiated Rate	$95.91
Rate for Payer: Cash Price	$73.35
Rate for Payer: Community Health Alliance Commercial	$95.91
Rate for Payer: Priority Health Commercial	$78.99
Rate for Payer: Priority Health PPO	$78.99

TC CISH QL, 1ST SING PRB ST

Facility

$131.22

Hospital Charge Code	3101663
Hospital Revenue Code	300
Min. Negotiated Rate	$91.85
Max. Negotiated Rate	$111.54
Rate for Payer: Cash Price	$85.29
Rate for Payer: Community Health Alliance Commercial	$111.54
Rate for Payer: Priority Health Commercial	$91.85
Rate for Payer: Priority Health PPO	$91.85

TC CYTOLOGY CYTOSPIN TC

Facility

$25.90

Hospital Charge Code	3101100
Hospital Revenue Code	311
Min. Negotiated Rate	$18.13
Max. Negotiated Rate	$22.02
Rate for Payer: Cash Price	$16.84
Rate for Payer: Community Health Alliance Commercial	$22.02
Rate for Payer: Priority Health Commercial	$18.13
Rate for Payer: Priority Health PPO	$18.13

T-CELL CLONALITY BY PCR

Facility

$181.23

Hospital Charge Code	3101311
Hospital Revenue Code	300
Min. Negotiated Rate	$126.86
Max. Negotiated Rate	$154.05
Rate for Payer: Cash Price	$117.80
Rate for Payer: Community Health Alliance Commercial	$154.05
Rate for Payer: Priority Health Commercial	$126.86
Rate for Payer: Priority Health PPO	$126.86

T CELL RECEPTOR

Facility

$349.83

Hospital Charge Code	31027705
Hospital Revenue Code	300
Min. Negotiated Rate	$244.88
Max. Negotiated Rate	$297.36
Rate for Payer: Cash Price	$227.39
Rate for Payer: Community Health Alliance Commercial	$297.36
Rate for Payer: Priority Health Commercial	$244.88
Rate for Payer: Priority Health PPO	$244.88

T CELLS TOTAL COUNT

Facility

$17.97

Hospital Charge Code	3100175
Hospital Revenue Code	302
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$15.27
Rate for Payer: Cash Price	$11.68
Rate for Payer: Community Health Alliance Commercial	$15.27
Rate for Payer: Priority Health Commercial	$12.58
Rate for Payer: Priority Health PPO	$12.58

TC ER/PR

Facility

$185.00

Hospital Charge Code	3000255
Hospital Revenue Code	310
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$157.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Community Health Alliance Commercial	$157.25
Rate for Payer: Priority Health Commercial	$129.50
Rate for Payer: Priority Health PPO	$129.50

TC IMMUNOFLUORESCENCE 1ST AB

Facility

$201.22

Hospital Charge Code	3101615
Hospital Revenue Code	310
Min. Negotiated Rate	$140.85
Max. Negotiated Rate	$171.04
Rate for Payer: Cash Price	$130.79
Rate for Payer: Community Health Alliance Commercial	$171.04
Rate for Payer: Priority Health Commercial	$140.85
Rate for Payer: Priority Health PPO	$140.85

TCMTNA-35-145-3-BH (COOK)

Facility

$46.00

Service Code	HCPCS C1769
Hospital Charge Code	27021063
Hospital Revenue Code	272
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

TC-PD-L1 IHC 22C3 PHARMDX

Facility

$168.00

Hospital Charge Code	3101271
Hospital Revenue Code	310
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$142.80
Rate for Payer: Cash Price	$109.20
Rate for Payer: Community Health Alliance Commercial	$142.80
Rate for Payer: Priority Health Commercial	$117.60
Rate for Payer: Priority Health PPO	$117.60

TCR-1

Facility

$174.91

Hospital Charge Code	31027706
Hospital Revenue Code	300
Min. Negotiated Rate	$122.44
Max. Negotiated Rate	$148.67
Rate for Payer: Cash Price	$113.69
Rate for Payer: Community Health Alliance Commercial	$148.67
Rate for Payer: Priority Health Commercial	$122.44
Rate for Payer: Priority Health PPO	$122.44

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges