Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

TCR-2

Facility

$174.92

Hospital Charge Code	31027707
Hospital Revenue Code	300
Min. Negotiated Rate	$122.44
Max. Negotiated Rate	$148.68
Rate for Payer: Cash Price	$113.70
Rate for Payer: Community Health Alliance Commercial	$148.68
Rate for Payer: Priority Health Commercial	$122.44
Rate for Payer: Priority Health PPO	$122.44

TCRUZ1

Facility

$57.50

Hospital Charge Code	31027534
Hospital Revenue Code	300
Min. Negotiated Rate	$40.25
Max. Negotiated Rate	$48.88
Rate for Payer: Cash Price	$37.38
Rate for Payer: Community Health Alliance Commercial	$48.88
Rate for Payer: Priority Health Commercial	$40.25
Rate for Payer: Priority Health PPO	$40.25

TCRUZ2

Facility

$57.50

Hospital Charge Code	31027535
Hospital Revenue Code	300
Min. Negotiated Rate	$40.25
Max. Negotiated Rate	$48.88
Rate for Payer: Cash Price	$37.38
Rate for Payer: Community Health Alliance Commercial	$48.88
Rate for Payer: Priority Health Commercial	$40.25
Rate for Payer: Priority Health PPO	$40.25

T. CRUZI IGG PANEL

Facility

$115.00

Hospital Charge Code	31027533
Hospital Revenue Code	300
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$97.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Community Health Alliance Commercial	$97.75
Rate for Payer: Priority Health Commercial	$80.50
Rate for Payer: Priority Health PPO	$80.50

TC TOUCH PREP EACH ADDL SITE

Facility

$60.00

Hospital Charge Code	3101085
Hospital Revenue Code	312
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

TC TUMOR CELL QN SQ MANUAL

Facility

$82.60

Hospital Charge Code	3101315
Hospital Revenue Code	310
Min. Negotiated Rate	$57.82
Max. Negotiated Rate	$70.21
Rate for Payer: Cash Price	$53.69
Rate for Payer: Community Health Alliance Commercial	$70.21
Rate for Payer: Priority Health Commercial	$57.82
Rate for Payer: Priority Health PPO	$57.82

TDAP 1

Facility

$7.74

Hospital Charge Code	31027443
Hospital Revenue Code	300
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$6.58
Rate for Payer: Cash Price	$5.03
Rate for Payer: Community Health Alliance Commercial	$6.58
Rate for Payer: Priority Health Commercial	$5.42
Rate for Payer: Priority Health PPO	$5.42

TDAP-1

Facility

$35.00

Hospital Charge Code	3102587
Hospital Revenue Code	300
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

TDAP 2

Facility

$7.74

Hospital Charge Code	31027444
Hospital Revenue Code	300
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$6.58
Rate for Payer: Cash Price	$5.03
Rate for Payer: Community Health Alliance Commercial	$6.58
Rate for Payer: Priority Health Commercial	$5.42
Rate for Payer: Priority Health PPO	$5.42

TDAP-2

Facility

$35.00

Hospital Charge Code	3102588
Hospital Revenue Code	300
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

TDAP-3

Facility

$35.00

Hospital Charge Code	3102589
Hospital Revenue Code	300
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

TDAP-4

Facility

$35.00

Hospital Charge Code	3102590
Hospital Revenue Code	300
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

TDAP LC

Facility

$15.48

Hospital Charge Code	31027442
Hospital Revenue Code	300
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$13.16
Rate for Payer: Cash Price	$10.06
Rate for Payer: Community Health Alliance Commercial	$13.16
Rate for Payer: Priority Health Commercial	$10.84
Rate for Payer: Priority Health PPO	$10.84

TDO OCCULT BLOOD IMMUN DIAGNOS

Facility

$63.00

Hospital Charge Code	3007722
Hospital Revenue Code	301
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$53.55
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health PPO	$44.10

TDO OCCULT BLOOD IMMUN SCREEN

Facility

$63.00

Service Code	HCPCS G0328 QW
Hospital Charge Code	3007721
Hospital Revenue Code	301
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$53.55
Rate for Payer: BCBS BCN 65	$18.95
Rate for Payer: Blue Care Network Medicare Advantage	$18.95
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	$18.95
Rate for Payer: Meridian Health Plan Medicare	$18.95
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health Medicaid	$18.95
Rate for Payer: Priority Health Medicare	$18.95
Rate for Payer: Priority Health PPO	$44.10
Rate for Payer: United Health Care Medicaid	$18.95
Rate for Payer: United Health Care Medicare Advantage	$8.34

TDO URINALYSIS

Facility

$29.00

Hospital Charge Code	3007726
Hospital Revenue Code	300
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$24.65
Rate for Payer: Cash Price	$18.85
Rate for Payer: Community Health Alliance Commercial	$24.65
Rate for Payer: Priority Health Commercial	$20.30
Rate for Payer: Priority Health PPO	$20.30

TECNOL HAND AID

Facility

$25.00

Hospital Charge Code	27013326
Hospital Revenue Code	270
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

TEFLON GUIDE WIRE

Facility

$56.00

Service Code	HCPCS C1769
Hospital Charge Code	27017574
Hospital Revenue Code	272
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

TEICHOIC ACID

Facility

$46.60

Service Code	HCPCS 86329
Hospital Charge Code	3007810
Hospital Revenue Code	302
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$39.61
Rate for Payer: BCBS BCN 65	$14.75
Rate for Payer: Blue Care Network Medicare Advantage	$14.75
Rate for Payer: Cash Price	$30.29
Rate for Payer: Cash Price	$30.29
Rate for Payer: Community Health Alliance Commercial	$39.61
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.75
Rate for Payer: Meridian Health Plan Medicare	$14.75
Rate for Payer: Priority Health Commercial	$32.62
Rate for Payer: Priority Health Medicaid	$14.75
Rate for Payer: Priority Health Medicare	$14.75
Rate for Payer: Priority Health PPO	$32.62
Rate for Payer: United Health Care Medicaid	$14.75
Rate for Payer: United Health Care Medicare Advantage	$6.49

TEMPORAL ARTERY PROCEDURE

Facility

$1,003.00

Hospital Charge Code	5150752
Hospital Revenue Code	960
Min. Negotiated Rate	$702.10
Max. Negotiated Rate	$852.55
Rate for Payer: Cash Price	$651.95
Rate for Payer: Community Health Alliance Commercial	$852.55
Rate for Payer: Priority Health Commercial	$702.10
Rate for Payer: Priority Health PPO	$702.10

TEMP. PACING LEAD

Facility

$217.00

Hospital Charge Code	27015305
Hospital Revenue Code	275
Min. Negotiated Rate	$151.90
Max. Negotiated Rate	$184.45
Rate for Payer: Cash Price	$141.05
Rate for Payer: Community Health Alliance Commercial	$184.45
Rate for Payer: Priority Health Commercial	$151.90
Rate for Payer: Priority Health PPO	$151.90

TEMP SENSOR - NASOPHARYNGEAL

Facility

$56.00

Hospital Charge Code	27013474
Hospital Revenue Code	270
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

TEMP SENSOR,TYMPANIC

Facility

$27.00

Hospital Charge Code	27019315
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

TENDON GRAFT

Facility

$2,117.00

Hospital Charge Code	27018127
Hospital Revenue Code	278
Min. Negotiated Rate	$1,481.90
Max. Negotiated Rate	$1,799.45
Rate for Payer: Cash Price	$1,376.05
Rate for Payer: Community Health Alliance Commercial	$1,799.45
Rate for Payer: Priority Health Commercial	$1,481.90
Rate for Payer: Priority Health PPO	$1,481.90

TENDON SPACED H.P.

Facility

$378.00

Hospital Charge Code	27015131
Hospital Revenue Code	270
Min. Negotiated Rate	$264.60
Max. Negotiated Rate	$321.30
Rate for Payer: Cash Price	$245.70
Rate for Payer: Community Health Alliance Commercial	$321.30
Rate for Payer: Priority Health Commercial	$264.60
Rate for Payer: Priority Health PPO	$264.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges