Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

THERAPEUTIC EXERCISES 15 MINUT

Facility

$95.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	4300000
Hospital Revenue Code	430
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$80.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
Rate for Payer: Priority Health Commercial	$66.50
Rate for Payer: Priority Health PPO	$66.50

THERAPUTIC PHLEBOTOMY

Facility

$123.00

Service Code	HCPCS 99195
Hospital Charge Code	3007855
Hospital Revenue Code	940
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$79.95
Rate for Payer: Cash Price	$79.95
Rate for Payer: Community Health Alliance Commercial	$104.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$86.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$86.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

THERAPY BALL 55CM

Facility

$40.00

Hospital Charge Code	27019380
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

THERAPY BALL 65 CM

Facility

$51.00

Hospital Charge Code	27060941
Hospital Revenue Code	270
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

THERMOMETER/ T-ADAPT

Facility

$19.00

Hospital Charge Code	27015651
Hospital Revenue Code	270
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$16.15
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health PPO	$13.30

THINPREP PAP DIAGMOSTIC

Facility

$22.40

Hospital Charge Code	3007659
Hospital Revenue Code	971
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$19.04
Rate for Payer: Cash Price	$14.56
Rate for Payer: Community Health Alliance Commercial	$19.04
Rate for Payer: Priority Health Commercial	$15.68
Rate for Payer: Priority Health PPO	$15.68

THIOCYANATE LEVEL

Facility

$44.00

Service Code	HCPCS 84430
Hospital Charge Code	3007890
Hospital Revenue Code	301
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$37.40
Rate for Payer: BCBS BCN 65	$12.21
Rate for Payer: Blue Care Network Medicare Advantage	$12.21
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.21
Rate for Payer: Meridian Health Plan Medicare	$12.21
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health Medicaid	$12.21
Rate for Payer: Priority Health Medicare	$12.21
Rate for Payer: Priority Health PPO	$30.80
Rate for Payer: United Health Care Medicaid	$12.21
Rate for Payer: United Health Care Medicare Advantage	$5.37

THIOPURINE METABOLITES

Facility

$95.00

Hospital Charge Code	3000551
Hospital Revenue Code	301
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$80.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
Rate for Payer: Priority Health Commercial	$66.50
Rate for Payer: Priority Health PPO	$66.50

THIORIDAZINE (MELLARIL)

Facility

$58.00

Service Code	HCPCS 80299
Hospital Charge Code	3007900
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$49.30
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$37.70
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
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	$40.60
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$40.60
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

THORACENTESIS

Facility

$1,248.00

Service Code	HCPCS 32555
Hospital Charge Code	4000251
Hospital Revenue Code	361
Min. Negotiated Rate	$296.09
Max. Negotiated Rate	$1,060.80
Rate for Payer: BCBS BCN 65	$672.93
Rate for Payer: Blue Care Network Medicare Advantage	$672.93
Rate for Payer: Cash Price	$811.20
Rate for Payer: Cash Price	$811.20
Rate for Payer: Community Health Alliance Commercial	$1,060.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$672.93
Rate for Payer: Meridian Health Plan Medicare	$672.93
Rate for Payer: Priority Health Commercial	$873.60
Rate for Payer: Priority Health Medicaid	$672.93
Rate for Payer: Priority Health Medicare	$672.93
Rate for Payer: Priority Health PPO	$873.60
Rate for Payer: United Health Care Medicaid	$672.93
Rate for Payer: United Health Care Medicare Advantage	$296.09

THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE

Facility

$672.93

Service Code	CPT 32555
Hospital Revenue Code	490
Min. Negotiated Rate	$296.09
Max. Negotiated Rate	$672.93
Rate for Payer: BCBS BCN 65	$672.93
Rate for Payer: Blue Care Network Medicare Advantage	$672.93
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$672.93
Rate for Payer: Meridian Health Plan Medicare	$672.93
Rate for Payer: Priority Health Medicaid	$672.93
Rate for Payer: Priority Health Medicare	$672.93
Rate for Payer: United Health Care Medicaid	$672.93
Rate for Payer: United Health Care Medicare Advantage	$296.09

THORACIC TROCAR SLEEVE #TT012

Facility

$99.00

Hospital Charge Code	27265403
Hospital Revenue Code	272
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$84.15
Rate for Payer: Cash Price	$64.35
Rate for Payer: Community Health Alliance Commercial	$84.15
Rate for Payer: Priority Health Commercial	$69.30
Rate for Payer: Priority Health PPO	$69.30

THORAZINE CHL OR PROMAZINE

Facility

$13.19

Service Code	HCPCS 80342
Hospital Charge Code	3007850
Hospital Revenue Code	301
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$11.21
Rate for Payer: Cash Price	$8.57
Rate for Payer: Community Health Alliance Commercial	$11.21
Rate for Payer: Priority Health Commercial	$9.23
Rate for Payer: Priority Health PPO	$9.23

THREADS, 12MM

Facility

$60.00

Hospital Charge Code	27016519
Hospital Revenue Code	270
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

THREADS, 5MM

Facility

$68.00

Hospital Charge Code	27016600
Hospital Revenue Code	270
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

THREADS, ETHICON

Facility

$19.00

Hospital Charge Code	27024489
Hospital Revenue Code	270
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$16.15
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health PPO	$13.30

THROMBIN TIME

Facility

$8.00

Service Code	HCPCS 85670
Hospital Charge Code	3007940
Hospital Revenue Code	305
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$6.80
Rate for Payer: BCBS BCN 65	$6.06
Rate for Payer: Blue Care Network Medicare Advantage	$6.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cash Price	$5.20
Rate for Payer: Community Health Alliance Commercial	$6.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.06
Rate for Payer: Meridian Health Plan Medicare	$6.06
Rate for Payer: Priority Health Commercial	$5.60
Rate for Payer: Priority Health Medicaid	$6.06
Rate for Payer: Priority Health Medicare	$6.06
Rate for Payer: Priority Health PPO	$5.60
Rate for Payer: United Health Care Medicaid	$6.06
Rate for Payer: United Health Care Medicare Advantage	$2.67

THROMBOPLASTIN,(FAC3)

Facility

$47.04

Service Code	HCPCS 85705
Hospital Charge Code	3007950
Hospital Revenue Code	305
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$39.98
Rate for Payer: BCBS BCN 65	$10.11
Rate for Payer: Blue Care Network Medicare Advantage	$10.11
Rate for Payer: Cash Price	$30.58
Rate for Payer: Cash Price	$30.58
Rate for Payer: Community Health Alliance Commercial	$39.98
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.11
Rate for Payer: Meridian Health Plan Medicare	$10.11
Rate for Payer: Priority Health Commercial	$32.93
Rate for Payer: Priority Health Medicaid	$10.11
Rate for Payer: Priority Health Medicare	$10.11
Rate for Payer: Priority Health PPO	$32.93
Rate for Payer: United Health Care Medicaid	$10.11
Rate for Payer: United Health Care Medicare Advantage	$4.45

THROMBOXANE URINE

Facility

$71.00

Hospital Charge Code	3100764
Hospital Revenue Code	301
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$60.35
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health PPO	$49.70

THRYOGLOBULIN BY RIA CHARGE ON

Facility

$2.50

Hospital Charge Code	3102446
Hospital Revenue Code	300
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$2.12
Rate for Payer: Cash Price	$1.63
Rate for Payer: Community Health Alliance Commercial	$2.12
Rate for Payer: Priority Health Commercial	$1.75
Rate for Payer: Priority Health PPO	$1.75

THS07 CHARGE-LC

Facility

$403.00

Hospital Charge Code	31027462
Hospital Revenue Code	300
Min. Negotiated Rate	$282.10
Max. Negotiated Rate	$342.55
Rate for Payer: Cash Price	$261.95
Rate for Payer: Community Health Alliance Commercial	$342.55
Rate for Payer: Priority Health Commercial	$282.10
Rate for Payer: Priority Health PPO	$282.10

THUMB BRACE, LIBERTY

Facility

$65.00

Hospital Charge Code	27021782
Hospital Revenue Code	270
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

THUMB POST

Facility

$38.00

Hospital Charge Code	27061006
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

THUMB PROTECTOR

Facility

$63.00

Hospital Charge Code	27021964
Hospital Revenue Code	270
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

THYAB-2

Facility

$3.37

Hospital Charge Code	3101827
Hospital Revenue Code	300
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$2.86
Rate for Payer: Cash Price	$2.19
Rate for Payer: Community Health Alliance Commercial	$2.86
Rate for Payer: Priority Health Commercial	$2.36
Rate for Payer: Priority Health PPO	$2.36

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges