Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

THYROGLOBULIN

Facility

$77.00

Service Code	HCPCS 84432
Hospital Charge Code	3007960
Hospital Revenue Code	301
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$65.45
Rate for Payer: BCBS BCN 65	$16.86
Rate for Payer: Blue Care Network Medicare Advantage	$16.86
Rate for Payer: Cash Price	$50.05
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.86
Rate for Payer: Meridian Health Plan Medicare	$16.86
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health Medicaid	$16.86
Rate for Payer: Priority Health Medicare	$16.86
Rate for Payer: Priority Health PPO	$53.90
Rate for Payer: United Health Care Medicaid	$16.86
Rate for Payer: United Health Care Medicare Advantage	$7.42

THYROGLOBULIN ANTIBODY & REFLE

Facility

$3.37

Hospital Charge Code	3101106
Hospital Revenue Code	302
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

THYROGLOBULIN BY IMA

Facility

$2.50

Hospital Charge Code	3102035
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

THYROGLOBULIN BY LS-MS/MS

Facility

$20.00

Hospital Charge Code	3101108
Hospital Revenue Code	301
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

THYROGLOBULIN TUMOR MARKER

Facility

$45.00

Hospital Charge Code	3101107
Hospital Revenue Code	301
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

THYROID BINDING GLOBULIN

Facility

$9.37

Service Code	HCPCS 84442
Hospital Charge Code	3007880
Hospital Revenue Code	301
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$15.52
Rate for Payer: BCBS BCN 65	$15.52
Rate for Payer: Blue Care Network Medicare Advantage	$15.52
Rate for Payer: Cash Price	$6.09
Rate for Payer: Cash Price	$6.09
Rate for Payer: Community Health Alliance Commercial	$7.96
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.52
Rate for Payer: Meridian Health Plan Medicare	$15.52
Rate for Payer: Priority Health Commercial	$6.56
Rate for Payer: Priority Health Medicaid	$15.52
Rate for Payer: Priority Health Medicare	$15.52
Rate for Payer: Priority Health PPO	$6.56
Rate for Payer: United Health Care Medicaid	$15.52
Rate for Payer: United Health Care Medicare Advantage	$6.83

THYROID STIMULATING

Facility

$24.44

Service Code	HCPCS 84445
Hospital Charge Code	3007870
Hospital Revenue Code	301
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$53.40
Rate for Payer: BCBS BCN 65	$53.40
Rate for Payer: Blue Care Network Medicare Advantage	$53.40
Rate for Payer: Cash Price	$15.89
Rate for Payer: Cash Price	$15.89
Rate for Payer: Community Health Alliance Commercial	$20.77
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$53.40
Rate for Payer: Meridian Health Plan Medicare	$53.40
Rate for Payer: Priority Health Commercial	$17.11
Rate for Payer: Priority Health Medicaid	$53.40
Rate for Payer: Priority Health Medicare	$53.40
Rate for Payer: Priority Health PPO	$17.11
Rate for Payer: United Health Care Medicaid	$53.40
Rate for Payer: United Health Care Medicare Advantage	$23.50

THYROTROPIN RECEPTOR AUTOANTIB

Facility

$50.00

Hospital Charge Code	3006622
Hospital Revenue Code	301
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

THYROXINE ANTIBODIES

Facility

$145.95

Service Code	HCPCS 83516
Hospital Charge Code	3008275
Hospital Revenue Code	300
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$124.06
Rate for Payer: BCBS BCN 65	$12.11
Rate for Payer: Blue Care Network Medicare Advantage	$12.11
Rate for Payer: Cash Price	$94.87
Rate for Payer: Cash Price	$94.87
Rate for Payer: Community Health Alliance Commercial	$124.06
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.11
Rate for Payer: Meridian Health Plan Medicare	$12.11
Rate for Payer: Priority Health Commercial	$102.17
Rate for Payer: Priority Health Medicaid	$12.11
Rate for Payer: Priority Health Medicare	$12.11
Rate for Payer: Priority Health PPO	$102.17
Rate for Payer: United Health Care Medicaid	$12.11
Rate for Payer: United Health Care Medicare Advantage	$5.33

TIBC-LC

Facility

$1.82

Hospital Charge Code	3102019
Hospital Revenue Code	300
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.55
Rate for Payer: Cash Price	$1.18
Rate for Payer: Community Health Alliance Commercial	$1.55
Rate for Payer: Priority Health Commercial	$1.27
Rate for Payer: Priority Health PPO	$1.27

TIB/FIB SPLINT-KNEE LENGTH

Facility

$234.00

Hospital Charge Code	27013250
Hospital Revenue Code	270
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$198.90
Rate for Payer: Cash Price	$152.10
Rate for Payer: Community Health Alliance Commercial	$198.90
Rate for Payer: Priority Health Commercial	$163.80
Rate for Payer: Priority Health PPO	$163.80

TIBIAL IMPLANTS

Facility

$2,937.00

Hospital Charge Code	27868530
Hospital Revenue Code	278
Min. Negotiated Rate	$2,055.90
Max. Negotiated Rate	$2,496.45
Rate for Payer: Cash Price	$1,909.05
Rate for Payer: Community Health Alliance Commercial	$2,496.45
Rate for Payer: Priority Health Commercial	$2,055.90
Rate for Payer: Priority Health PPO	$2,055.90

TIBIA NAIL

Facility

$2,383.00

Service Code	HCPCS C1713
Hospital Charge Code	27868175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,668.10
Max. Negotiated Rate	$2,025.55
Rate for Payer: Cash Price	$1,548.95
Rate for Payer: Community Health Alliance Commercial	$2,025.55
Rate for Payer: Priority Health Commercial	$1,668.10
Rate for Payer: Priority Health PPO	$1,668.10

TICK ANALYSIS TO STATE

Facility

$27.00

Hospital Charge Code	3006643
Hospital Revenue Code	306
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

TICK LYMES PCR

Facility

$64.00

Hospital Charge Code	3006644
Hospital Revenue Code	306
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$54.40
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health PPO	$44.80

TIP,DISTAL

Facility

$868.00

Service Code	HCPCS C2622
Hospital Charge Code	27868100
Hospital Revenue Code	278
Min. Negotiated Rate	$607.60
Max. Negotiated Rate	$737.80
Rate for Payer: Cash Price	$564.20
Rate for Payer: Community Health Alliance Commercial	$737.80
Rate for Payer: Priority Health Commercial	$607.60
Rate for Payer: Priority Health PPO	$607.60

TIP, DURA-II DISTAL 5CM X 12MM

Facility

$879.00

Hospital Charge Code	27868290
Hospital Revenue Code	278
Min. Negotiated Rate	$615.30
Max. Negotiated Rate	$747.15
Rate for Payer: Cash Price	$571.35
Rate for Payer: Community Health Alliance Commercial	$747.15
Rate for Payer: Priority Health Commercial	$615.30
Rate for Payer: Priority Health PPO	$615.30

TIP, DURA-II UNIV 2CM X 10MM

Facility

$879.00

Hospital Charge Code	27868308
Hospital Revenue Code	278
Min. Negotiated Rate	$615.30
Max. Negotiated Rate	$747.15
Rate for Payer: Cash Price	$571.35
Rate for Payer: Community Health Alliance Commercial	$747.15
Rate for Payer: Priority Health Commercial	$615.30
Rate for Payer: Priority Health PPO	$615.30

TIP, DURA II UNIV 2CM X 12MM

Facility

$868.00

Hospital Charge Code	27868266
Hospital Revenue Code	278
Min. Negotiated Rate	$607.60
Max. Negotiated Rate	$737.80
Rate for Payer: Cash Price	$564.20
Rate for Payer: Community Health Alliance Commercial	$737.80
Rate for Payer: Priority Health Commercial	$607.60
Rate for Payer: Priority Health PPO	$607.60

TIP,PROX

Facility

$868.00

Service Code	HCPCS C2622
Hospital Charge Code	27868092
Hospital Revenue Code	278
Min. Negotiated Rate	$607.60
Max. Negotiated Rate	$737.80
Rate for Payer: Cash Price	$564.20
Rate for Payer: Community Health Alliance Commercial	$737.80
Rate for Payer: Priority Health Commercial	$607.60
Rate for Payer: Priority Health PPO	$607.60

TISSUE CULTURE AMNIOTIC FLUID

Facility

$435.00

Hospital Charge Code	3007712
Hospital Revenue Code	311
Min. Negotiated Rate	$304.50
Max. Negotiated Rate	$369.75
Rate for Payer: Cash Price	$282.75
Rate for Payer: Community Health Alliance Commercial	$369.75
Rate for Payer: Priority Health Commercial	$304.50
Rate for Payer: Priority Health PPO	$304.50

TISSUE CULTURE BM BLD CELLS

Facility

$206.00

Hospital Charge Code	3101029
Hospital Revenue Code	310
Min. Negotiated Rate	$144.20
Max. Negotiated Rate	$175.10
Rate for Payer: Cash Price	$133.90
Rate for Payer: Community Health Alliance Commercial	$175.10
Rate for Payer: Priority Health Commercial	$144.20
Rate for Payer: Priority Health PPO	$144.20

TISSUE CULTURE BONE MARROW

Facility

$116.00

Hospital Charge Code	3101304
Hospital Revenue Code	310
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$98.60
Rate for Payer: Cash Price	$75.40
Rate for Payer: Community Health Alliance Commercial	$98.60
Rate for Payer: Priority Health Commercial	$81.20
Rate for Payer: Priority Health PPO	$81.20

TISSUE CULTURE FOR NN DISORDER

Facility

$424.00

Service Code	HCPCS 88230
Hospital Charge Code	3005491
Hospital Revenue Code	310
Min. Negotiated Rate	$53.82
Max. Negotiated Rate	$360.40
Rate for Payer: BCBS BCN 65	$122.31
Rate for Payer: Blue Care Network Medicare Advantage	$122.31
Rate for Payer: Cash Price	$275.60
Rate for Payer: Cash Price	$275.60
Rate for Payer: Community Health Alliance Commercial	$360.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$122.31
Rate for Payer: Meridian Health Plan Medicare	$122.31
Rate for Payer: Priority Health Commercial	$296.80
Rate for Payer: Priority Health Medicaid	$122.31
Rate for Payer: Priority Health Medicare	$122.31
Rate for Payer: Priority Health PPO	$296.80
Rate for Payer: United Health Care Medicaid	$122.31
Rate for Payer: United Health Care Medicare Advantage	$53.82

TISSUE CULTURE LYMPHOCYTES

Facility

$117.00

Hospital Charge Code	3101196
Hospital Revenue Code	311
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$99.45
Rate for Payer: Cash Price	$76.05
Rate for Payer: Community Health Alliance Commercial	$99.45
Rate for Payer: Priority Health Commercial	$81.90
Rate for Payer: Priority Health PPO	$81.90

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges