Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

TISSUE GRINDING

Facility

$9.75

Hospital Charge Code	3102000
Hospital Revenue Code	300
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$8.29
Rate for Payer: Cash Price	$6.34
Rate for Payer: Community Health Alliance Commercial	$8.29
Rate for Payer: Priority Health Commercial	$6.83
Rate for Payer: Priority Health PPO	$6.83

TISSUE HOMOGENIZATION

Facility

$17.00

Hospital Charge Code	3005499
Hospital Revenue Code	306
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

TIS TRNFR

Facility

$939.00

Hospital Charge Code	5150762
Hospital Revenue Code	960
Min. Negotiated Rate	$657.30
Max. Negotiated Rate	$798.15
Rate for Payer: Cash Price	$610.35
Rate for Payer: Community Health Alliance Commercial	$798.15
Rate for Payer: Priority Health Commercial	$657.30
Rate for Payer: Priority Health PPO	$657.30

TITANIUM LC

Facility

$36.26

Hospital Charge Code	31027445
Hospital Revenue Code	300
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$30.82
Rate for Payer: Cash Price	$23.57
Rate for Payer: Community Health Alliance Commercial	$30.82
Rate for Payer: Priority Health Commercial	$25.38
Rate for Payer: Priority Health PPO	$25.38

TITER

Facility

$27.00

Hospital Charge Code	3001946
Hospital Revenue Code	302
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

TMJ ELASTOGEL WRAP

Facility

$99.00

Hospital Charge Code	27021006
Hospital Revenue Code	270
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

TOBRAMYCIN PEAK

Facility

$109.00

Service Code	HCPCS 80200
Hospital Charge Code	3008040
Hospital Revenue Code	301
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$92.65
Rate for Payer: BCBS BCN 65	$16.94
Rate for Payer: Blue Care Network Medicare Advantage	$16.94
Rate for Payer: Cash Price	$70.85
Rate for Payer: Cash Price	$70.85
Rate for Payer: Community Health Alliance Commercial	$92.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.94
Rate for Payer: Meridian Health Plan Medicare	$16.94
Rate for Payer: Priority Health Commercial	$76.30
Rate for Payer: Priority Health Medicaid	$16.94
Rate for Payer: Priority Health Medicare	$16.94
Rate for Payer: Priority Health PPO	$76.30
Rate for Payer: United Health Care Medicaid	$16.94
Rate for Payer: United Health Care Medicare Advantage	$7.45

TOBRAMYCIN TROUGH

Facility

$95.00

Service Code	HCPCS 80200
Hospital Charge Code	3008060
Hospital Revenue Code	301
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$80.75
Rate for Payer: BCBS BCN 65	$16.94
Rate for Payer: Blue Care Network Medicare Advantage	$16.94
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.94
Rate for Payer: Meridian Health Plan Medicare	$16.94
Rate for Payer: Priority Health Commercial	$66.50
Rate for Payer: Priority Health Medicaid	$16.94
Rate for Payer: Priority Health Medicare	$16.94
Rate for Payer: Priority Health PPO	$66.50
Rate for Payer: United Health Care Medicaid	$16.94
Rate for Payer: United Health Care Medicare Advantage	$7.45

TOE-IMPLANT

Facility

$2,179.00

Service Code	HCPCS C1713
Hospital Charge Code	27018531
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.30
Max. Negotiated Rate	$1,852.15
Rate for Payer: Cash Price	$1,416.35
Rate for Payer: Community Health Alliance Commercial	$1,852.15
Rate for Payer: Priority Health Commercial	$1,525.30
Rate for Payer: Priority Health PPO	$1,525.30

TONSIL SPONGE

Facility

$21.00

Hospital Charge Code	27013060
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health PPO	$14.70

TOPIRAMATE (TOPAMAX) LEVEL

Facility

$9.77

Service Code	HCPCS 80201
Hospital Charge Code	3008065
Hospital Revenue Code	301
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$12.52
Rate for Payer: BCBS BCN 65	$12.52
Rate for Payer: Blue Care Network Medicare Advantage	$12.52
Rate for Payer: Cash Price	$6.35
Rate for Payer: Cash Price	$6.35
Rate for Payer: Community Health Alliance Commercial	$8.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.52
Rate for Payer: Meridian Health Plan Medicare	$12.52
Rate for Payer: Priority Health Commercial	$6.84
Rate for Payer: Priority Health Medicaid	$12.52
Rate for Payer: Priority Health Medicare	$12.52
Rate for Payer: Priority Health PPO	$6.84
Rate for Payer: United Health Care Medicaid	$12.52
Rate for Payer: United Health Care Medicare Advantage	$5.51

TORCH-1

Facility

$8.35

Hospital Charge Code	3102473
Hospital Revenue Code	300
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$7.10
Rate for Payer: Cash Price	$5.43
Rate for Payer: Community Health Alliance Commercial	$7.10
Rate for Payer: Priority Health Commercial	$5.84
Rate for Payer: Priority Health PPO	$5.84

TORCH-2

Facility

$8.35

Hospital Charge Code	3102474
Hospital Revenue Code	300
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$7.10
Rate for Payer: Cash Price	$5.43
Rate for Payer: Community Health Alliance Commercial	$7.10
Rate for Payer: Priority Health Commercial	$5.84
Rate for Payer: Priority Health PPO	$5.84

TORCH-3

Facility

$8.35

Hospital Charge Code	3102475
Hospital Revenue Code	300
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$7.10
Rate for Payer: Cash Price	$5.43
Rate for Payer: Community Health Alliance Commercial	$7.10
Rate for Payer: Priority Health Commercial	$5.84
Rate for Payer: Priority Health PPO	$5.84

TORCH-4

Facility

$8.35

Hospital Charge Code	3102476
Hospital Revenue Code	300
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$7.10
Rate for Payer: Cash Price	$5.43
Rate for Payer: Community Health Alliance Commercial	$7.10
Rate for Payer: Priority Health Commercial	$5.84
Rate for Payer: Priority Health PPO	$5.84

TORCH-5

Facility

$8.33

Hospital Charge Code	3102477
Hospital Revenue Code	300
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$7.08
Rate for Payer: Cash Price	$5.41
Rate for Payer: Community Health Alliance Commercial	$7.08
Rate for Payer: Priority Health Commercial	$5.83
Rate for Payer: Priority Health PPO	$5.83

TORCHM-1

Facility

$5.86

Hospital Charge Code	3102479
Hospital Revenue Code	300
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.98
Rate for Payer: Cash Price	$3.81
Rate for Payer: Community Health Alliance Commercial	$4.98
Rate for Payer: Priority Health Commercial	$4.10
Rate for Payer: Priority Health PPO	$4.10

TORCHM-2

Facility

$5.86

Hospital Charge Code	3102480
Hospital Revenue Code	300
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.98
Rate for Payer: Cash Price	$3.81
Rate for Payer: Community Health Alliance Commercial	$4.98
Rate for Payer: Priority Health Commercial	$4.10
Rate for Payer: Priority Health PPO	$4.10

TORCHM-3

Facility

$5.86

Hospital Charge Code	3102481
Hospital Revenue Code	300
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.98
Rate for Payer: Cash Price	$3.81
Rate for Payer: Community Health Alliance Commercial	$4.98
Rate for Payer: Priority Health Commercial	$4.10
Rate for Payer: Priority Health PPO	$4.10

TORCHM-4

Facility

$5.84

Hospital Charge Code	3102502
Hospital Revenue Code	300
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.80
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.09
Rate for Payer: Priority Health PPO	$4.09

TORQUE CATH. - C1

Facility

$88.00

Hospital Charge Code	27015081
Hospital Revenue Code	272
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$74.80
Rate for Payer: Cash Price	$57.20
Rate for Payer: Community Health Alliance Commercial	$74.80
Rate for Payer: Priority Health Commercial	$61.60
Rate for Payer: Priority Health PPO	$61.60

TORQUE CATH. - ROC

Facility

$88.00

Hospital Charge Code	27015099
Hospital Revenue Code	272
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$74.80
Rate for Payer: Cash Price	$57.20
Rate for Payer: Community Health Alliance Commercial	$74.80
Rate for Payer: Priority Health Commercial	$61.60
Rate for Payer: Priority Health PPO	$61.60

TOTAL SERUM IGA

Facility

$79.00

Hospital Charge Code	3000243
Hospital Revenue Code	301
Min. Negotiated Rate	$55.30
Max. Negotiated Rate	$67.15
Rate for Payer: Cash Price	$51.35
Rate for Payer: Community Health Alliance Commercial	$67.15
Rate for Payer: Priority Health Commercial	$55.30
Rate for Payer: Priority Health PPO	$55.30

TOUCH PREP EA ADDITIONAL SLIDE

Facility

$23.00

Hospital Charge Code	3006625
Hospital Revenue Code	312
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

TOUCH PREPS STAIN TECH

Facility

$92.00

Service Code	HCPCS 88161
Hospital Charge Code	3100540
Hospital Revenue Code	310
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$78.20
Rate for Payer: BCBS BCN 65	$31.03
Rate for Payer: Blue Care Network Medicare Advantage	$31.03
Rate for Payer: Cash Price	$59.80
Rate for Payer: Cash Price	$59.80
Rate for Payer: Community Health Alliance Commercial	$78.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$31.03
Rate for Payer: Meridian Health Plan Medicare	$31.03
Rate for Payer: Priority Health Commercial	$64.40
Rate for Payer: Priority Health Medicaid	$31.03
Rate for Payer: Priority Health Medicare	$31.03
Rate for Payer: Priority Health PPO	$64.40
Rate for Payer: United Health Care Medicaid	$31.03
Rate for Payer: United Health Care Medicare Advantage	$13.65

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges