Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

TRACERS BONE CEMENT ADDITIVE

Facility

$363.00

Hospital Charge Code	27264934
Hospital Revenue Code	272
Min. Negotiated Rate	$254.10
Max. Negotiated Rate	$308.55
Rate for Payer: Cash Price	$235.95
Rate for Payer: Community Health Alliance Commercial	$308.55
Rate for Payer: Priority Health Commercial	$254.10
Rate for Payer: Priority Health PPO	$254.10

TRACHEOSTOMY TUBE HOLDER #240

Facility

$23.00

Hospital Charge Code	27060560
Hospital Revenue Code	270
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

TRACH TUBE - SHILEY SIZE 4

Facility

$239.00

Hospital Charge Code	27015529
Hospital Revenue Code	272
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$203.15
Rate for Payer: Cash Price	$155.35
Rate for Payer: Community Health Alliance Commercial	$203.15
Rate for Payer: Priority Health Commercial	$167.30
Rate for Payer: Priority Health PPO	$167.30

TRACTION BOOT- UNIVERSAL

Facility

$91.00

Hospital Charge Code	27061444
Hospital Revenue Code	270
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$77.35
Rate for Payer: Cash Price	$59.15
Rate for Payer: Community Health Alliance Commercial	$77.35
Rate for Payer: Priority Health Commercial	$63.70
Rate for Payer: Priority Health PPO	$63.70

TRACTION MECHANICAL

Facility

$38.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	4200420
Hospital Revenue Code	420
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

TRACTION SET,CERV OVERHEAD

Facility

$31.00

Hospital Charge Code	27021634
Hospital Revenue Code	270
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$26.35
Rate for Payer: Cash Price	$20.15
Rate for Payer: Community Health Alliance Commercial	$26.35
Rate for Payer: Priority Health Commercial	$21.70
Rate for Payer: Priority Health PPO	$21.70

TRAIN FOR SPEECH DEVICE G0198

Facility

$171.00

Service Code	HCPCS 92609
Hospital Charge Code	4400055
Hospital Revenue Code	440
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$145.35
Rate for Payer: Cash Price	$111.15
Rate for Payer: Community Health Alliance Commercial	$145.35
Rate for Payer: Priority Health Commercial	$119.70
Rate for Payer: Priority Health PPO	$119.70

TRAMADOL & METABOLITES

Facility

$82.85

Hospital Charge Code	3005857
Hospital Revenue Code	301
Min. Negotiated Rate	$57.99
Max. Negotiated Rate	$70.42
Rate for Payer: Cash Price	$53.85
Rate for Payer: Community Health Alliance Commercial	$70.42
Rate for Payer: Priority Health Commercial	$57.99
Rate for Payer: Priority Health PPO	$57.99

TRANSCOBALAMIN LEVEL

Facility

$50.00

Service Code	HCPCS 82608
Hospital Charge Code	3008070
Hospital Revenue Code	301
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$15.04
Rate for Payer: Blue Care Network Medicare Advantage	$15.04
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.04
Rate for Payer: Meridian Health Plan Medicare	$15.04
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$15.04
Rate for Payer: Priority Health Medicare	$15.04
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$15.04
Rate for Payer: United Health Care Medicare Advantage	$6.62

TRANSDUCER, PRESSURE

Facility

$265.00

Hospital Charge Code	27018960
Hospital Revenue Code	272
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$225.25
Rate for Payer: Cash Price	$172.25
Rate for Payer: Community Health Alliance Commercial	$225.25
Rate for Payer: Priority Health Commercial	$185.50
Rate for Payer: Priority Health PPO	$185.50

TRANSDUCER,PRESSURE

Facility

$53.00

Hospital Charge Code	27263333
Hospital Revenue Code	272
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

TRANSFERRIN

Facility

$2.44

Service Code	HCPCS 84466
Hospital Charge Code	3008300
Hospital Revenue Code	301
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$13.40
Rate for Payer: BCBS BCN 65	$13.40
Rate for Payer: Blue Care Network Medicare Advantage	$13.40
Rate for Payer: Cash Price	$1.59
Rate for Payer: Cash Price	$1.59
Rate for Payer: Community Health Alliance Commercial	$2.07
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.40
Rate for Payer: Meridian Health Plan Medicare	$13.40
Rate for Payer: Priority Health Commercial	$1.71
Rate for Payer: Priority Health Medicaid	$13.40
Rate for Payer: Priority Health Medicare	$13.40
Rate for Payer: Priority Health PPO	$1.71
Rate for Payer: United Health Care Medicaid	$13.40
Rate for Payer: United Health Care Medicare Advantage	$5.90

TRANSFERRIN GROWTH FACTOR B

Facility

$39.00

Hospital Charge Code	3101804
Hospital Revenue Code	300
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$33.15
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health PPO	$27.30

TRANSFERRIN RECEPTOR

Facility

$52.00

Hospital Charge Code	3007084
Hospital Revenue Code	301
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

TRANSFERRIN RECEPTOR SATURATIO

Facility

$24.44

Hospital Charge Code	3008182
Hospital Revenue Code	301
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$20.77
Rate for Payer: Cash Price	$15.89
Rate for Payer: Community Health Alliance Commercial	$20.77
Rate for Payer: Priority Health Commercial	$17.11
Rate for Payer: Priority Health PPO	$17.11

TRANSFERRIN % SATURATION

Facility

$33.00

Service Code	HCPCS 84466
Hospital Charge Code	3008310
Hospital Revenue Code	301
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$13.40
Rate for Payer: Blue Care Network Medicare Advantage	$13.40
Rate for Payer: Cash Price	$21.45
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.40
Rate for Payer: Meridian Health Plan Medicare	$13.40
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$13.40
Rate for Payer: Priority Health Medicare	$13.40
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$13.40
Rate for Payer: United Health Care Medicare Advantage	$5.90

TRANSFIXATION PIN

Facility

$258.00

Hospital Charge Code	27015578
Hospital Revenue Code	272
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$219.30
Rate for Payer: Cash Price	$167.70
Rate for Payer: Community Health Alliance Commercial	$219.30
Rate for Payer: Priority Health Commercial	$180.60
Rate for Payer: Priority Health PPO	$180.60

TRANSFUSION REACTION WORKUP

Facility

$66.00

Service Code	HCPCS 86078
Hospital Charge Code	3910060
Hospital Revenue Code	971
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$182.76
Rate for Payer: BCBS BCN 65	$182.76
Rate for Payer: Blue Care Network Medicare Advantage	$182.76
Rate for Payer: Cash Price	$42.90
Rate for Payer: Cash Price	$42.90
Rate for Payer: Community Health Alliance Commercial	$56.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$182.76
Rate for Payer: Meridian Health Plan Medicare	$182.76
Rate for Payer: Priority Health Commercial	$46.20
Rate for Payer: Priority Health Medicaid	$182.76
Rate for Payer: Priority Health Medicare	$182.76
Rate for Payer: Priority Health PPO	$46.20
Rate for Payer: United Health Care Medicaid	$182.76
Rate for Payer: United Health Care Medicare Advantage	$80.42

TRANSFUSIONS-ER

Facility

$453.00

Service Code	HCPCS 36430
Hospital Charge Code	4500400
Hospital Revenue Code	391
Min. Negotiated Rate	$208.24
Max. Negotiated Rate	$473.27
Rate for Payer: BCBS BCN 65	$473.27
Rate for Payer: Blue Care Network Medicare Advantage	$473.27
Rate for Payer: Cash Price	$294.45
Rate for Payer: Cash Price	$294.45
Rate for Payer: Community Health Alliance Commercial	$385.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$473.27
Rate for Payer: Meridian Health Plan Medicare	$473.27
Rate for Payer: Priority Health Commercial	$317.10
Rate for Payer: Priority Health Medicaid	$473.27
Rate for Payer: Priority Health Medicare	$473.27
Rate for Payer: Priority Health PPO	$317.10
Rate for Payer: United Health Care Medicaid	$473.27
Rate for Payer: United Health Care Medicare Advantage	$208.24

TRANSFUSIONS - MED/SURG

Facility

$453.00

Service Code	HCPCS 36430
Hospital Charge Code	3919000
Hospital Revenue Code	391
Min. Negotiated Rate	$208.24
Max. Negotiated Rate	$473.27
Rate for Payer: BCBS BCN 65	$473.27
Rate for Payer: Blue Care Network Medicare Advantage	$473.27
Rate for Payer: Cash Price	$294.45
Rate for Payer: Cash Price	$294.45
Rate for Payer: Community Health Alliance Commercial	$385.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$473.27
Rate for Payer: Meridian Health Plan Medicare	$473.27
Rate for Payer: Priority Health Commercial	$317.10
Rate for Payer: Priority Health Medicaid	$473.27
Rate for Payer: Priority Health Medicare	$473.27
Rate for Payer: Priority Health PPO	$317.10
Rate for Payer: United Health Care Medicaid	$473.27
Rate for Payer: United Health Care Medicare Advantage	$208.24

TRANSGLUT AB IgA

Facility

$5.29

Hospital Charge Code	3008885
Hospital Revenue Code	301
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$4.50
Rate for Payer: Cash Price	$3.44
Rate for Payer: Community Health Alliance Commercial	$4.50
Rate for Payer: Priority Health Commercial	$3.70
Rate for Payer: Priority Health PPO	$3.70

TRANSGLUT AB IgG

Facility

$5.29

Hospital Charge Code	3008884
Hospital Revenue Code	301
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$4.50
Rate for Payer: Cash Price	$3.44
Rate for Payer: Community Health Alliance Commercial	$4.50
Rate for Payer: Priority Health Commercial	$3.70
Rate for Payer: Priority Health PPO	$3.70

TRANSVAGINAL ANCHOR SYSTEM

Facility

$1,503.00

Hospital Charge Code	27266633
Hospital Revenue Code	272
Min. Negotiated Rate	$1,052.10
Max. Negotiated Rate	$1,277.55
Rate for Payer: Cash Price	$976.95
Rate for Payer: Community Health Alliance Commercial	$1,277.55
Rate for Payer: Priority Health Commercial	$1,052.10
Rate for Payer: Priority Health PPO	$1,052.10

TRAPEASE VENA CAVA FILTER

Facility

$5,420.00

Hospital Charge Code	27264272
Hospital Revenue Code	272
Min. Negotiated Rate	$3,794.00
Max. Negotiated Rate	$4,607.00
Rate for Payer: Cash Price	$3,523.00
Rate for Payer: Community Health Alliance Commercial	$4,607.00
Rate for Payer: Priority Health Commercial	$3,794.00
Rate for Payer: Priority Health PPO	$3,794.00

TRAY 4FR MIDLINE

Facility

$250.00

Hospital Charge Code	27286007
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$212.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Community Health Alliance Commercial	$212.50
Rate for Payer: Priority Health Commercial	$175.00
Rate for Payer: Priority Health PPO	$175.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges