Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

Tree-LC1

Facility

$3.26

Hospital Charge Code	31027581
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC10

Facility

$3.26

Hospital Charge Code	31027590
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC11

Facility

$3.26

Hospital Charge Code	31027591
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC12

Facility

$3.26

Hospital Charge Code	31027592
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC2

Facility

$3.26

Hospital Charge Code	31027582
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC3

Facility

$3.26

Hospital Charge Code	31027583
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC4

Facility

$3.26

Hospital Charge Code	31027584
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC5

Facility

$3.26

Hospital Charge Code	31027585
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC6

Facility

$3.26

Hospital Charge Code	31027586
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC7

Facility

$3.26

Hospital Charge Code	31027587
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC8

Facility

$3.26

Hospital Charge Code	31027588
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Tree-LC9

Facility

$3.26

Hospital Charge Code	31027589
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

TREPHINE, 8.0MM

Facility

$296.00

Hospital Charge Code	27265486
Hospital Revenue Code	272
Min. Negotiated Rate	$207.20
Max. Negotiated Rate	$251.60
Rate for Payer: Cash Price	$192.40
Rate for Payer: Community Health Alliance Commercial	$251.60
Rate for Payer: Priority Health Commercial	$207.20
Rate for Payer: Priority Health PPO	$207.20

TREP PALLIDUM CASCASE

Facility

$4.89

Hospital Charge Code	3102552
Hospital Revenue Code	300
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$4.16
Rate for Payer: Cash Price	$3.18
Rate for Payer: Community Health Alliance Commercial	$4.16
Rate for Payer: Priority Health Commercial	$3.42
Rate for Payer: Priority Health PPO	$3.42

TREP PALLIDUM REFLEX

Facility

$1.63

Hospital Charge Code	3102553
Hospital Revenue Code	300
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.39
Rate for Payer: Cash Price	$1.06
Rate for Payer: Community Health Alliance Commercial	$1.39
Rate for Payer: Priority Health Commercial	$1.14
Rate for Payer: Priority Health PPO	$1.14

TRG GENE REARRANGEMENT ANAL

Facility

$182.00

Hospital Charge Code	3100691
Hospital Revenue Code	300
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$154.70
Rate for Payer: Cash Price	$118.30
Rate for Payer: Community Health Alliance Commercial	$154.70
Rate for Payer: Priority Health Commercial	$127.40
Rate for Payer: Priority Health PPO	$127.40

TRH-THYROTROPIN RELEAS HORMONE

Facility

$190.00

Service Code	HCPCS 83519
Hospital Charge Code	3007980
Hospital Revenue Code	301
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$161.50
Rate for Payer: BCBS BCN 65	$19.32
Rate for Payer: Blue Care Network Medicare Advantage	$19.32
Rate for Payer: Cash Price	$123.50
Rate for Payer: Cash Price	$123.50
Rate for Payer: Community Health Alliance Commercial	$161.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.32
Rate for Payer: Meridian Health Plan Medicare	$19.32
Rate for Payer: Priority Health Commercial	$133.00
Rate for Payer: Priority Health Medicaid	$19.32
Rate for Payer: Priority Health Medicare	$19.32
Rate for Payer: Priority Health PPO	$133.00
Rate for Payer: United Health Care Medicaid	$19.32
Rate for Payer: United Health Care Medicare Advantage	$8.50

TRIANGLE SLING

Facility

$17.00

Hospital Charge Code	27013169
Hospital Revenue Code	270
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

TRICHINELLA AB IGG BY ELISA

Facility

$124.68

Service Code	HCPCS 86784
Hospital Charge Code	3008299
Hospital Revenue Code	302
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$105.98
Rate for Payer: BCBS BCN 65	$13.19
Rate for Payer: Blue Care Network Medicare Advantage	$13.19
Rate for Payer: Cash Price	$81.04
Rate for Payer: Cash Price	$81.04
Rate for Payer: Community Health Alliance Commercial	$105.98
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.19
Rate for Payer: Meridian Health Plan Medicare	$13.19
Rate for Payer: Priority Health Commercial	$87.28
Rate for Payer: Priority Health Medicaid	$13.19
Rate for Payer: Priority Health Medicare	$13.19
Rate for Payer: Priority Health PPO	$87.28
Rate for Payer: United Health Care Medicaid	$13.19
Rate for Payer: United Health Care Medicare Advantage	$5.80

TRICHOMONAS VAGINALIS

Facility

$10.00

Hospital Charge Code	3002832
Hospital Revenue Code	306
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health PPO	$7.00

TRICHOMONAS VAGINALIS TMA

Facility

$33.00

Hospital Charge Code	3101006
Hospital Revenue Code	306
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$28.05
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health PPO	$23.10

TRICHROME STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100550
Hospital Revenue Code	310
Min. Negotiated Rate	$37.10
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	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
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	$37.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

TRICORTICAL BONE 2.2 X 4.5

Facility

$5,234.00

Hospital Charge Code	27865908
Hospital Revenue Code	278
Min. Negotiated Rate	$3,663.80
Max. Negotiated Rate	$4,448.90
Rate for Payer: Cash Price	$3,402.10
Rate for Payer: Community Health Alliance Commercial	$4,448.90
Rate for Payer: Priority Health Commercial	$3,663.80
Rate for Payer: Priority Health PPO	$3,663.80

TRICYLIC ANTIDEPRESSENTS

Facility

$120.00

Service Code	HCPCS G0481
Hospital Charge Code	3101013
Hospital Revenue Code	300
Min. Negotiated Rate	$72.34
Max. Negotiated Rate	$164.42
Rate for Payer: BCBS BCN 65	$164.42
Rate for Payer: Blue Care Network Medicare Advantage	$164.42
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$164.42
Rate for Payer: Meridian Health Plan Medicare	$164.42
Rate for Payer: Priority Health Commercial	$84.00
Rate for Payer: Priority Health Medicaid	$164.42
Rate for Payer: Priority Health Medicare	$164.42
Rate for Payer: Priority Health PPO	$84.00
Rate for Payer: United Health Care Medicaid	$164.42
Rate for Payer: United Health Care Medicare Advantage	$72.34

TRIEPTAL (OXCARBZEFINE)

Facility

$6.52

Service Code	HCPCS 80183
Hospital Charge Code	3008465
Hospital Revenue Code	301
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$13.91
Rate for Payer: BCBS BCN 65	$13.91
Rate for Payer: Blue Care Network Medicare Advantage	$13.91
Rate for Payer: Cash Price	$4.24
Rate for Payer: Cash Price	$4.24
Rate for Payer: Community Health Alliance Commercial	$5.54
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.91
Rate for Payer: Meridian Health Plan Medicare	$13.91
Rate for Payer: Priority Health Commercial	$4.56
Rate for Payer: Priority Health Medicaid	$13.91
Rate for Payer: Priority Health Medicare	$13.91
Rate for Payer: Priority Health PPO	$4.56
Rate for Payer: United Health Care Medicaid	$13.91
Rate for Payer: United Health Care Medicare Advantage	$6.12

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges