Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

TRI-EX EXTRACTION BALLOON

Facility

$411.00

Hospital Charge Code	27263867
Hospital Revenue Code	272
Min. Negotiated Rate	$287.70
Max. Negotiated Rate	$349.35
Rate for Payer: Cash Price	$267.15
Rate for Payer: Community Health Alliance Commercial	$349.35
Rate for Payer: Priority Health Commercial	$287.70
Rate for Payer: Priority Health PPO	$287.70

TRIFLUOPERAZINE STELAZINE SER

Facility

$49.00

Service Code	HCPCS G6058
Hospital Charge Code	3100960
Hospital Revenue Code	309
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$41.65
Rate for Payer: Cash Price	$31.85
Rate for Payer: Community Health Alliance Commercial	$41.65
Rate for Payer: Priority Health Commercial	$34.30
Rate for Payer: Priority Health PPO	$34.30

TRIGLYCERIDES

Facility

$2.25

Service Code	HCPCS 84478
Hospital Charge Code	3008460
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$6.03
Rate for Payer: BCBS BCN 65	$6.03
Rate for Payer: Blue Care Network Medicare Advantage	$6.03
Rate for Payer: Cash Price	$1.46
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.91
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.03
Rate for Payer: Meridian Health Plan Medicare	$6.03
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health Medicaid	$6.03
Rate for Payer: Priority Health Medicare	$6.03
Rate for Payer: Priority Health PPO	$1.57
Rate for Payer: United Health Care Medicaid	$6.03
Rate for Payer: United Health Care Medicare Advantage	$2.65

TRIGLYCERIDES

Facility

$39.00

Hospital Charge Code	3008461
Hospital Revenue Code	301
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

TRISCREEN

Facility

$253.00

Hospital Charge Code	3003383
Hospital Revenue Code	301
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$215.05
Rate for Payer: Cash Price	$164.45
Rate for Payer: Community Health Alliance Commercial	$215.05
Rate for Payer: Priority Health Commercial	$177.10
Rate for Payer: Priority Health PPO	$177.10

TROCAR, 10/12MM TRI-STAR

Facility

$418.00

Hospital Charge Code	27016675
Hospital Revenue Code	272
Min. Negotiated Rate	$292.60
Max. Negotiated Rate	$355.30
Rate for Payer: Cash Price	$271.70
Rate for Payer: Community Health Alliance Commercial	$355.30
Rate for Payer: Priority Health Commercial	$292.60
Rate for Payer: Priority Health PPO	$292.60

TROCAR 12MM

Facility

$40.00

Hospital Charge Code	27015768
Hospital Revenue Code	272
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

TROCAR 5MM

Facility

$31.00

Hospital Charge Code	27015750
Hospital Revenue Code	272
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

TROCAR, 5MM

Facility

$357.00

Hospital Charge Code	27016246
Hospital Revenue Code	272
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$303.45
Rate for Payer: Cash Price	$232.05
Rate for Payer: Community Health Alliance Commercial	$303.45
Rate for Payer: Priority Health Commercial	$249.90
Rate for Payer: Priority Health PPO	$249.90

TROCAR, BLUNT TIP B1011

Facility

$199.00

Hospital Charge Code	27018176
Hospital Revenue Code	272
Min. Negotiated Rate	$139.30
Max. Negotiated Rate	$169.15
Rate for Payer: Cash Price	$129.35
Rate for Payer: Community Health Alliance Commercial	$169.15
Rate for Payer: Priority Health Commercial	$139.30
Rate for Payer: Priority Health PPO	$139.30

TROCAR, ENDO 511S, 512X, 5120

Facility

$538.00

Hospital Charge Code	27017319
Hospital Revenue Code	272
Min. Negotiated Rate	$376.60
Max. Negotiated Rate	$457.30
Rate for Payer: Cash Price	$349.70
Rate for Payer: Community Health Alliance Commercial	$457.30
Rate for Payer: Priority Health Commercial	$376.60
Rate for Payer: Priority Health PPO	$376.60

TROCAR SLEEVE W/OBTURATOR

Facility

$321.00

Hospital Charge Code	27263704
Hospital Revenue Code	272
Min. Negotiated Rate	$224.70
Max. Negotiated Rate	$272.85
Rate for Payer: Cash Price	$208.65
Rate for Payer: Community Health Alliance Commercial	$272.85
Rate for Payer: Priority Health Commercial	$224.70
Rate for Payer: Priority Health PPO	$224.70

TROCAR-TIPPED GUIDE WIRE 420MM

Facility

$176.00

Hospital Charge Code	27268035
Hospital Revenue Code	272
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$149.60
Rate for Payer: Cash Price	$114.40
Rate for Payer: Community Health Alliance Commercial	$149.60
Rate for Payer: Priority Health Commercial	$123.20
Rate for Payer: Priority Health PPO	$123.20

TROCAR, TRISTAR TS112

Facility

$261.00

Hospital Charge Code	27018119
Hospital Revenue Code	272
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$221.85
Rate for Payer: Cash Price	$169.65
Rate for Payer: Community Health Alliance Commercial	$221.85
Rate for Payer: Priority Health Commercial	$182.70
Rate for Payer: Priority Health PPO	$182.70

TROCAR, TRNSPARENT TEC18

Facility

$365.00

Hospital Charge Code	27018101
Hospital Revenue Code	272
Min. Negotiated Rate	$255.50
Max. Negotiated Rate	$310.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Community Health Alliance Commercial	$310.25
Rate for Payer: Priority Health Commercial	$255.50
Rate for Payer: Priority Health PPO	$255.50

TROCHANTERIC NAIL 180 X 9MM

Facility

$2,397.00

Service Code	HCPCS C1713
Hospital Charge Code	27868837
Hospital Revenue Code	278
Min. Negotiated Rate	$1,677.90
Max. Negotiated Rate	$2,037.45
Rate for Payer: Cash Price	$1,558.05
Rate for Payer: Community Health Alliance Commercial	$2,037.45
Rate for Payer: Priority Health Commercial	$1,677.90
Rate for Payer: Priority Health PPO	$1,677.90

TROFILE

Facility

$1,246.00

Hospital Charge Code	3008842
Hospital Revenue Code	306
Min. Negotiated Rate	$872.20
Max. Negotiated Rate	$1,059.10
Rate for Payer: Cash Price	$809.90
Rate for Payer: Community Health Alliance Commercial	$1,059.10
Rate for Payer: Priority Health Commercial	$872.20
Rate for Payer: Priority Health PPO	$872.20

TROPONIN I

Facility

$39.95

Service Code	HCPCS 84484
Hospital Charge Code	3004590
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$33.96
Rate for Payer: BCBS BCN 65	$13.09
Rate for Payer: Blue Care Network Medicare Advantage	$13.09
Rate for Payer: Cash Price	$25.97
Rate for Payer: Cash Price	$25.97
Rate for Payer: Community Health Alliance Commercial	$33.96
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.09
Rate for Payer: Meridian Health Plan Medicare	$13.09
Rate for Payer: Priority Health Commercial	$27.96
Rate for Payer: Priority Health Medicaid	$13.09
Rate for Payer: Priority Health Medicare	$13.09
Rate for Payer: Priority Health PPO	$27.96
Rate for Payer: United Health Care Medicaid	$13.09
Rate for Payer: United Health Care Medicare Advantage	$5.76

TRYPANOSOMA CRUZI AB IGG

Facility

$52.00

Hospital Charge Code	3102531
Hospital Revenue Code	300
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

TRYPTASE

Facility

$35.71

Hospital Charge Code	3008490
Hospital Revenue Code	301
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$30.35
Rate for Payer: Cash Price	$23.21
Rate for Payer: Community Health Alliance Commercial	$30.35
Rate for Payer: Priority Health Commercial	$25.00
Rate for Payer: Priority Health PPO	$25.00

TRYPTOPHAN

Facility

$122.99

Service Code	HCPCS 82131
Hospital Charge Code	3008470
Hospital Revenue Code	301
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$104.54
Rate for Payer: BCBS BCN 65	$24.13
Rate for Payer: Blue Care Network Medicare Advantage	$24.13
Rate for Payer: Cash Price	$79.94
Rate for Payer: Cash Price	$79.94
Rate for Payer: Community Health Alliance Commercial	$104.54
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$24.13
Rate for Payer: Meridian Health Plan Medicare	$24.13
Rate for Payer: Priority Health Commercial	$86.09
Rate for Payer: Priority Health Medicaid	$24.13
Rate for Payer: Priority Health Medicare	$24.13
Rate for Payer: Priority Health PPO	$86.09
Rate for Payer: United Health Care Medicaid	$24.13
Rate for Payer: United Health Care Medicare Advantage	$10.62

TSH

Facility

$86.00

Service Code	HCPCS 84443
Hospital Charge Code	3008000
Hospital Revenue Code	301
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$73.10
Rate for Payer: BCBS BCN 65	$17.64
Rate for Payer: Blue Care Network Medicare Advantage	$17.64
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Community Health Alliance Commercial	$73.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.64
Rate for Payer: Meridian Health Plan Medicare	$17.64
Rate for Payer: Priority Health Commercial	$60.20
Rate for Payer: Priority Health Medicaid	$17.64
Rate for Payer: Priority Health Medicare	$17.64
Rate for Payer: Priority Health PPO	$60.20
Rate for Payer: United Health Care Medicaid	$17.64
Rate for Payer: United Health Care Medicare Advantage	$7.76

TSH RECEPTOR AB

Facility

$13.85

Hospital Charge Code	3100819
Hospital Revenue Code	301
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$11.77
Rate for Payer: Cash Price	$9.00
Rate for Payer: Community Health Alliance Commercial	$11.77
Rate for Payer: Priority Health Commercial	$9.70
Rate for Payer: Priority Health PPO	$9.70

TSH-SMBF

Facility

$3.71

Hospital Charge Code	3101145
Hospital Revenue Code	301
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$3.15
Rate for Payer: Cash Price	$2.41
Rate for Payer: Community Health Alliance Commercial	$3.15
Rate for Payer: Priority Health Commercial	$2.60
Rate for Payer: Priority Health PPO	$2.60

TTG IGA

Facility

$94.00

Hospital Charge Code	3000245
Hospital Revenue Code	301
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$79.90
Rate for Payer: Cash Price	$61.10
Rate for Payer: Community Health Alliance Commercial	$79.90
Rate for Payer: Priority Health Commercial	$65.80
Rate for Payer: Priority Health PPO	$65.80

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges