Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

TUBE, ROBERT SHAW

Facility

$325.00

Hospital Charge Code	27262362
Hospital Revenue Code	272
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$276.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Community Health Alliance Commercial	$276.25
Rate for Payer: Priority Health Commercial	$227.50
Rate for Payer: Priority Health PPO	$227.50

TUBE SALEM SUMP

Facility

$2.13

Hospital Charge Code	27079002
Hospital Revenue Code	272
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.81
Rate for Payer: Cash Price	$1.38
Rate for Payer: Community Health Alliance Commercial	$1.81
Rate for Payer: Priority Health Commercial	$1.49
Rate for Payer: Priority Health PPO	$1.49

TUBE, SALEM SUMP W/ANTI-REFLUX

Facility

$56.00

Hospital Charge Code	27013078
Hospital Revenue Code	272
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

TUBES,DURAVENT

Facility

$77.00

Hospital Charge Code	27019992
Hospital Revenue Code	270
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$65.45
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health PPO	$53.90

TUBE,SHILEY TRACHEOSTOMY #6

Facility

$216.00

Hospital Charge Code	27060280
Hospital Revenue Code	272
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$183.60
Rate for Payer: Cash Price	$140.40
Rate for Payer: Community Health Alliance Commercial	$183.60
Rate for Payer: Priority Health Commercial	$151.20
Rate for Payer: Priority Health PPO	$151.20

TUBE,SHILEY TRACHEOSTOMY #8

Facility

$216.00

Hospital Charge Code	27060297
Hospital Revenue Code	272
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$183.60
Rate for Payer: Cash Price	$140.40
Rate for Payer: Community Health Alliance Commercial	$183.60
Rate for Payer: Priority Health Commercial	$151.20
Rate for Payer: Priority Health PPO	$151.20

TUBE- STOMACH, 18 FR

Facility

$15.00

Hospital Charge Code	27011361
Hospital Revenue Code	272
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

TUBE, SUMP XRAY ANPRO AN-IO

Facility

$40.00

Hospital Charge Code	27011874
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

TUBE THORACOSTOMY

Facility

$869.00

Hospital Charge Code	4500943
Hospital Revenue Code	450
Min. Negotiated Rate	$608.30
Max. Negotiated Rate	$738.65
Rate for Payer: Cash Price	$564.85
Rate for Payer: Community Health Alliance Commercial	$738.65
Rate for Payer: Priority Health Commercial	$608.30
Rate for Payer: Priority Health PPO	$608.30

TUBE,TRACHEAL 7.5 MURPHY

Facility

$24.00

Hospital Charge Code	27019414
Hospital Revenue Code	272
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$20.40
Rate for Payer: Cash Price	$15.60
Rate for Payer: Community Health Alliance Commercial	$20.40
Rate for Payer: Priority Health Commercial	$16.80
Rate for Payer: Priority Health PPO	$16.80

TUBE, TRACHEOSTOMY

Facility

$135.00

Hospital Charge Code	27062346
Hospital Revenue Code	272
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$114.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Community Health Alliance Commercial	$114.75
Rate for Payer: Priority Health Commercial	$94.50
Rate for Payer: Priority Health PPO	$94.50

TUBE,VYGON ENDOTRACHEAL

Facility

$26.00

Hospital Charge Code	27022582
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

TUBING, IRRIVACMAX SUCTION SYS

Facility

$137.00

Hospital Charge Code	27022814
Hospital Revenue Code	272
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$116.45
Rate for Payer: Cash Price	$89.05
Rate for Payer: Community Health Alliance Commercial	$116.45
Rate for Payer: Priority Health Commercial	$95.90
Rate for Payer: Priority Health PPO	$95.90

TUBING - THORACENTESIS DRAIN

Facility

$42.00

Hospital Charge Code	27011163
Hospital Revenue Code	272
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

TUIP KNIFE

Facility

$298.00

Hospital Charge Code	27263936
Hospital Revenue Code	272
Min. Negotiated Rate	$208.60
Max. Negotiated Rate	$253.30
Rate for Payer: Cash Price	$193.70
Rate for Payer: Community Health Alliance Commercial	$253.30
Rate for Payer: Priority Health Commercial	$208.60
Rate for Payer: Priority Health PPO	$208.60

TUMOR NECROSIS FACTOR-ALPHA

Facility

$40.73

Hospital Charge Code	3101440
Hospital Revenue Code	300
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$34.62
Rate for Payer: Cash Price	$26.47
Rate for Payer: Community Health Alliance Commercial	$34.62
Rate for Payer: Priority Health Commercial	$28.51
Rate for Payer: Priority Health PPO	$28.51

TUNNELING ROD

Facility

$414.00

Hospital Charge Code	27862155
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$351.90
Rate for Payer: Cash Price	$269.10
Rate for Payer: Community Health Alliance Commercial	$351.90
Rate for Payer: Priority Health Commercial	$289.80
Rate for Payer: Priority Health PPO	$289.80

TURBOSONIC MICROTIP

Facility

$300.00

Hospital Charge Code	27022756
Hospital Revenue Code	270
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$255.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Community Health Alliance Commercial	$255.00
Rate for Payer: Priority Health Commercial	$210.00
Rate for Payer: Priority Health PPO	$210.00

TVT DEVICE

Facility

$3,334.00

Service Code	HCPCS C1771
Hospital Charge Code	27266237
Hospital Revenue Code	278
Min. Negotiated Rate	$2,333.80
Max. Negotiated Rate	$2,833.90
Rate for Payer: Cash Price	$2,167.10
Rate for Payer: Community Health Alliance Commercial	$2,833.90
Rate for Payer: Priority Health Commercial	$2,333.80
Rate for Payer: Priority Health PPO	$2,333.80

TVT SECUR SYSTEM

Facility

$3,062.00

Hospital Charge Code	27271955
Hospital Revenue Code	272
Min. Negotiated Rate	$2,143.40
Max. Negotiated Rate	$2,602.70
Rate for Payer: Cash Price	$1,990.30
Rate for Payer: Community Health Alliance Commercial	$2,602.70
Rate for Payer: Priority Health Commercial	$2,143.40
Rate for Payer: Priority Health PPO	$2,143.40

TWIST DRILL

Facility

$56.00

Hospital Charge Code	27018879
Hospital Revenue Code	270
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

TYMS

Facility

$274.75

Hospital Charge Code	3100970
Hospital Revenue Code	300
Min. Negotiated Rate	$192.32
Max. Negotiated Rate	$233.54
Rate for Payer: Cash Price	$178.59
Rate for Payer: Community Health Alliance Commercial	$233.54
Rate for Payer: Priority Health Commercial	$192.32
Rate for Payer: Priority Health PPO	$192.32

TYPE-ABO-BLOOD

Facility

$22.00

Service Code	HCPCS 86900
Hospital Charge Code	3006140
Hospital Revenue Code	300
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$18.70
Rate for Payer: BCBS BCN 65	$3.14
Rate for Payer: Blue Care Network Medicare Advantage	$3.14
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$14.30
Rate for Payer: Community Health Alliance Commercial	$18.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.14
Rate for Payer: Meridian Health Plan Medicare	$3.14
Rate for Payer: Priority Health Commercial	$15.40
Rate for Payer: Priority Health Medicaid	$3.14
Rate for Payer: Priority Health Medicare	$3.14
Rate for Payer: Priority Health PPO	$15.40
Rate for Payer: United Health Care Medicaid	$3.14
Rate for Payer: United Health Care Medicare Advantage	$1.38

U-BAG, URINE COLLECTOR

Facility

$17.00

Hospital Charge Code	27017483
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

UC/UROLOGY WORKUP

Facility

$11.98

Hospital Charge Code	31027528
Hospital Revenue Code	300
Min. Negotiated Rate	$8.39
Max. Negotiated Rate	$10.18
Rate for Payer: Cash Price	$7.79
Rate for Payer: Community Health Alliance Commercial	$10.18
Rate for Payer: Priority Health Commercial	$8.39
Rate for Payer: Priority Health PPO	$8.39

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges