Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA ACETAMINOPHEN 325 MG SUP

Facility

$3.44

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500080
Hospital Revenue Code	637
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$2.24
Rate for Payer: Community Health Alliance Commercial	$2.92
Rate for Payer: Priority Health Commercial	$2.41
Rate for Payer: Priority Health PPO	$2.41

PHA ACETAMINOPHEN 325 MG TAB

Facility

$0.26

Service Code	HCPCS A9270 GY
Hospital Charge Code	2510290
Hospital Revenue Code	637
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.17
Rate for Payer: Community Health Alliance Commercial	$0.22
Rate for Payer: Priority Health Commercial	$0.18
Rate for Payer: Priority Health PPO	$0.18

PHA ACETAMINOPHEN-CAFF-BUT 1TB

Facility

$11.31

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500170
Hospital Revenue Code	637
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$9.61
Rate for Payer: Cash Price	$7.35
Rate for Payer: Community Health Alliance Commercial	$9.61
Rate for Payer: Priority Health Commercial	$7.92
Rate for Payer: Priority Health PPO	$7.92

PHA ACETAMINOPHEN/COD #3 1 TAB

Facility

$3.18

Service Code	HCPCS A9270 GY
Hospital Charge Code	2510280
Hospital Revenue Code	637
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.70
Rate for Payer: Cash Price	$2.07
Rate for Payer: Community Health Alliance Commercial	$2.70
Rate for Payer: Priority Health Commercial	$2.23
Rate for Payer: Priority Health PPO	$2.23

PHA ACETAMINOPHEN W/HYDROCODO

Facility

$5.68

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501462
Hospital Revenue Code	637
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$4.83
Rate for Payer: Cash Price	$3.69
Rate for Payer: Community Health Alliance Commercial	$4.83
Rate for Payer: Priority Health Commercial	$3.98
Rate for Payer: Priority Health PPO	$3.98

PHA ACETAZOLAMIDE 250 MG TAB

Facility

$22.56

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500070
Hospital Revenue Code	637
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$19.18
Rate for Payer: Cash Price	$14.66
Rate for Payer: Community Health Alliance Commercial	$19.18
Rate for Payer: Priority Health Commercial	$15.79
Rate for Payer: Priority Health PPO	$15.79

PHA ACETAZOLAMIDE SOD 500 MG

Facility

$156.73

Service Code	NDC 39822019001
Hospital Charge Code	2500090
Hospital Revenue Code	250
Min. Negotiated Rate	$109.71
Max. Negotiated Rate	$133.22
Rate for Payer: Cash Price	$101.87
Rate for Payer: Community Health Alliance Commercial	$133.22
Rate for Payer: Priority Health Commercial	$109.71
Rate for Payer: Priority Health PPO	$109.71

PHA ACETYCLYSTEINE 20% 30ML

Facility

$141.61

Service Code	HCPCS J7608
Hospital Charge Code	2500060
Hospital Revenue Code	250
Min. Negotiated Rate	$99.13
Max. Negotiated Rate	$120.37
Rate for Payer: Cash Price	$92.05
Rate for Payer: Community Health Alliance Commercial	$120.37
Rate for Payer: Priority Health Commercial	$99.13
Rate for Payer: Priority Health PPO	$99.13

PHA ACETYLCYSTEINE 4 ML

Facility

$87.75

Service Code	HCPCS J7608
Hospital Charge Code	2500045
Hospital Revenue Code	636
Min. Negotiated Rate	$61.42
Max. Negotiated Rate	$74.59
Rate for Payer: Cash Price	$57.04
Rate for Payer: Community Health Alliance Commercial	$74.59
Rate for Payer: Priority Health Commercial	$61.42
Rate for Payer: Priority Health PPO	$61.42

PHA ACTEMRA 200MG/10ML VIAL

Facility

$3,633.16

Service Code	HCPCS J3262
Hospital Charge Code	2510929
Hospital Revenue Code	636
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$3,088.19
Rate for Payer: BCBS BCN 65	$5.89
Rate for Payer: Blue Care Network Medicare Advantage	$5.89
Rate for Payer: Cash Price	$2,361.55
Rate for Payer: Cash Price	$2,361.55
Rate for Payer: Community Health Alliance Commercial	$3,088.19
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.89
Rate for Payer: Meridian Health Plan Medicare	$5.89
Rate for Payer: Priority Health Commercial	$2,543.21
Rate for Payer: Priority Health Medicaid	$5.89
Rate for Payer: Priority Health Medicare	$5.89
Rate for Payer: Priority Health PPO	$2,543.21
Rate for Payer: United Health Care Medicaid	$5.89
Rate for Payer: United Health Care Medicare Advantage	$2.59

PHA ACTIVATED CHARCOAL PELLETS

Facility

$80.84

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502933
Hospital Revenue Code	637
Min. Negotiated Rate	$56.59
Max. Negotiated Rate	$68.71
Rate for Payer: Cash Price	$52.55
Rate for Payer: Community Health Alliance Commercial	$68.71
Rate for Payer: Priority Health Commercial	$56.59
Rate for Payer: Priority Health PPO	$56.59

PHA ACYCLOVIR 200 MG CAP

Facility

$7.97

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500200
Hospital Revenue Code	637
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$6.77
Rate for Payer: Cash Price	$5.18
Rate for Payer: Community Health Alliance Commercial	$6.77
Rate for Payer: Priority Health Commercial	$5.58
Rate for Payer: Priority Health PPO	$5.58

PHA ACYCLOVIR 800MG TABLET

Facility

$23.71

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500201
Hospital Revenue Code	637
Min. Negotiated Rate	$16.60
Max. Negotiated Rate	$20.15
Rate for Payer: Cash Price	$15.41
Rate for Payer: Community Health Alliance Commercial	$20.15
Rate for Payer: Priority Health Commercial	$16.60
Rate for Payer: Priority Health PPO	$16.60

PHA ACYCLOVIR SODIUM 500MG INJ

Facility

$73.28

Service Code	HCPCS J0133
Hospital Charge Code	2500210
Hospital Revenue Code	636
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$62.29
Rate for Payer: Cash Price	$47.63
Rate for Payer: Community Health Alliance Commercial	$62.29
Rate for Payer: Priority Health Commercial	$51.30
Rate for Payer: Priority Health PPO	$51.30

PHA ADENOSINE 60MG/20ML VIAL

Facility

$397.44

Service Code	HCPCS J0153
Hospital Charge Code	2510792
Hospital Revenue Code	636
Min. Negotiated Rate	$278.21
Max. Negotiated Rate	$337.82
Rate for Payer: Cash Price	$258.34
Rate for Payer: Community Health Alliance Commercial	$337.82
Rate for Payer: Priority Health Commercial	$278.21
Rate for Payer: Priority Health PPO	$278.21

PHA ADENOSINE 6 MG/ML APC 0917

Facility

$38.76

Service Code	HCPCS J0153
Hospital Charge Code	2500225
Hospital Revenue Code	636
Min. Negotiated Rate	$27.13
Max. Negotiated Rate	$32.95
Rate for Payer: Cash Price	$25.19
Rate for Payer: Community Health Alliance Commercial	$32.95
Rate for Payer: Priority Health Commercial	$27.13
Rate for Payer: Priority Health PPO	$27.13

PHA ALBUMIN HUMAN 25% 50 0962

Facility

$298.08

Service Code	HCPCS P9047
Hospital Charge Code	2500260
Hospital Revenue Code	636
Min. Negotiated Rate	$24.52
Max. Negotiated Rate	$253.37
Rate for Payer: BCBS BCN 65	$55.73
Rate for Payer: Blue Care Network Medicare Advantage	$55.73
Rate for Payer: Cash Price	$193.75
Rate for Payer: Cash Price	$193.75
Rate for Payer: Community Health Alliance Commercial	$253.37
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$55.73
Rate for Payer: Meridian Health Plan Medicare	$55.73
Rate for Payer: Priority Health Commercial	$208.66
Rate for Payer: Priority Health Medicaid	$55.73
Rate for Payer: Priority Health Medicare	$55.73
Rate for Payer: Priority Health PPO	$208.66
Rate for Payer: United Health Care Medicaid	$55.73
Rate for Payer: United Health Care Medicare Advantage	$24.52

PHA ALBUTEROL IPRATRO 14.7 GM

Facility

$1,532.51

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502016
Hospital Revenue Code	637
Min. Negotiated Rate	$1,072.76
Max. Negotiated Rate	$1,302.63
Rate for Payer: Cash Price	$996.13
Rate for Payer: Community Health Alliance Commercial	$1,302.63
Rate for Payer: Priority Health Commercial	$1,072.76
Rate for Payer: Priority Health PPO	$1,072.76

PHA ALBUTEROL SULF 2MG/5ML ML

Facility

$20.37

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508710
Hospital Revenue Code	637
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$17.31
Rate for Payer: Cash Price	$13.24
Rate for Payer: Community Health Alliance Commercial	$17.31
Rate for Payer: Priority Health Commercial	$14.26
Rate for Payer: Priority Health PPO	$14.26

PHA ALBUTEROL SULFATE

Facility

$6.41

Service Code	NDC 591379730
Hospital Charge Code	2500240
Hospital Revenue Code	250
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$5.45
Rate for Payer: Cash Price	$4.17
Rate for Payer: Community Health Alliance Commercial	$5.45
Rate for Payer: Priority Health Commercial	$4.49
Rate for Payer: Priority Health PPO	$4.49

PHA ALBUTEROL SULFATE HFA 60

Facility

$51.46

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506262
Hospital Revenue Code	637
Min. Negotiated Rate	$36.02
Max. Negotiated Rate	$43.74
Rate for Payer: Cash Price	$33.45
Rate for Payer: Community Health Alliance Commercial	$43.74
Rate for Payer: Priority Health Commercial	$36.02
Rate for Payer: Priority Health PPO	$36.02

PHA ALCOHOL 100% ML SOL

Facility

$457.99

Service Code	NDC 51552025606
Hospital Charge Code	2500618
Hospital Revenue Code	250
Min. Negotiated Rate	$320.59
Max. Negotiated Rate	$389.29
Rate for Payer: Cash Price	$297.69
Rate for Payer: Community Health Alliance Commercial	$389.29
Rate for Payer: Priority Health Commercial	$320.59
Rate for Payer: Priority Health PPO	$320.59

PHA ALENDRONATE 10 MG TAB

Facility

$93.71

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500415
Hospital Revenue Code	637
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$79.65
Rate for Payer: Cash Price	$60.91
Rate for Payer: Community Health Alliance Commercial	$79.65
Rate for Payer: Priority Health Commercial	$65.60
Rate for Payer: Priority Health PPO	$65.60

PHA ALIMTA 500MG/20ML VIAL

Facility

$11,061.65

Service Code	HCPCS J9305
Hospital Charge Code	2503108
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$9,402.40
Rate for Payer: BCBS BCN 65	$3.77
Rate for Payer: Blue Care Network Medicare Advantage	$3.77
Rate for Payer: Cash Price	$7,190.07
Rate for Payer: Cash Price	$7,190.07
Rate for Payer: Community Health Alliance Commercial	$9,402.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.77
Rate for Payer: Meridian Health Plan Medicare	$3.77
Rate for Payer: Priority Health Commercial	$7,743.15
Rate for Payer: Priority Health Medicaid	$3.77
Rate for Payer: Priority Health Medicare	$3.77
Rate for Payer: Priority Health PPO	$7,743.15
Rate for Payer: United Health Care Medicaid	$3.77
Rate for Payer: United Health Care Medicare Advantage	$1.66

PHA ALLOPURINOL 100 MG TAB

Facility

$1.98

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500350
Hospital Revenue Code	637
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.68
Rate for Payer: Cash Price	$1.29
Rate for Payer: Community Health Alliance Commercial	$1.68
Rate for Payer: Priority Health Commercial	$1.39
Rate for Payer: Priority Health PPO	$1.39

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges