Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA AMPICILLIN & SULBACTAM SOD

Facility

$66.87

Service Code	HCPCS J0295
Hospital Charge Code	2510340
Hospital Revenue Code	636
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$56.84
Rate for Payer: Cash Price	$43.47
Rate for Payer: Community Health Alliance Commercial	$56.84
Rate for Payer: Priority Health Commercial	$46.81
Rate for Payer: Priority Health PPO	$46.81

PHA AMYL NITRITE 1 EACH INH

Facility

$5.02

Service Code	NDC 46414222201
Hospital Charge Code	2500670
Hospital Revenue Code	250
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$4.27
Rate for Payer: Cash Price	$3.26
Rate for Payer: Community Health Alliance Commercial	$4.27
Rate for Payer: Priority Health Commercial	$3.51
Rate for Payer: Priority Health PPO	$3.51

PHA ANASTROZOLE 1MG TAB NF

Facility

$60.91

Service Code	NDC 16729003510
Hospital Charge Code	2510771
Hospital Revenue Code	637
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$51.77
Rate for Payer: Cash Price	$39.59
Rate for Payer: Community Health Alliance Commercial	$51.77
Rate for Payer: Priority Health Commercial	$42.64
Rate for Payer: Priority Health PPO	$42.64

PHA ANTARA 160MG TAB

Facility

$12.40

Service Code	NDC 378710177
Hospital Charge Code	2510786
Hospital Revenue Code	637
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$10.54
Rate for Payer: Cash Price	$8.06
Rate for Payer: Community Health Alliance Commercial	$10.54
Rate for Payer: Priority Health Commercial	$8.68
Rate for Payer: Priority Health PPO	$8.68

PHA ANTIHEMOPHILIC FACTOR

Facility

$10.68

Service Code	HCPCS J7187
Hospital Charge Code	2500418
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$9.08
Rate for Payer: BCBS BCN 65	$1.56
Rate for Payer: Blue Care Network Medicare Advantage	$1.56
Rate for Payer: Cash Price	$6.94
Rate for Payer: Cash Price	$6.94
Rate for Payer: Community Health Alliance Commercial	$9.08
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1.56
Rate for Payer: Meridian Health Plan Medicare	$1.56
Rate for Payer: Priority Health Commercial	$7.48
Rate for Payer: Priority Health Medicaid	$1.56
Rate for Payer: Priority Health Medicare	$1.56
Rate for Payer: Priority Health PPO	$7.48
Rate for Payer: United Health Care Medicaid	$1.56
Rate for Payer: United Health Care Medicare Advantage	$0.69

PHA ANTIHEMOPHILIC FACTOR 956

Facility

$10.68

Service Code	HCPCS J7187
Hospital Charge Code	2500419
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$9.08
Rate for Payer: BCBS BCN 65	$1.56
Rate for Payer: Blue Care Network Medicare Advantage	$1.56
Rate for Payer: Cash Price	$6.94
Rate for Payer: Cash Price	$6.94
Rate for Payer: Community Health Alliance Commercial	$9.08
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1.56
Rate for Payer: Meridian Health Plan Medicare	$1.56
Rate for Payer: Priority Health Commercial	$7.48
Rate for Payer: Priority Health Medicaid	$1.56
Rate for Payer: Priority Health Medicare	$1.56
Rate for Payer: Priority Health PPO	$7.48
Rate for Payer: United Health Care Medicaid	$1.56
Rate for Payer: United Health Care Medicare Advantage	$0.69

PHA ANTIHEMOPHILIC FACTOR 977

Facility

$10.68

Service Code	HCPCS J7187
Hospital Charge Code	2500422
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$9.08
Rate for Payer: BCBS BCN 65	$1.56
Rate for Payer: Blue Care Network Medicare Advantage	$1.56
Rate for Payer: Cash Price	$6.94
Rate for Payer: Cash Price	$6.94
Rate for Payer: Community Health Alliance Commercial	$9.08
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1.56
Rate for Payer: Meridian Health Plan Medicare	$1.56
Rate for Payer: Priority Health Commercial	$7.48
Rate for Payer: Priority Health Medicaid	$1.56
Rate for Payer: Priority Health Medicare	$1.56
Rate for Payer: Priority Health PPO	$7.48
Rate for Payer: United Health Care Medicaid	$1.56
Rate for Payer: United Health Care Medicare Advantage	$0.69

PHA APIXABAN BASE 2.5 MG TAB

Facility

$36.00

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501229
Hospital Revenue Code	637
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$30.60
Rate for Payer: Cash Price	$23.40
Rate for Payer: Community Health Alliance Commercial	$30.60
Rate for Payer: Priority Health Commercial	$25.20
Rate for Payer: Priority Health PPO	$25.20

PHA APRACLONIDINE HCL 0.1 ML

Facility

$132.41

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500700
Hospital Revenue Code	637
Min. Negotiated Rate	$92.69
Max. Negotiated Rate	$112.55
Rate for Payer: Cash Price	$86.07
Rate for Payer: Community Health Alliance Commercial	$112.55
Rate for Payer: Priority Health Commercial	$92.69
Rate for Payer: Priority Health PPO	$92.69

PHA ARANESP 100MCG/ML 1ML VIAL

Facility

$2,284.85

Service Code	NDC 55513000504
Hospital Charge Code	2510946
Hospital Revenue Code	250
Min. Negotiated Rate	$1,599.39
Max. Negotiated Rate	$1,942.12
Rate for Payer: Cash Price	$1,485.15
Rate for Payer: Community Health Alliance Commercial	$1,942.12
Rate for Payer: Priority Health Commercial	$1,599.39
Rate for Payer: Priority Health PPO	$1,599.39

PHA ARGATROBAN 250MG

Facility

$1,505.52

Service Code	HCPCS J0883
Hospital Charge Code	2510923
Hospital Revenue Code	636
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$1,279.69
Rate for Payer: BCBS BCN 65	$0.64
Rate for Payer: Blue Care Network Medicare Advantage	$0.64
Rate for Payer: Cash Price	$978.59
Rate for Payer: Cash Price	$978.59
Rate for Payer: Community Health Alliance Commercial	$1,279.69
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$0.64
Rate for Payer: Meridian Health Plan Medicare	$0.64
Rate for Payer: Priority Health Commercial	$1,053.86
Rate for Payer: Priority Health Medicaid	$0.64
Rate for Payer: Priority Health Medicare	$0.64
Rate for Payer: Priority Health PPO	$1,053.86
Rate for Payer: United Health Care Medicaid	$0.64
Rate for Payer: United Health Care Medicare Advantage	$0.28

PHA ARIPIPRAZOLE 10 MG TAB

Facility

$127.68

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500505
Hospital Revenue Code	637
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$108.53
Rate for Payer: Cash Price	$82.99
Rate for Payer: Community Health Alliance Commercial	$108.53
Rate for Payer: Priority Health Commercial	$89.38
Rate for Payer: Priority Health PPO	$89.38

PHA ARREPITANT 40 MG CAP

Facility

$390.95

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502626
Hospital Revenue Code	637
Min. Negotiated Rate	$273.67
Max. Negotiated Rate	$332.31
Rate for Payer: Cash Price	$254.12
Rate for Payer: Community Health Alliance Commercial	$332.31
Rate for Payer: Priority Health Commercial	$273.67
Rate for Payer: Priority Health PPO	$273.67

PHA ARTIFICL TEAR ONT .7 GM UD

Facility

$40.18

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500720
Hospital Revenue Code	637
Min. Negotiated Rate	$28.13
Max. Negotiated Rate	$34.15
Rate for Payer: Cash Price	$26.12
Rate for Payer: Community Health Alliance Commercial	$34.15
Rate for Payer: Priority Health Commercial	$28.13
Rate for Payer: Priority Health PPO	$28.13

PHA ARTIFICL TEAR SOL 15ML BTL

Facility

$27.20

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500740
Hospital Revenue Code	637
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$23.12
Rate for Payer: Cash Price	$17.68
Rate for Payer: Community Health Alliance Commercial	$23.12
Rate for Payer: Priority Health Commercial	$19.04
Rate for Payer: Priority Health PPO	$19.04

PHA ASCORBIC ACID 250 MG TAB

Facility

$1.46

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500780
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.24
Rate for Payer: Cash Price	$0.95
Rate for Payer: Community Health Alliance Commercial	$1.24
Rate for Payer: Priority Health Commercial	$1.02
Rate for Payer: Priority Health PPO	$1.02

PHA ASPIRIN 300MG SUPPOSITORY

Facility

$7.61

Service Code	NDC 574703412
Hospital Charge Code	2510774
Hospital Revenue Code	250
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$6.47
Rate for Payer: Cash Price	$4.95
Rate for Payer: Community Health Alliance Commercial	$6.47
Rate for Payer: Priority Health Commercial	$5.33
Rate for Payer: Priority Health PPO	$5.33

PHA ASPIRIN 325 MG TAB

Facility

$0.31

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500750
Hospital Revenue Code	637
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.26
Rate for Payer: Cash Price	$0.20
Rate for Payer: Community Health Alliance Commercial	$0.26
Rate for Payer: Priority Health Commercial	$0.22
Rate for Payer: Priority Health PPO	$0.22

PHA ASPIRIN 81 MG CHW

Facility

$0.52

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500760
Hospital Revenue Code	637
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.34
Rate for Payer: Community Health Alliance Commercial	$0.44
Rate for Payer: Priority Health Commercial	$0.36
Rate for Payer: Priority Health PPO	$0.36

PHA ATENOLOL 25 MG

Facility

$4.17

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500835
Hospital Revenue Code	637
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$3.54
Rate for Payer: Cash Price	$2.71
Rate for Payer: Community Health Alliance Commercial	$3.54
Rate for Payer: Priority Health Commercial	$2.92
Rate for Payer: Priority Health PPO	$2.92

PHA ATENOLOL 50 MG TAB

Facility

$4.64

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500840
Hospital Revenue Code	637
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$3.94
Rate for Payer: Cash Price	$3.02
Rate for Payer: Community Health Alliance Commercial	$3.94
Rate for Payer: Priority Health Commercial	$3.25
Rate for Payer: Priority Health PPO	$3.25

PHA ATORVASTATIN CALCIUM 10 MG

Facility

$2.61

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500845
Hospital Revenue Code	637
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.22
Rate for Payer: Cash Price	$1.70
Rate for Payer: Community Health Alliance Commercial	$2.22
Rate for Payer: Priority Health Commercial	$1.83
Rate for Payer: Priority Health PPO	$1.83

PHA ATRACURIUM BESYLATE 10GM/

Facility

$87.02

Service Code	NDC 67457069810
Hospital Charge Code	2500850
Hospital Revenue Code	250
Min. Negotiated Rate	$60.91
Max. Negotiated Rate	$73.97
Rate for Payer: Cash Price	$56.56
Rate for Payer: Community Health Alliance Commercial	$73.97
Rate for Payer: Priority Health Commercial	$60.91
Rate for Payer: Priority Health PPO	$60.91

PHA ATROPINE SULF 1% 15ML BTL

Facility

$299.81

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500910
Hospital Revenue Code	637
Min. Negotiated Rate	$209.87
Max. Negotiated Rate	$254.84
Rate for Payer: Cash Price	$194.88
Rate for Payer: Community Health Alliance Commercial	$254.84
Rate for Payer: Priority Health Commercial	$209.87
Rate for Payer: Priority Health PPO	$209.87

PHA ATROPINE SULF 1MG/10ML SYR

Facility

$415.99

Service Code	HCPCS J0461
Hospital Charge Code	2500870
Hospital Revenue Code	636
Min. Negotiated Rate	$291.19
Max. Negotiated Rate	$353.59
Rate for Payer: Cash Price	$270.39
Rate for Payer: Community Health Alliance Commercial	$353.59
Rate for Payer: Priority Health Commercial	$291.19
Rate for Payer: Priority Health PPO	$291.19

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges