Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA CARFILZOMIB 60 MG/30ML VIA

Facility

$10,355.19

Service Code	HCPCS J9047
Hospital Charge Code	2509399
Hospital Revenue Code	636
Min. Negotiated Rate	$25.69
Max. Negotiated Rate	$8,801.91
Rate for Payer: BCBS BCN 65	$58.39
Rate for Payer: Blue Care Network Medicare Advantage	$58.39
Rate for Payer: Cash Price	$6,730.87
Rate for Payer: Cash Price	$6,730.87
Rate for Payer: Community Health Alliance Commercial	$8,801.91
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$58.39
Rate for Payer: Meridian Health Plan Medicare	$58.39
Rate for Payer: Priority Health Commercial	$7,248.63
Rate for Payer: Priority Health Medicaid	$58.39
Rate for Payer: Priority Health Medicare	$58.39
Rate for Payer: Priority Health PPO	$7,248.63
Rate for Payer: United Health Care Medicaid	$58.39
Rate for Payer: United Health Care Medicare Advantage	$25.69

PHA CARVEDILOL 6.25 MG TAB

Facility

$0.57

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503404
Hospital Revenue Code	637
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.37
Rate for Payer: Community Health Alliance Commercial	$0.48
Rate for Payer: Priority Health Commercial	$0.40
Rate for Payer: Priority Health PPO	$0.40

PHA CASPOFUNGIN ACETATE 50 MG

Facility

$1,118.49

Service Code	HCPCS J0637
Hospital Charge Code	2500518
Hospital Revenue Code	636
Min. Negotiated Rate	$782.94
Max. Negotiated Rate	$950.72
Rate for Payer: Cash Price	$727.02
Rate for Payer: Community Health Alliance Commercial	$950.72
Rate for Payer: Priority Health Commercial	$782.94
Rate for Payer: Priority Health PPO	$782.94

PHA CASPOFUNGIN ACETATE 70MG

Facility

$1,162.13

Service Code	HCPCS J0637
Hospital Charge Code	2500516
Hospital Revenue Code	636
Min. Negotiated Rate	$813.49
Max. Negotiated Rate	$987.81
Rate for Payer: Cash Price	$755.38
Rate for Payer: Community Health Alliance Commercial	$987.81
Rate for Payer: Priority Health Commercial	$813.49
Rate for Payer: Priority Health PPO	$813.49

PHA CATHFLO ACTIVASE 2MG VIAL

Facility

$643.96

Service Code	HCPCS J2997
Hospital Charge Code	2500375
Hospital Revenue Code	636
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$547.37
Rate for Payer: BCBS BCN 65	$98.52
Rate for Payer: Blue Care Network Medicare Advantage	$98.52
Rate for Payer: Cash Price	$418.57
Rate for Payer: Cash Price	$418.57
Rate for Payer: Community Health Alliance Commercial	$547.37
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$98.52
Rate for Payer: Meridian Health Plan Medicare	$98.52
Rate for Payer: Priority Health Commercial	$450.77
Rate for Payer: Priority Health Medicaid	$98.52
Rate for Payer: Priority Health Medicare	$98.52
Rate for Payer: Priority Health PPO	$450.77
Rate for Payer: United Health Care Medicaid	$98.52
Rate for Payer: United Health Care Medicare Advantage	$43.35

PHA CEFAZOLIN SODIUM 1 GM VIAL

Facility

$10.32

Service Code	HCPCS J0690
Hospital Charge Code	2502730
Hospital Revenue Code	636
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$8.77
Rate for Payer: Cash Price	$6.71
Rate for Payer: Community Health Alliance Commercial	$8.77
Rate for Payer: Priority Health Commercial	$7.22
Rate for Payer: Priority Health PPO	$7.22

PHA CEFDINIR 125MG/5 ML 60 ML

Facility

$221.34

Service Code	NDC 68180072220
Hospital Charge Code	2500107
Hospital Revenue Code	250
Min. Negotiated Rate	$154.94
Max. Negotiated Rate	$188.14
Rate for Payer: Cash Price	$143.87
Rate for Payer: Community Health Alliance Commercial	$188.14
Rate for Payer: Priority Health Commercial	$154.94
Rate for Payer: Priority Health PPO	$154.94

PHA CEFEPIME HYDROCHLORIDE 1GM

Facility

$35.64

Service Code	HCPCS J0692
Hospital Charge Code	2505799
Hospital Revenue Code	636
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$30.29
Rate for Payer: Cash Price	$23.17
Rate for Payer: Community Health Alliance Commercial	$30.29
Rate for Payer: Priority Health Commercial	$24.95
Rate for Payer: Priority Health PPO	$24.95

PHA CEFOXITIN,2GM/USE 50ML INJ

Facility

$109.65

Service Code	HCPCS J0694
Hospital Charge Code	2502805
Hospital Revenue Code	636
Min. Negotiated Rate	$76.75
Max. Negotiated Rate	$93.20
Rate for Payer: Cash Price	$71.27
Rate for Payer: Community Health Alliance Commercial	$93.20
Rate for Payer: Priority Health Commercial	$76.75
Rate for Payer: Priority Health PPO	$76.75

PHA CEFOXITIN SODIUM 1 GM BAG

Facility

$43.71

Service Code	HCPCS J0694
Hospital Charge Code	2502791
Hospital Revenue Code	636
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$37.15
Rate for Payer: Cash Price	$28.41
Rate for Payer: Community Health Alliance Commercial	$37.15
Rate for Payer: Priority Health Commercial	$30.60
Rate for Payer: Priority Health PPO	$30.60

PHA CEFPROZIL 125MG/5ML 100M

Facility

$208.41

Service Code	NDC 65862009901
Hospital Charge Code	2500914
Hospital Revenue Code	250
Min. Negotiated Rate	$145.89
Max. Negotiated Rate	$177.15
Rate for Payer: Cash Price	$135.47
Rate for Payer: Community Health Alliance Commercial	$177.15
Rate for Payer: Priority Health Commercial	$145.89
Rate for Payer: Priority Health PPO	$145.89

PHA CEFTAROLINE 400MG VIAL

Facility

$895.34

Service Code	HCPCS J0712
Hospital Charge Code	2502853
Hospital Revenue Code	636
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$761.04
Rate for Payer: BCBS BCN 65	$4.45
Rate for Payer: Blue Care Network Medicare Advantage	$4.45
Rate for Payer: Cash Price	$581.97
Rate for Payer: Cash Price	$581.97
Rate for Payer: Community Health Alliance Commercial	$761.04
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.45
Rate for Payer: Meridian Health Plan Medicare	$4.45
Rate for Payer: Priority Health Commercial	$626.74
Rate for Payer: Priority Health Medicaid	$4.45
Rate for Payer: Priority Health Medicare	$4.45
Rate for Payer: Priority Health PPO	$626.74
Rate for Payer: United Health Care Medicaid	$4.45
Rate for Payer: United Health Care Medicare Advantage	$1.96

PHA CEFTAROLINE 600 MG VIAL

Facility

$895.34

Service Code	HCPCS J0712
Hospital Charge Code	2502852
Hospital Revenue Code	636
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$761.04
Rate for Payer: BCBS BCN 65	$4.45
Rate for Payer: Blue Care Network Medicare Advantage	$4.45
Rate for Payer: Cash Price	$581.97
Rate for Payer: Cash Price	$581.97
Rate for Payer: Community Health Alliance Commercial	$761.04
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.45
Rate for Payer: Meridian Health Plan Medicare	$4.45
Rate for Payer: Priority Health Commercial	$626.74
Rate for Payer: Priority Health Medicaid	$4.45
Rate for Payer: Priority Health Medicare	$4.45
Rate for Payer: Priority Health PPO	$626.74
Rate for Payer: United Health Care Medicaid	$4.45
Rate for Payer: United Health Care Medicare Advantage	$1.96

PHA CEFTAZIDIME 1 GM INJ

Facility

$26.68

Service Code	NDC 409508216
Hospital Charge Code	2502856
Hospital Revenue Code	250
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$22.68
Rate for Payer: Cash Price	$17.34
Rate for Payer: Community Health Alliance Commercial	$22.68
Rate for Payer: Priority Health Commercial	$18.68
Rate for Payer: Priority Health PPO	$18.68

PHA CEFTAZIDIME 2 GM INJ

Facility

$53.86

Service Code	NDC 44567024110
Hospital Charge Code	2502857
Hospital Revenue Code	250
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$45.78
Rate for Payer: Cash Price	$35.01
Rate for Payer: Community Health Alliance Commercial	$45.78
Rate for Payer: Priority Health Commercial	$37.70
Rate for Payer: Priority Health PPO	$37.70

PHA CEFTRIAXONE SOD 250MG INJ

Facility

$4.74

Service Code	HCPCS J0696
Hospital Charge Code	2502840
Hospital Revenue Code	636
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.03
Rate for Payer: Cash Price	$3.08
Rate for Payer: Community Health Alliance Commercial	$4.03
Rate for Payer: Priority Health Commercial	$3.32
Rate for Payer: Priority Health PPO	$3.32

PHA CEFTRIAXONE SODIUM 1GM VL

Facility

$16.88

Service Code	HCPCS J0696
Hospital Charge Code	2502820
Hospital Revenue Code	636
Min. Negotiated Rate	$11.82
Max. Negotiated Rate	$14.35
Rate for Payer: Cash Price	$10.97
Rate for Payer: Community Health Alliance Commercial	$14.35
Rate for Payer: Priority Health Commercial	$11.82
Rate for Payer: Priority Health PPO	$11.82

PHA CEFTRIAXONE SODIUM 2 GM

Facility

$305.31

Service Code	HCPCS J0696
Hospital Charge Code	2502821
Hospital Revenue Code	636
Min. Negotiated Rate	$213.72
Max. Negotiated Rate	$259.51
Rate for Payer: Cash Price	$198.45
Rate for Payer: Community Health Alliance Commercial	$259.51
Rate for Payer: Priority Health Commercial	$213.72
Rate for Payer: Priority Health PPO	$213.72

PHA CEFTRIAXONE SODIUM 500 MG

Facility

$7.82

Service Code	HCPCS J0696
Hospital Charge Code	2500185
Hospital Revenue Code	636
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$6.65
Rate for Payer: Cash Price	$5.08
Rate for Payer: Community Health Alliance Commercial	$6.65
Rate for Payer: Priority Health Commercial	$5.47
Rate for Payer: Priority Health PPO	$5.47

PHA CEFUROXIME ACETIL 250 MG T

Facility

$22.92

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502841
Hospital Revenue Code	637
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$19.48
Rate for Payer: Cash Price	$14.90
Rate for Payer: Community Health Alliance Commercial	$19.48
Rate for Payer: Priority Health Commercial	$16.04
Rate for Payer: Priority Health PPO	$16.04

PHA CEFUROXIME SOD 750MG VIAL

Facility

$19.12

Service Code	HCPCS J0697
Hospital Charge Code	2502880
Hospital Revenue Code	636
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$16.25
Rate for Payer: Cash Price	$12.43
Rate for Payer: Community Health Alliance Commercial	$16.25
Rate for Payer: Priority Health Commercial	$13.38
Rate for Payer: Priority Health PPO	$13.38

PHA CELECOXIB 200MG CAP

Facility

$12.66

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507887
Hospital Revenue Code	637
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$10.76
Rate for Payer: Cash Price	$8.23
Rate for Payer: Community Health Alliance Commercial	$10.76
Rate for Payer: Priority Health Commercial	$8.86
Rate for Payer: Priority Health PPO	$8.86

PHA CEPHALEXN MONOHY 125MG/5ML

Facility

$107.40

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502890
Hospital Revenue Code	637
Min. Negotiated Rate	$75.18
Max. Negotiated Rate	$91.29
Rate for Payer: Cash Price	$69.81
Rate for Payer: Community Health Alliance Commercial	$91.29
Rate for Payer: Priority Health Commercial	$75.18
Rate for Payer: Priority Health PPO	$75.18

PHA CEPHALEXN MONOHYD 500MG CP

Facility

$6.36

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502920
Hospital Revenue Code	637
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$5.41
Rate for Payer: Cash Price	$4.13
Rate for Payer: Community Health Alliance Commercial	$5.41
Rate for Payer: Priority Health Commercial	$4.45
Rate for Payer: Priority Health PPO	$4.45

PHA CETIRIZINE HCL 10 MG TAB

Facility

$12.97

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506754
Hospital Revenue Code	637
Min. Negotiated Rate	$9.08
Max. Negotiated Rate	$11.02
Rate for Payer: Cash Price	$8.43
Rate for Payer: Community Health Alliance Commercial	$11.02
Rate for Payer: Priority Health Commercial	$9.08
Rate for Payer: Priority Health PPO	$9.08

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges