Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA CETUXIMAB 200 MG/100ML VI

Facility

$4,645.91

Service Code	HCPCS J9055
Hospital Charge Code	2509036
Hospital Revenue Code	636
Min. Negotiated Rate	$37.12
Max. Negotiated Rate	$3,949.02
Rate for Payer: BCBS BCN 65	$84.36
Rate for Payer: Blue Care Network Medicare Advantage	$84.36
Rate for Payer: Cash Price	$3,019.84
Rate for Payer: Cash Price	$3,019.84
Rate for Payer: Community Health Alliance Commercial	$3,949.02
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$84.36
Rate for Payer: Meridian Health Plan Medicare	$84.36
Rate for Payer: Priority Health Commercial	$3,252.14
Rate for Payer: Priority Health Medicaid	$84.36
Rate for Payer: Priority Health Medicare	$84.36
Rate for Payer: Priority Health PPO	$3,252.14
Rate for Payer: United Health Care Medicaid	$84.36
Rate for Payer: United Health Care Medicare Advantage	$37.12

PHA CHARCOAL ACTIVATED 50 GM

Facility

$161.15

Service Code	NDC 66689020308
Hospital Charge Code	2500413
Hospital Revenue Code	250
Min. Negotiated Rate	$112.81
Max. Negotiated Rate	$136.98
Rate for Payer: Cash Price	$104.75
Rate for Payer: Community Health Alliance Commercial	$136.98
Rate for Payer: Priority Health Commercial	$112.81
Rate for Payer: Priority Health PPO	$112.81

PHA CHLORAL HYDRATE 500MG/5ML

Facility

$5.21

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503010
Hospital Revenue Code	637
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$4.43
Rate for Payer: Cash Price	$3.39
Rate for Payer: Community Health Alliance Commercial	$4.43
Rate for Payer: Priority Health Commercial	$3.65
Rate for Payer: Priority Health PPO	$3.65

PHA CHLORDIAZEPOXIDE HCL 25 MG

Facility

$2.24

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503015
Hospital Revenue Code	637
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.90
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.90
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health PPO	$1.57

PHA CHLORDIAZEPOXIDE HCL 5MG

Facility

$4.22

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503020
Hospital Revenue Code	637
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$3.59
Rate for Payer: Cash Price	$2.74
Rate for Payer: Community Health Alliance Commercial	$3.59
Rate for Payer: Priority Health Commercial	$2.95
Rate for Payer: Priority Health PPO	$2.95

PHA CHLORHEXIDINE GLUCONATE 4%

Facility

$20.42

Service Code	HCPCS A4248
Hospital Charge Code	2501239
Hospital Revenue Code	636
Min. Negotiated Rate	$14.29
Max. Negotiated Rate	$17.36
Rate for Payer: Cash Price	$13.27
Rate for Payer: Community Health Alliance Commercial	$17.36
Rate for Payer: Priority Health Commercial	$14.29
Rate for Payer: Priority Health PPO	$14.29

PHA CHLOROPROCAINE HCL MPF 3%

Facility

$121.83

Service Code	HCPCS J2400
Hospital Charge Code	2502225
Hospital Revenue Code	636
Min. Negotiated Rate	$85.28
Max. Negotiated Rate	$103.56
Rate for Payer: Cash Price	$79.19
Rate for Payer: Community Health Alliance Commercial	$103.56
Rate for Payer: Priority Health Commercial	$85.28
Rate for Payer: Priority Health PPO	$85.28

PHA CHLORPROMAZINE HCL 25MG/ML

Facility

$137.99

Service Code	NDC 641139735
Hospital Charge Code	2503050
Hospital Revenue Code	250
Min. Negotiated Rate	$96.59
Max. Negotiated Rate	$117.29
Rate for Payer: Cash Price	$89.69
Rate for Payer: Community Health Alliance Commercial	$117.29
Rate for Payer: Priority Health Commercial	$96.59
Rate for Payer: Priority Health PPO	$96.59

PHA CHOLECALCIFEROL 1000 TAB

Facility

$0.16

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500602
Hospital Revenue Code	637
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.10
Rate for Payer: Community Health Alliance Commercial	$0.14
Rate for Payer: Priority Health Commercial	$0.11
Rate for Payer: Priority Health PPO	$0.11

PHA CIPROFLOXACIN 400MG/200ML

Facility

$21.88

Service Code	NDC 36000000924
Hospital Charge Code	2503110
Hospital Revenue Code	250
Min. Negotiated Rate	$15.32
Max. Negotiated Rate	$18.60
Rate for Payer: Cash Price	$14.22
Rate for Payer: Community Health Alliance Commercial	$18.60
Rate for Payer: Priority Health Commercial	$15.32
Rate for Payer: Priority Health PPO	$15.32

PHA CIPROFLOXACIN 500MG TAB

Facility

$1.82

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503120
Hospital Revenue Code	637
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.55
Rate for Payer: Cash Price	$1.18
Rate for Payer: Community Health Alliance Commercial	$1.55
Rate for Payer: Priority Health Commercial	$1.27
Rate for Payer: Priority Health PPO	$1.27

PHA CISPLATIN 100 MG

Facility

$162.38

Service Code	HCPCS J9060
Hospital Charge Code	2503311
Hospital Revenue Code	636
Min. Negotiated Rate	$113.67
Max. Negotiated Rate	$138.02
Rate for Payer: Cash Price	$105.55
Rate for Payer: Community Health Alliance Commercial	$138.02
Rate for Payer: Priority Health Commercial	$113.67
Rate for Payer: Priority Health PPO	$113.67

PHA CISPLATIN 50MG/50ML VIAL

Facility

$93.43

Service Code	HCPCS J9060
Hospital Charge Code	2503310
Hospital Revenue Code	636
Min. Negotiated Rate	$65.40
Max. Negotiated Rate	$79.42
Rate for Payer: Cash Price	$60.73
Rate for Payer: Community Health Alliance Commercial	$79.42
Rate for Payer: Priority Health Commercial	$65.40
Rate for Payer: Priority Health PPO	$65.40

PHA CITALOPRAM HYDROBROMIDE 20

Facility

$14.01

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500222
Hospital Revenue Code	637
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$11.91
Rate for Payer: Cash Price	$9.11
Rate for Payer: Community Health Alliance Commercial	$11.91
Rate for Payer: Priority Health Commercial	$9.81
Rate for Payer: Priority Health PPO	$9.81

PHA CLARITHROMYCIN 250 MG

Facility

$31.36

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503331
Hospital Revenue Code	637
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$26.66
Rate for Payer: Cash Price	$20.38
Rate for Payer: Community Health Alliance Commercial	$26.66
Rate for Payer: Priority Health Commercial	$21.95
Rate for Payer: Priority Health PPO	$21.95

PHA CLINDAMYCIN 150MG CAPSULE

Facility

$6.20

Service Code	NDC 59762332801
Hospital Charge Code	2510781
Hospital Revenue Code	637
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$5.27
Rate for Payer: Cash Price	$4.03
Rate for Payer: Community Health Alliance Commercial	$5.27
Rate for Payer: Priority Health Commercial	$4.34
Rate for Payer: Priority Health PPO	$4.34

PHA CLINDAMYCIN HCL 150MG CAP

Facility

$3.80

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503340
Hospital Revenue Code	637
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$3.23
Rate for Payer: Cash Price	$2.47
Rate for Payer: Community Health Alliance Commercial	$3.23
Rate for Payer: Priority Health Commercial	$2.66
Rate for Payer: Priority Health PPO	$2.66

PHA CLINDAMYCIN PHOS 600MG/50

Facility

$67.97

Service Code	NDC 781328909
Hospital Charge Code	2503353
Hospital Revenue Code	250
Min. Negotiated Rate	$47.58
Max. Negotiated Rate	$57.77
Rate for Payer: Cash Price	$44.18
Rate for Payer: Community Health Alliance Commercial	$57.77
Rate for Payer: Priority Health Commercial	$47.58
Rate for Payer: Priority Health PPO	$47.58

PHA CLINDAMYCIN PHOS 900MG/50

Facility

$82.99

Service Code	NDC 781329009
Hospital Charge Code	2503354
Hospital Revenue Code	250
Min. Negotiated Rate	$58.09
Max. Negotiated Rate	$70.54
Rate for Payer: Cash Price	$53.94
Rate for Payer: Community Health Alliance Commercial	$70.54
Rate for Payer: Priority Health Commercial	$58.09
Rate for Payer: Priority Health PPO	$58.09

PHA CLINDAMYCIN PHOSPH 600MG

Facility

$16.31

Service Code	NDC 67457081504
Hospital Charge Code	2503350
Hospital Revenue Code	250
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$13.86
Rate for Payer: Cash Price	$10.60
Rate for Payer: Community Health Alliance Commercial	$13.86
Rate for Payer: Priority Health Commercial	$11.42
Rate for Payer: Priority Health PPO	$11.42

PHA CLINIMIX E 5/20 2000ML

Facility

$288.09

Service Code	NDC 338112504
Hospital Charge Code	2510833
Hospital Revenue Code	636
Min. Negotiated Rate	$201.66
Max. Negotiated Rate	$244.88
Rate for Payer: Cash Price	$187.26
Rate for Payer: Community Health Alliance Commercial	$244.88
Rate for Payer: Priority Health Commercial	$201.66
Rate for Payer: Priority Health PPO	$201.66

PHA CLONAZEPAM 0.5 MG TAB

Facility

$4.17

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503351
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 CLONIDINE HCL 0.1 MG PATCH

Facility

$131.82

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500527
Hospital Revenue Code	637
Min. Negotiated Rate	$92.27
Max. Negotiated Rate	$112.05
Rate for Payer: Cash Price	$85.68
Rate for Payer: Community Health Alliance Commercial	$112.05
Rate for Payer: Priority Health Commercial	$92.27
Rate for Payer: Priority Health PPO	$92.27

PHA CLONIDINE HCL 0.1 MG TAB

Facility

$1.20

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503360
Hospital Revenue Code	637
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.02
Rate for Payer: Cash Price	$0.78
Rate for Payer: Community Health Alliance Commercial	$1.02
Rate for Payer: Priority Health Commercial	$0.84
Rate for Payer: Priority Health PPO	$0.84

PHA CLONIDINE HCL 0.2 MG PATCH

Facility

$186.27

Service Code	NDC 378087299
Hospital Charge Code	2500106
Hospital Revenue Code	250
Min. Negotiated Rate	$130.39
Max. Negotiated Rate	$158.33
Rate for Payer: Cash Price	$121.08
Rate for Payer: Community Health Alliance Commercial	$158.33
Rate for Payer: Priority Health Commercial	$130.39
Rate for Payer: Priority Health PPO	$130.39

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges