Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA DACARBAZINE 100 MG INL

Facility

$68.10

Service Code	HCPCS J9130
Hospital Charge Code	2508002
Hospital Revenue Code	636
Min. Negotiated Rate	$47.67
Max. Negotiated Rate	$57.88
Rate for Payer: Cash Price	$44.27
Rate for Payer: Community Health Alliance Commercial	$57.88
Rate for Payer: Priority Health Commercial	$47.67
Rate for Payer: Priority Health PPO	$47.67

PHA DACARBAZINE 200 MG 0819

Facility

$84.57

Service Code	HCPCS J9130
Hospital Charge Code	2503520
Hospital Revenue Code	636
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$71.88
Rate for Payer: Cash Price	$54.97
Rate for Payer: Community Health Alliance Commercial	$71.88
Rate for Payer: Priority Health Commercial	$59.20
Rate for Payer: Priority Health PPO	$59.20

PHA DALVANCE 500 MG VIAL

Facility

$4,867.71

Service Code	HCPCS J0875
Hospital Charge Code	2503532
Hospital Revenue Code	636
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$4,137.55
Rate for Payer: BCBS BCN 65	$16.37
Rate for Payer: Blue Care Network Medicare Advantage	$16.37
Rate for Payer: Cash Price	$3,164.01
Rate for Payer: Cash Price	$3,164.01
Rate for Payer: Community Health Alliance Commercial	$4,137.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.37
Rate for Payer: Meridian Health Plan Medicare	$16.37
Rate for Payer: Priority Health Commercial	$3,407.40
Rate for Payer: Priority Health Medicaid	$16.37
Rate for Payer: Priority Health Medicare	$16.37
Rate for Payer: Priority Health PPO	$3,407.40
Rate for Payer: United Health Care Medicaid	$16.37
Rate for Payer: United Health Care Medicare Advantage	$7.20

PHA DANTROLENE SODIUM 20MG

Facility

$293.58

Service Code	NDC 42023012306
Hospital Charge Code	2503535
Hospital Revenue Code	250
Min. Negotiated Rate	$205.51
Max. Negotiated Rate	$249.54
Rate for Payer: Cash Price	$190.83
Rate for Payer: Community Health Alliance Commercial	$249.54
Rate for Payer: Priority Health Commercial	$205.51
Rate for Payer: Priority Health PPO	$205.51

PHA DARBEPOETIN 100 MCG

Facility

$2,284.85

Service Code	HCPCS J0881
Hospital Charge Code	2507032
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1,942.12
Rate for Payer: BCBS BCN 65	$3.17
Rate for Payer: Blue Care Network Medicare Advantage	$3.17
Rate for Payer: Cash Price	$1,485.15
Rate for Payer: Cash Price	$1,485.15
Rate for Payer: Community Health Alliance Commercial	$1,942.12
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.17
Rate for Payer: Meridian Health Plan Medicare	$3.17
Rate for Payer: Priority Health Commercial	$1,599.39
Rate for Payer: Priority Health Medicaid	$3.17
Rate for Payer: Priority Health Medicare	$3.17
Rate for Payer: Priority Health PPO	$1,599.39
Rate for Payer: United Health Care Medicaid	$3.17
Rate for Payer: United Health Care Medicare Advantage	$1.40

PHA DARBEPOETIN 200MCG/0.4CC S

Facility

$4,235.33

Service Code	HCPCS J0881
Hospital Charge Code	2507065
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3,600.03
Rate for Payer: BCBS BCN 65	$3.17
Rate for Payer: Blue Care Network Medicare Advantage	$3.17
Rate for Payer: Cash Price	$2,752.96
Rate for Payer: Cash Price	$2,752.96
Rate for Payer: Community Health Alliance Commercial	$3,600.03
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.17
Rate for Payer: Meridian Health Plan Medicare	$3.17
Rate for Payer: Priority Health Commercial	$2,964.73
Rate for Payer: Priority Health Medicaid	$3.17
Rate for Payer: Priority Health Medicare	$3.17
Rate for Payer: Priority Health PPO	$2,964.73
Rate for Payer: United Health Care Medicaid	$3.17
Rate for Payer: United Health Care Medicare Advantage	$1.40

PHA DARBEPOETIN 25 MCG

Facility

$618.02

Service Code	HCPCS J0881
Hospital Charge Code	2507036
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$525.32
Rate for Payer: BCBS BCN 65	$3.17
Rate for Payer: Blue Care Network Medicare Advantage	$3.17
Rate for Payer: Cash Price	$401.71
Rate for Payer: Cash Price	$401.71
Rate for Payer: Community Health Alliance Commercial	$525.32
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.17
Rate for Payer: Meridian Health Plan Medicare	$3.17
Rate for Payer: Priority Health Commercial	$432.61
Rate for Payer: Priority Health Medicaid	$3.17
Rate for Payer: Priority Health Medicare	$3.17
Rate for Payer: Priority Health PPO	$432.61
Rate for Payer: United Health Care Medicaid	$3.17
Rate for Payer: United Health Care Medicare Advantage	$1.40

PHA DARBEPOETIN 300 MCG INJ

Facility

$6,352.99

Service Code	HCPCS J0881
Hospital Charge Code	2507037
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5,400.04
Rate for Payer: BCBS BCN 65	$3.17
Rate for Payer: Blue Care Network Medicare Advantage	$3.17
Rate for Payer: Cash Price	$4,129.44
Rate for Payer: Cash Price	$4,129.44
Rate for Payer: Community Health Alliance Commercial	$5,400.04
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.17
Rate for Payer: Meridian Health Plan Medicare	$3.17
Rate for Payer: Priority Health Commercial	$4,447.09
Rate for Payer: Priority Health Medicaid	$3.17
Rate for Payer: Priority Health Medicare	$3.17
Rate for Payer: Priority Health PPO	$4,447.09
Rate for Payer: United Health Care Medicaid	$3.17
Rate for Payer: United Health Care Medicare Advantage	$1.40

PHA DARBEPOETIN 40MCG/ML VIAL

Facility

$988.83

Service Code	HCPCS J0881
Hospital Charge Code	2507033
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$840.51
Rate for Payer: BCBS BCN 65	$3.17
Rate for Payer: Blue Care Network Medicare Advantage	$3.17
Rate for Payer: Cash Price	$642.74
Rate for Payer: Cash Price	$642.74
Rate for Payer: Community Health Alliance Commercial	$840.51
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.17
Rate for Payer: Meridian Health Plan Medicare	$3.17
Rate for Payer: Priority Health Commercial	$692.18
Rate for Payer: Priority Health Medicaid	$3.17
Rate for Payer: Priority Health Medicare	$3.17
Rate for Payer: Priority Health PPO	$692.18
Rate for Payer: United Health Care Medicaid	$3.17
Rate for Payer: United Health Care Medicare Advantage	$1.40

PHA DARBEPOETIN 500MCG/0.5CC S

Facility

$10,588.32

Service Code	HCPCS J0881
Hospital Charge Code	2507039
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$9,000.07
Rate for Payer: BCBS BCN 65	$3.17
Rate for Payer: Blue Care Network Medicare Advantage	$3.17
Rate for Payer: Cash Price	$6,882.41
Rate for Payer: Cash Price	$6,882.41
Rate for Payer: Community Health Alliance Commercial	$9,000.07
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.17
Rate for Payer: Meridian Health Plan Medicare	$3.17
Rate for Payer: Priority Health Commercial	$7,411.82
Rate for Payer: Priority Health Medicaid	$3.17
Rate for Payer: Priority Health Medicare	$3.17
Rate for Payer: Priority Health PPO	$7,411.82
Rate for Payer: United Health Care Medicaid	$3.17
Rate for Payer: United Health Care Medicare Advantage	$1.40

PHA DARBEPOETIN 60 MCG/O.3 ML

Facility

$1,322.02

Service Code	HCPCS J0881
Hospital Charge Code	2507038
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1,123.72
Rate for Payer: BCBS BCN 65	$3.17
Rate for Payer: Blue Care Network Medicare Advantage	$3.17
Rate for Payer: Cash Price	$859.31
Rate for Payer: Cash Price	$859.31
Rate for Payer: Community Health Alliance Commercial	$1,123.72
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.17
Rate for Payer: Meridian Health Plan Medicare	$3.17
Rate for Payer: Priority Health Commercial	$925.41
Rate for Payer: Priority Health Medicaid	$3.17
Rate for Payer: Priority Health Medicare	$3.17
Rate for Payer: Priority Health PPO	$925.41
Rate for Payer: United Health Care Medicaid	$3.17
Rate for Payer: United Health Care Medicare Advantage	$1.40

PHA DARBEPOETIN ALFA-POLYSORB

Facility

$3,063.23

Service Code	HCPCS J0881
Hospital Charge Code	2507028
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2,603.75
Rate for Payer: BCBS BCN 65	$3.17
Rate for Payer: Blue Care Network Medicare Advantage	$3.17
Rate for Payer: Cash Price	$1,991.10
Rate for Payer: Cash Price	$1,991.10
Rate for Payer: Community Health Alliance Commercial	$2,603.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.17
Rate for Payer: Meridian Health Plan Medicare	$3.17
Rate for Payer: Priority Health Commercial	$2,144.26
Rate for Payer: Priority Health Medicaid	$3.17
Rate for Payer: Priority Health Medicare	$3.17
Rate for Payer: Priority Health PPO	$2,144.26
Rate for Payer: United Health Care Medicaid	$3.17
Rate for Payer: United Health Care Medicare Advantage	$1.40

PHA DARZALEX 400MG/20ML VIAL

Facility

$8,047.40

Service Code	HCPCS J9145
Hospital Charge Code	2510829
Hospital Revenue Code	636
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$6,840.29
Rate for Payer: BCBS BCN 65	$74.33
Rate for Payer: Blue Care Network Medicare Advantage	$74.33
Rate for Payer: Cash Price	$5,230.81
Rate for Payer: Cash Price	$5,230.81
Rate for Payer: Community Health Alliance Commercial	$6,840.29
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$74.33
Rate for Payer: Meridian Health Plan Medicare	$74.33
Rate for Payer: Priority Health Commercial	$5,633.18
Rate for Payer: Priority Health Medicaid	$74.33
Rate for Payer: Priority Health Medicare	$74.33
Rate for Payer: Priority Health PPO	$5,633.18
Rate for Payer: United Health Care Medicaid	$74.33
Rate for Payer: United Health Care Medicare Advantage	$32.70

PHA DECADRON 4MG TABLET

Facility

$6.20

Service Code	NDC 48102004701
Hospital Charge Code	2503622
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 DECITABINE 50 MG/10ML VIAL

Facility

$4,594.57

Service Code	HCPCS J0894
Hospital Charge Code	2500818
Hospital Revenue Code	636
Min. Negotiated Rate	$3,216.20
Max. Negotiated Rate	$3,905.38
Rate for Payer: Cash Price	$2,986.47
Rate for Payer: Community Health Alliance Commercial	$3,905.38
Rate for Payer: Priority Health Commercial	$3,216.20
Rate for Payer: Priority Health PPO	$3,216.20

PHA DEFEROXAMNE MESYLAT 500MG

Facility

$71.17

Service Code	HCPCS J0895
Hospital Charge Code	2503570
Hospital Revenue Code	636
Min. Negotiated Rate	$49.82
Max. Negotiated Rate	$60.49
Rate for Payer: Cash Price	$46.26
Rate for Payer: Community Health Alliance Commercial	$60.49
Rate for Payer: Priority Health Commercial	$49.82
Rate for Payer: Priority Health PPO	$49.82

PHA DEMECLOCYCLINE 150 MG TAB

Facility

$48.69

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503551
Hospital Revenue Code	637
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$41.39
Rate for Payer: Cash Price	$31.65
Rate for Payer: Community Health Alliance Commercial	$41.39
Rate for Payer: Priority Health Commercial	$34.08
Rate for Payer: Priority Health PPO	$34.08

PHA DENOSUMAB 120 MG SYR

Facility

$4,994.48

Service Code	HCPCS J0897
Hospital Charge Code	2503315
Hospital Revenue Code	636
Min. Negotiated Rate	$13.61
Max. Negotiated Rate	$4,245.31
Rate for Payer: BCBS BCN 65	$30.93
Rate for Payer: Blue Care Network Medicare Advantage	$30.93
Rate for Payer: Cash Price	$3,246.41
Rate for Payer: Cash Price	$3,246.41
Rate for Payer: Community Health Alliance Commercial	$4,245.31
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$30.93
Rate for Payer: Meridian Health Plan Medicare	$30.93
Rate for Payer: Priority Health Commercial	$3,496.14
Rate for Payer: Priority Health Medicaid	$30.93
Rate for Payer: Priority Health Medicare	$30.93
Rate for Payer: Priority Health PPO	$3,496.14
Rate for Payer: United Health Care Medicaid	$30.93
Rate for Payer: United Health Care Medicare Advantage	$13.61

PHA DENOSUMAB 60 MG 1 ML SYRIN

Facility

$2,200.00

Service Code	HCPCS J0897
Hospital Charge Code	2501211
Hospital Revenue Code	636
Min. Negotiated Rate	$13.61
Max. Negotiated Rate	$1,870.00
Rate for Payer: BCBS BCN 65	$30.93
Rate for Payer: Blue Care Network Medicare Advantage	$30.93
Rate for Payer: Cash Price	$1,430.00
Rate for Payer: Cash Price	$1,430.00
Rate for Payer: Community Health Alliance Commercial	$1,870.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$30.93
Rate for Payer: Meridian Health Plan Medicare	$30.93
Rate for Payer: Priority Health Commercial	$1,540.00
Rate for Payer: Priority Health Medicaid	$30.93
Rate for Payer: Priority Health Medicare	$30.93
Rate for Payer: Priority Health PPO	$1,540.00
Rate for Payer: United Health Care Medicaid	$30.93
Rate for Payer: United Health Care Medicare Advantage	$13.61

PHA DEPOMEDROL 40 MG.ML VIAL

Facility

$62.47

Service Code	HCPCS J1030
Hospital Charge Code	2501164
Hospital Revenue Code	636
Min. Negotiated Rate	$43.73
Max. Negotiated Rate	$53.10
Rate for Payer: Cash Price	$40.61
Rate for Payer: Community Health Alliance Commercial	$53.10
Rate for Payer: Priority Health Commercial	$43.73
Rate for Payer: Priority Health PPO	$43.73

PHA DESFLURANE 240 ML ML

Facility

$722.90

Service Code	NDC 10019064164
Hospital Charge Code	2503590
Hospital Revenue Code	250
Min. Negotiated Rate	$506.03
Max. Negotiated Rate	$614.47
Rate for Payer: Cash Price	$469.89
Rate for Payer: Community Health Alliance Commercial	$614.47
Rate for Payer: Priority Health Commercial	$506.03
Rate for Payer: Priority Health PPO	$506.03

PHA DESMOPRESSIN ACET 4MCG/ML

Facility

$181.49

Service Code	HCPCS J2597
Hospital Charge Code	2503600
Hospital Revenue Code	636
Min. Negotiated Rate	$127.04
Max. Negotiated Rate	$154.27
Rate for Payer: Cash Price	$117.97
Rate for Payer: Community Health Alliance Commercial	$154.27
Rate for Payer: Priority Health Commercial	$127.04
Rate for Payer: Priority Health PPO	$127.04

PHA DESTROSE 5% 100 ML BAG

Facility

$70.00

Service Code	NDC 338001748
Hospital Charge Code	2510885
Hospital Revenue Code	250
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

PHA DESTROSE 5% W SOD CHL 0.45

Facility

$70.00

Service Code	NDC 338008504
Hospital Charge Code	2510904
Hospital Revenue Code	250
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

PHA DEXAMETHASONE 10MG/1ML VIA

Facility

$46.89

Service Code	HCPCS J1100
Hospital Charge Code	2503621
Hospital Revenue Code	636
Min. Negotiated Rate	$32.82
Max. Negotiated Rate	$39.86
Rate for Payer: Cash Price	$30.48
Rate for Payer: Community Health Alliance Commercial	$39.86
Rate for Payer: Priority Health Commercial	$32.82
Rate for Payer: Priority Health PPO	$32.82

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges