Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA DILTIAZEM HCL 5MG/ML

Facility

$50.01

Service Code	NDC 641601510
Hospital Charge Code	2504655
Hospital Revenue Code	250
Min. Negotiated Rate	$35.01
Max. Negotiated Rate	$42.51
Rate for Payer: Cash Price	$32.51
Rate for Payer: Community Health Alliance Commercial	$42.51
Rate for Payer: Priority Health Commercial	$35.01
Rate for Payer: Priority Health PPO	$35.01

PHA DILTIAZEM HCL 5MG/ML VIAL

Facility

$21.36

Service Code	NDC 641601310
Hospital Charge Code	2503970
Hospital Revenue Code	250
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$18.16
Rate for Payer: Cash Price	$13.88
Rate for Payer: Community Health Alliance Commercial	$18.16
Rate for Payer: Priority Health Commercial	$14.95
Rate for Payer: Priority Health PPO	$14.95

PHA DILUADID 2MG/ML CARPUJECT

Facility

$21.05

Hospital Charge Code	2510928
Hospital Revenue Code	636
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$17.89
Rate for Payer: Cash Price	$13.68
Rate for Payer: Community Health Alliance Commercial	$17.89
Rate for Payer: Priority Health Commercial	$14.73
Rate for Payer: Priority Health PPO	$14.73

PHA DIMERCAPROL 100MG/ML

Facility

$214.36

Service Code	NDC 17478052603
Hospital Charge Code	2502065
Hospital Revenue Code	250
Min. Negotiated Rate	$150.05
Max. Negotiated Rate	$182.21
Rate for Payer: Cash Price	$139.33
Rate for Payer: Community Health Alliance Commercial	$182.21
Rate for Payer: Priority Health Commercial	$150.05
Rate for Payer: Priority Health PPO	$150.05

PHA DIMETHYL SULFOXIDE

Facility

$2,154.17

Service Code	HCPCS J1212
Hospital Charge Code	2502066
Hospital Revenue Code	636
Min. Negotiated Rate	$346.14
Max. Negotiated Rate	$1,831.04
Rate for Payer: BCBS BCN 65	$786.69
Rate for Payer: Blue Care Network Medicare Advantage	$786.69
Rate for Payer: Cash Price	$1,400.21
Rate for Payer: Cash Price	$1,400.21
Rate for Payer: Community Health Alliance Commercial	$1,831.04
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$786.69
Rate for Payer: Meridian Health Plan Medicare	$786.69
Rate for Payer: Priority Health Commercial	$1,507.92
Rate for Payer: Priority Health Medicaid	$786.69
Rate for Payer: Priority Health Medicare	$786.69
Rate for Payer: Priority Health PPO	$1,507.92
Rate for Payer: United Health Care Medicaid	$786.69
Rate for Payer: United Health Care Medicare Advantage	$346.14

PHA DIPHENHYDRAMINE HCL 12.5

Facility

$27.14

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503981
Hospital Revenue Code	637
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$23.07
Rate for Payer: Cash Price	$17.64
Rate for Payer: Community Health Alliance Commercial	$23.07
Rate for Payer: Priority Health Commercial	$19.00
Rate for Payer: Priority Health PPO	$19.00

PHA DIPHENHYDRAMINE HCL 25 MG

Facility

$0.21

Service Code	HCPCS A9270 GY
Hospital Charge Code	2504000
Hospital Revenue Code	637
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.14
Rate for Payer: Community Health Alliance Commercial	$0.18
Rate for Payer: Priority Health Commercial	$0.15
Rate for Payer: Priority Health PPO	$0.15

PHA DIPHENHYDRAMIN HCL 50MG/ML

Facility

$7.35

Service Code	NDC 641037625
Hospital Charge Code	2504010
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$6.25
Rate for Payer: Cash Price	$4.78
Rate for Payer: Community Health Alliance Commercial	$6.25
Rate for Payer: Priority Health Commercial	$5.14
Rate for Payer: Priority Health PPO	$5.14

PHA DIPHENOXYLATE HCL 2.5MG TB

Facility

$3.65

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503990
Hospital Revenue Code	637
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.10
Rate for Payer: Cash Price	$2.37
Rate for Payer: Community Health Alliance Commercial	$3.10
Rate for Payer: Priority Health Commercial	$2.56
Rate for Payer: Priority Health PPO	$2.56

PHA DIPYRIDAMOLE 25MG TAB

Facility

$7.40

Service Code	HCPCS A9270 GY
Hospital Charge Code	2504030
Hospital Revenue Code	637
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$6.29
Rate for Payer: Cash Price	$4.81
Rate for Payer: Community Health Alliance Commercial	$6.29
Rate for Payer: Priority Health Commercial	$5.18
Rate for Payer: Priority Health PPO	$5.18

PHA DISOPYRAMIDE PHOSPH 150MG

Facility

$17.61

Service Code	HCPCS A9270 GY
Hospital Charge Code	2504060
Hospital Revenue Code	637
Min. Negotiated Rate	$12.33
Max. Negotiated Rate	$14.97
Rate for Payer: Cash Price	$11.45
Rate for Payer: Community Health Alliance Commercial	$14.97
Rate for Payer: Priority Health Commercial	$12.33
Rate for Payer: Priority Health PPO	$12.33

PHA DIVALPROEX 125 MG TAB

Facility

$7.40

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503581
Hospital Revenue Code	637
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$6.29
Rate for Payer: Cash Price	$4.81
Rate for Payer: Community Health Alliance Commercial	$6.29
Rate for Payer: Priority Health Commercial	$5.18
Rate for Payer: Priority Health PPO	$5.18

PHA DIVALPROEX SODIUM 250MG TA

Facility

$8.08

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500607
Hospital Revenue Code	637
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$6.87
Rate for Payer: Cash Price	$5.25
Rate for Payer: Community Health Alliance Commercial	$6.87
Rate for Payer: Priority Health Commercial	$5.66
Rate for Payer: Priority Health PPO	$5.66

PHA DIVALPROEX SODIUM 250MG TB

Facility

$9.17

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503580
Hospital Revenue Code	637
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$7.79
Rate for Payer: Cash Price	$5.96
Rate for Payer: Community Health Alliance Commercial	$7.79
Rate for Payer: Priority Health Commercial	$6.42
Rate for Payer: Priority Health PPO	$6.42

PHA DOBUTAMINE HCL 12.5MG/ML

Facility

$51.02

Service Code	NDC 409234401
Hospital Charge Code	2504070
Hospital Revenue Code	250
Min. Negotiated Rate	$35.71
Max. Negotiated Rate	$43.37
Rate for Payer: Cash Price	$33.16
Rate for Payer: Community Health Alliance Commercial	$43.37
Rate for Payer: Priority Health Commercial	$35.71
Rate for Payer: Priority Health PPO	$35.71

PHA DOCETAXEL 20 MG/.5 ML

Facility

$1,271.31

Service Code	HCPCS J9171
Hospital Charge Code	2504074
Hospital Revenue Code	636
Min. Negotiated Rate	$889.92
Max. Negotiated Rate	$1,080.61
Rate for Payer: Cash Price	$826.35
Rate for Payer: Community Health Alliance Commercial	$1,080.61
Rate for Payer: Priority Health Commercial	$889.92
Rate for Payer: Priority Health PPO	$889.92

PHA DOCETAXEL 80 MG/2 ML

Facility

$1,284.12

Service Code	HCPCS J9171
Hospital Charge Code	2504075
Hospital Revenue Code	636
Min. Negotiated Rate	$898.88
Max. Negotiated Rate	$1,091.50
Rate for Payer: Cash Price	$834.68
Rate for Payer: Community Health Alliance Commercial	$1,091.50
Rate for Payer: Priority Health Commercial	$898.88
Rate for Payer: Priority Health PPO	$898.88

PHA DOCUSATE SODIUM 10 MG CAP

Facility

$0.89

Service Code	HCPCS A9270 GY
Hospital Charge Code	2504080
Hospital Revenue Code	637
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.76
Rate for Payer: Cash Price	$0.58
Rate for Payer: Community Health Alliance Commercial	$0.76
Rate for Payer: Priority Health Commercial	$0.62
Rate for Payer: Priority Health PPO	$0.62

PHA DONEPEZIL HYDRO 5 MG TAB

Facility

$0.83

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500701
Hospital Revenue Code	637
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.71
Rate for Payer: Cash Price	$0.54
Rate for Payer: Community Health Alliance Commercial	$0.71
Rate for Payer: Priority Health Commercial	$0.58
Rate for Payer: Priority Health PPO	$0.58

PHA DOPAMINE HCL 400 MG/250ML

Facility

$87.25

Service Code	NDC 409004212
Hospital Charge Code	2505005
Hospital Revenue Code	250
Min. Negotiated Rate	$61.08
Max. Negotiated Rate	$74.16
Rate for Payer: Cash Price	$56.71
Rate for Payer: Community Health Alliance Commercial	$74.16
Rate for Payer: Priority Health Commercial	$61.08
Rate for Payer: Priority Health PPO	$61.08

PHA DOXAZOSIN MESYLATE 1 MG

Facility

$5.31

Service Code	HCPCS A9270 GY
Hospital Charge Code	2505016
Hospital Revenue Code	637
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$4.51
Rate for Payer: Cash Price	$3.45
Rate for Payer: Community Health Alliance Commercial	$4.51
Rate for Payer: Priority Health Commercial	$3.72
Rate for Payer: Priority Health PPO	$3.72

PHA DOXORUBICIN 20 MG

Facility

$3,234.62

Service Code	HCPCS J9000
Hospital Charge Code	2500412
Hospital Revenue Code	636
Min. Negotiated Rate	$2,264.23
Max. Negotiated Rate	$2,749.43
Rate for Payer: Cash Price	$2,102.50
Rate for Payer: Community Health Alliance Commercial	$2,749.43
Rate for Payer: Priority Health Commercial	$2,264.23
Rate for Payer: Priority Health PPO	$2,264.23

PHA DOXORUBICIN 2MG/ML 5ML VIA

Facility

$66.50

Service Code	HCPCS J9000
Hospital Charge Code	2500729
Hospital Revenue Code	636
Min. Negotiated Rate	$46.55
Max. Negotiated Rate	$56.52
Rate for Payer: Cash Price	$43.23
Rate for Payer: Community Health Alliance Commercial	$56.52
Rate for Payer: Priority Health Commercial	$46.55
Rate for Payer: Priority Health PPO	$46.55

PHA DOXORUBICIN HCL 50MG/25ML

Facility

$117.33

Service Code	HCPCS J9000
Hospital Charge Code	2505040
Hospital Revenue Code	636
Min. Negotiated Rate	$82.13
Max. Negotiated Rate	$99.73
Rate for Payer: Cash Price	$76.26
Rate for Payer: Community Health Alliance Commercial	$99.73
Rate for Payer: Priority Health Commercial	$82.13
Rate for Payer: Priority Health PPO	$82.13

PHA DOXYCYCLINE HYCLATE 100MG

Facility

$125.77

Service Code	NDC 63323013011
Hospital Charge Code	2505060
Hospital Revenue Code	250
Min. Negotiated Rate	$88.04
Max. Negotiated Rate	$106.90
Rate for Payer: Cash Price	$81.75
Rate for Payer: Community Health Alliance Commercial	$106.90
Rate for Payer: Priority Health Commercial	$88.04
Rate for Payer: Priority Health PPO	$88.04

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges