Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA DOXYCYCLINE HYCLATE 100MG

Facility

$13.65

Service Code	HCPCS A9270 GY
Hospital Charge Code	2505050
Hospital Revenue Code	637
Min. Negotiated Rate	$9.55
Max. Negotiated Rate	$11.60
Rate for Payer: Cash Price	$8.87
Rate for Payer: Community Health Alliance Commercial	$11.60
Rate for Payer: Priority Health Commercial	$9.55
Rate for Payer: Priority Health PPO	$9.55

PHA DULOXETINE HCL 30 MG CAP

Facility

$30.90

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501013
Hospital Revenue Code	637
Min. Negotiated Rate	$21.63
Max. Negotiated Rate	$26.27
Rate for Payer: Cash Price	$20.09
Rate for Payer: Community Health Alliance Commercial	$26.27
Rate for Payer: Priority Health Commercial	$21.63
Rate for Payer: Priority Health PPO	$21.63

PHA EDETATE CALICUM DISODIUM

Facility

$19.54

Service Code	NDC 62991202601
Hospital Charge Code	2505995
Hospital Revenue Code	250
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$16.61
Rate for Payer: Cash Price	$12.70
Rate for Payer: Community Health Alliance Commercial	$16.61
Rate for Payer: Priority Health Commercial	$13.68
Rate for Payer: Priority Health PPO	$13.68

PHA ELIGARD 22.5MG INJ

Facility

$3,707.46

Service Code	HCPCS J9217
Hospital Charge Code	2501125
Hospital Revenue Code	636
Min. Negotiated Rate	$78.90
Max. Negotiated Rate	$3,151.34
Rate for Payer: BCBS BCN 65	$179.32
Rate for Payer: Blue Care Network Medicare Advantage	$179.32
Rate for Payer: Cash Price	$2,409.85
Rate for Payer: Cash Price	$2,409.85
Rate for Payer: Community Health Alliance Commercial	$3,151.34
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$179.32
Rate for Payer: Meridian Health Plan Medicare	$179.32
Rate for Payer: Priority Health Commercial	$2,595.22
Rate for Payer: Priority Health Medicaid	$179.32
Rate for Payer: Priority Health Medicare	$179.32
Rate for Payer: Priority Health PPO	$2,595.22
Rate for Payer: United Health Care Medicaid	$179.32
Rate for Payer: United Health Care Medicare Advantage	$78.90

PHA ELIGARD 45MG KIT

Facility

$6,859.43

Service Code	HCPCS J9217
Hospital Charge Code	2508383
Hospital Revenue Code	636
Min. Negotiated Rate	$78.90
Max. Negotiated Rate	$5,830.52
Rate for Payer: BCBS BCN 65	$179.32
Rate for Payer: Blue Care Network Medicare Advantage	$179.32
Rate for Payer: Cash Price	$4,458.63
Rate for Payer: Cash Price	$4,458.63
Rate for Payer: Community Health Alliance Commercial	$5,830.52
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$179.32
Rate for Payer: Meridian Health Plan Medicare	$179.32
Rate for Payer: Priority Health Commercial	$4,801.60
Rate for Payer: Priority Health Medicaid	$179.32
Rate for Payer: Priority Health Medicare	$179.32
Rate for Payer: Priority Health PPO	$4,801.60
Rate for Payer: United Health Care Medicaid	$179.32
Rate for Payer: United Health Care Medicare Advantage	$78.90

PHA ELIQUIS 5MG TABLET

Facility

$36.00

Service Code	NDC 3089421
Hospital Charge Code	2510772
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 ELITEK 7.5 MG VIAL

Facility

$15,295.08

Service Code	HCPCS J2783
Hospital Charge Code	2500211
Hospital Revenue Code	636
Min. Negotiated Rate	$177.12
Max. Negotiated Rate	$13,000.82
Rate for Payer: BCBS BCN 65	$402.54
Rate for Payer: Blue Care Network Medicare Advantage	$402.54
Rate for Payer: Cash Price	$9,941.80
Rate for Payer: Cash Price	$9,941.80
Rate for Payer: Community Health Alliance Commercial	$13,000.82
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$402.54
Rate for Payer: Meridian Health Plan Medicare	$402.54
Rate for Payer: Priority Health Commercial	$10,706.56
Rate for Payer: Priority Health Medicaid	$402.54
Rate for Payer: Priority Health Medicare	$402.54
Rate for Payer: Priority Health PPO	$10,706.56
Rate for Payer: United Health Care Medicaid	$402.54
Rate for Payer: United Health Care Medicare Advantage	$177.12

PHA EMEND 150 MG VIAL

Facility

$1,060.56

Service Code	HCPCS J1453
Hospital Charge Code	2500131
Hospital Revenue Code	636
Min. Negotiated Rate	$742.39
Max. Negotiated Rate	$901.48
Rate for Payer: Cash Price	$689.36
Rate for Payer: Community Health Alliance Commercial	$901.48
Rate for Payer: Priority Health Commercial	$742.39
Rate for Payer: Priority Health PPO	$742.39

PHA EMPTY EVACUATED CONT

Facility

$27.08

Hospital Charge Code	2506035
Hospital Revenue Code	270
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$23.02
Rate for Payer: Cash Price	$17.60
Rate for Payer: Community Health Alliance Commercial	$23.02
Rate for Payer: Priority Health Commercial	$18.96
Rate for Payer: Priority Health PPO	$18.96

PHA ENALAPRILAT 1.25 MG/ML

Facility

$52.12

Service Code	NDC 143978610
Hospital Charge Code	2506036
Hospital Revenue Code	250
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$44.30
Rate for Payer: Cash Price	$33.88
Rate for Payer: Community Health Alliance Commercial	$44.30
Rate for Payer: Priority Health Commercial	$36.48
Rate for Payer: Priority Health PPO	$36.48

PHA ENDRATE 150MG/ML 1ML VIAL

Facility

$5.84

Service Code	NDC 67457014720
Hospital Charge Code	2510943
Hospital Revenue Code	250
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.80
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.09
Rate for Payer: Priority Health PPO	$4.09

PHA ENOXAPARIN SOD 30MG

Facility

$37.30

Service Code	HCPCS J1650
Hospital Charge Code	2506045
Hospital Revenue Code	636
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$31.70
Rate for Payer: Cash Price	$24.25
Rate for Payer: Community Health Alliance Commercial	$31.70
Rate for Payer: Priority Health Commercial	$26.11
Rate for Payer: Priority Health PPO	$26.11

PHA ENOXAPARIN SODIUM 100MG

Facility

$82.44

Service Code	NDC 60505079504
Hospital Charge Code	2506043
Hospital Revenue Code	250
Min. Negotiated Rate	$57.71
Max. Negotiated Rate	$70.07
Rate for Payer: Cash Price	$53.59
Rate for Payer: Community Health Alliance Commercial	$70.07
Rate for Payer: Priority Health Commercial	$57.71
Rate for Payer: Priority Health PPO	$57.71

PHA ENOXAPARIN SODIUM 40 MG SY

Facility

$23.03

Service Code	HCPCS J1650
Hospital Charge Code	2506042
Hospital Revenue Code	636
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$19.58
Rate for Payer: Cash Price	$14.97
Rate for Payer: Community Health Alliance Commercial	$19.58
Rate for Payer: Priority Health Commercial	$16.12
Rate for Payer: Priority Health PPO	$16.12

PHA ENTRESTO 24MG/26MG TAB NF

Facility

$66.55

Service Code	NDC 78065920
Hospital Charge Code	2510782
Hospital Revenue Code	637
Min. Negotiated Rate	$46.59
Max. Negotiated Rate	$56.57
Rate for Payer: Cash Price	$43.26
Rate for Payer: Community Health Alliance Commercial	$56.57
Rate for Payer: Priority Health Commercial	$46.59
Rate for Payer: Priority Health PPO	$46.59

PHA ENTYVIO 300 MG

Facility

$27,657.40

Service Code	HCPCS J3380
Hospital Charge Code	2510422
Hospital Revenue Code	636
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$23,508.79
Rate for Payer: BCBS BCN 65	$22.44
Rate for Payer: Blue Care Network Medicare Advantage	$22.44
Rate for Payer: Cash Price	$17,977.31
Rate for Payer: Cash Price	$17,977.31
Rate for Payer: Community Health Alliance Commercial	$23,508.79
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$22.44
Rate for Payer: Meridian Health Plan Medicare	$22.44
Rate for Payer: Priority Health Commercial	$19,360.18
Rate for Payer: Priority Health Medicaid	$22.44
Rate for Payer: Priority Health Medicare	$22.44
Rate for Payer: Priority Health PPO	$19,360.18
Rate for Payer: United Health Care Medicaid	$22.44
Rate for Payer: United Health Care Medicare Advantage	$9.87

PHA EPHEDRINE SULFATE 50MG/ML

Facility

$138.70

Service Code	NDC 42023021625
Hospital Charge Code	2506060
Hospital Revenue Code	250
Min. Negotiated Rate	$97.09
Max. Negotiated Rate	$117.89
Rate for Payer: Cash Price	$90.16
Rate for Payer: Community Health Alliance Commercial	$117.89
Rate for Payer: Priority Health Commercial	$97.09
Rate for Payer: Priority Health PPO	$97.09

PHA EPINEPHRINE 0.3 MG SYR

Facility

$517.50

Service Code	NDC 49502010202
Hospital Charge Code	2502113
Hospital Revenue Code	250
Min. Negotiated Rate	$362.25
Max. Negotiated Rate	$439.88
Rate for Payer: Cash Price	$336.38
Rate for Payer: Community Health Alliance Commercial	$439.88
Rate for Payer: Priority Health Commercial	$362.25
Rate for Payer: Priority Health PPO	$362.25

PHA EPINEPHRINE HCL 0.1 MG/ML

Facility

$32.77

Service Code	NDC 409492134
Hospital Charge Code	2507020
Hospital Revenue Code	250
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$27.85
Rate for Payer: Cash Price	$21.30
Rate for Payer: Community Health Alliance Commercial	$27.85
Rate for Payer: Priority Health Commercial	$22.94
Rate for Payer: Priority Health PPO	$22.94

PHA EPINEPHRINE HCL 1MG

Facility

$51.27

Service Code	HCPCS J0171
Hospital Charge Code	2500528
Hospital Revenue Code	636
Min. Negotiated Rate	$35.89
Max. Negotiated Rate	$43.58
Rate for Payer: Cash Price	$33.33
Rate for Payer: Community Health Alliance Commercial	$43.58
Rate for Payer: Priority Health Commercial	$35.89
Rate for Payer: Priority Health PPO	$35.89

PHA EPINEPHRINE HCL 1 MG/ML VL

Facility

$324.58

Service Code	NDC 42023016801
Hospital Charge Code	2506080
Hospital Revenue Code	250
Min. Negotiated Rate	$227.21
Max. Negotiated Rate	$275.89
Rate for Payer: Cash Price	$210.98
Rate for Payer: Community Health Alliance Commercial	$275.89
Rate for Payer: Priority Health Commercial	$227.21
Rate for Payer: Priority Health PPO	$227.21

PHA EPIRUBICIN HCL 200MG/100ML

Facility

$802.80

Service Code	HCPCS J9178
Hospital Charge Code	2558996
Hospital Revenue Code	636
Min. Negotiated Rate	$561.96
Max. Negotiated Rate	$682.38
Rate for Payer: Cash Price	$521.82
Rate for Payer: Community Health Alliance Commercial	$682.38
Rate for Payer: Priority Health Commercial	$561.96
Rate for Payer: Priority Health PPO	$561.96

PHA EPIRUBICIN HCL 50 MG INJ

Facility

$199.46

Service Code	HCPCS J9178
Hospital Charge Code	2558995
Hospital Revenue Code	636
Min. Negotiated Rate	$139.62
Max. Negotiated Rate	$169.54
Rate for Payer: Cash Price	$129.65
Rate for Payer: Community Health Alliance Commercial	$169.54
Rate for Payer: Priority Health Commercial	$139.62
Rate for Payer: Priority Health PPO	$139.62

PHA EPOETIN ALFA 20000 U/ML ML

Facility

$1,577.84

Service Code	HCPCS J0885
Hospital Charge Code	2507031
Hospital Revenue Code	636
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$1,341.16
Rate for Payer: BCBS BCN 65	$8.13
Rate for Payer: Blue Care Network Medicare Advantage	$8.13
Rate for Payer: Cash Price	$1,025.60
Rate for Payer: Cash Price	$1,025.60
Rate for Payer: Community Health Alliance Commercial	$1,341.16
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.13
Rate for Payer: Meridian Health Plan Medicare	$8.13
Rate for Payer: Priority Health Commercial	$1,104.49
Rate for Payer: Priority Health Medicaid	$8.13
Rate for Payer: Priority Health Medicare	$8.13
Rate for Payer: Priority Health PPO	$1,104.49
Rate for Payer: United Health Care Medicaid	$8.13
Rate for Payer: United Health Care Medicare Advantage	$3.58

PHA EPOETIN ALFA 40000MG

Facility

$2,924.78

Service Code	HCPCS J0885
Hospital Charge Code	2507029
Hospital Revenue Code	636
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$2,486.06
Rate for Payer: BCBS BCN 65	$8.13
Rate for Payer: Blue Care Network Medicare Advantage	$8.13
Rate for Payer: Cash Price	$1,901.11
Rate for Payer: Cash Price	$1,901.11
Rate for Payer: Community Health Alliance Commercial	$2,486.06
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.13
Rate for Payer: Meridian Health Plan Medicare	$8.13
Rate for Payer: Priority Health Commercial	$2,047.35
Rate for Payer: Priority Health Medicaid	$8.13
Rate for Payer: Priority Health Medicare	$8.13
Rate for Payer: Priority Health PPO	$2,047.35
Rate for Payer: United Health Care Medicaid	$8.13
Rate for Payer: United Health Care Medicare Advantage	$3.58

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges