Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA EPOGEN 4000 UNITS/ML

Facility

$265.80

Service Code	NDC 55513014810
Hospital Charge Code	2510944
Hospital Revenue Code	250
Min. Negotiated Rate	$186.06
Max. Negotiated Rate	$225.93
Rate for Payer: Cash Price	$172.77
Rate for Payer: Community Health Alliance Commercial	$225.93
Rate for Payer: Priority Health Commercial	$186.06
Rate for Payer: Priority Health PPO	$186.06

PHA ERBITUX 100MG 50ML VIAL

Facility

$2,322.98

Service Code	HCPCS J9055
Hospital Charge Code	2509035
Hospital Revenue Code	636
Min. Negotiated Rate	$37.12
Max. Negotiated Rate	$1,974.53
Rate for Payer: BCBS BCN 65	$84.36
Rate for Payer: Blue Care Network Medicare Advantage	$84.36
Rate for Payer: Cash Price	$1,509.94
Rate for Payer: Cash Price	$1,509.94
Rate for Payer: Community Health Alliance Commercial	$1,974.53
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	$1,626.09
Rate for Payer: Priority Health Medicaid	$84.36
Rate for Payer: Priority Health Medicare	$84.36
Rate for Payer: Priority Health PPO	$1,626.09
Rate for Payer: United Health Care Medicaid	$84.36
Rate for Payer: United Health Care Medicare Advantage	$37.12

PHA ERGOCALCIFEROL 50000 UNIT

Facility

$10.26

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500209
Hospital Revenue Code	637
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$8.72
Rate for Payer: Cash Price	$6.67
Rate for Payer: Community Health Alliance Commercial	$8.72
Rate for Payer: Priority Health Commercial	$7.18
Rate for Payer: Priority Health PPO	$7.18

PHA ERTAPENEM SODIUM 1GM INJ

Facility

$191.04

Service Code	HCPCS J1335
Hospital Charge Code	2501005
Hospital Revenue Code	636
Min. Negotiated Rate	$133.73
Max. Negotiated Rate	$162.38
Rate for Payer: Cash Price	$124.18
Rate for Payer: Community Health Alliance Commercial	$162.38
Rate for Payer: Priority Health Commercial	$133.73
Rate for Payer: Priority Health PPO	$133.73

PHA ERYTHROMYCIN BASE 1 GM TB

Facility

$46.81

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508010
Hospital Revenue Code	637
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$39.79
Rate for Payer: Cash Price	$30.43
Rate for Payer: Community Health Alliance Commercial	$39.79
Rate for Payer: Priority Health Commercial	$32.77
Rate for Payer: Priority Health PPO	$32.77

PHA ERYTHROMYCIN ETHYLSUCCINAT

Facility

$1,246.08

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506003
Hospital Revenue Code	637
Min. Negotiated Rate	$872.26
Max. Negotiated Rate	$1,059.17
Rate for Payer: Cash Price	$809.95
Rate for Payer: Community Health Alliance Commercial	$1,059.17
Rate for Payer: Priority Health Commercial	$872.26
Rate for Payer: Priority Health PPO	$872.26

PHA ERYTHROMYCIN LACTOBIONATE

Facility

$654.23

Service Code	NDC 409648201
Hospital Charge Code	2507095
Hospital Revenue Code	250
Min. Negotiated Rate	$457.96
Max. Negotiated Rate	$556.10
Rate for Payer: Cash Price	$425.25
Rate for Payer: Community Health Alliance Commercial	$556.10
Rate for Payer: Priority Health Commercial	$457.96
Rate for Payer: Priority Health PPO	$457.96

PHA ESMOLOL HCL 10MG/ML INJ

Facility

$45.85

Service Code	NDC 55150019410
Hospital Charge Code	2508020
Hospital Revenue Code	250
Min. Negotiated Rate	$32.09
Max. Negotiated Rate	$38.97
Rate for Payer: Cash Price	$29.80
Rate for Payer: Community Health Alliance Commercial	$38.97
Rate for Payer: Priority Health Commercial	$32.09
Rate for Payer: Priority Health PPO	$32.09

PHA ESOMEPRAZOLE SODIUM

Facility

$178.96

Service Code	NDC 186604001
Hospital Charge Code	2504479
Hospital Revenue Code	250
Min. Negotiated Rate	$125.27
Max. Negotiated Rate	$152.12
Rate for Payer: Cash Price	$116.32
Rate for Payer: Community Health Alliance Commercial	$152.12
Rate for Payer: Priority Health Commercial	$125.27
Rate for Payer: Priority Health PPO	$125.27

PHA ESTRADIOL CYPIONATE 5MG/ML

Facility

$854.30

Service Code	HCPCS J1000
Hospital Charge Code	2508040
Hospital Revenue Code	636
Min. Negotiated Rate	$598.01
Max. Negotiated Rate	$726.15
Rate for Payer: Cash Price	$555.30
Rate for Payer: Community Health Alliance Commercial	$726.15
Rate for Payer: Priority Health Commercial	$598.01
Rate for Payer: Priority Health PPO	$598.01

PHA ETOMIDATE 2 MG/ML VIAL

Facility

$50.84

Service Code	HCPCS J3490
Hospital Charge Code	2506255
Hospital Revenue Code	636
Min. Negotiated Rate	$35.59
Max. Negotiated Rate	$43.21
Rate for Payer: Cash Price	$33.05
Rate for Payer: Community Health Alliance Commercial	$43.21
Rate for Payer: Priority Health Commercial	$35.59
Rate for Payer: Priority Health PPO	$35.59

PHA ETOPOSIDE 1000MG INJ

Facility

$304.54

Service Code	HCPCS J9181
Hospital Charge Code	2508065
Hospital Revenue Code	636
Min. Negotiated Rate	$213.18
Max. Negotiated Rate	$258.86
Rate for Payer: Cash Price	$197.95
Rate for Payer: Community Health Alliance Commercial	$258.86
Rate for Payer: Priority Health Commercial	$213.18
Rate for Payer: Priority Health PPO	$213.18

PHA ETOPOSIDE 100 MG INJ 0824

Facility

$52.07

Service Code	HCPCS J9181
Hospital Charge Code	2508060
Hospital Revenue Code	636
Min. Negotiated Rate	$36.45
Max. Negotiated Rate	$44.26
Rate for Payer: Cash Price	$33.85
Rate for Payer: Community Health Alliance Commercial	$44.26
Rate for Payer: Priority Health Commercial	$36.45
Rate for Payer: Priority Health PPO	$36.45

PHA FAMOTIDINE 20 MG/2 ML VIAL

Facility

$5.63

Service Code	NDC 63323073912
Hospital Charge Code	2508090
Hospital Revenue Code	250
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$4.79
Rate for Payer: Cash Price	$3.66
Rate for Payer: Community Health Alliance Commercial	$4.79
Rate for Payer: Priority Health Commercial	$3.94
Rate for Payer: Priority Health PPO	$3.94

PHA FAMOTIDINE 20MG TAB

Facility

$0.52

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508095
Hospital Revenue Code	637
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.34
Rate for Payer: Community Health Alliance Commercial	$0.44
Rate for Payer: Priority Health Commercial	$0.36
Rate for Payer: Priority Health PPO	$0.36

PHA FAT EMULSION 10% 500ML BTL

Facility

$231.00

Hospital Charge Code	2509020
Hospital Revenue Code	258
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$196.35
Rate for Payer: Cash Price	$150.15
Rate for Payer: Community Health Alliance Commercial	$196.35
Rate for Payer: Priority Health Commercial	$161.70
Rate for Payer: Priority Health PPO	$161.70

PHA FAT EMULSION 20% 250 ML BA

Facility

$188.84

Service Code	NDC 338051909
Hospital Charge Code	2500517
Hospital Revenue Code	250
Min. Negotiated Rate	$132.19
Max. Negotiated Rate	$160.51
Rate for Payer: Cash Price	$122.75
Rate for Payer: Community Health Alliance Commercial	$160.51
Rate for Payer: Priority Health Commercial	$132.19
Rate for Payer: Priority Health PPO	$132.19

PHA FENTANYL 12MCG/HR PATCH

Facility

$92.97

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500604
Hospital Revenue Code	637
Min. Negotiated Rate	$65.08
Max. Negotiated Rate	$79.02
Rate for Payer: Cash Price	$60.43
Rate for Payer: Community Health Alliance Commercial	$79.02
Rate for Payer: Priority Health Commercial	$65.08
Rate for Payer: Priority Health PPO	$65.08

PHA FENTANYL 25 MCG/HR PTCH

Facility

$97.42

Service Code	HCPCS A9270 GY
Hospital Charge Code	2509040
Hospital Revenue Code	637
Min. Negotiated Rate	$68.19
Max. Negotiated Rate	$82.81
Rate for Payer: Cash Price	$63.32
Rate for Payer: Community Health Alliance Commercial	$82.81
Rate for Payer: Priority Health Commercial	$68.19
Rate for Payer: Priority Health PPO	$68.19

PHA FENTANYL 50 MCG PATCH

Facility

$154.74

Service Code	HCPCS A9270 GY
Hospital Charge Code	2509041
Hospital Revenue Code	637
Min. Negotiated Rate	$108.32
Max. Negotiated Rate	$131.53
Rate for Payer: Cash Price	$100.58
Rate for Payer: Community Health Alliance Commercial	$131.53
Rate for Payer: Priority Health Commercial	$108.32
Rate for Payer: Priority Health PPO	$108.32

PHA FENTANYL CITRATE 100 MCG

Facility

$26.15

Service Code	HCPCS J3010
Hospital Charge Code	2501214
Hospital Revenue Code	636
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

PHA FENTANYL CITRATE 50MCG/1ML

Facility

$13.81

Service Code	HCPCS J3010
Hospital Charge Code	2510926
Hospital Revenue Code	636
Min. Negotiated Rate	$9.67
Max. Negotiated Rate	$11.74
Rate for Payer: Cash Price	$8.98
Rate for Payer: Community Health Alliance Commercial	$11.74
Rate for Payer: Priority Health Commercial	$9.67
Rate for Payer: Priority Health PPO	$9.67

PHA FENTANYL-ROPIVACAINE 2MCG

Facility

$179.62

Service Code	NDC 61553014848
Hospital Charge Code	2509071
Hospital Revenue Code	250
Min. Negotiated Rate	$125.73
Max. Negotiated Rate	$152.68
Rate for Payer: Cash Price	$116.75
Rate for Payer: Community Health Alliance Commercial	$152.68
Rate for Payer: Priority Health Commercial	$125.73
Rate for Payer: Priority Health PPO	$125.73

PHA FERAHEME 510MG 30ML VIAL

Facility

$3,265.74

Service Code	HCPCS Q0138
Hospital Charge Code	2505555
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2,775.88
Rate for Payer: BCBS BCN 65	$0.38
Rate for Payer: Blue Care Network Medicare Advantage	$0.38
Rate for Payer: Cash Price	$2,122.73
Rate for Payer: Cash Price	$2,122.73
Rate for Payer: Community Health Alliance Commercial	$2,775.88
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$0.38
Rate for Payer: Meridian Health Plan Medicare	$0.38
Rate for Payer: Priority Health Commercial	$2,286.02
Rate for Payer: Priority Health Medicaid	$0.38
Rate for Payer: Priority Health Medicare	$0.38
Rate for Payer: Priority Health PPO	$2,286.02
Rate for Payer: United Health Care Medicaid	$0.38
Rate for Payer: United Health Care Medicare Advantage	$0.17

PHA FERRIC SUBSULFATE 500 ML

Facility

$1.37

Service Code	NDC 51552035705
Hospital Charge Code	2500508
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.89
Rate for Payer: Community Health Alliance Commercial	$1.16
Rate for Payer: Priority Health Commercial	$0.96
Rate for Payer: Priority Health PPO	$0.96

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges