Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA FERROUS SULFATE 325 MG TAB

Facility

$0.57

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500001
Hospital Revenue Code	637
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.37
Rate for Payer: Community Health Alliance Commercial	$0.48
Rate for Payer: Priority Health Commercial	$0.40
Rate for Payer: Priority Health PPO	$0.40

PHA FEXOFENADINE HYDR 60MG TAB

Facility

$7.87

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500171
Hospital Revenue Code	637
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$6.69
Rate for Payer: Cash Price	$5.12
Rate for Payer: Community Health Alliance Commercial	$6.69
Rate for Payer: Priority Health Commercial	$5.51
Rate for Payer: Priority Health PPO	$5.51

PHA FINASTERIDE 5MG TAB

Facility

$16.20

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500705
Hospital Revenue Code	637
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$13.77
Rate for Payer: Cash Price	$10.53
Rate for Payer: Community Health Alliance Commercial	$13.77
Rate for Payer: Priority Health Commercial	$11.34
Rate for Payer: Priority Health PPO	$11.34

PHA FLORINEF 0.1MG TAB NF

Facility

$4.12

Service Code	NDC 555099702
Hospital Charge Code	2510787
Hospital Revenue Code	637
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$3.50
Rate for Payer: Cash Price	$2.68
Rate for Payer: Community Health Alliance Commercial	$3.50
Rate for Payer: Priority Health Commercial	$2.88
Rate for Payer: Priority Health PPO	$2.88

PHA FLUCONAZOLE 100MG TAB

Facility

$49.65

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501037
Hospital Revenue Code	637
Min. Negotiated Rate	$34.76
Max. Negotiated Rate	$42.20
Rate for Payer: Cash Price	$32.27
Rate for Payer: Community Health Alliance Commercial	$42.20
Rate for Payer: Priority Health Commercial	$34.76
Rate for Payer: Priority Health PPO	$34.76

PHA FLUCONAZOLE 200 MG BAG

Facility

$28.13

Service Code	HCPCS J1450
Hospital Charge Code	2501040
Hospital Revenue Code	636
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$23.91
Rate for Payer: Cash Price	$18.28
Rate for Payer: Community Health Alliance Commercial	$23.91
Rate for Payer: Priority Health Commercial	$19.69
Rate for Payer: Priority Health PPO	$19.69

PHA FLUDARABINE PHOSPHATE 50MG

Facility

$364.32

Service Code	HCPCS J9185
Hospital Charge Code	2501045
Hospital Revenue Code	636
Min. Negotiated Rate	$255.02
Max. Negotiated Rate	$309.67
Rate for Payer: Cash Price	$236.81
Rate for Payer: Community Health Alliance Commercial	$309.67
Rate for Payer: Priority Health Commercial	$255.02
Rate for Payer: Priority Health PPO	$255.02

PHA FLUMAZENIL 0.1MG/ML VIAL

Facility

$46.37

Service Code	NDC 63323042405
Hospital Charge Code	2501050
Hospital Revenue Code	250
Min. Negotiated Rate	$32.46
Max. Negotiated Rate	$39.41
Rate for Payer: Cash Price	$30.14
Rate for Payer: Community Health Alliance Commercial	$39.41
Rate for Payer: Priority Health Commercial	$32.46
Rate for Payer: Priority Health PPO	$32.46

PHA FLUOROMETHOLONE 0.1% OINT

Facility

$531.24

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501061
Hospital Revenue Code	637
Min. Negotiated Rate	$371.87
Max. Negotiated Rate	$451.55
Rate for Payer: Cash Price	$345.31
Rate for Payer: Community Health Alliance Commercial	$451.55
Rate for Payer: Priority Health Commercial	$371.87
Rate for Payer: Priority Health PPO	$371.87

PHA FLUOROMETHOLONE .25% 5ML

Facility

$557.80

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501070
Hospital Revenue Code	637
Min. Negotiated Rate	$390.46
Max. Negotiated Rate	$474.13
Rate for Payer: Cash Price	$362.57
Rate for Payer: Community Health Alliance Commercial	$474.13
Rate for Payer: Priority Health Commercial	$390.46
Rate for Payer: Priority Health PPO	$390.46

PHA FLUOROURACIL 1000MG

Facility

$114.19

Service Code	HCPCS J9190
Hospital Charge Code	2505508
Hospital Revenue Code	636
Min. Negotiated Rate	$79.93
Max. Negotiated Rate	$97.06
Rate for Payer: Cash Price	$74.22
Rate for Payer: Community Health Alliance Commercial	$97.06
Rate for Payer: Priority Health Commercial	$79.93
Rate for Payer: Priority Health PPO	$79.93

PHA FLUOROURACIL 2500MG

Facility

$80.52

Service Code	HCPCS J9190
Hospital Charge Code	2505507
Hospital Revenue Code	636
Min. Negotiated Rate	$56.36
Max. Negotiated Rate	$68.44
Rate for Payer: Cash Price	$52.34
Rate for Payer: Community Health Alliance Commercial	$68.44
Rate for Payer: Priority Health Commercial	$56.36
Rate for Payer: Priority Health PPO	$56.36

PHA FLUOROURACIL 500 MG VIAL

Facility

$21.36

Service Code	HCPCS J9190
Hospital Charge Code	2502000
Hospital Revenue Code	636
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 FLUOROURACIL 50MG/ML

Facility

$159.04

Service Code	HCPCS J9190
Hospital Charge Code	25050313
Hospital Revenue Code	636
Min. Negotiated Rate	$111.33
Max. Negotiated Rate	$135.18
Rate for Payer: Cash Price	$103.38
Rate for Payer: Community Health Alliance Commercial	$135.18
Rate for Payer: Priority Health Commercial	$111.33
Rate for Payer: Priority Health PPO	$111.33

PHA FLUOXETINE 40MG TAB NF

Facility

$27.77

Service Code	NDC 781282401
Hospital Charge Code	2510788
Hospital Revenue Code	637
Min. Negotiated Rate	$19.44
Max. Negotiated Rate	$23.60
Rate for Payer: Cash Price	$18.05
Rate for Payer: Community Health Alliance Commercial	$23.60
Rate for Payer: Priority Health Commercial	$19.44
Rate for Payer: Priority Health PPO	$19.44

PHA FLUTICASONE 250/50 14 PUFF

Facility

$20.32

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507667
Hospital Revenue Code	637
Min. Negotiated Rate	$14.22
Max. Negotiated Rate	$17.27
Rate for Payer: Cash Price	$13.21
Rate for Payer: Community Health Alliance Commercial	$17.27
Rate for Payer: Priority Health Commercial	$14.22
Rate for Payer: Priority Health PPO	$14.22

PHA FLUTICASONE 50 MCG SPRAY

Facility

$284.77

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502019
Hospital Revenue Code	637
Min. Negotiated Rate	$199.34
Max. Negotiated Rate	$242.05
Rate for Payer: Cash Price	$185.10
Rate for Payer: Community Health Alliance Commercial	$242.05
Rate for Payer: Priority Health Commercial	$199.34
Rate for Payer: Priority Health PPO	$199.34

PHA FLUTICASONE DISKUS 500 INH

Facility

$33.14

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502021
Hospital Revenue Code	637
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$28.17
Rate for Payer: Cash Price	$21.54
Rate for Payer: Community Health Alliance Commercial	$28.17
Rate for Payer: Priority Health Commercial	$23.20
Rate for Payer: Priority Health PPO	$23.20

PHA FLUTICASONE PROPIONATE

Facility

$906.94

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502022
Hospital Revenue Code	637
Min. Negotiated Rate	$634.86
Max. Negotiated Rate	$770.90
Rate for Payer: Cash Price	$589.51
Rate for Payer: Community Health Alliance Commercial	$770.90
Rate for Payer: Priority Health Commercial	$634.86
Rate for Payer: Priority Health PPO	$634.86

PHA FOLIC ACID 1 MG TAB

Facility

$1.09

Service Code	HCPCS A9270 GY
Hospital Charge Code	2505520
Hospital Revenue Code	637
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.71
Rate for Payer: Community Health Alliance Commercial	$0.93
Rate for Payer: Priority Health Commercial	$0.76
Rate for Payer: Priority Health PPO	$0.76

PHA FOLIC ACID 5MG/ML VIAL

Facility

$292.02

Service Code	NDC 63323018410
Hospital Charge Code	2505530
Hospital Revenue Code	250
Min. Negotiated Rate	$204.41
Max. Negotiated Rate	$248.22
Rate for Payer: Cash Price	$189.81
Rate for Payer: Community Health Alliance Commercial	$248.22
Rate for Payer: Priority Health Commercial	$204.41
Rate for Payer: Priority Health PPO	$204.41

PHA FONDAPARINUX SODIUM 2.5MG

Facility

$754.20

Service Code	HCPCS J1652
Hospital Charge Code	2500706
Hospital Revenue Code	636
Min. Negotiated Rate	$527.94
Max. Negotiated Rate	$641.07
Rate for Payer: Cash Price	$490.23
Rate for Payer: Community Health Alliance Commercial	$641.07
Rate for Payer: Priority Health Commercial	$527.94
Rate for Payer: Priority Health PPO	$527.94

PHA FORMETEROL FUMARATE 10 MCG

Facility

$100.81

Service Code	HCPCS J7606
Hospital Charge Code	2500707
Hospital Revenue Code	636
Min. Negotiated Rate	$70.57
Max. Negotiated Rate	$85.69
Rate for Payer: Cash Price	$65.53
Rate for Payer: Community Health Alliance Commercial	$85.69
Rate for Payer: Priority Health Commercial	$70.57
Rate for Payer: Priority Health PPO	$70.57

PHA FOSAPREPITANT DIMEGLUMINE

Facility

$603.75

Service Code	NDC 6388432
Hospital Charge Code	2502628
Hospital Revenue Code	250
Min. Negotiated Rate	$422.62
Max. Negotiated Rate	$513.19
Rate for Payer: Cash Price	$392.44
Rate for Payer: Community Health Alliance Commercial	$513.19
Rate for Payer: Priority Health Commercial	$422.62
Rate for Payer: Priority Health PPO	$422.62

PHA FUROSEMIDE 10MG/ML ML

Facility

$58.03

Service Code	HCPCS J1940
Hospital Charge Code	2505560
Hospital Revenue Code	636
Min. Negotiated Rate	$40.62
Max. Negotiated Rate	$49.33
Rate for Payer: Cash Price	$37.72
Rate for Payer: Community Health Alliance Commercial	$49.33
Rate for Payer: Priority Health Commercial	$40.62
Rate for Payer: Priority Health PPO	$40.62

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges