Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA MEMANTINE HCL 5MG TAB

Facility

$31.78

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506699
Hospital Revenue Code	637
Min. Negotiated Rate	$22.25
Max. Negotiated Rate	$27.01
Rate for Payer: Cash Price	$20.66
Rate for Payer: Community Health Alliance Commercial	$27.01
Rate for Payer: Priority Health Commercial	$22.25
Rate for Payer: Priority Health PPO	$22.25

PHA MEMETASONE 50 MCG SPRAY

Facility

$707.25

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502014
Hospital Revenue Code	637
Min. Negotiated Rate	$495.07
Max. Negotiated Rate	$601.16
Rate for Payer: Cash Price	$459.71
Rate for Payer: Community Health Alliance Commercial	$601.16
Rate for Payer: Priority Health Commercial	$495.07
Rate for Payer: Priority Health PPO	$495.07

PHA MEPERIDINE 25 MG VIAL

Facility

$15.84

Service Code	NDC 641605225
Hospital Charge Code	2501685
Hospital Revenue Code	250
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$13.46
Rate for Payer: Cash Price	$10.30
Rate for Payer: Community Health Alliance Commercial	$13.46
Rate for Payer: Priority Health Commercial	$11.09
Rate for Payer: Priority Health PPO	$11.09

PHA MEPERIDINE HCL 500 MG INJ

Facility

$128.00

Service Code	HCPCS J2175
Hospital Charge Code	2501721
Hospital Revenue Code	636
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$108.80
Rate for Payer: Cash Price	$83.20
Rate for Payer: Community Health Alliance Commercial	$108.80
Rate for Payer: Priority Health Commercial	$89.60
Rate for Payer: Priority Health PPO	$89.60

PHA MEPOLZUMAB (NUCALA) 100MG

Facility

$10,054.48

Service Code	HCPCS J2182
Hospital Charge Code	2501755
Hospital Revenue Code	636
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$8,546.31
Rate for Payer: BCBS BCN 65	$33.48
Rate for Payer: Blue Care Network Medicare Advantage	$33.48
Rate for Payer: Cash Price	$6,535.41
Rate for Payer: Cash Price	$6,535.41
Rate for Payer: Community Health Alliance Commercial	$8,546.31
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$33.48
Rate for Payer: Meridian Health Plan Medicare	$33.48
Rate for Payer: Priority Health Commercial	$7,038.14
Rate for Payer: Priority Health Medicaid	$33.48
Rate for Payer: Priority Health Medicare	$33.48
Rate for Payer: Priority Health PPO	$7,038.14
Rate for Payer: United Health Care Medicaid	$33.48
Rate for Payer: United Health Care Medicare Advantage	$14.73

PHA MERREM 500 MG VIAL

Facility

$37.51

Service Code	HCPCS J2185
Hospital Charge Code	2501753
Hospital Revenue Code	636
Min. Negotiated Rate	$26.26
Max. Negotiated Rate	$31.88
Rate for Payer: Cash Price	$24.38
Rate for Payer: Community Health Alliance Commercial	$31.88
Rate for Payer: Priority Health Commercial	$26.26
Rate for Payer: Priority Health PPO	$26.26

PHA MESNA 1GM VIAL 0732

Facility

$265.73

Service Code	HCPCS J9209
Hospital Charge Code	2501770
Hospital Revenue Code	636
Min. Negotiated Rate	$186.01
Max. Negotiated Rate	$225.87
Rate for Payer: Cash Price	$172.72
Rate for Payer: Community Health Alliance Commercial	$225.87
Rate for Payer: Priority Health Commercial	$186.01
Rate for Payer: Priority Health PPO	$186.01

PHA METFORMIN HYDROCHL 500 MG

Facility

$0.42

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501835
Hospital Revenue Code	637
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.36
Rate for Payer: Cash Price	$0.27
Rate for Payer: Community Health Alliance Commercial	$0.36
Rate for Payer: Priority Health Commercial	$0.29
Rate for Payer: Priority Health PPO	$0.29

PHA METFORMIN HYDROCHL 850 MG

Facility

$1.30

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501836
Hospital Revenue Code	637
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.10
Rate for Payer: Cash Price	$0.85
Rate for Payer: Community Health Alliance Commercial	$1.10
Rate for Payer: Priority Health Commercial	$0.91
Rate for Payer: Priority Health PPO	$0.91

PHA METFORMIN XR HCL 500 MG TB

Facility

$6.98

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501837
Hospital Revenue Code	637
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$5.93
Rate for Payer: Cash Price	$4.54
Rate for Payer: Community Health Alliance Commercial	$5.93
Rate for Payer: Priority Health Commercial	$4.89
Rate for Payer: Priority Health PPO	$4.89

PHA METHADONE HCL 10MG TAB

Facility

$3.54

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508826
Hospital Revenue Code	637
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$3.01
Rate for Payer: Cash Price	$2.30
Rate for Payer: Community Health Alliance Commercial	$3.01
Rate for Payer: Priority Health Commercial	$2.48
Rate for Payer: Priority Health PPO	$2.48

PHA METHOTREXATE SOD 50MG/2ML

Facility

$25.53

Service Code	HCPCS J9250
Hospital Charge Code	2501950
Hospital Revenue Code	636
Min. Negotiated Rate	$17.87
Max. Negotiated Rate	$21.70
Rate for Payer: Cash Price	$16.59
Rate for Payer: Community Health Alliance Commercial	$21.70
Rate for Payer: Priority Health Commercial	$17.87
Rate for Payer: Priority Health PPO	$17.87

PHA METHYLENE BLUE 10MG/ML AMP

Facility

$555.75

Service Code	NDC 17478050410
Hospital Charge Code	2501970
Hospital Revenue Code	250
Min. Negotiated Rate	$389.02
Max. Negotiated Rate	$472.39
Rate for Payer: Cash Price	$361.24
Rate for Payer: Community Health Alliance Commercial	$472.39
Rate for Payer: Priority Health Commercial	$389.02
Rate for Payer: Priority Health PPO	$389.02

PHA METHYL MALEATE .2MG/ML AMP

Facility

$149.41

Service Code	HCPCS J2210
Hospital Charge Code	2501840
Hospital Revenue Code	636
Min. Negotiated Rate	$104.59
Max. Negotiated Rate	$127.00
Rate for Payer: Cash Price	$97.12
Rate for Payer: Community Health Alliance Commercial	$127.00
Rate for Payer: Priority Health Commercial	$104.59
Rate for Payer: Priority Health PPO	$104.59

PHA METHYLPHENIDATE HCL 5MG TA

Facility

$14.64

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503434
Hospital Revenue Code	637
Min. Negotiated Rate	$10.25
Max. Negotiated Rate	$12.44
Rate for Payer: Cash Price	$9.52
Rate for Payer: Community Health Alliance Commercial	$12.44
Rate for Payer: Priority Health Commercial	$10.25
Rate for Payer: Priority Health PPO	$10.25

PHA METHYLPRED ACETATE 80MG/ML

Facility

$108.41

Service Code	NDC 9347503
Hospital Charge Code	2501960
Hospital Revenue Code	250
Min. Negotiated Rate	$75.89
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$70.47
Rate for Payer: Community Health Alliance Commercial	$92.15
Rate for Payer: Priority Health Commercial	$75.89
Rate for Payer: Priority Health PPO	$75.89

PHA METHYLPREDNISOLONE 4 MG

Facility

$8.60

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501935
Hospital Revenue Code	637
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$7.31
Rate for Payer: Cash Price	$5.59
Rate for Payer: Community Health Alliance Commercial	$7.31
Rate for Payer: Priority Health Commercial	$6.02
Rate for Payer: Priority Health PPO	$6.02

PHA METHYLPREDNISOLONE 4MG TAB

Facility

$11.20

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506565
Hospital Revenue Code	637
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$9.52
Rate for Payer: Cash Price	$7.28
Rate for Payer: Community Health Alliance Commercial	$9.52
Rate for Payer: Priority Health Commercial	$7.84
Rate for Payer: Priority Health PPO	$7.84

PHA METHYLPRED SOD SUCC 1000MG

Facility

$176.29

Service Code	HCPCS J2919
Hospital Charge Code	2501860
Hospital Revenue Code	636
Min. Negotiated Rate	$123.40
Max. Negotiated Rate	$149.85
Rate for Payer: Cash Price	$114.59
Rate for Payer: Community Health Alliance Commercial	$149.85
Rate for Payer: Priority Health Commercial	$123.40
Rate for Payer: Priority Health PPO	$123.40

PHA METHYLPRED SOD SUCC 125MG

Facility

$57.25

Service Code	HCPCS J2919
Hospital Charge Code	2501870
Hospital Revenue Code	636
Min. Negotiated Rate	$40.08
Max. Negotiated Rate	$48.66
Rate for Payer: Cash Price	$37.21
Rate for Payer: Community Health Alliance Commercial	$48.66
Rate for Payer: Priority Health Commercial	$40.08
Rate for Payer: Priority Health PPO	$40.08

PHA METHYNALTREXONE BROMIDE 12

Facility

$618.52

Service Code	HCPCS J2212
Hospital Charge Code	2500425
Hospital Revenue Code	636
Min. Negotiated Rate	$432.96
Max. Negotiated Rate	$525.74
Rate for Payer: Cash Price	$402.04
Rate for Payer: Community Health Alliance Commercial	$525.74
Rate for Payer: Priority Health Commercial	$432.96
Rate for Payer: Priority Health PPO	$432.96

PHA METOCLOPRAMIDE HCL 0754

Facility

$7.76

Service Code	HCPCS J2765
Hospital Charge Code	2502120
Hospital Revenue Code	636
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$6.60
Rate for Payer: Cash Price	$5.04
Rate for Payer: Community Health Alliance Commercial	$6.60
Rate for Payer: Priority Health Commercial	$5.43
Rate for Payer: Priority Health PPO	$5.43

PHA METOCLOPRAMIDE HCL 10MG TB

Facility

$0.68

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502110
Hospital Revenue Code	637
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.44
Rate for Payer: Community Health Alliance Commercial	$0.58
Rate for Payer: Priority Health Commercial	$0.48
Rate for Payer: Priority Health PPO	$0.48

PHA METOCLOPRAMIDE HCL 5MG SYR

Facility

$25.32

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502150
Hospital Revenue Code	637
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$21.52
Rate for Payer: Cash Price	$16.46
Rate for Payer: Community Health Alliance Commercial	$21.52
Rate for Payer: Priority Health Commercial	$17.72
Rate for Payer: Priority Health PPO	$17.72

PHA METOLAZONE 2.5MG TAB

Facility

$17.14

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502130
Hospital Revenue Code	637
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$14.57
Rate for Payer: Cash Price	$11.14
Rate for Payer: Community Health Alliance Commercial	$14.57
Rate for Payer: Priority Health Commercial	$12.00
Rate for Payer: Priority Health PPO	$12.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges