Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA MORPHINE SULFATE 30MG TAB

Facility

$19.17

Service Code	HCPCS A9270 GY
Hospital Charge Code	2504170
Hospital Revenue Code	637
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$16.29
Rate for Payer: Cash Price	$12.46
Rate for Payer: Community Health Alliance Commercial	$16.29
Rate for Payer: Priority Health Commercial	$13.42
Rate for Payer: Priority Health PPO	$13.42

PHA MORPHINE SULFATE 4MG INJ

Facility

$49.46

Service Code	NDC 409189101
Hospital Charge Code	2504155
Hospital Revenue Code	250
Min. Negotiated Rate	$34.62
Max. Negotiated Rate	$42.04
Rate for Payer: Cash Price	$32.15
Rate for Payer: Community Health Alliance Commercial	$42.04
Rate for Payer: Priority Health Commercial	$34.62
Rate for Payer: Priority Health PPO	$34.62

PHA MORPHINE SULFATE 4MG/ML

Facility

$15.63

Service Code	NDC 641612525
Hospital Charge Code	2510971
Hospital Revenue Code	636
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$13.29
Rate for Payer: Cash Price	$10.16
Rate for Payer: Community Health Alliance Commercial	$13.29
Rate for Payer: Priority Health Commercial	$10.94
Rate for Payer: Priority Health PPO	$10.94

PHA MORPHINE SULFATE 50 MG

Facility

$50.11

Service Code	HCPCS A9270 GY
Hospital Charge Code	2504191
Hospital Revenue Code	637
Min. Negotiated Rate	$35.08
Max. Negotiated Rate	$42.59
Rate for Payer: Cash Price	$32.57
Rate for Payer: Community Health Alliance Commercial	$42.59
Rate for Payer: Priority Health Commercial	$35.08
Rate for Payer: Priority Health PPO	$35.08

PHA MORPHONE SULFATE 0.5MG/ML

Facility

$111.16

Service Code	HCPCS J2274
Hospital Charge Code	2500815
Hospital Revenue Code	636
Min. Negotiated Rate	$77.81
Max. Negotiated Rate	$94.49
Rate for Payer: Cash Price	$72.25
Rate for Payer: Community Health Alliance Commercial	$94.49
Rate for Payer: Priority Health Commercial	$77.81
Rate for Payer: Priority Health PPO	$77.81

PHA MORPHONE SULFATE 2 MG/ML

Facility

$54.96

Service Code	HCPCS J2270
Hospital Charge Code	2501028
Hospital Revenue Code	636
Min. Negotiated Rate	$38.47
Max. Negotiated Rate	$46.72
Rate for Payer: Cash Price	$35.72
Rate for Payer: Community Health Alliance Commercial	$46.72
Rate for Payer: Priority Health Commercial	$38.47
Rate for Payer: Priority Health PPO	$38.47

PHA MOXIFLOXACIN HYDROCHLORIDE

Facility

$17.92

Service Code	NDC 82667070003
Hospital Charge Code	2505746
Hospital Revenue Code	250
Min. Negotiated Rate	$12.54
Max. Negotiated Rate	$15.23
Rate for Payer: Cash Price	$11.65
Rate for Payer: Community Health Alliance Commercial	$15.23
Rate for Payer: Priority Health Commercial	$12.54
Rate for Payer: Priority Health PPO	$12.54

PHA MULTIPLE VITAMIN 10ML VL

Facility

$84.55

Service Code	NDC 54643564901
Hospital Charge Code	2505140
Hospital Revenue Code	250
Min. Negotiated Rate	$59.19
Max. Negotiated Rate	$71.87
Rate for Payer: Cash Price	$54.96
Rate for Payer: Community Health Alliance Commercial	$71.87
Rate for Payer: Priority Health Commercial	$59.19
Rate for Payer: Priority Health PPO	$59.19

PHA MULTI VITAMINS W/MIN 1 TAB

Facility

$0.26

Service Code	HCPCS A9270 GY
Hospital Charge Code	2505130
Hospital Revenue Code	637
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.17
Rate for Payer: Community Health Alliance Commercial	$0.22
Rate for Payer: Priority Health Commercial	$0.18
Rate for Payer: Priority Health PPO	$0.18

PHA MUPIROCIN 2% OINT 22 GM

Facility

$114.50

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500224
Hospital Revenue Code	637
Min. Negotiated Rate	$80.15
Max. Negotiated Rate	$97.33
Rate for Payer: Cash Price	$74.43
Rate for Payer: Community Health Alliance Commercial	$97.33
Rate for Payer: Priority Health Commercial	$80.15
Rate for Payer: Priority Health PPO	$80.15

PHA NAFCILLIN SODIUM 1GM VIAL

Facility

$66.41

Service Code	NDC 55150012215
Hospital Charge Code	2505180
Hospital Revenue Code	250
Min. Negotiated Rate	$46.49
Max. Negotiated Rate	$56.45
Rate for Payer: Cash Price	$43.17
Rate for Payer: Community Health Alliance Commercial	$56.45
Rate for Payer: Priority Health Commercial	$46.49
Rate for Payer: Priority Health PPO	$46.49

PHA NAFCILLIN SODIUM 2GM VIAL

Facility

$68.70

Service Code	NDC 55150012315
Hospital Charge Code	2505190
Hospital Revenue Code	250
Min. Negotiated Rate	$48.09
Max. Negotiated Rate	$58.40
Rate for Payer: Cash Price	$44.66
Rate for Payer: Community Health Alliance Commercial	$58.40
Rate for Payer: Priority Health Commercial	$48.09
Rate for Payer: Priority Health PPO	$48.09

PHA NA HYALURONATE & NA CHONDR

Facility

$434.67

Service Code	NDC 8065183150
Hospital Charge Code	2504747
Hospital Revenue Code	250
Min. Negotiated Rate	$304.27
Max. Negotiated Rate	$369.47
Rate for Payer: Cash Price	$282.54
Rate for Payer: Community Health Alliance Commercial	$369.47
Rate for Payer: Priority Health Commercial	$304.27
Rate for Payer: Priority Health PPO	$304.27

PHA NALBUPHINE HCL 20MG/ML AMP

Facility

$58.99

Service Code	HCPCS J2300
Hospital Charge Code	2506120
Hospital Revenue Code	636
Min. Negotiated Rate	$41.29
Max. Negotiated Rate	$50.14
Rate for Payer: Cash Price	$38.34
Rate for Payer: Community Health Alliance Commercial	$50.14
Rate for Payer: Priority Health Commercial	$41.29
Rate for Payer: Priority Health PPO	$41.29

PHA NALOXONE HCL 0.4MG/ML VIAL

Facility

$37.51

Service Code	NDC 641613225
Hospital Charge Code	2506150
Hospital Revenue Code	250
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 NALOXONE HCL 1MG/ML

Facility

$157.61

Service Code	HCPCS J2310
Hospital Charge Code	2506162
Hospital Revenue Code	636
Min. Negotiated Rate	$110.33
Max. Negotiated Rate	$133.97
Rate for Payer: Cash Price	$102.45
Rate for Payer: Community Health Alliance Commercial	$133.97
Rate for Payer: Priority Health Commercial	$110.33
Rate for Payer: Priority Health PPO	$110.33

PHA NAPROXEN 250MG TAB

Facility

$4.06

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506180
Hospital Revenue Code	637
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$3.45
Rate for Payer: Cash Price	$2.64
Rate for Payer: Community Health Alliance Commercial	$3.45
Rate for Payer: Priority Health Commercial	$2.84
Rate for Payer: Priority Health PPO	$2.84

PHA NAROPIN 0.75% 20 ML VIAL

Facility

$102.92

Service Code	NDC 63323028721
Hospital Charge Code	2510856
Hospital Revenue Code	250
Min. Negotiated Rate	$72.04
Max. Negotiated Rate	$87.48
Rate for Payer: Cash Price	$66.90
Rate for Payer: Community Health Alliance Commercial	$87.48
Rate for Payer: Priority Health Commercial	$72.04
Rate for Payer: Priority Health PPO	$72.04

PHA NEO-BACI POLY 5MG-400IU

Facility

$0.73

Service Code	NDC 47682022335
Hospital Charge Code	2510849
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.62
Rate for Payer: Cash Price	$0.47
Rate for Payer: Community Health Alliance Commercial	$0.62
Rate for Payer: Priority Health Commercial	$0.51
Rate for Payer: Priority Health PPO	$0.51

PHA NEOMYCIN-BACITRACIN-POLY

Facility

$184.54

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507140
Hospital Revenue Code	637
Min. Negotiated Rate	$129.18
Max. Negotiated Rate	$156.86
Rate for Payer: Cash Price	$119.95
Rate for Payer: Community Health Alliance Commercial	$156.86
Rate for Payer: Priority Health Commercial	$129.18
Rate for Payer: Priority Health PPO	$129.18

PHA NEOMYCIN-BACITRACIN-POLYMY

Facility

$19.43

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507150
Hospital Revenue Code	637
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$16.52
Rate for Payer: Cash Price	$12.63
Rate for Payer: Community Health Alliance Commercial	$16.52
Rate for Payer: Priority Health Commercial	$13.60
Rate for Payer: Priority Health PPO	$13.60

PHA NEOMYCIN-POLYMY-DEX 3.5GM

Facility

$69.39

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501630
Hospital Revenue Code	637
Min. Negotiated Rate	$48.57
Max. Negotiated Rate	$58.98
Rate for Payer: Cash Price	$45.10
Rate for Payer: Community Health Alliance Commercial	$58.98
Rate for Payer: Priority Health Commercial	$48.57
Rate for Payer: Priority Health PPO	$48.57

PHA NEOMYCIN-POLYMY-DEX 5ML BT

Facility

$90.96

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507120
Hospital Revenue Code	637
Min. Negotiated Rate	$63.67
Max. Negotiated Rate	$77.32
Rate for Payer: Cash Price	$59.12
Rate for Payer: Community Health Alliance Commercial	$77.32
Rate for Payer: Priority Health Commercial	$63.67
Rate for Payer: Priority Health PPO	$63.67

PHA NEOMYCIN-POLYMYXIN-HC 10ML

Facility

$277.88

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503420
Hospital Revenue Code	637
Min. Negotiated Rate	$194.52
Max. Negotiated Rate	$236.20
Rate for Payer: Cash Price	$180.62
Rate for Payer: Community Health Alliance Commercial	$236.20
Rate for Payer: Priority Health Commercial	$194.52
Rate for Payer: Priority Health PPO	$194.52

PHA NEOMYCIN-POLYMYXIN-HC 10ML

Facility

$289.47

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503430
Hospital Revenue Code	637
Min. Negotiated Rate	$202.63
Max. Negotiated Rate	$246.05
Rate for Payer: Cash Price	$188.16
Rate for Payer: Community Health Alliance Commercial	$246.05
Rate for Payer: Priority Health Commercial	$202.63
Rate for Payer: Priority Health PPO	$202.63

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges