Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA NEOMYCN-POLYMY-GRAMICD 5ML

Facility

$100.69

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507160
Hospital Revenue Code	637
Min. Negotiated Rate	$70.48
Max. Negotiated Rate	$85.59
Rate for Payer: Cash Price	$65.45
Rate for Payer: Community Health Alliance Commercial	$85.59
Rate for Payer: Priority Health Commercial	$70.48
Rate for Payer: Priority Health PPO	$70.48

PHA NEOSTIGIMINE METHYSULFATE

Facility

$50.02

Service Code	HCPCS J2710
Hospital Charge Code	2501003
Hospital Revenue Code	636
Min. Negotiated Rate	$35.01
Max. Negotiated Rate	$42.52
Rate for Payer: Cash Price	$32.51
Rate for Payer: Community Health Alliance Commercial	$42.52
Rate for Payer: Priority Health Commercial	$35.01
Rate for Payer: Priority Health PPO	$35.01

PHA NEUROTIN 400MG CAP

Facility

$8.44

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502084
Hospital Revenue Code	637
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$7.17
Rate for Payer: Cash Price	$5.49
Rate for Payer: Community Health Alliance Commercial	$7.17
Rate for Payer: Priority Health Commercial	$5.91
Rate for Payer: Priority Health PPO	$5.91

PHA NEXIUM 40MG CAPSULE NF

Facility

$49.29

Service Code	NDC 186504054
Hospital Charge Code	2510783
Hospital Revenue Code	637
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$41.90
Rate for Payer: Cash Price	$32.04
Rate for Payer: Community Health Alliance Commercial	$41.90
Rate for Payer: Priority Health Commercial	$34.50
Rate for Payer: Priority Health PPO	$34.50

PHA NF LISINOPRIL 40 MG TAB

Facility

$8.13

Service Code	NDC 68180097901
Hospital Charge Code	2510862
Hospital Revenue Code	637
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$6.91
Rate for Payer: Cash Price	$5.28
Rate for Payer: Community Health Alliance Commercial	$6.91
Rate for Payer: Priority Health Commercial	$5.69
Rate for Payer: Priority Health PPO	$5.69

PHA NF LOVASTATIN 10MG

Facility

$7.03

Service Code	NDC 45963063301
Hospital Charge Code	2510798
Hospital Revenue Code	637
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$4.57
Rate for Payer: Community Health Alliance Commercial	$5.98
Rate for Payer: Priority Health Commercial	$4.92
Rate for Payer: Priority Health PPO	$4.92

PHA NF PRAMIPEXOLE 0.5 MG TAB

Facility

$15.37

Service Code	NDC 57237018290
Hospital Charge Code	2510913
Hospital Revenue Code	637
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$13.06
Rate for Payer: Cash Price	$9.99
Rate for Payer: Community Health Alliance Commercial	$13.06
Rate for Payer: Priority Health Commercial	$10.76
Rate for Payer: Priority Health PPO	$10.76

PHA NF ROMFLUMILAST 500MCG TAB

Facility

$86.24

Service Code	NDC 310009530
Hospital Charge Code	2510914
Hospital Revenue Code	637
Min. Negotiated Rate	$60.37
Max. Negotiated Rate	$73.30
Rate for Payer: Cash Price	$56.06
Rate for Payer: Community Health Alliance Commercial	$73.30
Rate for Payer: Priority Health Commercial	$60.37
Rate for Payer: Priority Health PPO	$60.37

PHA NF VILAZIDONE 40MG TAB

Facility

$70.17

Service Code	NDC 456114030
Hospital Charge Code	2510871
Hospital Revenue Code	637
Min. Negotiated Rate	$49.12
Max. Negotiated Rate	$59.64
Rate for Payer: Cash Price	$45.61
Rate for Payer: Community Health Alliance Commercial	$59.64
Rate for Payer: Priority Health Commercial	$49.12
Rate for Payer: Priority Health PPO	$49.12

PHA NF ZYPREXA 2.5 MG TAB

Facility

$51.30

Service Code	NDC 55111016330
Hospital Charge Code	2510804
Hospital Revenue Code	637
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$43.60
Rate for Payer: Cash Price	$33.35
Rate for Payer: Community Health Alliance Commercial	$43.60
Rate for Payer: Priority Health Commercial	$35.91
Rate for Payer: Priority Health PPO	$35.91

PHA NIACIN 100MG TAB

Facility

$2.34

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507190
Hospital Revenue Code	637
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.99
Rate for Payer: Cash Price	$1.52
Rate for Payer: Community Health Alliance Commercial	$1.99
Rate for Payer: Priority Health Commercial	$1.64
Rate for Payer: Priority Health PPO	$1.64

PHA NICARDIPINE 2.5MG/ML 10 ML

Facility

$121.87

Service Code	NDC 143968910
Hospital Charge Code	2507335
Hospital Revenue Code	250
Min. Negotiated Rate	$85.31
Max. Negotiated Rate	$103.59
Rate for Payer: Cash Price	$79.22
Rate for Payer: Community Health Alliance Commercial	$103.59
Rate for Payer: Priority Health Commercial	$85.31
Rate for Payer: Priority Health PPO	$85.31

PHA NICOTINE 14MG PTCH

Facility

$14.38

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507200
Hospital Revenue Code	637
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$12.22
Rate for Payer: Cash Price	$9.35
Rate for Payer: Community Health Alliance Commercial	$12.22
Rate for Payer: Priority Health Commercial	$10.07
Rate for Payer: Priority Health PPO	$10.07

PHA NICOTINE 21MG PTCH

Facility

$11.15

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507210
Hospital Revenue Code	637
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$9.48
Rate for Payer: Cash Price	$7.25
Rate for Payer: Community Health Alliance Commercial	$9.48
Rate for Payer: Priority Health Commercial	$7.80
Rate for Payer: Priority Health PPO	$7.80

PHA NIFEDIPINE 30MG TAB

Facility

$9.33

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507240
Hospital Revenue Code	637
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$7.93
Rate for Payer: Cash Price	$6.06
Rate for Payer: Community Health Alliance Commercial	$7.93
Rate for Payer: Priority Health Commercial	$6.53
Rate for Payer: Priority Health PPO	$6.53

PHA NIFEREX 150MG CAP

Facility

$1.46

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507575
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.24
Rate for Payer: Cash Price	$0.95
Rate for Payer: Community Health Alliance Commercial	$1.24
Rate for Payer: Priority Health Commercial	$1.02
Rate for Payer: Priority Health PPO	$1.02

PHA NITROFURANTOIN MONOHYD MAC

Facility

$17.61

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500122
Hospital Revenue Code	637
Min. Negotiated Rate	$12.33
Max. Negotiated Rate	$14.97
Rate for Payer: Cash Price	$11.45
Rate for Payer: Community Health Alliance Commercial	$14.97
Rate for Payer: Priority Health Commercial	$12.33
Rate for Payer: Priority Health PPO	$12.33

PHA NITROGLYCERIN 0.1MG/HR

Facility

$9.69

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507250
Hospital Revenue Code	637
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$8.24
Rate for Payer: Cash Price	$6.30
Rate for Payer: Community Health Alliance Commercial	$8.24
Rate for Payer: Priority Health Commercial	$6.78
Rate for Payer: Priority Health PPO	$6.78

PHA NITROGLYCERIN 0.2MG/HR

Facility

$8.44

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507260
Hospital Revenue Code	637
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$7.17
Rate for Payer: Cash Price	$5.49
Rate for Payer: Community Health Alliance Commercial	$7.17
Rate for Payer: Priority Health Commercial	$5.91
Rate for Payer: Priority Health PPO	$5.91

PHA NITROGLYCERIN 0.4 MG/HR

Facility

$11.31

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507280
Hospital Revenue Code	637
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$9.61
Rate for Payer: Cash Price	$7.35
Rate for Payer: Community Health Alliance Commercial	$9.61
Rate for Payer: Priority Health Commercial	$7.92
Rate for Payer: Priority Health PPO	$7.92

PHA NITROGLYCERIN 0.4MG TAB

Facility

$6.40

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507290
Hospital Revenue Code	637
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$5.44
Rate for Payer: Cash Price	$4.16
Rate for Payer: Community Health Alliance Commercial	$5.44
Rate for Payer: Priority Health Commercial	$4.48
Rate for Payer: Priority Health PPO	$4.48

PHA NITROGLYCERIN 1 GM PACKET

Facility

$15.79

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507676
Hospital Revenue Code	637
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$13.42
Rate for Payer: Cash Price	$10.26
Rate for Payer: Community Health Alliance Commercial	$13.42
Rate for Payer: Priority Health Commercial	$11.05
Rate for Payer: Priority Health PPO	$11.05

PHA NITROGLYCERIN 6.5 MG CAP

Facility

$6.72

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507320
Hospital Revenue Code	637
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$5.71
Rate for Payer: Cash Price	$4.37
Rate for Payer: Community Health Alliance Commercial	$5.71
Rate for Payer: Priority Health Commercial	$4.70
Rate for Payer: Priority Health PPO	$4.70

PHA NITROPRUSSIDE SODIUM 50MG

Facility

$320.64

Service Code	NDC 14789001202
Hospital Charge Code	2507310
Hospital Revenue Code	250
Min. Negotiated Rate	$224.45
Max. Negotiated Rate	$272.54
Rate for Payer: Cash Price	$208.42
Rate for Payer: Community Health Alliance Commercial	$272.54
Rate for Payer: Priority Health Commercial	$224.45
Rate for Payer: Priority Health PPO	$224.45

PHA NIVEA CREAM 60 GM TUBE

Facility

$18.69

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507365
Hospital Revenue Code	637
Min. Negotiated Rate	$13.08
Max. Negotiated Rate	$15.89
Rate for Payer: Cash Price	$12.15
Rate for Payer: Community Health Alliance Commercial	$15.89
Rate for Payer: Priority Health Commercial	$13.08
Rate for Payer: Priority Health PPO	$13.08

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges