Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA OXALIPLATIN 50 MG INJ

Facility

$298.08

Service Code	HCPCS J9263
Hospital Charge Code	2502655
Hospital Revenue Code	636
Min. Negotiated Rate	$208.66
Max. Negotiated Rate	$253.37
Rate for Payer: Cash Price	$193.75
Rate for Payer: Community Health Alliance Commercial	$253.37
Rate for Payer: Priority Health Commercial	$208.66
Rate for Payer: Priority Health PPO	$208.66

PHA OXMETAZOLINE HCL 30 ML

Facility

$6.67

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500250
Hospital Revenue Code	637
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$5.67
Rate for Payer: Cash Price	$4.34
Rate for Payer: Community Health Alliance Commercial	$5.67
Rate for Payer: Priority Health Commercial	$4.67
Rate for Payer: Priority Health PPO	$4.67

PHA OXYBUTYNIN CHLORIDE 5MG TB

Facility

$3.23

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507530
Hospital Revenue Code	637
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$2.75
Rate for Payer: Cash Price	$2.10
Rate for Payer: Community Health Alliance Commercial	$2.75
Rate for Payer: Priority Health Commercial	$2.26
Rate for Payer: Priority Health PPO	$2.26

PHA OXYBUTYNIN CHL XL 5 MG TAB

Facility

$17.09

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506025
Hospital Revenue Code	637
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$14.53
Rate for Payer: Cash Price	$11.11
Rate for Payer: Community Health Alliance Commercial	$14.53
Rate for Payer: Priority Health Commercial	$11.96
Rate for Payer: Priority Health PPO	$11.96

PHA OXYCODONE 20 MG TABLET

Facility

$64.62

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507537
Hospital Revenue Code	637
Min. Negotiated Rate	$45.23
Max. Negotiated Rate	$54.93
Rate for Payer: Cash Price	$42.00
Rate for Payer: Community Health Alliance Commercial	$54.93
Rate for Payer: Priority Health Commercial	$45.23
Rate for Payer: Priority Health PPO	$45.23

PHA OXYCODONE HCL 10 MG TAB

Facility

$39.44

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507536
Hospital Revenue Code	637
Min. Negotiated Rate	$27.61
Max. Negotiated Rate	$33.52
Rate for Payer: Cash Price	$25.64
Rate for Payer: Community Health Alliance Commercial	$33.52
Rate for Payer: Priority Health Commercial	$27.61
Rate for Payer: Priority Health PPO	$27.61

PHA OXYCODONE HCL 5 MG

Facility

$3.07

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507535
Hospital Revenue Code	637
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$2.61
Rate for Payer: Cash Price	$2.00
Rate for Payer: Community Health Alliance Commercial	$2.61
Rate for Payer: Priority Health Commercial	$2.15
Rate for Payer: Priority Health PPO	$2.15

PHA OXYCODONE W/ACETAMINOPHEN

Facility

$7.24

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508215
Hospital Revenue Code	637
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$6.15
Rate for Payer: Cash Price	$4.71
Rate for Payer: Community Health Alliance Commercial	$6.15
Rate for Payer: Priority Health Commercial	$5.07
Rate for Payer: Priority Health PPO	$5.07

PHA OXYCODONE W/ACETAMINOPHEN

Facility

$15.68

Service Code	HCPCS A9270 GY
Hospital Charge Code	2510300
Hospital Revenue Code	637
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$13.33
Rate for Payer: Cash Price	$10.19
Rate for Payer: Community Health Alliance Commercial	$13.33
Rate for Payer: Priority Health Commercial	$10.98
Rate for Payer: Priority Health PPO	$10.98

PHA OXYTOCIN 10 U/ML VIAL

Facility

$9.33

Service Code	NDC 63323001201
Hospital Charge Code	2507520
Hospital Revenue Code	250
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 OXYTOCIN 20 UNITS/1000ML

Facility

$51.48

Service Code	HCPCS J2590
Hospital Charge Code	2507523
Hospital Revenue Code	636
Min. Negotiated Rate	$36.04
Max. Negotiated Rate	$43.76
Rate for Payer: Cash Price	$33.46
Rate for Payer: Community Health Alliance Commercial	$43.76
Rate for Payer: Priority Health Commercial	$36.04
Rate for Payer: Priority Health PPO	$36.04

PHA PACLITAXEL 300 MG/50 ML IN

Facility

$428.24

Service Code	HCPCS J9267
Hospital Charge Code	2509633
Hospital Revenue Code	636
Min. Negotiated Rate	$299.77
Max. Negotiated Rate	$364.00
Rate for Payer: Cash Price	$278.36
Rate for Payer: Community Health Alliance Commercial	$364.00
Rate for Payer: Priority Health Commercial	$299.77
Rate for Payer: Priority Health PPO	$299.77

PHA PACLITAXEL 30MG/5ML VIAL

Facility

$58.20

Service Code	HCPCS J9267
Hospital Charge Code	2509640
Hospital Revenue Code	636
Min. Negotiated Rate	$40.74
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$37.83
Rate for Payer: Community Health Alliance Commercial	$49.47
Rate for Payer: Priority Health Commercial	$40.74
Rate for Payer: Priority Health PPO	$40.74

PHA PALONOSETRON HCL 0.25MG

Facility

$662.40

Service Code	HCPCS J2469
Hospital Charge Code	2508895
Hospital Revenue Code	636
Min. Negotiated Rate	$463.68
Max. Negotiated Rate	$563.04
Rate for Payer: Cash Price	$430.56
Rate for Payer: Community Health Alliance Commercial	$563.04
Rate for Payer: Priority Health Commercial	$463.68
Rate for Payer: Priority Health PPO	$463.68

PHA PAMIDRONATE DISODIUM 0730

Facility

$128.95

Service Code	HCPCS J2430
Hospital Charge Code	2507540
Hospital Revenue Code	636
Min. Negotiated Rate	$90.27
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$83.82
Rate for Payer: Community Health Alliance Commercial	$109.61
Rate for Payer: Priority Health Commercial	$90.27
Rate for Payer: Priority Health PPO	$90.27

PHA PAMIDRONATE DISODIUM 90MG

Facility

$225.92

Service Code	HCPCS J2430
Hospital Charge Code	2500325
Hospital Revenue Code	636
Min. Negotiated Rate	$158.14
Max. Negotiated Rate	$192.03
Rate for Payer: Cash Price	$146.85
Rate for Payer: Community Health Alliance Commercial	$192.03
Rate for Payer: Priority Health Commercial	$158.14
Rate for Payer: Priority Health PPO	$158.14

PHA PANCURONIUM BROMIDE 1MGINJ

Facility

$25.06

Service Code	NDC 10019028001
Hospital Charge Code	2509525
Hospital Revenue Code	250
Min. Negotiated Rate	$17.54
Max. Negotiated Rate	$21.30
Rate for Payer: Cash Price	$16.29
Rate for Payer: Community Health Alliance Commercial	$21.30
Rate for Payer: Priority Health Commercial	$17.54
Rate for Payer: Priority Health PPO	$17.54

PHA PANITUMUMAB 100 MG/5 ML VI

Facility

$5,204.51

Service Code	HCPCS J9303
Hospital Charge Code	2504243
Hospital Revenue Code	636
Min. Negotiated Rate	$80.24
Max. Negotiated Rate	$4,423.83
Rate for Payer: BCBS BCN 65	$182.35
Rate for Payer: Blue Care Network Medicare Advantage	$182.35
Rate for Payer: Cash Price	$3,382.93
Rate for Payer: Cash Price	$3,382.93
Rate for Payer: Community Health Alliance Commercial	$4,423.83
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$182.35
Rate for Payer: Meridian Health Plan Medicare	$182.35
Rate for Payer: Priority Health Commercial	$3,643.16
Rate for Payer: Priority Health Medicaid	$182.35
Rate for Payer: Priority Health Medicare	$182.35
Rate for Payer: Priority Health PPO	$3,643.16
Rate for Payer: United Health Care Medicaid	$182.35
Rate for Payer: United Health Care Medicare Advantage	$80.24

PHA PANITUMUMAB 400MG 20ML VIA

Facility

$20,824.34

Service Code	HCPCS J9303
Hospital Charge Code	2504242
Hospital Revenue Code	636
Min. Negotiated Rate	$80.24
Max. Negotiated Rate	$17,700.69
Rate for Payer: BCBS BCN 65	$182.35
Rate for Payer: Blue Care Network Medicare Advantage	$182.35
Rate for Payer: Cash Price	$13,535.82
Rate for Payer: Cash Price	$13,535.82
Rate for Payer: Community Health Alliance Commercial	$17,700.69
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$182.35
Rate for Payer: Meridian Health Plan Medicare	$182.35
Rate for Payer: Priority Health Commercial	$14,577.04
Rate for Payer: Priority Health Medicaid	$182.35
Rate for Payer: Priority Health Medicare	$182.35
Rate for Payer: Priority Health PPO	$14,577.04
Rate for Payer: United Health Care Medicaid	$182.35
Rate for Payer: United Health Care Medicare Advantage	$80.24

PHA PANTOPRAZOLE INJ 40MG VIAL

Facility

$31.26

Service Code	NDC 55150020210
Hospital Charge Code	2505075
Hospital Revenue Code	250
Min. Negotiated Rate	$21.88
Max. Negotiated Rate	$26.57
Rate for Payer: Cash Price	$20.32
Rate for Payer: Community Health Alliance Commercial	$26.57
Rate for Payer: Priority Health Commercial	$21.88
Rate for Payer: Priority Health PPO	$21.88

PHA PANTOPRAZOLE SODIUM 40MG T

Facility

$21.31

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500203
Hospital Revenue Code	637
Min. Negotiated Rate	$14.92
Max. Negotiated Rate	$18.11
Rate for Payer: Cash Price	$13.85
Rate for Payer: Community Health Alliance Commercial	$18.11
Rate for Payer: Priority Health Commercial	$14.92
Rate for Payer: Priority Health PPO	$14.92

PHA PAPAVERINE HCL 30MG/ML AMP

Facility

$119.40

Service Code	NDC 517401001
Hospital Charge Code	2507560
Hospital Revenue Code	250
Min. Negotiated Rate	$83.58
Max. Negotiated Rate	$101.49
Rate for Payer: Cash Price	$77.61
Rate for Payer: Community Health Alliance Commercial	$101.49
Rate for Payer: Priority Health Commercial	$83.58
Rate for Payer: Priority Health PPO	$83.58

PHA PARENTERAL ELECTRO 20ML VL

Facility

$15.27

Service Code	NDC 409323601
Hospital Charge Code	2507580
Hospital Revenue Code	250
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$12.98
Rate for Payer: Cash Price	$9.93
Rate for Payer: Community Health Alliance Commercial	$12.98
Rate for Payer: Priority Health Commercial	$10.69
Rate for Payer: Priority Health PPO	$10.69

PHA PAROXETIME 30MG TAB NF

Facility

$14.69

Service Code	NDC 60505008402
Hospital Charge Code	2510807
Hospital Revenue Code	637
Min. Negotiated Rate	$10.28
Max. Negotiated Rate	$12.49
Rate for Payer: Cash Price	$9.55
Rate for Payer: Community Health Alliance Commercial	$12.49
Rate for Payer: Priority Health Commercial	$10.28
Rate for Payer: Priority Health PPO	$10.28

PHA PAROXETINE 10MG TAB

Facility

$14.64

Service Code	HCPCS A9270 GY
Hospital Charge Code	2505151
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges