Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA PEG-ELECTROLYTE 4000ML SOL

Facility

$117.17

Service Code	NDC 43386006019
Hospital Charge Code	2507615
Hospital Revenue Code	250
Min. Negotiated Rate	$82.02
Max. Negotiated Rate	$99.59
Rate for Payer: Cash Price	$76.16
Rate for Payer: Community Health Alliance Commercial	$99.59
Rate for Payer: Priority Health Commercial	$82.02
Rate for Payer: Priority Health PPO	$82.02

PHA PEMETREXED DISODIUM 100MG

Facility

$2,393.29

Service Code	HCPCS J9305
Hospital Charge Code	2500216
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2,034.30
Rate for Payer: BCBS BCN 65	$3.77
Rate for Payer: Blue Care Network Medicare Advantage	$3.77
Rate for Payer: Cash Price	$1,555.64
Rate for Payer: Cash Price	$1,555.64
Rate for Payer: Community Health Alliance Commercial	$2,034.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.77
Rate for Payer: Meridian Health Plan Medicare	$3.77
Rate for Payer: Priority Health Commercial	$1,675.30
Rate for Payer: Priority Health Medicaid	$3.77
Rate for Payer: Priority Health Medicare	$3.77
Rate for Payer: Priority Health PPO	$1,675.30
Rate for Payer: United Health Care Medicaid	$3.77
Rate for Payer: United Health Care Medicare Advantage	$1.66

PHA PENICILLIN 2.5

Facility

$72.14

Service Code	HCPCS J2540
Hospital Charge Code	2507661
Hospital Revenue Code	636
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$61.32
Rate for Payer: Cash Price	$46.89
Rate for Payer: Community Health Alliance Commercial	$61.32
Rate for Payer: Priority Health Commercial	$50.50
Rate for Payer: Priority Health PPO	$50.50

PHA PENICILLIN G BENZATHINE

Facility

$284.94

Service Code	NDC 60793070010
Hospital Charge Code	2507682
Hospital Revenue Code	250
Min. Negotiated Rate	$199.46
Max. Negotiated Rate	$242.20
Rate for Payer: Cash Price	$185.21
Rate for Payer: Community Health Alliance Commercial	$242.20
Rate for Payer: Priority Health Commercial	$199.46
Rate for Payer: Priority Health PPO	$199.46

PHA PENICILLIN V POTASS 250MG

Facility

$2.40

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507830
Hospital Revenue Code	637
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$2.04
Rate for Payer: Cash Price	$1.56
Rate for Payer: Community Health Alliance Commercial	$2.04
Rate for Payer: Priority Health Commercial	$1.68
Rate for Payer: Priority Health PPO	$1.68

PHA PENICILN G POTASS 5000000U

Facility

$27.25

Service Code	HCPCS J2540
Hospital Charge Code	2507660
Hospital Revenue Code	636
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$23.16
Rate for Payer: Cash Price	$17.71
Rate for Payer: Community Health Alliance Commercial	$23.16
Rate for Payer: Priority Health Commercial	$19.07
Rate for Payer: Priority Health PPO	$19.07

PHA PENICILN G PROCANE 600000U

Facility

$281.10

Service Code	NDC 60793013010
Hospital Charge Code	2507670
Hospital Revenue Code	250
Min. Negotiated Rate	$196.77
Max. Negotiated Rate	$238.94
Rate for Payer: Cash Price	$182.72
Rate for Payer: Community Health Alliance Commercial	$238.94
Rate for Payer: Priority Health Commercial	$196.77
Rate for Payer: Priority Health PPO	$196.77

PHA PERCOCET 10MG/325MG TAB

Facility

$18.50

Service Code	NDC 904643961
Hospital Charge Code	2510855
Hospital Revenue Code	637
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$15.72
Rate for Payer: Cash Price	$12.03
Rate for Payer: Community Health Alliance Commercial	$15.72
Rate for Payer: Priority Health Commercial	$12.95
Rate for Payer: Priority Health PPO	$12.95

PHA PERMETHRIN 1% LOTION 59ML

Facility

$54.91

Service Code	NDC 49781002802
Hospital Charge Code	2501228
Hospital Revenue Code	250
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$46.67
Rate for Payer: Cash Price	$35.69
Rate for Payer: Community Health Alliance Commercial	$46.67
Rate for Payer: Priority Health Commercial	$38.44
Rate for Payer: Priority Health PPO	$38.44

PHA PERTUZUMAB 30MG/ML 14ML

Facility

$18,847.46

Service Code	HCPCS J9306
Hospital Charge Code	2501226
Hospital Revenue Code	636
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$16,020.34
Rate for Payer: BCBS BCN 65	$17.86
Rate for Payer: Blue Care Network Medicare Advantage	$17.86
Rate for Payer: Cash Price	$12,250.85
Rate for Payer: Cash Price	$12,250.85
Rate for Payer: Community Health Alliance Commercial	$16,020.34
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.86
Rate for Payer: Meridian Health Plan Medicare	$17.86
Rate for Payer: Priority Health Commercial	$13,193.22
Rate for Payer: Priority Health Medicaid	$17.86
Rate for Payer: Priority Health Medicare	$17.86
Rate for Payer: Priority Health PPO	$13,193.22
Rate for Payer: United Health Care Medicaid	$17.86
Rate for Payer: United Health Care Medicare Advantage	$7.86

PHA PHENAZOPYRIDINE HCL 100MG

Facility

$1.67

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508170
Hospital Revenue Code	637
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$1.09
Rate for Payer: Community Health Alliance Commercial	$1.42
Rate for Payer: Priority Health Commercial	$1.17
Rate for Payer: Priority Health PPO	$1.17

PHA PHENOBARB&BELLA ALK 5ML

Facility

$22.72

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508185
Hospital Revenue Code	637
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$19.31
Rate for Payer: Cash Price	$14.77
Rate for Payer: Community Health Alliance Commercial	$19.31
Rate for Payer: Priority Health Commercial	$15.90
Rate for Payer: Priority Health PPO	$15.90

PHA PHENOBARB BELLADONNA ALK

Facility

$172.01

Service Code	NDC 1234567899
Hospital Charge Code	2505566
Hospital Revenue Code	250
Min. Negotiated Rate	$120.41
Max. Negotiated Rate	$146.21
Rate for Payer: Cash Price	$111.81
Rate for Payer: Community Health Alliance Commercial	$146.21
Rate for Payer: Priority Health Commercial	$120.41
Rate for Payer: Priority Health PPO	$120.41

PHA PHENOBARBITAL 15 MG TAB

Facility

$3.59

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508120
Hospital Revenue Code	637
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$3.05
Rate for Payer: Cash Price	$2.33
Rate for Payer: Community Health Alliance Commercial	$3.05
Rate for Payer: Priority Health Commercial	$2.51
Rate for Payer: Priority Health PPO	$2.51

PHA PHENOBARBITAL SOD 65MG/ML

Facility

$109.92

Service Code	NDC 641047625
Hospital Charge Code	2508160
Hospital Revenue Code	250
Min. Negotiated Rate	$76.94
Max. Negotiated Rate	$93.43
Rate for Payer: Cash Price	$71.45
Rate for Payer: Community Health Alliance Commercial	$93.43
Rate for Payer: Priority Health Commercial	$76.94
Rate for Payer: Priority Health PPO	$76.94

PHA PHENOL 180 ML BTL

Facility

$18.26

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503061
Hospital Revenue Code	637
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$11.87
Rate for Payer: Community Health Alliance Commercial	$15.52
Rate for Payer: Priority Health Commercial	$12.78
Rate for Payer: Priority Health PPO	$12.78

PHA PHENYLEPHRINE 10MG/ML AMP

Facility

$7.09

Service Code	HCPCS J2371
Hospital Charge Code	2507890
Hospital Revenue Code	636
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$6.03
Rate for Payer: Cash Price	$4.61
Rate for Payer: Community Health Alliance Commercial	$6.03
Rate for Payer: Priority Health Commercial	$4.96
Rate for Payer: Priority Health PPO	$4.96

PHA PHENYLEPHRINE 1% 15 ML ML

Facility

$20.58

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508130
Hospital Revenue Code	637
Min. Negotiated Rate	$14.41
Max. Negotiated Rate	$17.49
Rate for Payer: Cash Price	$13.38
Rate for Payer: Community Health Alliance Commercial	$17.49
Rate for Payer: Priority Health Commercial	$14.41
Rate for Payer: Priority Health PPO	$14.41

PHA PHENYLEPHRINE 2.5% 2 ML

Facility

$1.17

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508141
Hospital Revenue Code	637
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.99
Rate for Payer: Cash Price	$0.76
Rate for Payer: Community Health Alliance Commercial	$0.99
Rate for Payer: Priority Health Commercial	$0.82
Rate for Payer: Priority Health PPO	$0.82

PHA PHENYLEPHRIN HCL 0.5% 15ML

Facility

$19.80

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507870
Hospital Revenue Code	637
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$16.83
Rate for Payer: Cash Price	$12.87
Rate for Payer: Community Health Alliance Commercial	$16.83
Rate for Payer: Priority Health Commercial	$13.86
Rate for Payer: Priority Health PPO	$13.86

PHA PHENYTOIN 125 MG/5 ML ML

Facility

$45.01

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508110
Hospital Revenue Code	637
Min. Negotiated Rate	$31.51
Max. Negotiated Rate	$38.26
Rate for Payer: Cash Price	$29.26
Rate for Payer: Community Health Alliance Commercial	$38.26
Rate for Payer: Priority Health Commercial	$31.51
Rate for Payer: Priority Health PPO	$31.51

PHA PHENYTOIN SOD 100MG/2ML V

Facility

$8.70

Service Code	HCPCS J1165
Hospital Charge Code	2507930
Hospital Revenue Code	636
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$7.39
Rate for Payer: Cash Price	$5.66
Rate for Payer: Community Health Alliance Commercial	$7.39
Rate for Payer: Priority Health Commercial	$6.09
Rate for Payer: Priority Health PPO	$6.09

PHA PHENYTOIN SOD 250MG/5ML V

Facility

$12.45

Service Code	HCPCS J1165
Hospital Charge Code	2507931
Hospital Revenue Code	636
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$10.58
Rate for Payer: Cash Price	$8.09
Rate for Payer: Community Health Alliance Commercial	$10.58
Rate for Payer: Priority Health Commercial	$8.71
Rate for Payer: Priority Health PPO	$8.71

PHA PHENYTOIN SODIUM 100MG CAP

Facility

$3.80

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507880
Hospital Revenue Code	637
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$3.23
Rate for Payer: Cash Price	$2.47
Rate for Payer: Community Health Alliance Commercial	$3.23
Rate for Payer: Priority Health Commercial	$2.66
Rate for Payer: Priority Health PPO	$2.66

PHA PHYSOSTIGMIN SALICYLAT 1MG

Facility

$313.76

Service Code	NDC 17478051002
Hospital Charge Code	2507940
Hospital Revenue Code	250
Min. Negotiated Rate	$219.63
Max. Negotiated Rate	$266.70
Rate for Payer: Cash Price	$203.94
Rate for Payer: Community Health Alliance Commercial	$266.70
Rate for Payer: Priority Health Commercial	$219.63
Rate for Payer: Priority Health PPO	$219.63

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges