Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA PHYTONADIONE 10MG/ML AMP

Facility

$196.26

Service Code	NDC 409915801
Hospital Charge Code	2507950
Hospital Revenue Code	250
Min. Negotiated Rate	$137.38
Max. Negotiated Rate	$166.82
Rate for Payer: Cash Price	$127.57
Rate for Payer: Community Health Alliance Commercial	$166.82
Rate for Payer: Priority Health Commercial	$137.38
Rate for Payer: Priority Health PPO	$137.38

PHA PHYTONADIONE 1MG/0.5ML AMP

Facility

$118.13

Service Code	NDC 76329124001
Hospital Charge Code	2507960
Hospital Revenue Code	250
Min. Negotiated Rate	$82.69
Max. Negotiated Rate	$100.41
Rate for Payer: Cash Price	$76.78
Rate for Payer: Community Health Alliance Commercial	$100.41
Rate for Payer: Priority Health Commercial	$82.69
Rate for Payer: Priority Health PPO	$82.69

PHA PILOCARPINE 1% 15 ML SOL

Facility

$329.19

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507980
Hospital Revenue Code	637
Min. Negotiated Rate	$230.43
Max. Negotiated Rate	$279.81
Rate for Payer: Cash Price	$213.97
Rate for Payer: Community Health Alliance Commercial	$279.81
Rate for Payer: Priority Health Commercial	$230.43
Rate for Payer: Priority Health PPO	$230.43

PHA PILOCARPINE 2% 15 ML OPTH

Facility

$278.24

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507990
Hospital Revenue Code	637
Min. Negotiated Rate	$194.77
Max. Negotiated Rate	$236.50
Rate for Payer: Cash Price	$180.86
Rate for Payer: Community Health Alliance Commercial	$236.50
Rate for Payer: Priority Health Commercial	$194.77
Rate for Payer: Priority Health PPO	$194.77

PHA PILOCARPINE 4% 15 ML OPTH

Facility

$104.71

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508200
Hospital Revenue Code	637
Min. Negotiated Rate	$73.30
Max. Negotiated Rate	$89.00
Rate for Payer: Cash Price	$68.06
Rate for Payer: Community Health Alliance Commercial	$89.00
Rate for Payer: Priority Health Commercial	$73.30
Rate for Payer: Priority Health PPO	$73.30

PHA PIPERACILLIN SODIUM

Facility

$18.76

Service Code	NDC 55150011930
Hospital Charge Code	2507474
Hospital Revenue Code	250
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$15.95
Rate for Payer: Cash Price	$12.19
Rate for Payer: Community Health Alliance Commercial	$15.95
Rate for Payer: Priority Health Commercial	$13.13
Rate for Payer: Priority Health PPO	$13.13

PHA PIPERACILLIN SODIUM-TAZ

Facility

$109.65

Service Code	HCPCS J2543
Hospital Charge Code	2507836
Hospital Revenue Code	636
Min. Negotiated Rate	$76.75
Max. Negotiated Rate	$93.20
Rate for Payer: Cash Price	$71.27
Rate for Payer: Community Health Alliance Commercial	$93.20
Rate for Payer: Priority Health Commercial	$76.75
Rate for Payer: Priority Health PPO	$76.75

PHA PITOCIN 10 UNITS/1000ML

Facility

$51.98

Service Code	HCPCS J2590
Hospital Charge Code	2507522
Hospital Revenue Code	636
Min. Negotiated Rate	$36.39
Max. Negotiated Rate	$44.18
Rate for Payer: Cash Price	$33.79
Rate for Payer: Community Health Alliance Commercial	$44.18
Rate for Payer: Priority Health Commercial	$36.39
Rate for Payer: Priority Health PPO	$36.39

PHA PLAN B 0.75 MG TAB

Facility

$109.92

Service Code	NDC 62756071860
Hospital Charge Code	2502635
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 PLAQUENIL 100MG TABLET NF

Facility

$21.31

Service Code	NDC 66993005702
Hospital Charge Code	2510791
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 PNEUMOVAX 25MCG/0.5ML

Facility

$387.78

Service Code	NDC 6494300
Hospital Charge Code	2507725
Hospital Revenue Code	636
Min. Negotiated Rate	$271.45
Max. Negotiated Rate	$329.61
Rate for Payer: Cash Price	$252.06
Rate for Payer: Community Health Alliance Commercial	$329.61
Rate for Payer: Priority Health Commercial	$271.45
Rate for Payer: Priority Health PPO	$271.45

PHA POLYMYXIN B SULF 500000 U

Facility

$91.71

Hospital Charge Code	2508270
Hospital Revenue Code	250
Min. Negotiated Rate	$64.20
Max. Negotiated Rate	$77.95
Rate for Payer: Cash Price	$59.61
Rate for Payer: Community Health Alliance Commercial	$77.95
Rate for Payer: Priority Health Commercial	$64.20
Rate for Payer: Priority Health PPO	$64.20

PHA POTASS BICARBONATE 25MEQ

Facility

$4.85

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508300
Hospital Revenue Code	637
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.12
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.12
Rate for Payer: Priority Health Commercial	$3.40
Rate for Payer: Priority Health PPO	$3.40

PHA POTASS CHLORIDE 10MEQ CAP

Facility

$3.23

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508260
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 POTASS CHLORIDE 8 MEQ CAP

Facility

$3.44

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508320
Hospital Revenue Code	637
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$2.24
Rate for Payer: Community Health Alliance Commercial	$2.92
Rate for Payer: Priority Health Commercial	$2.41
Rate for Payer: Priority Health PPO	$2.41

PHA POTASS CHLR 20MEQ/15ML ML

Facility

$104.52

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508330
Hospital Revenue Code	637
Min. Negotiated Rate	$73.16
Max. Negotiated Rate	$88.84
Rate for Payer: Cash Price	$67.94
Rate for Payer: Community Health Alliance Commercial	$88.84
Rate for Payer: Priority Health Commercial	$73.16
Rate for Payer: Priority Health PPO	$73.16

PHA POTASS CHLR 40MEQ/20ML VL

Facility

$31.62

Service Code	NDC 409665305
Hospital Charge Code	2508310
Hospital Revenue Code	250
Min. Negotiated Rate	$22.13
Max. Negotiated Rate	$26.88
Rate for Payer: Cash Price	$20.55
Rate for Payer: Community Health Alliance Commercial	$26.88
Rate for Payer: Priority Health Commercial	$22.13
Rate for Payer: Priority Health PPO	$22.13

PHA POTASSIUM CHL 100 ML INJ

Facility

$24.70

Service Code	NDC 338070948
Hospital Charge Code	2508297
Hospital Revenue Code	250
Min. Negotiated Rate	$17.29
Max. Negotiated Rate	$21.00
Rate for Payer: Cash Price	$16.06
Rate for Payer: Community Health Alliance Commercial	$21.00
Rate for Payer: Priority Health Commercial	$17.29
Rate for Payer: Priority Health PPO	$17.29

PHA POTASSIUM CHLORIDE 1000ML

Facility

$36.94

Service Code	NDC 338067104
Hospital Charge Code	2508296
Hospital Revenue Code	250
Min. Negotiated Rate	$25.86
Max. Negotiated Rate	$31.40
Rate for Payer: Cash Price	$24.01
Rate for Payer: Community Health Alliance Commercial	$31.40
Rate for Payer: Priority Health Commercial	$25.86
Rate for Payer: Priority Health PPO	$25.86

PHA POTASSIUM CHLORIDE 1000ML

Facility

$58.44

Service Code	NDC 338069104
Hospital Charge Code	2508292
Hospital Revenue Code	250
Min. Negotiated Rate	$40.91
Max. Negotiated Rate	$49.67
Rate for Payer: Cash Price	$37.99
Rate for Payer: Community Health Alliance Commercial	$49.67
Rate for Payer: Priority Health Commercial	$40.91
Rate for Payer: Priority Health PPO	$40.91

PHA POTASSIUM CHLORIDE 40MEQ

Facility

$65.86

Service Code	NDC 338069504
Hospital Charge Code	2508293
Hospital Revenue Code	250
Min. Negotiated Rate	$46.10
Max. Negotiated Rate	$55.98
Rate for Payer: Cash Price	$42.81
Rate for Payer: Community Health Alliance Commercial	$55.98
Rate for Payer: Priority Health Commercial	$46.10
Rate for Payer: Priority Health PPO	$46.10

PHA POTASSIUM PHOSPHATE 3MM

Facility

$81.39

Service Code	NDC 63323008605
Hospital Charge Code	2508338
Hospital Revenue Code	250
Min. Negotiated Rate	$56.97
Max. Negotiated Rate	$69.18
Rate for Payer: Cash Price	$52.90
Rate for Payer: Community Health Alliance Commercial	$69.18
Rate for Payer: Priority Health Commercial	$56.97
Rate for Payer: Priority Health PPO	$56.97

PHA POT PHOSPHATE DIBASIC

Facility

$2.66

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501014
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$2.26
Rate for Payer: Cash Price	$1.73
Rate for Payer: Community Health Alliance Commercial	$2.26
Rate for Payer: Priority Health Commercial	$1.86
Rate for Payer: Priority Health PPO	$1.86

PHA PRALIDOXIME CHLORIDE 1GM

Facility

$287.15

Service Code	NDC 60977014101
Hospital Charge Code	2508345
Hospital Revenue Code	250
Min. Negotiated Rate	$201.00
Max. Negotiated Rate	$244.08
Rate for Payer: Cash Price	$186.65
Rate for Payer: Community Health Alliance Commercial	$244.08
Rate for Payer: Priority Health Commercial	$201.00
Rate for Payer: Priority Health PPO	$201.00

PHA PRAVASTATION 80MG TAB NF

Facility

$24.96

Service Code	NDC 68462019890
Hospital Charge Code	2510809
Hospital Revenue Code	637
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$21.22
Rate for Payer: Cash Price	$16.22
Rate for Payer: Community Health Alliance Commercial	$21.22
Rate for Payer: Priority Health Commercial	$17.47
Rate for Payer: Priority Health PPO	$17.47

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges