Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA PRAVASTIN 40MG TAB NF

Facility

$22.35

Service Code	NDC 904589361
Hospital Charge Code	2510808
Hospital Revenue Code	637
Min. Negotiated Rate	$15.64
Max. Negotiated Rate	$19.00
Rate for Payer: Cash Price	$14.53
Rate for Payer: Community Health Alliance Commercial	$19.00
Rate for Payer: Priority Health Commercial	$15.64
Rate for Payer: Priority Health PPO	$15.64

PHA PRECEDEX 200MCG/50ML VIAL

Facility

$185.17

Service Code	NDC 781349491
Hospital Charge Code	2510866
Hospital Revenue Code	250
Min. Negotiated Rate	$129.62
Max. Negotiated Rate	$157.39
Rate for Payer: Cash Price	$120.36
Rate for Payer: Community Health Alliance Commercial	$157.39
Rate for Payer: Priority Health Commercial	$129.62
Rate for Payer: Priority Health PPO	$129.62

PHA PREDNISOLONE 15 MG/5ML SYR

Facility

$12.56

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508778
Hospital Revenue Code	637
Min. Negotiated Rate	$8.79
Max. Negotiated Rate	$10.68
Rate for Payer: Cash Price	$8.16
Rate for Payer: Community Health Alliance Commercial	$10.68
Rate for Payer: Priority Health Commercial	$8.79
Rate for Payer: Priority Health PPO	$8.79

PHA PREDNISOLONE SOD PHOS BTL

Facility

$184.77

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508391
Hospital Revenue Code	637
Min. Negotiated Rate	$129.34
Max. Negotiated Rate	$157.05
Rate for Payer: Cash Price	$120.10
Rate for Payer: Community Health Alliance Commercial	$157.05
Rate for Payer: Priority Health Commercial	$129.34
Rate for Payer: Priority Health PPO	$129.34

PHA PREDNISONE 20 MG TAB 7050

Facility

$1.25

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508360
Hospital Revenue Code	637
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.06
Rate for Payer: Cash Price	$0.81
Rate for Payer: Community Health Alliance Commercial	$1.06
Rate for Payer: Priority Health Commercial	$0.88
Rate for Payer: Priority Health PPO	$0.88

PHA PREDNISONE 50 MG TABLET

Facility

$2.19

Service Code	NDC 54001920
Hospital Charge Code	2510848
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.86
Rate for Payer: Cash Price	$1.42
Rate for Payer: Community Health Alliance Commercial	$1.86
Rate for Payer: Priority Health Commercial	$1.53
Rate for Payer: Priority Health PPO	$1.53

PHA PREDNISONE 5 MG TAB 7050

Facility

$1.09

Service Code	HCPCS J7512
Hospital Charge Code	2508370
Hospital Revenue Code	636
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.71
Rate for Payer: Community Health Alliance Commercial	$0.93
Rate for Payer: Priority Health Commercial	$0.76
Rate for Payer: Priority Health PPO	$0.76

PHA PREGABALIN 75 MG CAP

Facility

$61.19

Service Code	HCPCS A9270 GY
Hospital Charge Code	2509053
Hospital Revenue Code	637
Min. Negotiated Rate	$42.83
Max. Negotiated Rate	$52.01
Rate for Payer: Cash Price	$39.77
Rate for Payer: Community Health Alliance Commercial	$52.01
Rate for Payer: Priority Health Commercial	$42.83
Rate for Payer: Priority Health PPO	$42.83

PHA PREVNAR 13

Facility

$749.53

Service Code	NDC 5197102
Hospital Charge Code	2508251
Hospital Revenue Code	636
Min. Negotiated Rate	$524.67
Max. Negotiated Rate	$637.10
Rate for Payer: Cash Price	$487.19
Rate for Payer: Community Health Alliance Commercial	$637.10
Rate for Payer: Priority Health Commercial	$524.67
Rate for Payer: Priority Health PPO	$524.67

PHA PROCHLORPERAZINE 25MG

Facility

$65.54

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508495
Hospital Revenue Code	637
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$55.71
Rate for Payer: Cash Price	$42.60
Rate for Payer: Community Health Alliance Commercial	$55.71
Rate for Payer: Priority Health Commercial	$45.88
Rate for Payer: Priority Health PPO	$45.88

PHA PROCHLORPERAZINE EDISYLATE

Facility

$98.93

Service Code	NDC 14789070002
Hospital Charge Code	2508540
Hospital Revenue Code	250
Min. Negotiated Rate	$69.25
Max. Negotiated Rate	$84.09
Rate for Payer: Cash Price	$64.30
Rate for Payer: Community Health Alliance Commercial	$84.09
Rate for Payer: Priority Health Commercial	$69.25
Rate for Payer: Priority Health PPO	$69.25

PHA PROCHLORPERAZINE MAL5MGTAB

Facility

$3.18

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508530
Hospital Revenue Code	637
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.70
Rate for Payer: Cash Price	$2.07
Rate for Payer: Community Health Alliance Commercial	$2.70
Rate for Payer: Priority Health Commercial	$2.23
Rate for Payer: Priority Health PPO	$2.23

PHA PROGESTERONE 50 MG INJECT

Facility

$20.37

Service Code	NDC 517075001
Hospital Charge Code	2503025
Hospital Revenue Code	250
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$17.31
Rate for Payer: Cash Price	$13.24
Rate for Payer: Community Health Alliance Commercial	$17.31
Rate for Payer: Priority Health Commercial	$14.26
Rate for Payer: Priority Health PPO	$14.26

PHA PROMETHAZINE-DM 480ML ML

Facility

$7.24

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508610
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 PROMETHAZINE HCL 1 ML ML

Facility

$1.20

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508620
Hospital Revenue Code	637
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.02
Rate for Payer: Cash Price	$0.78
Rate for Payer: Community Health Alliance Commercial	$1.02
Rate for Payer: Priority Health Commercial	$0.84
Rate for Payer: Priority Health PPO	$0.84

PHA PROMETHAZINE HCL 25MG SUP

Facility

$92.27

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508580
Hospital Revenue Code	637
Min. Negotiated Rate	$64.59
Max. Negotiated Rate	$78.43
Rate for Payer: Cash Price	$59.98
Rate for Payer: Community Health Alliance Commercial	$78.43
Rate for Payer: Priority Health Commercial	$64.59
Rate for Payer: Priority Health PPO	$64.59

PHA PROMETHAZINE HCL 25MG TAB

Facility

$3.56

Service Code	HCPCS Q0169
Hospital Charge Code	2508560
Hospital Revenue Code	250
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$3.03
Rate for Payer: Cash Price	$2.31
Rate for Payer: Community Health Alliance Commercial	$3.03
Rate for Payer: Priority Health Commercial	$2.49
Rate for Payer: Priority Health PPO	$2.49

PHA PROMETHAZINE W/COD 5 ML

Facility

$1.82

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508605
Hospital Revenue Code	637
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.55
Rate for Payer: Cash Price	$1.18
Rate for Payer: Community Health Alliance Commercial	$1.55
Rate for Payer: Priority Health Commercial	$1.27
Rate for Payer: Priority Health PPO	$1.27

PHA PROMETHAZIN HCL 12.5MG SUP

Facility

$92.27

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508550
Hospital Revenue Code	637
Min. Negotiated Rate	$64.59
Max. Negotiated Rate	$78.43
Rate for Payer: Cash Price	$59.98
Rate for Payer: Community Health Alliance Commercial	$78.43
Rate for Payer: Priority Health Commercial	$64.59
Rate for Payer: Priority Health PPO	$64.59

PHA PROMETHAZN HCL 25MG/ML AMP

Facility

$11.57

Service Code	HCPCS J2550
Hospital Charge Code	2508570
Hospital Revenue Code	636
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$9.83
Rate for Payer: Cash Price	$7.52
Rate for Payer: Community Health Alliance Commercial	$9.83
Rate for Payer: Priority Health Commercial	$8.10
Rate for Payer: Priority Health PPO	$8.10

PHA PROPARACAINE HCL 15ML BTL

Facility

$64.94

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508630
Hospital Revenue Code	637
Min. Negotiated Rate	$45.46
Max. Negotiated Rate	$55.20
Rate for Payer: Cash Price	$42.21
Rate for Payer: Community Health Alliance Commercial	$55.20
Rate for Payer: Priority Health Commercial	$45.46
Rate for Payer: Priority Health PPO	$45.46

PHA PROPOFOL 10MG/ML AMP

Facility

$44.91

Service Code	HCPCS J2704
Hospital Charge Code	2508680
Hospital Revenue Code	636
Min. Negotiated Rate	$31.44
Max. Negotiated Rate	$38.17
Rate for Payer: Cash Price	$29.19
Rate for Payer: Community Health Alliance Commercial	$38.17
Rate for Payer: Priority Health Commercial	$31.44
Rate for Payer: Priority Health PPO	$31.44

PHA PROPOFOL 1% 100 ML INJ

Facility

$167.41

Service Code	NDC 63323026965
Hospital Charge Code	2508686
Hospital Revenue Code	250
Min. Negotiated Rate	$117.19
Max. Negotiated Rate	$142.30
Rate for Payer: Cash Price	$108.82
Rate for Payer: Community Health Alliance Commercial	$142.30
Rate for Payer: Priority Health Commercial	$117.19
Rate for Payer: Priority Health PPO	$117.19

PHA PROPOFOL1% 10MG 50 ML INJ

Facility

$94.64

Service Code	HCPCS J2704
Hospital Charge Code	2508685
Hospital Revenue Code	636
Min. Negotiated Rate	$66.25
Max. Negotiated Rate	$80.44
Rate for Payer: Cash Price	$61.52
Rate for Payer: Community Health Alliance Commercial	$80.44
Rate for Payer: Priority Health Commercial	$66.25
Rate for Payer: Priority Health PPO	$66.25

PHA PROPRANOLOL HCL 10 MG TAB

Facility

$0.51

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508640
Hospital Revenue Code	637
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.43
Rate for Payer: Cash Price	$0.33
Rate for Payer: Community Health Alliance Commercial	$0.43
Rate for Payer: Priority Health Commercial	$0.36
Rate for Payer: Priority Health PPO	$0.36

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges