Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA PROPYLTHIOURACIL 50MG TAB

Facility

$4.69

Service Code	HCPCS A9270 GY
Hospital Charge Code	2503737
Hospital Revenue Code	637
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.99
Rate for Payer: Cash Price	$3.05
Rate for Payer: Community Health Alliance Commercial	$3.99
Rate for Payer: Priority Health Commercial	$3.28
Rate for Payer: Priority Health PPO	$3.28

PHA PROTAMINE SULFATE 10MG/ML

Facility

$96.96

Service Code	NDC 63323022905
Hospital Charge Code	2508700
Hospital Revenue Code	250
Min. Negotiated Rate	$67.87
Max. Negotiated Rate	$82.42
Rate for Payer: Cash Price	$63.02
Rate for Payer: Community Health Alliance Commercial	$82.42
Rate for Payer: Priority Health Commercial	$67.87
Rate for Payer: Priority Health PPO	$67.87

PHA PROVAYBLUE 5MG/ML 10 ML

Facility

$776.31

Service Code	NDC 517037405
Hospital Charge Code	2510854
Hospital Revenue Code	250
Min. Negotiated Rate	$543.42
Max. Negotiated Rate	$659.86
Rate for Payer: Cash Price	$504.60
Rate for Payer: Community Health Alliance Commercial	$659.86
Rate for Payer: Priority Health Commercial	$543.42
Rate for Payer: Priority Health PPO	$543.42

PHA PROZAC 10 MG CAPSULE

Facility

$12.61

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506055
Hospital Revenue Code	637
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$10.72
Rate for Payer: Cash Price	$8.20
Rate for Payer: Community Health Alliance Commercial	$10.72
Rate for Payer: Priority Health Commercial	$8.83
Rate for Payer: Priority Health PPO	$8.83

PHA PSEUDOEPHEDRINE 30MG TAB

Facility

$0.16

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508743
Hospital Revenue Code	637
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.10
Rate for Payer: Community Health Alliance Commercial	$0.14
Rate for Payer: Priority Health Commercial	$0.11
Rate for Payer: Priority Health PPO	$0.11

PHA PSYLIUM(EFFERVESCNT)5.4GM

Facility

$2.66

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508750
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 PYRIDOXINE 100MG/ML VIAL

Facility

$118.29

Service Code	HCPCS J3415
Hospital Charge Code	2508761
Hospital Revenue Code	636
Min. Negotiated Rate	$82.80
Max. Negotiated Rate	$100.55
Rate for Payer: Cash Price	$76.89
Rate for Payer: Community Health Alliance Commercial	$100.55
Rate for Payer: Priority Health Commercial	$82.80
Rate for Payer: Priority Health PPO	$82.80

PHA QUESTRAN 4MG PACKET NF

Facility

$37.04

Service Code	NDC 49884093665
Hospital Charge Code	2510779
Hospital Revenue Code	250
Min. Negotiated Rate	$25.93
Max. Negotiated Rate	$31.48
Rate for Payer: Cash Price	$24.08
Rate for Payer: Community Health Alliance Commercial	$31.48
Rate for Payer: Priority Health Commercial	$25.93
Rate for Payer: Priority Health PPO	$25.93

PHA QUETIAPINE FUMARATE 100MG

Facility

$13.01

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506215
Hospital Revenue Code	637
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$11.06
Rate for Payer: Cash Price	$8.46
Rate for Payer: Community Health Alliance Commercial	$11.06
Rate for Payer: Priority Health Commercial	$9.11
Rate for Payer: Priority Health PPO	$9.11

PHA QUETIAPINE FUMARATE 25MG

Facility

$20.84

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506225
Hospital Revenue Code	637
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$17.71
Rate for Payer: Cash Price	$13.55
Rate for Payer: Community Health Alliance Commercial	$17.71
Rate for Payer: Priority Health Commercial	$14.59
Rate for Payer: Priority Health PPO	$14.59

PHA QUINIDINE SULFATE 200MG TB

Facility

$1.04

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508780
Hospital Revenue Code	637
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.88
Rate for Payer: Cash Price	$0.68
Rate for Payer: Community Health Alliance Commercial	$0.88
Rate for Payer: Priority Health Commercial	$0.73
Rate for Payer: Priority Health PPO	$0.73

PHA RABIES IMMUNE GLOBULIN 150

Facility

$9,171.60

Service Code	HCPCS 90375
Hospital Charge Code	2508935
Hospital Revenue Code	636
Min. Negotiated Rate	$129.34
Max. Negotiated Rate	$7,795.86
Rate for Payer: BCBS BCN 65	$293.95
Rate for Payer: Blue Care Network Medicare Advantage	$293.95
Rate for Payer: Cash Price	$5,961.54
Rate for Payer: Cash Price	$5,961.54
Rate for Payer: Community Health Alliance Commercial	$7,795.86
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$293.95
Rate for Payer: Meridian Health Plan Medicare	$293.95
Rate for Payer: Priority Health Commercial	$6,420.12
Rate for Payer: Priority Health Medicaid	$293.95
Rate for Payer: Priority Health Medicare	$293.95
Rate for Payer: Priority Health PPO	$6,420.12
Rate for Payer: United Health Care Medicaid	$293.95
Rate for Payer: United Health Care Medicare Advantage	$129.34

PHA RABIES IMMUN GLOB 150IU/ML

Facility

$2,201.06

Service Code	HCPCS 90375
Hospital Charge Code	2508930
Hospital Revenue Code	636
Min. Negotiated Rate	$129.34
Max. Negotiated Rate	$1,870.90
Rate for Payer: BCBS BCN 65	$293.95
Rate for Payer: Blue Care Network Medicare Advantage	$293.95
Rate for Payer: Cash Price	$1,430.69
Rate for Payer: Cash Price	$1,430.69
Rate for Payer: Community Health Alliance Commercial	$1,870.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$293.95
Rate for Payer: Meridian Health Plan Medicare	$293.95
Rate for Payer: Priority Health Commercial	$1,540.74
Rate for Payer: Priority Health Medicaid	$293.95
Rate for Payer: Priority Health Medicare	$293.95
Rate for Payer: Priority Health PPO	$1,540.74
Rate for Payer: United Health Care Medicaid	$293.95
Rate for Payer: United Health Care Medicare Advantage	$129.34

PHA RABIES VAC ABSORBED 2.5 U

Facility

$1,280.60

Service Code	HCPCS 90675
Hospital Charge Code	2508940
Hospital Revenue Code	636
Min. Negotiated Rate	$147.72
Max. Negotiated Rate	$1,088.51
Rate for Payer: BCBS BCN 65	$335.74
Rate for Payer: Blue Care Network Medicare Advantage	$335.74
Rate for Payer: Cash Price	$832.39
Rate for Payer: Cash Price	$832.39
Rate for Payer: Community Health Alliance Commercial	$1,088.51
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$335.74
Rate for Payer: Meridian Health Plan Medicare	$335.74
Rate for Payer: Priority Health Commercial	$896.42
Rate for Payer: Priority Health Medicaid	$335.74
Rate for Payer: Priority Health Medicare	$335.74
Rate for Payer: Priority Health PPO	$896.42
Rate for Payer: United Health Care Medicaid	$335.74
Rate for Payer: United Health Care Medicare Advantage	$147.72

PHA RACEMIC EPINEPHRINE .5ML S

Facility

$13.03

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508947
Hospital Revenue Code	637
Min. Negotiated Rate	$9.12
Max. Negotiated Rate	$11.08
Rate for Payer: Cash Price	$8.47
Rate for Payer: Community Health Alliance Commercial	$11.08
Rate for Payer: Priority Health Commercial	$9.12
Rate for Payer: Priority Health PPO	$9.12

PHA RANEXA 500MG TAB NF

Facility

$34.80

Service Code	NDC 61958100301
Hospital Charge Code	2510813
Hospital Revenue Code	637
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$29.58
Rate for Payer: Cash Price	$22.62
Rate for Payer: Community Health Alliance Commercial	$29.58
Rate for Payer: Priority Health Commercial	$24.36
Rate for Payer: Priority Health PPO	$24.36

PHA RANITIDINE HCL 150MG TAB

Facility

$1.88

Service Code	HCPCS A9270 GY
Hospital Charge Code	2508950
Hospital Revenue Code	637
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$1.22
Rate for Payer: Community Health Alliance Commercial	$1.60
Rate for Payer: Priority Health Commercial	$1.32
Rate for Payer: Priority Health PPO	$1.32

PHA RECLAST 5MG/100ML PREMIX

Facility

$1,159.20

Service Code	HCPCS J3489
Hospital Charge Code	2510924
Hospital Revenue Code	636
Min. Negotiated Rate	$811.44
Max. Negotiated Rate	$985.32
Rate for Payer: Cash Price	$753.48
Rate for Payer: Community Health Alliance Commercial	$985.32
Rate for Payer: Priority Health Commercial	$811.44
Rate for Payer: Priority Health PPO	$811.44

PHA RECLAST 5MG/100 ML VIAL

Facility

$496.80

Service Code	HCPCS J3489
Hospital Charge Code	2506622
Hospital Revenue Code	636
Min. Negotiated Rate	$347.76
Max. Negotiated Rate	$422.28
Rate for Payer: Cash Price	$322.92
Rate for Payer: Community Health Alliance Commercial	$422.28
Rate for Payer: Priority Health Commercial	$347.76
Rate for Payer: Priority Health PPO	$347.76

PHA REMEDESIVIR

Facility

$1,537.99

Service Code	HCPCS J0248
Hospital Charge Code	2510869
Hospital Revenue Code	250
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$1,307.29
Rate for Payer: BCBS BCN 65	$7.25
Rate for Payer: Blue Care Network Medicare Advantage	$7.25
Rate for Payer: Cash Price	$999.69
Rate for Payer: Cash Price	$999.69
Rate for Payer: Community Health Alliance Commercial	$1,307.29
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.25
Rate for Payer: Meridian Health Plan Medicare	$7.25
Rate for Payer: Priority Health Commercial	$1,076.59
Rate for Payer: Priority Health Medicaid	$7.25
Rate for Payer: Priority Health Medicare	$7.25
Rate for Payer: Priority Health PPO	$1,076.59
Rate for Payer: United Health Care Medicaid	$7.25
Rate for Payer: United Health Care Medicare Advantage	$3.19

PHA REMICADE, 100 MG INJ 7043

Facility

$3,195.15

Service Code	HCPCS J1745
Hospital Charge Code	2502657
Hospital Revenue Code	636
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$2,715.88
Rate for Payer: BCBS BCN 65	$34.04
Rate for Payer: Blue Care Network Medicare Advantage	$34.04
Rate for Payer: Cash Price	$2,076.85
Rate for Payer: Cash Price	$2,076.85
Rate for Payer: Community Health Alliance Commercial	$2,715.88
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$34.04
Rate for Payer: Meridian Health Plan Medicare	$34.04
Rate for Payer: Priority Health Commercial	$2,236.61
Rate for Payer: Priority Health Medicaid	$34.04
Rate for Payer: Priority Health Medicare	$34.04
Rate for Payer: Priority Health PPO	$2,236.61
Rate for Payer: United Health Care Medicaid	$34.04
Rate for Payer: United Health Care Medicare Advantage	$14.98

PHA RENFLEXIS 100MG VIAL

Facility

$2,224.01

Service Code	NDC 78206016201
Hospital Charge Code	2510973
Hospital Revenue Code	636
Min. Negotiated Rate	$1,556.81
Max. Negotiated Rate	$1,890.41
Rate for Payer: Cash Price	$1,445.61
Rate for Payer: Community Health Alliance Commercial	$1,890.41
Rate for Payer: Priority Health Commercial	$1,556.81
Rate for Payer: Priority Health PPO	$1,556.81

PHA RETACRIT 10.000 UNITS/ML

Facility

$374.31

Service Code	NDC 69130810
Hospital Charge Code	2510955
Hospital Revenue Code	636
Min. Negotiated Rate	$262.02
Max. Negotiated Rate	$318.16
Rate for Payer: Cash Price	$243.30
Rate for Payer: Community Health Alliance Commercial	$318.16
Rate for Payer: Priority Health Commercial	$262.02
Rate for Payer: Priority Health PPO	$262.02

PHA RETACRIT 2,000 IU VIAL

Facility

$107.94

Service Code	NDC 69130510
Hospital Charge Code	2510945
Hospital Revenue Code	250
Min. Negotiated Rate	$75.56
Max. Negotiated Rate	$91.75
Rate for Payer: Cash Price	$70.16
Rate for Payer: Community Health Alliance Commercial	$91.75
Rate for Payer: Priority Health Commercial	$75.56
Rate for Payer: Priority Health PPO	$75.56

PHA RETACRIT 3000IU/VIAL

Facility

$161.95

Service Code	NDC 69130610
Hospital Charge Code	2510949
Hospital Revenue Code	250
Min. Negotiated Rate	$113.36
Max. Negotiated Rate	$137.66
Rate for Payer: Cash Price	$105.27
Rate for Payer: Community Health Alliance Commercial	$137.66
Rate for Payer: Priority Health Commercial	$113.36
Rate for Payer: Priority Health PPO	$113.36

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges