Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA TUBERCULIN 5 U/0.1ML VIAL

Facility

$69.34

Service Code	NDC 49281075221
Hospital Charge Code	2510260
Hospital Revenue Code	250
Min. Negotiated Rate	$48.54
Max. Negotiated Rate	$58.94
Rate for Payer: Cash Price	$45.07
Rate for Payer: Community Health Alliance Commercial	$58.94
Rate for Payer: Priority Health Commercial	$48.54
Rate for Payer: Priority Health PPO	$48.54

PHA VALACYCLOVIR 500MG TABLET

Facility

$37.62

Service Code	NDC 45963055830
Hospital Charge Code	2510401
Hospital Revenue Code	637
Min. Negotiated Rate	$26.33
Max. Negotiated Rate	$31.98
Rate for Payer: Cash Price	$24.45
Rate for Payer: Community Health Alliance Commercial	$31.98
Rate for Payer: Priority Health Commercial	$26.33
Rate for Payer: Priority Health PPO	$26.33

PHA VALPROIC ACID 500MG INJ

Facility

$41.89

Service Code	NDC 63323049405
Hospital Charge Code	2507935
Hospital Revenue Code	250
Min. Negotiated Rate	$29.32
Max. Negotiated Rate	$35.61
Rate for Payer: Cash Price	$27.23
Rate for Payer: Community Health Alliance Commercial	$35.61
Rate for Payer: Priority Health Commercial	$29.32
Rate for Payer: Priority Health PPO	$29.32

PHA VANCOMYCIN 125 MG TAB

Facility

$138.58

Service Code	HCPCS A9270 GY
Hospital Charge Code	2502891
Hospital Revenue Code	637
Min. Negotiated Rate	$97.01
Max. Negotiated Rate	$117.79
Rate for Payer: Cash Price	$90.08
Rate for Payer: Community Health Alliance Commercial	$117.79
Rate for Payer: Priority Health Commercial	$97.01
Rate for Payer: Priority Health PPO	$97.01

PHA VANCOMYCIN HCL 1 GM VIAL

Facility

$37.51

Service Code	HCPCS J3373
Hospital Charge Code	2510390
Hospital Revenue Code	636
Min. Negotiated Rate	$26.26
Max. Negotiated Rate	$31.88
Rate for Payer: Cash Price	$24.38
Rate for Payer: Community Health Alliance Commercial	$31.88
Rate for Payer: Priority Health Commercial	$26.26
Rate for Payer: Priority Health PPO	$26.26

PHA VANCOMYCIN HCL 500 MG VIAL

Facility

$18.76

Service Code	HCPCS J3370
Hospital Charge Code	2507557
Hospital Revenue Code	636
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 VARICELLA VIRUS VACCINE

Facility

$349.91

Service Code	HCPCS 90716
Hospital Charge Code	2510405
Hospital Revenue Code	636
Min. Negotiated Rate	$244.94
Max. Negotiated Rate	$297.42
Rate for Payer: Cash Price	$227.44
Rate for Payer: Community Health Alliance Commercial	$297.42
Rate for Payer: Priority Health Commercial	$244.94
Rate for Payer: Priority Health PPO	$244.94

PHA VASOPRESSIN 20U/ML VIAL

Facility

$54.50

Service Code	NDC 42023016425
Hospital Charge Code	2510410
Hospital Revenue Code	250
Min. Negotiated Rate	$38.15
Max. Negotiated Rate	$46.33
Rate for Payer: Cash Price	$35.43
Rate for Payer: Community Health Alliance Commercial	$46.33
Rate for Payer: Priority Health Commercial	$38.15
Rate for Payer: Priority Health PPO	$38.15

PHA VECURONIUM BROM 10MG VIAL

Facility

$46.72

Service Code	NDC 47335093144
Hospital Charge Code	2510421
Hospital Revenue Code	250
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$39.71
Rate for Payer: Cash Price	$30.37
Rate for Payer: Community Health Alliance Commercial	$39.71
Rate for Payer: Priority Health Commercial	$32.70
Rate for Payer: Priority Health PPO	$32.70

PHA VENLAFAXINE 37.5 MG TAB

Facility

$10.42

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501031
Hospital Revenue Code	637
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$8.86
Rate for Payer: Cash Price	$6.77
Rate for Payer: Community Health Alliance Commercial	$8.86
Rate for Payer: Priority Health Commercial	$7.29
Rate for Payer: Priority Health PPO	$7.29

PHA VENLAFAXINE ER 150 MG

Facility

$3.65

Service Code	NDC 904647061
Hospital Charge Code	2510872
Hospital Revenue Code	637
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.10
Rate for Payer: Cash Price	$2.37
Rate for Payer: Community Health Alliance Commercial	$3.10
Rate for Payer: Priority Health Commercial	$2.56
Rate for Payer: Priority Health PPO	$2.56

PHA VENLAFAXINE XR 37.5MG CAP

Facility

$19.49

Service Code	HCPCS A9270 GY
Hospital Charge Code	2501035
Hospital Revenue Code	637
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$16.57
Rate for Payer: Cash Price	$12.67
Rate for Payer: Community Health Alliance Commercial	$16.57
Rate for Payer: Priority Health Commercial	$13.64
Rate for Payer: Priority Health PPO	$13.64

PHA VERAPAMIL 120 MG TABLET

Facility

$8.80

Service Code	HCPCS A9270 GY
Hospital Charge Code	2506065
Hospital Revenue Code	637
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$7.48
Rate for Payer: Cash Price	$5.72
Rate for Payer: Community Health Alliance Commercial	$7.48
Rate for Payer: Priority Health Commercial	$6.16
Rate for Payer: Priority Health PPO	$6.16

PHA VERAPAMIL HCL 180MG TAB

Facility

$9.43

Service Code	HCPCS A9270 GY
Hospital Charge Code	2510450
Hospital Revenue Code	637
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$8.02
Rate for Payer: Cash Price	$6.13
Rate for Payer: Community Health Alliance Commercial	$8.02
Rate for Payer: Priority Health Commercial	$6.60
Rate for Payer: Priority Health PPO	$6.60

PHA VERAPAMIL HCL 2.5 MG/ML VL

Facility

$57.71

Service Code	NDC 42571031387
Hospital Charge Code	2510460
Hospital Revenue Code	250
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$49.05
Rate for Payer: Cash Price	$37.51
Rate for Payer: Community Health Alliance Commercial	$49.05
Rate for Payer: Priority Health Commercial	$40.40
Rate for Payer: Priority Health PPO	$40.40

PHA VERAPAMIL HCL 80 MG TAB

Facility

$2.97

Service Code	HCPCS A9270 GY
Hospital Charge Code	2510480
Hospital Revenue Code	637
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$2.52
Rate for Payer: Cash Price	$1.93
Rate for Payer: Community Health Alliance Commercial	$2.52
Rate for Payer: Priority Health Commercial	$2.08
Rate for Payer: Priority Health PPO	$2.08

PHA VIATMINS A&D APP

Facility

$4.35

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500044
Hospital Revenue Code	637
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.70
Rate for Payer: Cash Price	$2.83
Rate for Payer: Community Health Alliance Commercial	$3.70
Rate for Payer: Priority Health Commercial	$3.04
Rate for Payer: Priority Health PPO	$3.04

PHA VIDAZA 100MG/4ML VIAL

Facility

$1,727.63

Service Code	HCPCS J9025
Hospital Charge Code	2508787
Hospital Revenue Code	636
Min. Negotiated Rate	$1,209.34
Max. Negotiated Rate	$1,468.49
Rate for Payer: Cash Price	$1,122.96
Rate for Payer: Community Health Alliance Commercial	$1,468.49
Rate for Payer: Priority Health Commercial	$1,209.34
Rate for Payer: Priority Health PPO	$1,209.34

PHA VINBLASTINE SULFATE 1MG/ML

Facility

$245.62

Service Code	HCPCS J9360
Hospital Charge Code	2510500
Hospital Revenue Code	636
Min. Negotiated Rate	$171.93
Max. Negotiated Rate	$208.78
Rate for Payer: Cash Price	$159.65
Rate for Payer: Community Health Alliance Commercial	$208.78
Rate for Payer: Priority Health Commercial	$171.93
Rate for Payer: Priority Health PPO	$171.93

PHA VINCRISTINE SULFATE 1MG/ML

Facility

$102.45

Service Code	HCPCS J9370
Hospital Charge Code	2510510
Hospital Revenue Code	636
Min. Negotiated Rate	$71.72
Max. Negotiated Rate	$87.08
Rate for Payer: Cash Price	$66.59
Rate for Payer: Community Health Alliance Commercial	$87.08
Rate for Payer: Priority Health Commercial	$71.72
Rate for Payer: Priority Health PPO	$71.72

PHA VINORELBINE TARTRATE 50MG

Facility

$503.42

Service Code	HCPCS J9390
Hospital Charge Code	2510765
Hospital Revenue Code	636
Min. Negotiated Rate	$352.39
Max. Negotiated Rate	$427.91
Rate for Payer: Cash Price	$327.22
Rate for Payer: Community Health Alliance Commercial	$427.91
Rate for Payer: Priority Health Commercial	$352.39
Rate for Payer: Priority Health PPO	$352.39

PHA VIROPTIC 1% EYE DROPS NF

Facility

$492.05

Service Code	NDC 61314004475
Hospital Charge Code	2510821
Hospital Revenue Code	637
Min. Negotiated Rate	$344.44
Max. Negotiated Rate	$418.24
Rate for Payer: Cash Price	$319.83
Rate for Payer: Community Health Alliance Commercial	$418.24
Rate for Payer: Priority Health Commercial	$344.44
Rate for Payer: Priority Health PPO	$344.44

PHA VISCOAT .5 ML SYR

Facility

$656.66

Service Code	NDC 8065183905
Hospital Charge Code	2510525
Hospital Revenue Code	250
Min. Negotiated Rate	$459.66
Max. Negotiated Rate	$558.16
Rate for Payer: Cash Price	$426.83
Rate for Payer: Community Health Alliance Commercial	$558.16
Rate for Payer: Priority Health Commercial	$459.66
Rate for Payer: Priority Health PPO	$459.66

PHA VISIPAQUE 270MG/1ML 100 BT

Facility

$315.61

Service Code	HCPCS Q9966
Hospital Charge Code	3500012
Hospital Revenue Code	350
Min. Negotiated Rate	$220.93
Max. Negotiated Rate	$268.27
Rate for Payer: Cash Price	$205.15
Rate for Payer: Community Health Alliance Commercial	$268.27
Rate for Payer: Priority Health Commercial	$220.93
Rate for Payer: Priority Health PPO	$220.93

PHA VORICONAZOLE 200 MG VIAL

Facility

$241.68

Service Code	HCPCS J3465
Hospital Charge Code	2500414
Hospital Revenue Code	636
Min. Negotiated Rate	$169.18
Max. Negotiated Rate	$205.43
Rate for Payer: Cash Price	$157.09
Rate for Payer: Community Health Alliance Commercial	$205.43
Rate for Payer: Priority Health Commercial	$169.18
Rate for Payer: Priority Health PPO	$169.18

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges