Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHA WARFARIN SODIUM 1MG TAB

Facility

$3.18

Service Code	HCPCS A9270 GY
Hospital Charge Code	2510535
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 WARFARIN SODIUM 5 MG TAB

Facility

$14.48

Service Code	HCPCS A9270 GY
Hospital Charge Code	2510540
Hospital Revenue Code	637
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$12.31
Rate for Payer: Cash Price	$9.41
Rate for Payer: Community Health Alliance Commercial	$12.31
Rate for Payer: Priority Health Commercial	$10.14
Rate for Payer: Priority Health PPO	$10.14

PHA WATER FOR INJ,BACTERIOSTAT

Facility

$13.00

Hospital Charge Code	2510560
Hospital Revenue Code	250
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$11.05
Rate for Payer: Cash Price	$8.45
Rate for Payer: Community Health Alliance Commercial	$11.05
Rate for Payer: Priority Health Commercial	$9.10
Rate for Payer: Priority Health PPO	$9.10

PHA WITCH HAZEL 40 PAD PAD

Facility

$20.51

Service Code	HCPCS A9270 GY
Hospital Charge Code	2510270
Hospital Revenue Code	637
Min. Negotiated Rate	$14.36
Max. Negotiated Rate	$17.43
Rate for Payer: Cash Price	$13.33
Rate for Payer: Community Health Alliance Commercial	$17.43
Rate for Payer: Priority Health Commercial	$14.36
Rate for Payer: Priority Health PPO	$14.36

PHA XIFAXAN 550MG TAB NF

Facility

$245.22

Service Code	NDC 65649030302
Hospital Charge Code	2510814
Hospital Revenue Code	637
Min. Negotiated Rate	$171.65
Max. Negotiated Rate	$208.44
Rate for Payer: Cash Price	$159.39
Rate for Payer: Community Health Alliance Commercial	$208.44
Rate for Payer: Priority Health Commercial	$171.65
Rate for Payer: Priority Health PPO	$171.65

PHA ZINC OXIDE OINT 30 GM

Facility

$12.87

Service Code	HCPCS A9270 GY
Hospital Charge Code	2510715
Hospital Revenue Code	637
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$10.94
Rate for Payer: Cash Price	$8.37
Rate for Payer: Community Health Alliance Commercial	$10.94
Rate for Payer: Priority Health Commercial	$9.01
Rate for Payer: Priority Health PPO	$9.01

PHA ZINC SULFATE 1MG/ML VIAL

Facility

$16.62

Service Code	NDC 517611025
Hospital Charge Code	2510700
Hospital Revenue Code	250
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$14.13
Rate for Payer: Cash Price	$10.80
Rate for Payer: Community Health Alliance Commercial	$14.13
Rate for Payer: Priority Health Commercial	$11.63
Rate for Payer: Priority Health PPO	$11.63

PHA ZINECARD 250MG VIAL

Facility

$914.64

Service Code	HCPCS J1190
Hospital Charge Code	2501117
Hospital Revenue Code	636
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$777.44
Rate for Payer: BCBS BCN 65	$60.91
Rate for Payer: Blue Care Network Medicare Advantage	$60.91
Rate for Payer: Cash Price	$594.52
Rate for Payer: Cash Price	$594.52
Rate for Payer: Community Health Alliance Commercial	$777.44
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$60.91
Rate for Payer: Meridian Health Plan Medicare	$60.91
Rate for Payer: Priority Health Commercial	$640.25
Rate for Payer: Priority Health Medicaid	$60.91
Rate for Payer: Priority Health Medicare	$60.91
Rate for Payer: Priority Health PPO	$640.25
Rate for Payer: United Health Care Medicaid	$60.91
Rate for Payer: United Health Care Medicare Advantage	$26.80

PHA ZINECARD 500MG VIAL

Facility

$1,619.20

Service Code	HCPCS J1190
Hospital Charge Code	2501127
Hospital Revenue Code	636
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$1,376.32
Rate for Payer: BCBS BCN 65	$60.91
Rate for Payer: Blue Care Network Medicare Advantage	$60.91
Rate for Payer: Cash Price	$1,052.48
Rate for Payer: Cash Price	$1,052.48
Rate for Payer: Community Health Alliance Commercial	$1,376.32
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$60.91
Rate for Payer: Meridian Health Plan Medicare	$60.91
Rate for Payer: Priority Health Commercial	$1,133.44
Rate for Payer: Priority Health Medicaid	$60.91
Rate for Payer: Priority Health Medicare	$60.91
Rate for Payer: Priority Health PPO	$1,133.44
Rate for Payer: United Health Care Medicaid	$60.91
Rate for Payer: United Health Care Medicare Advantage	$26.80

PHA ZOCOR 20MG TAB NF

Facility

$25.63

Service Code	NDC 93715498
Hospital Charge Code	2510815
Hospital Revenue Code	637
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$21.79
Rate for Payer: Cash Price	$16.66
Rate for Payer: Community Health Alliance Commercial	$21.79
Rate for Payer: Priority Health Commercial	$17.94
Rate for Payer: Priority Health PPO	$17.94

PHA ZOLEDRONIC ACID 4 MG VIAL

Facility

$300.60

Service Code	HCPCS J3489
Hospital Charge Code	2507545
Hospital Revenue Code	636
Min. Negotiated Rate	$210.42
Max. Negotiated Rate	$255.51
Rate for Payer: Cash Price	$195.39
Rate for Payer: Community Health Alliance Commercial	$255.51
Rate for Payer: Priority Health Commercial	$210.42
Rate for Payer: Priority Health PPO	$210.42

PHA ZOLPIDEM TARTRATE 5 MG TAB

Facility

$0.52

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500430
Hospital Revenue Code	637
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.34
Rate for Payer: Community Health Alliance Commercial	$0.44
Rate for Payer: Priority Health Commercial	$0.36
Rate for Payer: Priority Health PPO	$0.36

PHA ZOMETA 4MG/100ML

Facility

$596.16

Service Code	HCPCS J3489
Hospital Charge Code	2508234
Hospital Revenue Code	636
Min. Negotiated Rate	$417.31
Max. Negotiated Rate	$506.74
Rate for Payer: Cash Price	$387.50
Rate for Payer: Community Health Alliance Commercial	$506.74
Rate for Payer: Priority Health Commercial	$417.31
Rate for Payer: Priority Health PPO	$417.31

PHA ZOSYN 3.375

Facility

$54.96

Service Code	NDC 39822012504
Hospital Charge Code	2507835
Hospital Revenue Code	250
Min. Negotiated Rate	$38.47
Max. Negotiated Rate	$46.72
Rate for Payer: Cash Price	$35.72
Rate for Payer: Community Health Alliance Commercial	$46.72
Rate for Payer: Priority Health Commercial	$38.47
Rate for Payer: Priority Health PPO	$38.47

PHA ZOVIRAX 400MG TABLET

Facility

$19.54

Service Code	NDC 50268006115
Hospital Charge Code	2510964
Hospital Revenue Code	250
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$16.61
Rate for Payer: Cash Price	$12.70
Rate for Payer: Community Health Alliance Commercial	$16.61
Rate for Payer: Priority Health Commercial	$13.68
Rate for Payer: Priority Health PPO	$13.68

PHA ZOVIRAX 50MG/ML 20ML VIAL

Facility

$119.40

Service Code	NDC 55150015520
Hospital Charge Code	2510919
Hospital Revenue Code	250
Min. Negotiated Rate	$83.58
Max. Negotiated Rate	$101.49
Rate for Payer: Cash Price	$77.61
Rate for Payer: Community Health Alliance Commercial	$101.49
Rate for Payer: Priority Health Commercial	$83.58
Rate for Payer: Priority Health PPO	$83.58

PHA ZPREXA 10MG IM VIAL

Facility

$201.44

Service Code	HCPCS J3490
Hospital Charge Code	2507401
Hospital Revenue Code	636
Min. Negotiated Rate	$141.01
Max. Negotiated Rate	$171.22
Rate for Payer: Cash Price	$130.94
Rate for Payer: Community Health Alliance Commercial	$171.22
Rate for Payer: Priority Health Commercial	$141.01
Rate for Payer: Priority Health PPO	$141.01

PHA ZYVOX 2 MG/ML BAG

Facility

$260.95

Service Code	HCPCS J2020
Hospital Charge Code	2507715
Hospital Revenue Code	636
Min. Negotiated Rate	$182.66
Max. Negotiated Rate	$221.81
Rate for Payer: Cash Price	$169.62
Rate for Payer: Community Health Alliance Commercial	$221.81
Rate for Payer: Priority Health Commercial	$182.66
Rate for Payer: Priority Health PPO	$182.66

PH BLOOD

Facility

$31.00

Service Code	HCPCS 82800
Hospital Charge Code	3006320
Hospital Revenue Code	301
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$26.35
Rate for Payer: BCBS BCN 65	$11.55
Rate for Payer: Blue Care Network Medicare Advantage	$11.55
Rate for Payer: Cash Price	$20.15
Rate for Payer: Cash Price	$20.15
Rate for Payer: Community Health Alliance Commercial	$26.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$11.55
Rate for Payer: Meridian Health Plan Medicare	$11.55
Rate for Payer: Priority Health Commercial	$21.70
Rate for Payer: Priority Health Medicaid	$11.55
Rate for Payer: Priority Health Medicare	$11.55
Rate for Payer: Priority Health PPO	$21.70
Rate for Payer: United Health Care Medicaid	$11.55
Rate for Payer: United Health Care Medicare Advantage	$5.08

PH, BODY FLUIDS,EXCEPT BLOOD

Facility

$4.80

Hospital Charge Code	3006480
Hospital Revenue Code	301
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$4.08
Rate for Payer: Cash Price	$3.12
Rate for Payer: Community Health Alliance Commercial	$4.08
Rate for Payer: Priority Health Commercial	$3.36
Rate for Payer: Priority Health PPO	$3.36

PHENOBARBITOL

Facility

$6.00

Service Code	HCPCS 80184
Hospital Charge Code	3006500
Hospital Revenue Code	301
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$16.07
Rate for Payer: BCBS BCN 65	$16.07
Rate for Payer: Blue Care Network Medicare Advantage	$16.07
Rate for Payer: Cash Price	$3.90
Rate for Payer: Cash Price	$3.90
Rate for Payer: Community Health Alliance Commercial	$5.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.07
Rate for Payer: Meridian Health Plan Medicare	$16.07
Rate for Payer: Priority Health Commercial	$4.20
Rate for Payer: Priority Health Medicaid	$16.07
Rate for Payer: Priority Health Medicare	$16.07
Rate for Payer: Priority Health PPO	$4.20
Rate for Payer: United Health Care Medicaid	$16.07
Rate for Payer: United Health Care Medicare Advantage	$7.07

PHENOSENSE-10

Facility

$63.33

Hospital Charge Code	3102344
Hospital Revenue Code	300
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$53.83
Rate for Payer: Cash Price	$41.16
Rate for Payer: Community Health Alliance Commercial	$53.83
Rate for Payer: Priority Health Commercial	$44.33
Rate for Payer: Priority Health PPO	$44.33

PHENOSENSE-11

Facility

$63.33

Hospital Charge Code	3102345
Hospital Revenue Code	300
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$53.83
Rate for Payer: Cash Price	$41.16
Rate for Payer: Community Health Alliance Commercial	$53.83
Rate for Payer: Priority Health Commercial	$44.33
Rate for Payer: Priority Health PPO	$44.33

PHENOSENSE-12

Facility

$63.33

Hospital Charge Code	3102346
Hospital Revenue Code	300
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$53.83
Rate for Payer: Cash Price	$41.16
Rate for Payer: Community Health Alliance Commercial	$53.83
Rate for Payer: Priority Health Commercial	$44.33
Rate for Payer: Priority Health PPO	$44.33

PHENOSENSE-13

Facility

$63.38

Hospital Charge Code	3102347
Hospital Revenue Code	300
Min. Negotiated Rate	$44.37
Max. Negotiated Rate	$53.87
Rate for Payer: Cash Price	$41.20
Rate for Payer: Community Health Alliance Commercial	$53.87
Rate for Payer: Priority Health Commercial	$44.37
Rate for Payer: Priority Health PPO	$44.37

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges