COREWELL HEALTH LAKELAND HOSPITALS

Legal name: LAKELAND HOSPITALS AT NILES AND ST JOSEPH, INC

SAINT JOSEPH, MI 490852112 (269) 983-8300 273R00000X

Published Procedure Prices

Procedure	CPT	Cash Price	Insurance Range
LEUCOVORIN CALCIUM 100 MG IJ SOLR [4392]	00574	N/A	N/A
NYSTATIN 100000 UNIT/GM EXT POWD [39136]	10006	N/A	N/A
KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN [22472]	10019	N/A	N/A
ADALIMUMAB 40 MG/0.4ML SUBCUT PSKT [150535]	10702	N/A	N/A
ZINC OXIDE 20 % EXT OINT [8874]	11701	N/A	N/A
LURASIDONE HCL 40 MG PO TABS [101636]	12547	N/A	N/A
MAGNESIUM SULFATE 4 GM/50ML IV SOLN [125078]	13107	N/A	N/A
ERYTHROMYCIN 5 MG/GM OPTH OINT [2888]	13668	N/A	N/A
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT [104596]	13925	N/A	N/A
MECLIZINE HCL 25 MG PO TABS [12025]	14428	N/A	N/A
SODIUM CHLORIDE 0.9 % IV SOLN [27838]	16571	N/A	N/A
BEVACIZUMAB 100 MG/4ML IV SOLN [102676]	16729	N/A	N/A
FLUCONAZOLE 150 MG PO TABS [13577]	16784	N/A	N/A
PALIPERIDONE PALMITATE ER 156 MG/ML IM SUSY [152671]	16864	N/A	N/A
ACYCLOVIR 400 MG PO TABS [8971]	17271	N/A	N/A
KETAMINE HCL 100 MG/ML IJ SOLN [4237]	17478	N/A	N/A
LINEZOLID 100 MG/5ML PO SUSR [28225]	19903	N/A	N/A
DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX [2511]	20555	N/A	N/A

Prices shown are published rates from hospital chargemaster files and insurer rate data. Your actual cost depends on your insurance plan, deductible status, and services rendered.