COREWELL HEALTH GRAND RAPIDS HOSPITALS REHABILITATION UNIT

Legal name: SPECTRUM HEALTH HOSPITALS

GRAND RAPIDS, MI 495062921 (616) 774-5300 273Y00000X

Published Procedure Prices

Procedure	CPT	Cash Price	Insurance Range
DOCUSATE SODIUM 100 MG PO CAPS [2566]	00574	N/A	N/A
BUDESONIDE 0.5 MG/2ML INH SUSP [28775]	01490	N/A	N/A
CLINDAMYCIN HCL 150 MG PO CAPS [1740]	07610	N/A	N/A
CEFTRIAXONE SODIUM 1 G IJ SOLR [9487]	10006	N/A	N/A
DORNASE ALFA 2.5 MG/2.5ML INH SOLN [12211]	10019	N/A	N/A
WARFARIN SODIUM 10 MG PO TABS [8748]	10135	N/A	N/A
WARFARIN SODIUM 2 MG PO TABS [8749]	10702	N/A	N/A
CEFAZOLIN SODIUM 300 G IJ SOLR [31087]	10858	N/A	N/A
CLONIDINE 0.2 MG/24HR TD PTWK [145258]	11701	N/A	N/A
PEGFILGRASTIM 6 MG/0.6ML SUBCUT SOSY [125079]	11845	N/A	N/A
CARMUSTINE 100 MG IV SOLR [28911]	11868	N/A	N/A
SODIUM CHLORIDE 0.9 % IV SOLN [27838]	12165	N/A	N/A
LORAZEPAM 0.5 MG PO TABS [4572]	12546	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.