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
MONTELUKAST SODIUM 10 MG PO TABS [22509]	01490	N/A	N/A
CLINDAMYCIN HCL 150 MG PO CAPS [1740]	07610	N/A	N/A
TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN [7784]	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
RIVASTIGMINE TARTRATE 1.5 MG PO CAPS [28278]	10702	N/A	N/A
CEFAZOLIN SODIUM 300 G IJ SOLR [31087]	10858	N/A	N/A
NEVIRAPINE 50 MG/5ML PO SUSP [24119]	11701	N/A	N/A
DEFEROXAMINE MESYLATE 500 MG IJ SOLR [9723]	11845	N/A	N/A
CARMUSTINE 100 MG IV SOLR [28911]	11868	N/A	N/A
SODIUM CHLORIDE 0.9% CT INJECTOR FLUSH [408034008]	12165	N/A	N/A
FUROSEMIDE 20 MG PO TABS [3294]	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.