Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

WARFARIN 2.5 MG TABLET

Facility

$2.73

Service Code	NDC 00832121389
Hospital Charge Code	8750
Hospital Revenue Code	637
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna Medicare	$1.36
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: BCBS Complete	$1.09
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.91
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.46
Rate for Payer: MI Amish Medical Board Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.05
Rate for Payer: PHP Commercial	$2.32
Rate for Payer: Priority Health SBD	$1.72
Rate for Payer: UHC All Payor (Choice/PPO)	$1.77
Rate for Payer: UHC Core	$1.42
Rate for Payer: UHC Exchange	$1.07

WARFARIN 2.5 MG TABLET

Facility

$278.35

Service Code	NDC 68084002711
Hospital Charge Code	8750
Hospital Revenue Code	637
Min. Negotiated Rate	$109.39
Max. Negotiated Rate	$250.51
Rate for Payer: Aetna Commercial	$236.60
Rate for Payer: Aetna Medicare	$139.18
Rate for Payer: Aetna New Business (MI Preferred)	$180.93
Rate for Payer: BCBS Complete	$111.34
Rate for Payer: Cash Price	$222.68
Rate for Payer: Cofinity Advantage	$194.84
Rate for Payer: Cofinity Commercial	$239.38
Rate for Payer: Encore Health Key Benefits Commercial	$222.68
Rate for Payer: Healthscope Commercial	$250.51
Rate for Payer: MI Amish Medical Board Commercial	$222.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$236.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$208.76
Rate for Payer: PHP Commercial	$236.60
Rate for Payer: Priority Health SBD	$175.36
Rate for Payer: UHC All Payor (Choice/PPO)	$180.93
Rate for Payer: UHC Core	$145.02
Rate for Payer: UHC Exchange	$109.39

WARFARIN 2.5 MG TABLET

Facility

$278.35

Service Code	NDC 68084002701
Hospital Charge Code	8750
Hospital Revenue Code	637
Min. Negotiated Rate	$175.36
Max. Negotiated Rate	$250.51
Rate for Payer: Aetna Commercial	$236.60
Rate for Payer: Aetna New Business (MI Preferred)	$180.93
Rate for Payer: Cash Price	$222.68
Rate for Payer: Cofinity Advantage	$194.84
Rate for Payer: Cofinity Commercial	$239.38
Rate for Payer: Encore Health Key Benefits Commercial	$222.68
Rate for Payer: Healthscope Commercial	$250.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$236.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$208.76
Rate for Payer: PHP Commercial	$236.60
Rate for Payer: Priority Health SBD	$175.36

WARFARIN 2 MG TABLET

Facility

$267.90

Service Code	NDC 00093171301
Hospital Charge Code	8749
Hospital Revenue Code	637
Min. Negotiated Rate	$168.78
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna New Business (MI Preferred)	$174.13
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Advantage	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.93
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health SBD	$168.78

WARFARIN 2 MG TABLET

Facility

$2.73

Service Code	NDC 62584098411
Hospital Charge Code	8749
Hospital Revenue Code	637
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna Medicare	$1.36
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: BCBS Complete	$1.09
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.91
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.46
Rate for Payer: MI Amish Medical Board Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.05
Rate for Payer: PHP Commercial	$2.32
Rate for Payer: Priority Health SBD	$1.72
Rate for Payer: UHC All Payor (Choice/PPO)	$1.77
Rate for Payer: UHC Core	$1.42
Rate for Payer: UHC Exchange	$1.07

WARFARIN 2 MG TABLET

Facility

$267.90

Service Code	NDC 00093171301
Hospital Charge Code	8749
Hospital Revenue Code	637
Min. Negotiated Rate	$105.28
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna Medicare	$133.95
Rate for Payer: Aetna New Business (MI Preferred)	$174.13
Rate for Payer: BCBS Complete	$107.16
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Advantage	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: MI Amish Medical Board Commercial	$214.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.93
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health SBD	$168.78
Rate for Payer: UHC All Payor (Choice/PPO)	$174.13
Rate for Payer: UHC Core	$139.58
Rate for Payer: UHC Exchange	$105.28

WARFARIN 2 MG TABLET

Facility

$272.65

Service Code	NDC 62584098401
Hospital Charge Code	8749
Hospital Revenue Code	637
Min. Negotiated Rate	$171.77
Max. Negotiated Rate	$245.38
Rate for Payer: Aetna Commercial	$231.75
Rate for Payer: Aetna New Business (MI Preferred)	$177.22
Rate for Payer: Cash Price	$218.12
Rate for Payer: Cofinity Advantage	$190.85
Rate for Payer: Cofinity Commercial	$234.48
Rate for Payer: Encore Health Key Benefits Commercial	$218.12
Rate for Payer: Healthscope Commercial	$245.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$204.49
Rate for Payer: PHP Commercial	$231.75
Rate for Payer: Priority Health SBD	$171.77

WARFARIN 2 MG TABLET

Facility

$272.65

Service Code	NDC 62584098401
Hospital Charge Code	8749
Hospital Revenue Code	637
Min. Negotiated Rate	$107.15
Max. Negotiated Rate	$245.38
Rate for Payer: Aetna Commercial	$231.75
Rate for Payer: Aetna Medicare	$136.32
Rate for Payer: Aetna New Business (MI Preferred)	$177.22
Rate for Payer: BCBS Complete	$109.06
Rate for Payer: Cash Price	$218.12
Rate for Payer: Cofinity Advantage	$190.85
Rate for Payer: Cofinity Commercial	$234.48
Rate for Payer: Encore Health Key Benefits Commercial	$218.12
Rate for Payer: Healthscope Commercial	$245.38
Rate for Payer: MI Amish Medical Board Commercial	$218.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$204.49
Rate for Payer: PHP Commercial	$231.75
Rate for Payer: Priority Health SBD	$171.77
Rate for Payer: UHC All Payor (Choice/PPO)	$177.22
Rate for Payer: UHC Core	$142.05
Rate for Payer: UHC Exchange	$107.15

WARFARIN 2 MG TABLET

Facility

$2.73

Service Code	NDC 62584098411
Hospital Charge Code	8749
Hospital Revenue Code	637
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.91
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.05
Rate for Payer: PHP Commercial	$2.32
Rate for Payer: Priority Health SBD	$1.72

WARFARIN 5 MG TABLET

Facility

$272.60

Service Code	NDC 00832121601
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$107.13
Max. Negotiated Rate	$245.34
Rate for Payer: Aetna Commercial	$231.71
Rate for Payer: Aetna Medicare	$136.30
Rate for Payer: Aetna New Business (MI Preferred)	$177.19
Rate for Payer: BCBS Complete	$109.04
Rate for Payer: Cash Price	$218.08
Rate for Payer: Cofinity Advantage	$190.82
Rate for Payer: Cofinity Commercial	$234.44
Rate for Payer: Encore Health Key Benefits Commercial	$218.08
Rate for Payer: Healthscope Commercial	$245.34
Rate for Payer: MI Amish Medical Board Commercial	$218.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$204.45
Rate for Payer: PHP Commercial	$231.71
Rate for Payer: Priority Health SBD	$171.74
Rate for Payer: UHC All Payor (Choice/PPO)	$177.19
Rate for Payer: UHC Core	$142.02
Rate for Payer: UHC Exchange	$107.13

WARFARIN 5 MG TABLET

Facility

$272.60

Service Code	NDC 00832121601
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$171.74
Max. Negotiated Rate	$245.34
Rate for Payer: Aetna Commercial	$231.71
Rate for Payer: Aetna New Business (MI Preferred)	$177.19
Rate for Payer: Cash Price	$218.08
Rate for Payer: Cofinity Advantage	$190.82
Rate for Payer: Cofinity Commercial	$234.44
Rate for Payer: Encore Health Key Benefits Commercial	$218.08
Rate for Payer: Healthscope Commercial	$245.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$204.45
Rate for Payer: PHP Commercial	$231.71
Rate for Payer: Priority Health SBD	$171.74

WARFARIN 5 MG TABLET

Facility

$3.09

Service Code	NDC 62584099411
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$2.78
Rate for Payer: Aetna Commercial	$2.63
Rate for Payer: Aetna New Business (MI Preferred)	$2.01
Rate for Payer: Cash Price	$2.47
Rate for Payer: Cofinity Advantage	$2.16
Rate for Payer: Cofinity Commercial	$2.66
Rate for Payer: Encore Health Key Benefits Commercial	$2.47
Rate for Payer: Healthscope Commercial	$2.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.32
Rate for Payer: PHP Commercial	$2.63
Rate for Payer: Priority Health SBD	$1.95

WARFARIN 5 MG TABLET

Facility

$2.73

Service Code	NDC 00832121689
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.91
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.05
Rate for Payer: PHP Commercial	$2.32
Rate for Payer: Priority Health SBD	$1.72

WARFARIN 5 MG TABLET

Facility

$2.73

Service Code	NDC 00832121689
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna Medicare	$1.36
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: BCBS Complete	$1.09
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.91
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.46
Rate for Payer: MI Amish Medical Board Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.05
Rate for Payer: PHP Commercial	$2.32
Rate for Payer: Priority Health SBD	$1.72
Rate for Payer: UHC All Payor (Choice/PPO)	$1.77
Rate for Payer: UHC Core	$1.42
Rate for Payer: UHC Exchange	$1.07

WARFARIN 5 MG TABLET

Facility

$308.75

Service Code	NDC 62584099401
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$194.51
Max. Negotiated Rate	$277.88
Rate for Payer: Aetna Commercial	$262.44
Rate for Payer: Aetna New Business (MI Preferred)	$200.69
Rate for Payer: Cash Price	$247.00
Rate for Payer: Cofinity Advantage	$216.12
Rate for Payer: Cofinity Commercial	$265.52
Rate for Payer: Encore Health Key Benefits Commercial	$247.00
Rate for Payer: Healthscope Commercial	$277.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$262.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$231.56
Rate for Payer: PHP Commercial	$262.44
Rate for Payer: Priority Health SBD	$194.51

WARFARIN 5 MG TABLET

Facility

$3.09

Service Code	NDC 62584099411
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$2.78
Rate for Payer: Aetna Commercial	$2.63
Rate for Payer: Aetna Medicare	$1.54
Rate for Payer: Aetna New Business (MI Preferred)	$2.01
Rate for Payer: BCBS Complete	$1.24
Rate for Payer: Cash Price	$2.47
Rate for Payer: Cofinity Advantage	$2.16
Rate for Payer: Cofinity Commercial	$2.66
Rate for Payer: Encore Health Key Benefits Commercial	$2.47
Rate for Payer: Healthscope Commercial	$2.78
Rate for Payer: MI Amish Medical Board Commercial	$2.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.32
Rate for Payer: PHP Commercial	$2.63
Rate for Payer: Priority Health SBD	$1.95
Rate for Payer: UHC All Payor (Choice/PPO)	$2.01
Rate for Payer: UHC Core	$1.61
Rate for Payer: UHC Exchange	$1.21

WARFARIN 5 MG TABLET

Facility

$286.70

Service Code	NDC 00093172101
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$180.62
Max. Negotiated Rate	$258.03
Rate for Payer: Aetna Commercial	$243.69
Rate for Payer: Aetna New Business (MI Preferred)	$186.35
Rate for Payer: Cash Price	$229.36
Rate for Payer: Cofinity Advantage	$200.69
Rate for Payer: Cofinity Commercial	$246.56
Rate for Payer: Encore Health Key Benefits Commercial	$229.36
Rate for Payer: Healthscope Commercial	$258.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.03
Rate for Payer: PHP Commercial	$243.69
Rate for Payer: Priority Health SBD	$180.62

WARFARIN 5 MG TABLET

Facility

$286.70

Service Code	NDC 00093172101
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$112.67
Max. Negotiated Rate	$258.03
Rate for Payer: Aetna Commercial	$243.69
Rate for Payer: Aetna Medicare	$143.35
Rate for Payer: Aetna New Business (MI Preferred)	$186.35
Rate for Payer: BCBS Complete	$114.68
Rate for Payer: Cash Price	$229.36
Rate for Payer: Cofinity Advantage	$200.69
Rate for Payer: Cofinity Commercial	$246.56
Rate for Payer: Encore Health Key Benefits Commercial	$229.36
Rate for Payer: Healthscope Commercial	$258.03
Rate for Payer: MI Amish Medical Board Commercial	$229.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.03
Rate for Payer: PHP Commercial	$243.69
Rate for Payer: Priority Health SBD	$180.62
Rate for Payer: UHC All Payor (Choice/PPO)	$186.35
Rate for Payer: UHC Core	$149.37
Rate for Payer: UHC Exchange	$112.67

WARFARIN 5 MG TABLET

Facility

$308.75

Service Code	NDC 62584099401
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$121.34
Max. Negotiated Rate	$277.88
Rate for Payer: Aetna Commercial	$262.44
Rate for Payer: Aetna Medicare	$154.38
Rate for Payer: Aetna New Business (MI Preferred)	$200.69
Rate for Payer: BCBS Complete	$123.50
Rate for Payer: Cash Price	$247.00
Rate for Payer: Cofinity Advantage	$216.12
Rate for Payer: Cofinity Commercial	$265.52
Rate for Payer: Encore Health Key Benefits Commercial	$247.00
Rate for Payer: Healthscope Commercial	$277.88
Rate for Payer: MI Amish Medical Board Commercial	$247.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$262.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$231.56
Rate for Payer: PHP Commercial	$262.44
Rate for Payer: Priority Health SBD	$194.51
Rate for Payer: UHC All Payor (Choice/PPO)	$200.69
Rate for Payer: UHC Core	$160.86
Rate for Payer: UHC Exchange	$121.34

WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION

Facility

$51.00

Service Code	NDC 00409397703
Hospital Charge Code	864
Hospital Revenue Code	250
Min. Negotiated Rate	$20.04
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Advantage	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: MI Amish Medical Board Commercial	$40.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.25
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health SBD	$32.13
Rate for Payer: UHC All Payor (Choice/PPO)	$33.15
Rate for Payer: UHC Core	$26.57
Rate for Payer: UHC Exchange	$20.04

WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION

Facility

$51.00

Service Code	NDC 00409397701
Hospital Charge Code	864
Hospital Revenue Code	250
Min. Negotiated Rate	$20.04
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Advantage	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: MI Amish Medical Board Commercial	$40.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.25
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health SBD	$32.13
Rate for Payer: UHC All Payor (Choice/PPO)	$33.15
Rate for Payer: UHC Core	$26.57
Rate for Payer: UHC Exchange	$20.04

WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION

Facility

$51.00

Service Code	NDC 00409397701
Hospital Charge Code	864
Hospital Revenue Code	250
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Advantage	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.25
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health SBD	$32.13

WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION

Facility

$51.00

Service Code	NDC 00409397703
Hospital Charge Code	864
Hospital Revenue Code	250
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Advantage	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.25
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health SBD	$32.13

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$19.14

Service Code	NDC 00409488723
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$17.23
Rate for Payer: Aetna Commercial	$16.27
Rate for Payer: Aetna New Business (MI Preferred)	$12.44
Rate for Payer: Cash Price	$15.31
Rate for Payer: Cofinity Advantage	$13.40
Rate for Payer: Cofinity Commercial	$16.46
Rate for Payer: Encore Health Key Benefits Commercial	$15.31
Rate for Payer: Healthscope Commercial	$17.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.36
Rate for Payer: PHP Commercial	$16.27
Rate for Payer: Priority Health SBD	$12.06

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$29.37

Service Code	NDC 00409488725
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$26.43
Rate for Payer: Aetna Commercial	$24.96
Rate for Payer: Aetna New Business (MI Preferred)	$19.09
Rate for Payer: Cash Price	$23.50
Rate for Payer: Cofinity Advantage	$20.56
Rate for Payer: Cofinity Commercial	$25.26
Rate for Payer: Encore Health Key Benefits Commercial	$23.50
Rate for Payer: Healthscope Commercial	$26.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.03
Rate for Payer: PHP Commercial	$24.96
Rate for Payer: Priority Health SBD	$18.50

Know your out-of-pocket cost for care.

All Charges