Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION

Facility

$45.00

Service Code	NDC 00409397701
Hospital Charge Code	864
Hospital Revenue Code	250
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna New Business (MI Preferred)	$29.25
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$31.50
Rate for Payer: Cofinity Commercial	$38.70
Rate for Payer: Cofinity Medicare Advantage	$31.50
Rate for Payer: Encore Health Key Benefits Commercial	$36.00
Rate for Payer: Healthscope Commercial	$40.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.25
Rate for Payer: PHP Commercial	$38.25
Rate for Payer: Priority Health Cigna Priority Health	$29.25
Rate for Payer: Priority Health SBD	$28.35

WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION

Facility

$45.00

Service Code	NDC 00409397701
Hospital Charge Code	864
Hospital Revenue Code	250
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: Aetna New Business (MI Preferred)	$29.25
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$31.50
Rate for Payer: Cofinity Commercial	$38.70
Rate for Payer: Cofinity Medicare Advantage	$31.50
Rate for Payer: Encore Health Key Benefits Commercial	$36.00
Rate for Payer: Healthscope Commercial	$40.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.25
Rate for Payer: PHP Commercial	$38.25
Rate for Payer: Priority Health Cigna Priority Health	$29.25
Rate for Payer: Priority Health SBD	$28.35

WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION

Facility

$45.00

Service Code	NDC 00409397703
Hospital Charge Code	864
Hospital Revenue Code	250
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: Aetna New Business (MI Preferred)	$29.25
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$31.50
Rate for Payer: Cofinity Commercial	$38.70
Rate for Payer: Cofinity Medicare Advantage	$31.50
Rate for Payer: Encore Health Key Benefits Commercial	$36.00
Rate for Payer: Healthscope Commercial	$40.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.25
Rate for Payer: PHP Commercial	$38.25
Rate for Payer: Priority Health Cigna Priority Health	$29.25
Rate for Payer: Priority Health SBD	$28.35

WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION

Facility

$45.00

Service Code	NDC 00409397703
Hospital Charge Code	864
Hospital Revenue Code	250
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna New Business (MI Preferred)	$29.25
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$31.50
Rate for Payer: Cofinity Commercial	$38.70
Rate for Payer: Cofinity Medicare Advantage	$31.50
Rate for Payer: Encore Health Key Benefits Commercial	$36.00
Rate for Payer: Healthscope Commercial	$40.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.25
Rate for Payer: PHP Commercial	$38.25
Rate for Payer: Priority Health Cigna Priority Health	$29.25
Rate for Payer: Priority Health SBD	$28.35

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$13.75

Service Code	NDC 00409488717
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$11.69
Rate for Payer: Aetna New Business (MI Preferred)	$8.94
Rate for Payer: Cash Price	$11.00
Rate for Payer: Cofinity Commercial	$11.82
Rate for Payer: Cofinity Commercial	$9.62
Rate for Payer: Cofinity Medicare Advantage	$9.62
Rate for Payer: Encore Health Key Benefits Commercial	$11.00
Rate for Payer: Healthscope Commercial	$12.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.69
Rate for Payer: PHP Commercial	$11.69
Rate for Payer: Priority Health Cigna Priority Health	$8.94
Rate for Payer: Priority Health SBD	$8.66

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$30.71

Service Code	NDC 63323018509
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$27.64
Rate for Payer: Aetna Commercial	$26.10
Rate for Payer: Aetna New Business (MI Preferred)	$19.96
Rate for Payer: Cash Price	$24.57
Rate for Payer: Cofinity Commercial	$21.50
Rate for Payer: Cofinity Commercial	$26.41
Rate for Payer: Cofinity Medicare Advantage	$21.50
Rate for Payer: Encore Health Key Benefits Commercial	$24.57
Rate for Payer: Healthscope Commercial	$27.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.10
Rate for Payer: PHP Commercial	$26.10
Rate for Payer: Priority Health Cigna Priority Health	$19.96
Rate for Payer: Priority Health SBD	$19.35

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$26.83

Service Code	NDC 00409488724
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$24.15
Rate for Payer: Aetna Commercial	$22.81
Rate for Payer: Aetna New Business (MI Preferred)	$17.44
Rate for Payer: Cash Price	$21.46
Rate for Payer: Cofinity Commercial	$18.78
Rate for Payer: Cofinity Commercial	$23.07
Rate for Payer: Cofinity Medicare Advantage	$18.78
Rate for Payer: Encore Health Key Benefits Commercial	$21.46
Rate for Payer: Healthscope Commercial	$24.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.81
Rate for Payer: PHP Commercial	$22.81
Rate for Payer: Priority Health Cigna Priority Health	$17.44
Rate for Payer: Priority Health SBD	$16.90

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$13.75

Service Code	NDC 00409488710
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$11.69
Rate for Payer: Aetna Medicare	$6.88
Rate for Payer: Aetna New Business (MI Preferred)	$8.94
Rate for Payer: BCBS Complete	$5.50
Rate for Payer: Cash Price	$11.00
Rate for Payer: Cofinity Commercial	$11.82
Rate for Payer: Cofinity Commercial	$9.62
Rate for Payer: Cofinity Medicare Advantage	$9.62
Rate for Payer: Encore Health Key Benefits Commercial	$11.00
Rate for Payer: Healthscope Commercial	$12.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.69
Rate for Payer: PHP Commercial	$11.69
Rate for Payer: Priority Health Cigna Priority Health	$8.94
Rate for Payer: Priority Health SBD	$8.66

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$14.79

Service Code	NDC 00409488723
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$13.31
Rate for Payer: Aetna Commercial	$12.57
Rate for Payer: Aetna New Business (MI Preferred)	$9.61
Rate for Payer: Cash Price	$11.83
Rate for Payer: Cofinity Commercial	$10.35
Rate for Payer: Cofinity Commercial	$12.72
Rate for Payer: Cofinity Medicare Advantage	$10.35
Rate for Payer: Encore Health Key Benefits Commercial	$11.83
Rate for Payer: Healthscope Commercial	$13.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.57
Rate for Payer: PHP Commercial	$12.57
Rate for Payer: Priority Health Cigna Priority Health	$9.61
Rate for Payer: Priority Health SBD	$9.32

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$19.14

Service Code	NDC 00409488799
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$17.23
Rate for Payer: Aetna Commercial	$16.27
Rate for Payer: Aetna Medicare	$9.57
Rate for Payer: Aetna New Business (MI Preferred)	$12.44
Rate for Payer: BCBS Complete	$7.66
Rate for Payer: Cash Price	$15.31
Rate for Payer: Cofinity Commercial	$13.40
Rate for Payer: Cofinity Commercial	$16.46
Rate for Payer: Cofinity Medicare Advantage	$13.40
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: PHP Commercial	$16.27
Rate for Payer: Priority Health Cigna Priority Health	$12.44
Rate for Payer: Priority Health SBD	$12.06

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$14.79

Service Code	NDC 00409488720
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$13.31
Rate for Payer: Aetna Commercial	$12.57
Rate for Payer: Aetna Medicare	$7.40
Rate for Payer: Aetna New Business (MI Preferred)	$9.61
Rate for Payer: BCBS Complete	$5.92
Rate for Payer: Cash Price	$11.83
Rate for Payer: Cofinity Commercial	$10.35
Rate for Payer: Cofinity Commercial	$12.72
Rate for Payer: Cofinity Medicare Advantage	$10.35
Rate for Payer: Encore Health Key Benefits Commercial	$11.83
Rate for Payer: Healthscope Commercial	$13.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.57
Rate for Payer: PHP Commercial	$12.57
Rate for Payer: Priority Health Cigna Priority Health	$9.61
Rate for Payer: Priority Health SBD	$9.32

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$13.75

Service Code	NDC 00409488717
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$11.69
Rate for Payer: Aetna Medicare	$6.88
Rate for Payer: Aetna New Business (MI Preferred)	$8.94
Rate for Payer: BCBS Complete	$5.50
Rate for Payer: Cash Price	$11.00
Rate for Payer: Cofinity Commercial	$11.82
Rate for Payer: Cofinity Commercial	$9.62
Rate for Payer: Cofinity Medicare Advantage	$9.62
Rate for Payer: Encore Health Key Benefits Commercial	$11.00
Rate for Payer: Healthscope Commercial	$12.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.69
Rate for Payer: PHP Commercial	$11.69
Rate for Payer: Priority Health Cigna Priority Health	$8.94
Rate for Payer: Priority Health SBD	$8.66

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$14.79

Service Code	NDC 00409488723
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$13.31
Rate for Payer: Aetna Commercial	$12.57
Rate for Payer: Aetna Medicare	$7.40
Rate for Payer: Aetna New Business (MI Preferred)	$9.61
Rate for Payer: BCBS Complete	$5.92
Rate for Payer: Cash Price	$11.83
Rate for Payer: Cofinity Commercial	$10.35
Rate for Payer: Cofinity Commercial	$12.72
Rate for Payer: Cofinity Medicare Advantage	$10.35
Rate for Payer: Encore Health Key Benefits Commercial	$11.83
Rate for Payer: Healthscope Commercial	$13.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.57
Rate for Payer: PHP Commercial	$12.57
Rate for Payer: Priority Health Cigna Priority Health	$9.61
Rate for Payer: Priority Health SBD	$9.32

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$19.14

Service Code	NDC 00409488725
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 Commercial	$13.40
Rate for Payer: Cofinity Commercial	$16.46
Rate for Payer: Cofinity Medicare Advantage	$13.40
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: PHP Commercial	$16.27
Rate for Payer: Priority Health Cigna Priority Health	$12.44
Rate for Payer: Priority Health SBD	$12.06

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$26.83

Service Code	NDC 00409488750
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$10.73
Max. Negotiated Rate	$24.15
Rate for Payer: Aetna Commercial	$22.81
Rate for Payer: Aetna Medicare	$13.42
Rate for Payer: Aetna New Business (MI Preferred)	$17.44
Rate for Payer: BCBS Complete	$10.73
Rate for Payer: Cash Price	$21.46
Rate for Payer: Cofinity Commercial	$18.78
Rate for Payer: Cofinity Commercial	$23.07
Rate for Payer: Cofinity Medicare Advantage	$18.78
Rate for Payer: Encore Health Key Benefits Commercial	$21.46
Rate for Payer: Healthscope Commercial	$24.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.81
Rate for Payer: PHP Commercial	$22.81
Rate for Payer: Priority Health Cigna Priority Health	$17.44
Rate for Payer: Priority Health SBD	$16.90

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$26.83

Service Code	NDC 00409488750
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$24.15
Rate for Payer: Aetna Commercial	$22.81
Rate for Payer: Aetna New Business (MI Preferred)	$17.44
Rate for Payer: Cash Price	$21.46
Rate for Payer: Cofinity Commercial	$18.78
Rate for Payer: Cofinity Commercial	$23.07
Rate for Payer: Cofinity Medicare Advantage	$18.78
Rate for Payer: Encore Health Key Benefits Commercial	$21.46
Rate for Payer: Healthscope Commercial	$24.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.81
Rate for Payer: PHP Commercial	$22.81
Rate for Payer: Priority Health Cigna Priority Health	$17.44
Rate for Payer: Priority Health SBD	$16.90

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$19.14

Service Code	NDC 00409488725
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$17.23
Rate for Payer: Aetna Commercial	$16.27
Rate for Payer: Aetna Medicare	$9.57
Rate for Payer: Aetna New Business (MI Preferred)	$12.44
Rate for Payer: BCBS Complete	$7.66
Rate for Payer: Cash Price	$15.31
Rate for Payer: Cofinity Commercial	$13.40
Rate for Payer: Cofinity Commercial	$16.46
Rate for Payer: Cofinity Medicare Advantage	$13.40
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: PHP Commercial	$16.27
Rate for Payer: Priority Health Cigna Priority Health	$12.44
Rate for Payer: Priority Health SBD	$12.06

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$14.79

Service Code	NDC 00409488720
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$13.31
Rate for Payer: Aetna Commercial	$12.57
Rate for Payer: Aetna New Business (MI Preferred)	$9.61
Rate for Payer: Cash Price	$11.83
Rate for Payer: Cofinity Commercial	$10.35
Rate for Payer: Cofinity Commercial	$12.72
Rate for Payer: Cofinity Medicare Advantage	$10.35
Rate for Payer: Encore Health Key Benefits Commercial	$11.83
Rate for Payer: Healthscope Commercial	$13.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.57
Rate for Payer: PHP Commercial	$12.57
Rate for Payer: Priority Health Cigna Priority Health	$9.61
Rate for Payer: Priority Health SBD	$9.32

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$30.71

Service Code	NDC 63323018550
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$27.64
Rate for Payer: Aetna Commercial	$26.10
Rate for Payer: Aetna Medicare	$15.36
Rate for Payer: Aetna New Business (MI Preferred)	$19.96
Rate for Payer: BCBS Complete	$12.28
Rate for Payer: Cash Price	$24.57
Rate for Payer: Cofinity Commercial	$21.50
Rate for Payer: Cofinity Commercial	$26.41
Rate for Payer: Cofinity Medicare Advantage	$21.50
Rate for Payer: Encore Health Key Benefits Commercial	$24.57
Rate for Payer: Healthscope Commercial	$27.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.10
Rate for Payer: PHP Commercial	$26.10
Rate for Payer: Priority Health Cigna Priority Health	$19.96
Rate for Payer: Priority Health SBD	$19.35

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$13.75

Service Code	NDC 00409488710
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$11.69
Rate for Payer: Aetna New Business (MI Preferred)	$8.94
Rate for Payer: Cash Price	$11.00
Rate for Payer: Cofinity Commercial	$11.82
Rate for Payer: Cofinity Commercial	$9.62
Rate for Payer: Cofinity Medicare Advantage	$9.62
Rate for Payer: Encore Health Key Benefits Commercial	$11.00
Rate for Payer: Healthscope Commercial	$12.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.69
Rate for Payer: PHP Commercial	$11.69
Rate for Payer: Priority Health Cigna Priority Health	$8.94
Rate for Payer: Priority Health SBD	$8.66

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$30.71

Service Code	NDC 63323018509
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$27.64
Rate for Payer: Aetna Commercial	$26.10
Rate for Payer: Aetna Medicare	$15.36
Rate for Payer: Aetna New Business (MI Preferred)	$19.96
Rate for Payer: BCBS Complete	$12.28
Rate for Payer: Cash Price	$24.57
Rate for Payer: Cofinity Commercial	$21.50
Rate for Payer: Cofinity Commercial	$26.41
Rate for Payer: Cofinity Medicare Advantage	$21.50
Rate for Payer: Encore Health Key Benefits Commercial	$24.57
Rate for Payer: Healthscope Commercial	$27.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.10
Rate for Payer: PHP Commercial	$26.10
Rate for Payer: Priority Health Cigna Priority Health	$19.96
Rate for Payer: Priority Health SBD	$19.35

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$26.83

Service Code	NDC 00409488724
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$10.73
Max. Negotiated Rate	$24.15
Rate for Payer: Aetna Commercial	$22.81
Rate for Payer: Aetna Medicare	$13.42
Rate for Payer: Aetna New Business (MI Preferred)	$17.44
Rate for Payer: BCBS Complete	$10.73
Rate for Payer: Cash Price	$21.46
Rate for Payer: Cofinity Commercial	$18.78
Rate for Payer: Cofinity Commercial	$23.07
Rate for Payer: Cofinity Medicare Advantage	$18.78
Rate for Payer: Encore Health Key Benefits Commercial	$21.46
Rate for Payer: Healthscope Commercial	$24.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.81
Rate for Payer: PHP Commercial	$22.81
Rate for Payer: Priority Health Cigna Priority Health	$17.44
Rate for Payer: Priority Health SBD	$16.90

WATER FOR INJECTION, STERILE INJECTION SOLUTION

Facility

$30.71

Service Code	NDC 63323018550
Hospital Charge Code	11671
Hospital Revenue Code	250
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$27.64
Rate for Payer: Aetna Commercial	$26.10
Rate for Payer: Aetna New Business (MI Preferred)	$19.96
Rate for Payer: Cash Price	$24.57
Rate for Payer: Cofinity Commercial	$26.41
Rate for Payer: Cofinity Commercial	$21.50
Rate for Payer: Cofinity Medicare Advantage	$21.50
Rate for Payer: Encore Health Key Benefits Commercial	$24.57
Rate for Payer: Healthscope Commercial	$27.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.10
Rate for Payer: PHP Commercial	$26.10
Rate for Payer: Priority Health Cigna Priority Health	$19.96
Rate for Payer: Priority Health SBD	$19.35

WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES

Facility

$18.12

Service Code	NDC 63323018507
Hospital Charge Code	301772
Hospital Revenue Code	250
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$16.31
Rate for Payer: Aetna Commercial	$15.40
Rate for Payer: Aetna Medicare	$9.06
Rate for Payer: Aetna New Business (MI Preferred)	$11.78
Rate for Payer: BCBS Complete	$7.25
Rate for Payer: Cash Price	$14.50
Rate for Payer: Cofinity Commercial	$12.68
Rate for Payer: Cofinity Commercial	$15.58
Rate for Payer: Cofinity Medicare Advantage	$12.68
Rate for Payer: Encore Health Key Benefits Commercial	$14.50
Rate for Payer: Healthscope Commercial	$16.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.40
Rate for Payer: PHP Commercial	$15.40
Rate for Payer: Priority Health Cigna Priority Health	$11.78
Rate for Payer: Priority Health SBD	$11.42

WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES

Facility

$18.12

Service Code	NDC 63323018510
Hospital Charge Code	301772
Hospital Revenue Code	250
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$16.31
Rate for Payer: Aetna Commercial	$15.40
Rate for Payer: Aetna New Business (MI Preferred)	$11.78
Rate for Payer: Cash Price	$14.50
Rate for Payer: Cofinity Commercial	$12.68
Rate for Payer: Cofinity Commercial	$15.58
Rate for Payer: Cofinity Medicare Advantage	$12.68
Rate for Payer: Encore Health Key Benefits Commercial	$14.50
Rate for Payer: Healthscope Commercial	$16.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.40
Rate for Payer: PHP Commercial	$15.40
Rate for Payer: Priority Health Cigna Priority Health	$11.78
Rate for Payer: Priority Health SBD	$11.42

Know your out-of-pocket cost for care.

All Charges