Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION

Facility

$65.86

Service Code	NDC 81665020001
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$41.49
Max. Negotiated Rate	$59.27
Rate for Payer: Aetna Commercial	$55.98
Rate for Payer: Aetna New Business (MI Preferred)	$42.81
Rate for Payer: Cash Price	$52.69
Rate for Payer: Cofinity Advantage	$46.10
Rate for Payer: Cofinity Commercial	$56.64
Rate for Payer: Encore Health Key Benefits Commercial	$52.69
Rate for Payer: Healthscope Commercial	$59.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.40
Rate for Payer: PHP Commercial	$55.98
Rate for Payer: Priority Health SBD	$41.49

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION

Facility

$37.38

Service Code	NDC 70095005001
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$33.64
Rate for Payer: Aetna Commercial	$31.77
Rate for Payer: Aetna Medicare	$18.69
Rate for Payer: Aetna New Business (MI Preferred)	$24.30
Rate for Payer: BCBS Complete	$14.95
Rate for Payer: Cash Price	$29.90
Rate for Payer: Cofinity Advantage	$26.17
Rate for Payer: Cofinity Commercial	$32.15
Rate for Payer: Encore Health Key Benefits Commercial	$29.90
Rate for Payer: Healthscope Commercial	$33.64
Rate for Payer: MI Amish Medical Board Commercial	$29.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.04
Rate for Payer: PHP Commercial	$31.77
Rate for Payer: Priority Health SBD	$23.55
Rate for Payer: UHC All Payor (Choice/PPO)	$24.30
Rate for Payer: UHC Core	$19.47
Rate for Payer: UHC Exchange	$14.69

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION

Facility

$21.14

Service Code	NDC 68462095165
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$19.03
Rate for Payer: Aetna Commercial	$17.97
Rate for Payer: Aetna Medicare	$10.57
Rate for Payer: Aetna New Business (MI Preferred)	$13.74
Rate for Payer: BCBS Complete	$8.46
Rate for Payer: Cash Price	$16.91
Rate for Payer: Cofinity Advantage	$14.80
Rate for Payer: Cofinity Commercial	$18.18
Rate for Payer: Encore Health Key Benefits Commercial	$16.91
Rate for Payer: Healthscope Commercial	$19.03
Rate for Payer: MI Amish Medical Board Commercial	$16.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.86
Rate for Payer: PHP Commercial	$17.97
Rate for Payer: Priority Health SBD	$13.32
Rate for Payer: UHC All Payor (Choice/PPO)	$13.74
Rate for Payer: UHC Core	$11.01
Rate for Payer: UHC Exchange	$8.31

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION

Facility

$23.81

Service Code	NDC 51754500105
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$21.43
Rate for Payer: Aetna Commercial	$20.24
Rate for Payer: Aetna Medicare	$11.90
Rate for Payer: Aetna New Business (MI Preferred)	$15.48
Rate for Payer: BCBS Complete	$9.52
Rate for Payer: Cash Price	$19.05
Rate for Payer: Cofinity Advantage	$16.67
Rate for Payer: Cofinity Commercial	$20.48
Rate for Payer: Encore Health Key Benefits Commercial	$19.05
Rate for Payer: Healthscope Commercial	$21.43
Rate for Payer: MI Amish Medical Board Commercial	$19.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.86
Rate for Payer: PHP Commercial	$20.24
Rate for Payer: Priority Health SBD	$15.00
Rate for Payer: UHC All Payor (Choice/PPO)	$15.48
Rate for Payer: UHC Core	$12.41
Rate for Payer: UHC Exchange	$9.36

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION

Facility

$37.38

Service Code	NDC 70095005001
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$23.55
Max. Negotiated Rate	$33.64
Rate for Payer: Aetna Commercial	$31.77
Rate for Payer: Aetna New Business (MI Preferred)	$24.30
Rate for Payer: Cash Price	$29.90
Rate for Payer: Cofinity Advantage	$26.17
Rate for Payer: Cofinity Commercial	$32.15
Rate for Payer: Encore Health Key Benefits Commercial	$29.90
Rate for Payer: Healthscope Commercial	$33.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.04
Rate for Payer: PHP Commercial	$31.77
Rate for Payer: Priority Health SBD	$23.55

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION

Facility

$21.14

Service Code	NDC 68462095150
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$19.03
Rate for Payer: Aetna Commercial	$17.97
Rate for Payer: Aetna New Business (MI Preferred)	$13.74
Rate for Payer: Cash Price	$16.91
Rate for Payer: Cofinity Advantage	$14.80
Rate for Payer: Cofinity Commercial	$18.18
Rate for Payer: Encore Health Key Benefits Commercial	$16.91
Rate for Payer: Healthscope Commercial	$19.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.86
Rate for Payer: PHP Commercial	$17.97
Rate for Payer: Priority Health SBD	$13.32

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION

Facility

$21.14

Service Code	NDC 68462095165
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$19.03
Rate for Payer: Aetna Commercial	$17.97
Rate for Payer: Aetna New Business (MI Preferred)	$13.74
Rate for Payer: Cash Price	$16.91
Rate for Payer: Cofinity Advantage	$14.80
Rate for Payer: Cofinity Commercial	$18.18
Rate for Payer: Encore Health Key Benefits Commercial	$16.91
Rate for Payer: Healthscope Commercial	$19.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.86
Rate for Payer: PHP Commercial	$17.97
Rate for Payer: Priority Health SBD	$13.32

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION

Facility

$102.80

Service Code	NDC 63323008950
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$64.76
Max. Negotiated Rate	$92.52
Rate for Payer: Aetna Commercial	$87.38
Rate for Payer: Aetna New Business (MI Preferred)	$66.82
Rate for Payer: Cash Price	$82.24
Rate for Payer: Cofinity Advantage	$71.96
Rate for Payer: Cofinity Commercial	$88.41
Rate for Payer: Encore Health Key Benefits Commercial	$82.24
Rate for Payer: Healthscope Commercial	$92.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.10
Rate for Payer: PHP Commercial	$87.38
Rate for Payer: Priority Health SBD	$64.76

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION

Facility

$37.38

Service Code	NDC 70095005003
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$33.64
Rate for Payer: Aetna Commercial	$31.77
Rate for Payer: Aetna Medicare	$18.69
Rate for Payer: Aetna New Business (MI Preferred)	$24.30
Rate for Payer: BCBS Complete	$14.95
Rate for Payer: Cash Price	$29.90
Rate for Payer: Cofinity Advantage	$26.17
Rate for Payer: Cofinity Commercial	$32.15
Rate for Payer: Encore Health Key Benefits Commercial	$29.90
Rate for Payer: Healthscope Commercial	$33.64
Rate for Payer: MI Amish Medical Board Commercial	$29.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.04
Rate for Payer: PHP Commercial	$31.77
Rate for Payer: Priority Health SBD	$23.55
Rate for Payer: UHC All Payor (Choice/PPO)	$24.30
Rate for Payer: UHC Core	$19.47
Rate for Payer: UHC Exchange	$14.69

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER

Facility

$35.60

Service Code	NDC 00409662514
Hospital Charge Code	302029
Hospital Revenue Code	250
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$32.04
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna Medicare	$17.80
Rate for Payer: Aetna New Business (MI Preferred)	$23.14
Rate for Payer: BCBS Complete	$14.24
Rate for Payer: Cash Price	$28.48
Rate for Payer: Cofinity Advantage	$24.92
Rate for Payer: Cofinity Commercial	$30.62
Rate for Payer: Encore Health Key Benefits Commercial	$28.48
Rate for Payer: Healthscope Commercial	$32.04
Rate for Payer: MI Amish Medical Board Commercial	$28.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.70
Rate for Payer: PHP Commercial	$30.26
Rate for Payer: Priority Health SBD	$22.43
Rate for Payer: UHC All Payor (Choice/PPO)	$23.14
Rate for Payer: UHC Core	$18.55
Rate for Payer: UHC Exchange	$13.99

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER

Facility

$35.60

Service Code	NDC 00409662514
Hospital Charge Code	302029
Hospital Revenue Code	250
Min. Negotiated Rate	$22.43
Max. Negotiated Rate	$32.04
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna New Business (MI Preferred)	$23.14
Rate for Payer: Cash Price	$28.48
Rate for Payer: Cofinity Advantage	$24.92
Rate for Payer: Cofinity Commercial	$30.62
Rate for Payer: Encore Health Key Benefits Commercial	$28.48
Rate for Payer: Healthscope Commercial	$32.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.70
Rate for Payer: PHP Commercial	$30.26
Rate for Payer: Priority Health SBD	$22.43

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER

Facility

$35.60

Service Code	NDC 00409662522
Hospital Charge Code	302029
Hospital Revenue Code	250
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$32.04
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna Medicare	$17.80
Rate for Payer: Aetna New Business (MI Preferred)	$23.14
Rate for Payer: BCBS Complete	$14.24
Rate for Payer: Cash Price	$28.48
Rate for Payer: Cofinity Advantage	$24.92
Rate for Payer: Cofinity Commercial	$30.62
Rate for Payer: Encore Health Key Benefits Commercial	$28.48
Rate for Payer: Healthscope Commercial	$32.04
Rate for Payer: MI Amish Medical Board Commercial	$28.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.70
Rate for Payer: PHP Commercial	$30.26
Rate for Payer: Priority Health SBD	$22.43
Rate for Payer: UHC All Payor (Choice/PPO)	$23.14
Rate for Payer: UHC Core	$18.55
Rate for Payer: UHC Exchange	$13.99

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER

Facility

$35.60

Service Code	NDC 00409662522
Hospital Charge Code	302029
Hospital Revenue Code	250
Min. Negotiated Rate	$22.43
Max. Negotiated Rate	$32.04
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna New Business (MI Preferred)	$23.14
Rate for Payer: Cash Price	$28.48
Rate for Payer: Cofinity Advantage	$24.92
Rate for Payer: Cofinity Commercial	$30.62
Rate for Payer: Encore Health Key Benefits Commercial	$28.48
Rate for Payer: Healthscope Commercial	$32.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.70
Rate for Payer: PHP Commercial	$30.26
Rate for Payer: Priority Health SBD	$22.43

SODIUM BICARBONATE 2485 MG-CITRIC ACID 1949 MG (PICOT) POWDER PACKET

Facility

$4.40

Service Code	NDC 64613004562
Hospital Charge Code	301795
Hospital Revenue Code	637
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.74
Rate for Payer: Aetna New Business (MI Preferred)	$2.86
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cofinity Advantage	$3.08
Rate for Payer: Cofinity Commercial	$3.78
Rate for Payer: Encore Health Key Benefits Commercial	$3.52
Rate for Payer: Healthscope Commercial	$3.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.30
Rate for Payer: PHP Commercial	$3.74
Rate for Payer: Priority Health SBD	$2.77

SODIUM BICARBONATE 2485 MG-CITRIC ACID 1949 MG (PICOT) POWDER PACKET

Facility

$4.40

Service Code	NDC 64613004562
Hospital Charge Code	301795
Hospital Revenue Code	637
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.74
Rate for Payer: Aetna Medicare	$2.20
Rate for Payer: Aetna New Business (MI Preferred)	$2.86
Rate for Payer: BCBS Complete	$1.76
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cofinity Advantage	$3.08
Rate for Payer: Cofinity Commercial	$3.78
Rate for Payer: Encore Health Key Benefits Commercial	$3.52
Rate for Payer: Healthscope Commercial	$3.96
Rate for Payer: MI Amish Medical Board Commercial	$3.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.30
Rate for Payer: PHP Commercial	$3.74
Rate for Payer: Priority Health SBD	$2.77
Rate for Payer: UHC All Payor (Choice/PPO)	$2.86
Rate for Payer: UHC Core	$2.29
Rate for Payer: UHC Exchange	$1.73

SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE

Facility

$73.21

Service Code	NDC 00409663714
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$28.77
Max. Negotiated Rate	$65.89
Rate for Payer: Aetna Commercial	$62.23
Rate for Payer: Aetna Medicare	$36.60
Rate for Payer: Aetna New Business (MI Preferred)	$47.59
Rate for Payer: BCBS Complete	$29.28
Rate for Payer: Cash Price	$58.57
Rate for Payer: Cofinity Advantage	$51.25
Rate for Payer: Cofinity Commercial	$62.96
Rate for Payer: Encore Health Key Benefits Commercial	$58.57
Rate for Payer: Healthscope Commercial	$65.89
Rate for Payer: MI Amish Medical Board Commercial	$58.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.91
Rate for Payer: PHP Commercial	$62.23
Rate for Payer: Priority Health SBD	$46.12
Rate for Payer: UHC All Payor (Choice/PPO)	$47.59
Rate for Payer: UHC Core	$38.14
Rate for Payer: UHC Exchange	$28.77

SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE

Facility

$73.21

Service Code	NDC 00409663724
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$28.77
Max. Negotiated Rate	$65.89
Rate for Payer: Aetna Commercial	$62.23
Rate for Payer: Aetna Medicare	$36.60
Rate for Payer: Aetna New Business (MI Preferred)	$47.59
Rate for Payer: BCBS Complete	$29.28
Rate for Payer: Cash Price	$58.57
Rate for Payer: Cofinity Advantage	$51.25
Rate for Payer: Cofinity Commercial	$62.96
Rate for Payer: Encore Health Key Benefits Commercial	$58.57
Rate for Payer: Healthscope Commercial	$65.89
Rate for Payer: MI Amish Medical Board Commercial	$58.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.91
Rate for Payer: PHP Commercial	$62.23
Rate for Payer: Priority Health SBD	$46.12
Rate for Payer: UHC All Payor (Choice/PPO)	$47.59
Rate for Payer: UHC Core	$38.14
Rate for Payer: UHC Exchange	$28.77

SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE

Facility

$73.21

Service Code	NDC 00409663714
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$46.12
Max. Negotiated Rate	$65.89
Rate for Payer: Aetna Commercial	$62.23
Rate for Payer: Aetna New Business (MI Preferred)	$47.59
Rate for Payer: Cash Price	$58.57
Rate for Payer: Cofinity Advantage	$51.25
Rate for Payer: Cofinity Commercial	$62.96
Rate for Payer: Encore Health Key Benefits Commercial	$58.57
Rate for Payer: Healthscope Commercial	$65.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.91
Rate for Payer: PHP Commercial	$62.23
Rate for Payer: Priority Health SBD	$46.12

SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE

Facility

$73.21

Service Code	NDC 00409663724
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$46.12
Max. Negotiated Rate	$65.89
Rate for Payer: Aetna Commercial	$62.23
Rate for Payer: Aetna New Business (MI Preferred)	$47.59
Rate for Payer: Cash Price	$58.57
Rate for Payer: Cofinity Advantage	$51.25
Rate for Payer: Cofinity Commercial	$62.96
Rate for Payer: Encore Health Key Benefits Commercial	$58.57
Rate for Payer: Healthscope Commercial	$65.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.91
Rate for Payer: PHP Commercial	$62.23
Rate for Payer: Priority Health SBD	$46.12

SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE

Facility

$73.43

Service Code	NDC 76329335201
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$46.26
Max. Negotiated Rate	$66.09
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna New Business (MI Preferred)	$47.73
Rate for Payer: Cash Price	$58.74
Rate for Payer: Cofinity Advantage	$51.40
Rate for Payer: Cofinity Commercial	$63.15
Rate for Payer: Encore Health Key Benefits Commercial	$58.74
Rate for Payer: Healthscope Commercial	$66.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.07
Rate for Payer: PHP Commercial	$62.42
Rate for Payer: Priority Health SBD	$46.26

SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE

Facility

$73.43

Service Code	NDC 76329335201
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$28.86
Max. Negotiated Rate	$66.09
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna Medicare	$36.72
Rate for Payer: Aetna New Business (MI Preferred)	$47.73
Rate for Payer: BCBS Complete	$29.37
Rate for Payer: Cash Price	$58.74
Rate for Payer: Cofinity Advantage	$51.40
Rate for Payer: Cofinity Commercial	$63.15
Rate for Payer: Encore Health Key Benefits Commercial	$58.74
Rate for Payer: Healthscope Commercial	$66.09
Rate for Payer: MI Amish Medical Board Commercial	$58.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.07
Rate for Payer: PHP Commercial	$62.42
Rate for Payer: Priority Health SBD	$46.26
Rate for Payer: UHC All Payor (Choice/PPO)	$47.73
Rate for Payer: UHC Core	$38.26
Rate for Payer: UHC Exchange	$28.86

SODIUM BICARBONATE 650 MG TABLET

Facility

$305.50

Service Code	NDC 64980052810
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$192.47
Max. Negotiated Rate	$274.95
Rate for Payer: Aetna Commercial	$259.68
Rate for Payer: Aetna New Business (MI Preferred)	$198.57
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cofinity Advantage	$213.85
Rate for Payer: Cofinity Commercial	$262.73
Rate for Payer: Encore Health Key Benefits Commercial	$244.40
Rate for Payer: Healthscope Commercial	$274.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$229.12
Rate for Payer: PHP Commercial	$259.68
Rate for Payer: Priority Health SBD	$192.47

SODIUM BICARBONATE 650 MG TABLET

Facility

$3.20

Service Code	NDC 77333082725
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: Aetna Medicare	$1.60
Rate for Payer: Aetna New Business (MI Preferred)	$2.08
Rate for Payer: BCBS Complete	$1.28
Rate for Payer: Cash Price	$2.56
Rate for Payer: Cofinity Advantage	$2.24
Rate for Payer: Cofinity Commercial	$2.75
Rate for Payer: Encore Health Key Benefits Commercial	$2.56
Rate for Payer: Healthscope Commercial	$2.88
Rate for Payer: MI Amish Medical Board Commercial	$2.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.40
Rate for Payer: PHP Commercial	$2.72
Rate for Payer: Priority Health SBD	$2.02
Rate for Payer: UHC All Payor (Choice/PPO)	$2.08
Rate for Payer: UHC Core	$1.67
Rate for Payer: UHC Exchange	$1.26

SODIUM BICARBONATE 650 MG TABLET

Facility

$3.20

Service Code	NDC 77333082725
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: Aetna New Business (MI Preferred)	$2.08
Rate for Payer: Cash Price	$2.56
Rate for Payer: Cofinity Advantage	$2.24
Rate for Payer: Cofinity Commercial	$2.75
Rate for Payer: Encore Health Key Benefits Commercial	$2.56
Rate for Payer: Healthscope Commercial	$2.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.40
Rate for Payer: PHP Commercial	$2.72
Rate for Payer: Priority Health SBD	$2.02

SODIUM BICARBONATE 650 MG TABLET

Facility

$319.60

Service Code	NDC 77333082710
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$201.35
Max. Negotiated Rate	$287.64
Rate for Payer: Aetna Commercial	$271.66
Rate for Payer: Aetna New Business (MI Preferred)	$207.74
Rate for Payer: Cash Price	$255.68
Rate for Payer: Cofinity Advantage	$223.72
Rate for Payer: Cofinity Commercial	$274.86
Rate for Payer: Encore Health Key Benefits Commercial	$255.68
Rate for Payer: Healthscope Commercial	$287.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$271.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$239.70
Rate for Payer: PHP Commercial	$271.66
Rate for Payer: Priority Health SBD	$201.35

Know your out-of-pocket cost for care.

All Charges