Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)

Facility

$64.97

Service Code	NDC 09900001916
Hospital Charge Code	300441
Hospital Revenue Code	250
Min. Negotiated Rate	$25.99
Max. Negotiated Rate	$58.47
Rate for Payer: Aetna Commercial	$55.22
Rate for Payer: Aetna Medicare	$32.48
Rate for Payer: Aetna New Business (MI Preferred)	$42.23
Rate for Payer: BCBS Complete	$25.99
Rate for Payer: Cash Price	$51.98
Rate for Payer: Cofinity Commercial	$45.48
Rate for Payer: Cofinity Commercial	$55.87
Rate for Payer: Cofinity Medicare Advantage	$45.48
Rate for Payer: Encore Health Key Benefits Commercial	$51.98
Rate for Payer: Healthscope Commercial	$58.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.22
Rate for Payer: PHP Commercial	$55.22
Rate for Payer: Priority Health Cigna Priority Health	$42.23
Rate for Payer: Priority Health SBD	$40.93

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 Commercial	$71.96
Rate for Payer: Cofinity Commercial	$88.41
Rate for Payer: Cofinity Medicare Advantage	$71.96
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: PHP Commercial	$87.38
Rate for Payer: Priority Health Cigna Priority Health	$66.82
Rate for Payer: Priority Health SBD	$64.76

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

Facility

$35.60

Service Code	NDC 00409662514
Hospital Charge Code	108819
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 Commercial	$30.62
Rate for Payer: Cofinity Commercial	$24.92
Rate for Payer: Cofinity Medicare Advantage	$24.92
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: PHP Commercial	$30.26
Rate for Payer: Priority Health Cigna Priority Health	$23.14
Rate for Payer: Priority Health SBD	$22.43

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

Facility

$35.60

Service Code	NDC 00409662514
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$14.24
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 Commercial	$24.92
Rate for Payer: Cofinity Commercial	$30.62
Rate for Payer: Cofinity Medicare Advantage	$24.92
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: PHP Commercial	$30.26
Rate for Payer: Priority Health Cigna Priority Health	$23.14
Rate for Payer: Priority Health SBD	$22.43

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

Facility

$35.60

Service Code	NDC 00409662522
Hospital Charge Code	108819
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 Commercial	$24.92
Rate for Payer: Cofinity Commercial	$30.62
Rate for Payer: Cofinity Medicare Advantage	$24.92
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: PHP Commercial	$30.26
Rate for Payer: Priority Health Cigna Priority Health	$23.14
Rate for Payer: Priority Health SBD	$22.43

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

Facility

$22.70

Service Code	NDC 51754500101
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$9.08
Max. Negotiated Rate	$20.43
Rate for Payer: Aetna Commercial	$19.30
Rate for Payer: Aetna Medicare	$11.35
Rate for Payer: Aetna New Business (MI Preferred)	$14.76
Rate for Payer: BCBS Complete	$9.08
Rate for Payer: Cash Price	$18.16
Rate for Payer: Cofinity Commercial	$15.89
Rate for Payer: Cofinity Commercial	$19.52
Rate for Payer: Cofinity Medicare Advantage	$15.89
Rate for Payer: Encore Health Key Benefits Commercial	$18.16
Rate for Payer: Healthscope Commercial	$20.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.30
Rate for Payer: PHP Commercial	$19.30
Rate for Payer: Priority Health Cigna Priority Health	$14.76
Rate for Payer: Priority Health SBD	$14.30

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	$9.52
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 Commercial	$16.67
Rate for Payer: Cofinity Commercial	$20.48
Rate for Payer: Cofinity Medicare Advantage	$16.67
Rate for Payer: Encore Health Key Benefits Commercial	$19.05
Rate for Payer: Healthscope Commercial	$21.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.24
Rate for Payer: PHP Commercial	$20.24
Rate for Payer: Priority Health Cigna Priority Health	$15.48
Rate for Payer: Priority Health SBD	$15.00

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

Facility

$22.70

Service Code	NDC 51754500101
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$20.43
Rate for Payer: Aetna Commercial	$19.30
Rate for Payer: Aetna New Business (MI Preferred)	$14.76
Rate for Payer: Cash Price	$18.16
Rate for Payer: Cofinity Commercial	$15.89
Rate for Payer: Cofinity Commercial	$19.52
Rate for Payer: Cofinity Medicare Advantage	$15.89
Rate for Payer: Encore Health Key Benefits Commercial	$18.16
Rate for Payer: Healthscope Commercial	$20.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.30
Rate for Payer: PHP Commercial	$19.30
Rate for Payer: Priority Health Cigna Priority Health	$14.76
Rate for Payer: Priority Health SBD	$14.30

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	$41.12
Max. Negotiated Rate	$92.52
Rate for Payer: Aetna Commercial	$87.38
Rate for Payer: Aetna Medicare	$51.40
Rate for Payer: Aetna New Business (MI Preferred)	$66.82
Rate for Payer: BCBS Complete	$41.12
Rate for Payer: Cash Price	$82.24
Rate for Payer: Cofinity Commercial	$71.96
Rate for Payer: Cofinity Commercial	$88.41
Rate for Payer: Cofinity Medicare Advantage	$71.96
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: PHP Commercial	$87.38
Rate for Payer: Priority Health Cigna Priority Health	$66.82
Rate for Payer: Priority Health SBD	$64.76

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

Facility

$35.60

Service Code	NDC 00409662522
Hospital Charge Code	108819
Hospital Revenue Code	250
Min. Negotiated Rate	$14.24
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 Commercial	$24.92
Rate for Payer: Cofinity Commercial	$30.62
Rate for Payer: Cofinity Medicare Advantage	$24.92
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: PHP Commercial	$30.26
Rate for Payer: Priority Health Cigna Priority Health	$23.14
Rate for Payer: Priority Health SBD	$22.43

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	$15.00
Max. Negotiated Rate	$21.43
Rate for Payer: Aetna Commercial	$20.24
Rate for Payer: Aetna New Business (MI Preferred)	$15.48
Rate for Payer: Cash Price	$19.05
Rate for Payer: Cofinity Commercial	$16.67
Rate for Payer: Cofinity Commercial	$20.48
Rate for Payer: Cofinity Medicare Advantage	$16.67
Rate for Payer: Encore Health Key Benefits Commercial	$19.05
Rate for Payer: Healthscope Commercial	$21.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.24
Rate for Payer: PHP Commercial	$20.24
Rate for Payer: Priority Health Cigna Priority Health	$15.48
Rate for Payer: Priority Health SBD	$15.00

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 Commercial	$3.08
Rate for Payer: Cofinity Commercial	$3.78
Rate for Payer: Cofinity Medicare Advantage	$3.08
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: PHP Commercial	$3.74
Rate for Payer: Priority Health Cigna Priority Health	$2.86
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	$1.76
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 Commercial	$3.08
Rate for Payer: Cofinity Commercial	$3.78
Rate for Payer: Cofinity Medicare Advantage	$3.08
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: PHP Commercial	$3.74
Rate for Payer: Priority Health Cigna Priority Health	$2.86
Rate for Payer: Priority Health SBD	$2.77

SODIUM BICARBONATE 650 MG TABLET

Facility

$2.78

Service Code	NDC 77333083125
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$2.36
Rate for Payer: Aetna Medicare	$1.39
Rate for Payer: Aetna New Business (MI Preferred)	$1.81
Rate for Payer: BCBS Complete	$1.11
Rate for Payer: Cash Price	$2.22
Rate for Payer: Cofinity Commercial	$1.95
Rate for Payer: Cofinity Commercial	$2.39
Rate for Payer: Cofinity Medicare Advantage	$1.95
Rate for Payer: Encore Health Key Benefits Commercial	$2.22
Rate for Payer: Healthscope Commercial	$2.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.36
Rate for Payer: PHP Commercial	$2.36
Rate for Payer: Priority Health Cigna Priority Health	$1.81
Rate for Payer: Priority Health SBD	$1.75

SODIUM BICARBONATE 650 MG TABLET

Facility

$296.10

Service Code	NDC 77333082710
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$186.54
Max. Negotiated Rate	$266.49
Rate for Payer: Aetna Commercial	$251.68
Rate for Payer: Aetna New Business (MI Preferred)	$192.46
Rate for Payer: Cash Price	$236.88
Rate for Payer: Cofinity Commercial	$207.27
Rate for Payer: Cofinity Commercial	$254.65
Rate for Payer: Cofinity Medicare Advantage	$207.27
Rate for Payer: Encore Health Key Benefits Commercial	$236.88
Rate for Payer: Healthscope Commercial	$266.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$251.68
Rate for Payer: PHP Commercial	$251.68
Rate for Payer: Priority Health Cigna Priority Health	$192.46
Rate for Payer: Priority Health SBD	$186.54

SODIUM BICARBONATE 650 MG TABLET

Facility

$258.50

Service Code	NDC 64980052810
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$162.86
Max. Negotiated Rate	$232.65
Rate for Payer: Aetna Commercial	$219.72
Rate for Payer: Aetna New Business (MI Preferred)	$168.02
Rate for Payer: Cash Price	$206.80
Rate for Payer: Cofinity Commercial	$180.95
Rate for Payer: Cofinity Commercial	$222.31
Rate for Payer: Cofinity Medicare Advantage	$180.95
Rate for Payer: Encore Health Key Benefits Commercial	$206.80
Rate for Payer: Healthscope Commercial	$232.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.72
Rate for Payer: PHP Commercial	$219.72
Rate for Payer: Priority Health Cigna Priority Health	$168.02
Rate for Payer: Priority Health SBD	$162.86

SODIUM BICARBONATE 650 MG TABLET

Facility

$277.30

Service Code	NDC 77333083110
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$110.92
Max. Negotiated Rate	$249.57
Rate for Payer: Aetna Commercial	$235.70
Rate for Payer: Aetna Medicare	$138.65
Rate for Payer: Aetna New Business (MI Preferred)	$180.24
Rate for Payer: BCBS Complete	$110.92
Rate for Payer: Cash Price	$221.84
Rate for Payer: Cofinity Commercial	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Cofinity Medicare Advantage	$194.11
Rate for Payer: Encore Health Key Benefits Commercial	$221.84
Rate for Payer: Healthscope Commercial	$249.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.70
Rate for Payer: PHP Commercial	$235.70
Rate for Payer: Priority Health Cigna Priority Health	$180.24
Rate for Payer: Priority Health SBD	$174.70

SODIUM BICARBONATE 650 MG TABLET

Facility

$258.50

Service Code	NDC 64980052810
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$232.65
Rate for Payer: Aetna Commercial	$219.72
Rate for Payer: Aetna Medicare	$129.25
Rate for Payer: Aetna New Business (MI Preferred)	$168.02
Rate for Payer: BCBS Complete	$103.40
Rate for Payer: Cash Price	$206.80
Rate for Payer: Cofinity Commercial	$180.95
Rate for Payer: Cofinity Commercial	$222.31
Rate for Payer: Cofinity Medicare Advantage	$180.95
Rate for Payer: Encore Health Key Benefits Commercial	$206.80
Rate for Payer: Healthscope Commercial	$232.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.72
Rate for Payer: PHP Commercial	$219.72
Rate for Payer: Priority Health Cigna Priority Health	$168.02
Rate for Payer: Priority Health SBD	$162.86

SODIUM BICARBONATE 650 MG TABLET

Facility

$2.97

Service Code	NDC 77333082725
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna Commercial	$2.52
Rate for Payer: Aetna Medicare	$1.48
Rate for Payer: Aetna New Business (MI Preferred)	$1.93
Rate for Payer: BCBS Complete	$1.19
Rate for Payer: Cash Price	$2.38
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Cofinity Commercial	$2.55
Rate for Payer: Cofinity Medicare Advantage	$2.08
Rate for Payer: Encore Health Key Benefits Commercial	$2.38
Rate for Payer: Healthscope Commercial	$2.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.52
Rate for Payer: PHP Commercial	$2.52
Rate for Payer: Priority Health Cigna Priority Health	$1.93
Rate for Payer: Priority Health SBD	$1.87

SODIUM BICARBONATE 650 MG TABLET

Facility

$296.10

Service Code	NDC 77333082710
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$118.44
Max. Negotiated Rate	$266.49
Rate for Payer: Aetna Commercial	$251.68
Rate for Payer: Aetna Medicare	$148.05
Rate for Payer: Aetna New Business (MI Preferred)	$192.46
Rate for Payer: BCBS Complete	$118.44
Rate for Payer: Cash Price	$236.88
Rate for Payer: Cofinity Commercial	$207.27
Rate for Payer: Cofinity Commercial	$254.65
Rate for Payer: Cofinity Medicare Advantage	$207.27
Rate for Payer: Encore Health Key Benefits Commercial	$236.88
Rate for Payer: Healthscope Commercial	$266.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$251.68
Rate for Payer: PHP Commercial	$251.68
Rate for Payer: Priority Health Cigna Priority Health	$192.46
Rate for Payer: Priority Health SBD	$186.54

SODIUM BICARBONATE 650 MG TABLET

Facility

$277.30

Service Code	NDC 77333083110
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$174.70
Max. Negotiated Rate	$249.57
Rate for Payer: Aetna Commercial	$235.70
Rate for Payer: Aetna New Business (MI Preferred)	$180.24
Rate for Payer: Cash Price	$221.84
Rate for Payer: Cofinity Commercial	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Cofinity Medicare Advantage	$194.11
Rate for Payer: Encore Health Key Benefits Commercial	$221.84
Rate for Payer: Healthscope Commercial	$249.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.70
Rate for Payer: PHP Commercial	$235.70
Rate for Payer: Priority Health Cigna Priority Health	$180.24
Rate for Payer: Priority Health SBD	$174.70

SODIUM BICARBONATE 650 MG TABLET

Facility

$2.97

Service Code	NDC 77333082725
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna Commercial	$2.52
Rate for Payer: Aetna New Business (MI Preferred)	$1.93
Rate for Payer: Cash Price	$2.38
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Cofinity Commercial	$2.55
Rate for Payer: Cofinity Medicare Advantage	$2.08
Rate for Payer: Encore Health Key Benefits Commercial	$2.38
Rate for Payer: Healthscope Commercial	$2.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.52
Rate for Payer: PHP Commercial	$2.52
Rate for Payer: Priority Health Cigna Priority Health	$1.93
Rate for Payer: Priority Health SBD	$1.87

SODIUM BICARBONATE 650 MG TABLET

Facility

$2.78

Service Code	NDC 77333083125
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$2.36
Rate for Payer: Aetna New Business (MI Preferred)	$1.81
Rate for Payer: Cash Price	$2.22
Rate for Payer: Cofinity Commercial	$1.95
Rate for Payer: Cofinity Commercial	$2.39
Rate for Payer: Cofinity Medicare Advantage	$1.95
Rate for Payer: Encore Health Key Benefits Commercial	$2.22
Rate for Payer: Healthscope Commercial	$2.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.36
Rate for Payer: PHP Commercial	$2.36
Rate for Payer: Priority Health Cigna Priority Health	$1.81
Rate for Payer: Priority Health SBD	$1.75

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

Facility

$72.32

Service Code	NDC 00409663714
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$45.56
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$61.47
Rate for Payer: Aetna New Business (MI Preferred)	$47.01
Rate for Payer: Cash Price	$57.86
Rate for Payer: Cofinity Commercial	$50.62
Rate for Payer: Cofinity Commercial	$62.20
Rate for Payer: Cofinity Medicare Advantage	$50.62
Rate for Payer: Encore Health Key Benefits Commercial	$57.86
Rate for Payer: Healthscope Commercial	$65.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.47
Rate for Payer: PHP Commercial	$61.47
Rate for Payer: Priority Health Cigna Priority Health	$47.01
Rate for Payer: Priority Health SBD	$45.56

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

Facility

$72.32

Service Code	NDC 00409663724
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$45.56
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$61.47
Rate for Payer: Aetna New Business (MI Preferred)	$47.01
Rate for Payer: Cash Price	$57.86
Rate for Payer: Cofinity Commercial	$50.62
Rate for Payer: Cofinity Commercial	$62.20
Rate for Payer: Cofinity Medicare Advantage	$50.62
Rate for Payer: Encore Health Key Benefits Commercial	$57.86
Rate for Payer: Healthscope Commercial	$65.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.47
Rate for Payer: PHP Commercial	$61.47
Rate for Payer: Priority Health Cigna Priority Health	$47.01
Rate for Payer: Priority Health SBD	$45.56

Know your out-of-pocket cost for care.

All Charges