|
FAMOTIDINE 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
163732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.59 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.45
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Advantage |
$65.10
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.40
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.75
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: Priority Health SBD |
$58.59
|
|
|
FAMOTIDINE 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
163732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna Medicare |
$46.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.45
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Advantage |
$65.10
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.40
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.75
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: Priority Health SBD |
$58.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$1,500.17
|
|
|
Service Code
|
NDC 00187442030
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$945.11 |
| Max. Negotiated Rate |
$1,350.15 |
| Rate for Payer: Aetna Commercial |
$1,275.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.11
|
| Rate for Payer: Cash Price |
$1,200.14
|
| Rate for Payer: Cofinity Advantage |
$1,050.12
|
| Rate for Payer: Cofinity Commercial |
$1,290.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.14
|
| Rate for Payer: Healthscope Commercial |
$1,350.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,125.13
|
| Rate for Payer: PHP Commercial |
$1,275.14
|
| Rate for Payer: Priority Health SBD |
$945.11
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
NDC 00904578017
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.94 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna Commercial |
$79.90
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.10
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Advantage |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$80.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.20
|
| Rate for Payer: Healthscope Commercial |
$84.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
| Rate for Payer: PHP Commercial |
$79.90
|
| Rate for Payer: Priority Health SBD |
$59.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.10
|
| Rate for Payer: UHC Core |
$48.97
|
| Rate for Payer: UHC Exchange |
$36.94
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 00904719306
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.51 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
NDC 50268030311
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Advantage |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.66
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.15
|
| Rate for Payer: UHC Exchange |
$0.87
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 00536129801
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$1,339.50
|
|
|
Service Code
|
NDC 61442012110
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$843.88 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Aetna Commercial |
$1,138.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.67
|
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cofinity Advantage |
$937.65
|
| Rate for Payer: Cofinity Commercial |
$1,151.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.60
|
| Rate for Payer: Healthscope Commercial |
$1,205.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,138.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,004.62
|
| Rate for Payer: PHP Commercial |
$1,138.58
|
| Rate for Payer: Priority Health SBD |
$843.88
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 61442012101
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health SBD |
$93.27
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$1,339.50
|
|
|
Service Code
|
NDC 61442012110
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$526.42 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Aetna Commercial |
$1,138.58
|
| Rate for Payer: Aetna Medicare |
$669.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.67
|
| Rate for Payer: BCBS Complete |
$535.80
|
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cofinity Advantage |
$937.65
|
| Rate for Payer: Cofinity Commercial |
$1,151.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.60
|
| Rate for Payer: Healthscope Commercial |
$1,205.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,071.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,138.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,004.62
|
| Rate for Payer: PHP Commercial |
$1,138.58
|
| Rate for Payer: Priority Health SBD |
$843.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$870.67
|
| Rate for Payer: UHC Core |
$697.88
|
| Rate for Payer: UHC Exchange |
$526.42
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 65862085901
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 00904719306
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.90
|
| Rate for Payer: UHC Core |
$62.44
|
| Rate for Payer: UHC Exchange |
$47.10
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$1,500.17
|
|
|
Service Code
|
NDC 00187442030
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$589.57 |
| Max. Negotiated Rate |
$1,350.15 |
| Rate for Payer: Aetna Commercial |
$1,275.14
|
| Rate for Payer: Aetna Medicare |
$750.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.11
|
| Rate for Payer: BCBS Complete |
$600.07
|
| Rate for Payer: Cash Price |
$1,200.14
|
| Rate for Payer: Cofinity Advantage |
$1,050.12
|
| Rate for Payer: Cofinity Commercial |
$1,290.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.14
|
| Rate for Payer: Healthscope Commercial |
$1,350.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,200.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,125.13
|
| Rate for Payer: PHP Commercial |
$1,275.14
|
| Rate for Payer: Priority Health SBD |
$945.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.11
|
| Rate for Payer: UHC Core |
$781.59
|
| Rate for Payer: UHC Exchange |
$589.57
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 60687059501
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.85 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.73
|
| Rate for Payer: UHC Core |
$210.59
|
| Rate for Payer: UHC Exchange |
$158.85
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
NDC 00904578017
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna Commercial |
$79.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.10
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Advantage |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$80.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.20
|
| Rate for Payer: Healthscope Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
| Rate for Payer: PHP Commercial |
$79.90
|
| Rate for Payer: Priority Health SBD |
$59.22
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 50268030315
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$55.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.79
|
| Rate for Payer: UHC Core |
$57.54
|
| Rate for Payer: UHC Exchange |
$43.41
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$5,000.55
|
|
|
Service Code
|
NDC 00187442010
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,150.35 |
| Max. Negotiated Rate |
$4,500.49 |
| Rate for Payer: Aetna Commercial |
$4,250.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,250.36
|
| Rate for Payer: Cash Price |
$4,000.44
|
| Rate for Payer: Cofinity Advantage |
$3,500.39
|
| Rate for Payer: Cofinity Commercial |
$4,300.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,000.44
|
| Rate for Payer: Healthscope Commercial |
$4,500.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,250.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,750.41
|
| Rate for Payer: PHP Commercial |
$4,250.47
|
| Rate for Payer: Priority Health SBD |
$3,150.35
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 60687059501
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.65 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health SBD |
$254.65
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$116.33
|
|
|
Service Code
|
NDC 00904578051
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.29 |
| Max. Negotiated Rate |
$104.70 |
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.61
|
| Rate for Payer: Cash Price |
$93.06
|
| Rate for Payer: Cofinity Advantage |
$81.43
|
| Rate for Payer: Cofinity Commercial |
$100.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.06
|
| Rate for Payer: Healthscope Commercial |
$104.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.25
|
| Rate for Payer: PHP Commercial |
$98.88
|
| Rate for Payer: Priority Health SBD |
$73.29
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$5,000.55
|
|
|
Service Code
|
NDC 00187442010
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,965.22 |
| Max. Negotiated Rate |
$4,500.49 |
| Rate for Payer: Aetna Commercial |
$4,250.47
|
| Rate for Payer: Aetna Medicare |
$2,500.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,250.36
|
| Rate for Payer: BCBS Complete |
$2,000.22
|
| Rate for Payer: Cash Price |
$4,000.44
|
| Rate for Payer: Cofinity Advantage |
$3,500.39
|
| Rate for Payer: Cofinity Commercial |
$4,300.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,000.44
|
| Rate for Payer: Healthscope Commercial |
$4,500.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,000.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,250.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,750.41
|
| Rate for Payer: PHP Commercial |
$4,250.47
|
| Rate for Payer: Priority Health SBD |
$3,150.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,250.36
|
| Rate for Payer: UHC Core |
$2,605.29
|
| Rate for Payer: UHC Exchange |
$1,965.22
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 72606050902
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Advantage |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health SBD |
$167.30
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 61442012101
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.18 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$74.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.23
|
| Rate for Payer: UHC Core |
$77.13
|
| Rate for Payer: UHC Exchange |
$58.18
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
NDC 60687059511
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Advantage |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.63
|
| Rate for Payer: UHC Core |
$2.11
|
| Rate for Payer: UHC Exchange |
$1.59
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 51079096620
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health SBD |
$93.27
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
NDC 00172572870
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$769.86 |
| Max. Negotiated Rate |
$1,099.80 |
| Rate for Payer: Aetna Commercial |
$1,038.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.30
|
| Rate for Payer: Cash Price |
$977.60
|
| Rate for Payer: Cofinity Advantage |
$855.40
|
| Rate for Payer: Cofinity Commercial |
$1,050.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.60
|
| Rate for Payer: Healthscope Commercial |
$1,099.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$916.50
|
| Rate for Payer: PHP Commercial |
$1,038.70
|
| Rate for Payer: Priority Health SBD |
$769.86
|
|
