Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FAMOTIDINE 20 MG TABLET

Facility

$1.49

Service Code	NDC 51079096601
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna Medicare	$0.75
Rate for Payer: Aetna New Business (MI Preferred)	$0.97
Rate for Payer: BCBS Complete	$0.60
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cofinity Advantage	$1.04
Rate for Payer: Cofinity Commercial	$1.28
Rate for Payer: Encore Health Key Benefits Commercial	$1.19
Rate for Payer: Healthscope Commercial	$1.34
Rate for Payer: MI Amish Medical Board Commercial	$1.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.12
Rate for Payer: PHP Commercial	$1.27
Rate for Payer: Priority Health SBD	$0.94
Rate for Payer: UHC All Payor (Choice/PPO)	$0.97
Rate for Payer: UHC Core	$0.78
Rate for Payer: UHC Exchange	$0.59

FAMOTIDINE 20 MG TABLET

Facility

$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

$218.55

Service Code	NDC 62332000131
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

$218.55

Service Code	NDC 65862085901
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$85.89
Max. Negotiated Rate	$196.69
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna Medicare	$109.28
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: BCBS Complete	$87.42
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: MI Amish Medical Board Commercial	$174.84
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
Rate for Payer: UHC All Payor (Choice/PPO)	$142.06
Rate for Payer: UHC Core	$113.86
Rate for Payer: UHC Exchange	$85.89

FAMOTIDINE 20 MG TABLET

Facility

$265.55

Service Code	NDC 72606050902
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$104.36
Max. Negotiated Rate	$239.00
Rate for Payer: Aetna Commercial	$225.72
Rate for Payer: Aetna Medicare	$132.78
Rate for Payer: Aetna New Business (MI Preferred)	$172.61
Rate for Payer: BCBS Complete	$106.22
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: MI Amish Medical Board Commercial	$212.44
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
Rate for Payer: UHC All Payor (Choice/PPO)	$172.61
Rate for Payer: UHC Core	$138.35
Rate for Payer: UHC Exchange	$104.36

FAMOTIDINE 20 MG TABLET

Facility

$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

$184.30

Service Code	NDC 16837085550
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$72.43
Max. Negotiated Rate	$165.87
Rate for Payer: Aetna Commercial	$156.66
Rate for Payer: Aetna Medicare	$92.15
Rate for Payer: Aetna New Business (MI Preferred)	$119.80
Rate for Payer: BCBS Complete	$73.72
Rate for Payer: Cash Price	$147.44
Rate for Payer: Cofinity Advantage	$129.01
Rate for Payer: Cofinity Commercial	$158.50
Rate for Payer: Encore Health Key Benefits Commercial	$147.44
Rate for Payer: Healthscope Commercial	$165.87
Rate for Payer: MI Amish Medical Board Commercial	$147.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.22
Rate for Payer: PHP Commercial	$156.66
Rate for Payer: Priority Health SBD	$116.11
Rate for Payer: UHC All Payor (Choice/PPO)	$119.80
Rate for Payer: UHC Core	$96.02
Rate for Payer: UHC Exchange	$72.43

FAMOTIDINE 20 MG TABLET

Facility

$148.05

Service Code	NDC 51079096620
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

$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

$218.55

Service Code	NDC 62332000131
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$85.89
Max. Negotiated Rate	$196.69
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna Medicare	$109.28
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: BCBS Complete	$87.42
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: MI Amish Medical Board Commercial	$174.84
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
Rate for Payer: UHC All Payor (Choice/PPO)	$142.06
Rate for Payer: UHC Core	$113.86
Rate for Payer: UHC Exchange	$85.89

FAMOTIDINE 20 MG TABLET

Facility

$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

$98.70

Service Code	NDC 67877084201
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$62.18
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.89
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Advantage	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Encore Health Key Benefits Commercial	$78.96
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$74.03
Rate for Payer: PHP Commercial	$83.89
Rate for Payer: Priority Health SBD	$62.18

FAMOTIDINE 20 MG TABLET

Facility

$244.40

Service Code	NDC 00172572860
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$153.97
Max. Negotiated Rate	$219.96
Rate for Payer: Aetna Commercial	$207.74
Rate for Payer: Aetna New Business (MI Preferred)	$158.86
Rate for Payer: Cash Price	$195.52
Rate for Payer: Cofinity Advantage	$171.08
Rate for Payer: Cofinity Commercial	$210.18
Rate for Payer: Encore Health Key Benefits Commercial	$195.52
Rate for Payer: Healthscope Commercial	$219.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.30
Rate for Payer: PHP Commercial	$207.74
Rate for Payer: Priority Health SBD	$153.97

FAMOTIDINE 20 MG TABLET

Facility

$244.40

Service Code	NDC 00172572860
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$219.96
Rate for Payer: Aetna Commercial	$207.74
Rate for Payer: Aetna Medicare	$122.20
Rate for Payer: Aetna New Business (MI Preferred)	$158.86
Rate for Payer: BCBS Complete	$97.76
Rate for Payer: Cash Price	$195.52
Rate for Payer: Cofinity Advantage	$171.08
Rate for Payer: Cofinity Commercial	$210.18
Rate for Payer: Encore Health Key Benefits Commercial	$195.52
Rate for Payer: Healthscope Commercial	$219.96
Rate for Payer: MI Amish Medical Board Commercial	$195.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.30
Rate for Payer: PHP Commercial	$207.74
Rate for Payer: Priority Health SBD	$153.97
Rate for Payer: UHC All Payor (Choice/PPO)	$158.86
Rate for Payer: UHC Core	$127.33
Rate for Payer: UHC Exchange	$96.05

FAMOTIDINE 20 MG TABLET

Facility

$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

$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

FAMOTIDINE 20 MG TABLET

Facility

$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

$1,222.00

Service Code	NDC 00172572870
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$480.25
Max. Negotiated Rate	$1,099.80
Rate for Payer: Aetna Commercial	$1,038.70
Rate for Payer: Aetna Medicare	$611.00
Rate for Payer: Aetna New Business (MI Preferred)	$794.30
Rate for Payer: BCBS Complete	$488.80
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: MI Amish Medical Board Commercial	$977.60
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
Rate for Payer: UHC All Payor (Choice/PPO)	$794.30
Rate for Payer: UHC Core	$636.66
Rate for Payer: UHC Exchange	$480.25

FAMOTIDINE 20 MG TABLET

Facility

$110.45

Service Code	NDC 50268030315
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$99.41
Rate for Payer: Aetna Commercial	$93.88
Rate for Payer: Aetna New Business (MI Preferred)	$71.79
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: 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

FAMOTIDINE 20 MG TABLET

Facility

$2.21

Service Code	NDC 50268030311
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.99
Rate for Payer: Aetna Commercial	$1.88
Rate for Payer: Aetna New Business (MI Preferred)	$1.44
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: 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

FAMOTIDINE 20 MG TABLET

Facility

$98.70

Service Code	NDC 67877084201
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$38.79
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.89
Rate for Payer: Aetna Medicare	$49.35
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: BCBS Complete	$39.48
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Advantage	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Encore Health Key Benefits Commercial	$78.96
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: MI Amish Medical Board Commercial	$78.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$74.03
Rate for Payer: PHP Commercial	$83.89
Rate for Payer: Priority Health SBD	$62.18
Rate for Payer: UHC All Payor (Choice/PPO)	$64.16
Rate for Payer: UHC Core	$51.42
Rate for Payer: UHC Exchange	$38.79

FAMOTIDINE 40 MG TABLET

Facility

$988.00

Service Code	NDC 00172572970
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$622.44
Max. Negotiated Rate	$889.20
Rate for Payer: Aetna Commercial	$839.80
Rate for Payer: Aetna New Business (MI Preferred)	$642.20
Rate for Payer: Cash Price	$790.40
Rate for Payer: Cofinity Advantage	$691.60
Rate for Payer: Cofinity Commercial	$849.68
Rate for Payer: Encore Health Key Benefits Commercial	$790.40
Rate for Payer: Healthscope Commercial	$889.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$839.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$741.00
Rate for Payer: PHP Commercial	$839.80
Rate for Payer: Priority Health SBD	$622.44

FAMOTIDINE 40 MG TABLET

Facility

$197.60

Service Code	NDC 00172572960
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$77.66
Max. Negotiated Rate	$177.84
Rate for Payer: Aetna Commercial	$167.96
Rate for Payer: Aetna Medicare	$98.80
Rate for Payer: Aetna New Business (MI Preferred)	$128.44
Rate for Payer: BCBS Complete	$79.04
Rate for Payer: Cash Price	$158.08
Rate for Payer: Cofinity Advantage	$138.32
Rate for Payer: Cofinity Commercial	$169.94
Rate for Payer: Encore Health Key Benefits Commercial	$158.08
Rate for Payer: Healthscope Commercial	$177.84
Rate for Payer: MI Amish Medical Board Commercial	$158.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$167.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$148.20
Rate for Payer: PHP Commercial	$167.96
Rate for Payer: Priority Health SBD	$124.49
Rate for Payer: UHC All Payor (Choice/PPO)	$128.44
Rate for Payer: UHC Core	$102.95
Rate for Payer: UHC Exchange	$77.66

FAMOTIDINE 40 MG TABLET

Facility

$2.38

Service Code	NDC 50268030411
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.14
Rate for Payer: Aetna Commercial	$2.02
Rate for Payer: Aetna New Business (MI Preferred)	$1.55
Rate for Payer: Cash Price	$1.90
Rate for Payer: Cofinity Advantage	$1.67
Rate for Payer: Cofinity Commercial	$2.05
Rate for Payer: Encore Health Key Benefits Commercial	$1.90
Rate for Payer: Healthscope Commercial	$2.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.78
Rate for Payer: PHP Commercial	$2.02
Rate for Payer: Priority Health SBD	$1.50

FAMOTIDINE 40 MG TABLET

Facility

$988.00

Service Code	NDC 00172572970
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$388.28
Max. Negotiated Rate	$889.20
Rate for Payer: Aetna Commercial	$839.80
Rate for Payer: Aetna Medicare	$494.00
Rate for Payer: Aetna New Business (MI Preferred)	$642.20
Rate for Payer: BCBS Complete	$395.20
Rate for Payer: Cash Price	$790.40
Rate for Payer: Cofinity Advantage	$691.60
Rate for Payer: Cofinity Commercial	$849.68
Rate for Payer: Encore Health Key Benefits Commercial	$790.40
Rate for Payer: Healthscope Commercial	$889.20
Rate for Payer: MI Amish Medical Board Commercial	$790.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$839.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$741.00
Rate for Payer: PHP Commercial	$839.80
Rate for Payer: Priority Health SBD	$622.44
Rate for Payer: UHC All Payor (Choice/PPO)	$642.20
Rate for Payer: UHC Core	$514.75
Rate for Payer: UHC Exchange	$388.28

Know your out-of-pocket cost for care.

All Charges