Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FAMOTIDINE 20 MG TABLET

Facility

$1,386.50

Service Code	NDC 61442012110
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$554.60
Max. Negotiated Rate	$1,247.85
Rate for Payer: Aetna Commercial	$1,178.53
Rate for Payer: Aetna Medicare	$693.25
Rate for Payer: Aetna New Business (MI Preferred)	$901.23
Rate for Payer: BCBS Complete	$554.60
Rate for Payer: Cash Price	$1,109.20
Rate for Payer: Cofinity Commercial	$1,192.39
Rate for Payer: Cofinity Commercial	$970.55
Rate for Payer: Cofinity Medicare Advantage	$970.55
Rate for Payer: Encore Health Key Benefits Commercial	$1,109.20
Rate for Payer: Healthscope Commercial	$1,247.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,178.53
Rate for Payer: PHP Commercial	$1,178.53
Rate for Payer: Priority Health Cigna Priority Health	$901.23
Rate for Payer: Priority Health SBD	$873.50

FAMOTIDINE 20 MG TABLET

Facility

$111.63

Service Code	NDC 00904719306
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$44.65
Max. Negotiated Rate	$100.47
Rate for Payer: Aetna Commercial	$94.89
Rate for Payer: Aetna Medicare	$55.81
Rate for Payer: Aetna New Business (MI Preferred)	$72.56
Rate for Payer: BCBS Complete	$44.65
Rate for Payer: Cash Price	$89.30
Rate for Payer: Cofinity Commercial	$78.14
Rate for Payer: Cofinity Commercial	$96.00
Rate for Payer: Cofinity Medicare Advantage	$78.14
Rate for Payer: Encore Health Key Benefits Commercial	$89.30
Rate for Payer: Healthscope Commercial	$100.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.89
Rate for Payer: PHP Commercial	$94.89
Rate for Payer: Priority Health Cigna Priority Health	$72.56
Rate for Payer: Priority Health SBD	$70.33

FAMOTIDINE 20 MG TABLET

Facility

$4,550.26

Service Code	NDC 00187442010
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$1,820.10
Max. Negotiated Rate	$4,095.23
Rate for Payer: Aetna Commercial	$3,867.72
Rate for Payer: Aetna Medicare	$2,275.13
Rate for Payer: Aetna New Business (MI Preferred)	$2,957.67
Rate for Payer: BCBS Complete	$1,820.10
Rate for Payer: Cash Price	$3,640.21
Rate for Payer: Cofinity Commercial	$3,185.18
Rate for Payer: Cofinity Commercial	$3,913.22
Rate for Payer: Cofinity Medicare Advantage	$3,185.18
Rate for Payer: Encore Health Key Benefits Commercial	$3,640.21
Rate for Payer: Healthscope Commercial	$4,095.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,867.72
Rate for Payer: PHP Commercial	$3,867.72
Rate for Payer: Priority Health Cigna Priority Health	$2,957.67
Rate for Payer: Priority Health SBD	$2,866.66

FAMOTIDINE 20 MG TABLET

Facility

$150.40

Service Code	NDC 61442012101
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$94.75
Max. Negotiated Rate	$135.36
Rate for Payer: Aetna Commercial	$127.84
Rate for Payer: Aetna New Business (MI Preferred)	$97.76
Rate for Payer: Cash Price	$120.32
Rate for Payer: Cofinity Commercial	$105.28
Rate for Payer: Cofinity Commercial	$129.34
Rate for Payer: Cofinity Medicare Advantage	$105.28
Rate for Payer: Encore Health Key Benefits Commercial	$120.32
Rate for Payer: Healthscope Commercial	$135.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.84
Rate for Payer: PHP Commercial	$127.84
Rate for Payer: Priority Health Cigna Priority Health	$97.76
Rate for Payer: Priority Health SBD	$94.75

FAMOTIDINE 20 MG TABLET

Facility

$112.80

Service Code	NDC 00172572860
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$45.12
Max. Negotiated Rate	$101.52
Rate for Payer: Aetna Commercial	$95.88
Rate for Payer: Aetna Medicare	$56.40
Rate for Payer: Aetna New Business (MI Preferred)	$73.32
Rate for Payer: BCBS Complete	$45.12
Rate for Payer: Cash Price	$90.24
Rate for Payer: Cofinity Commercial	$78.96
Rate for Payer: Cofinity Commercial	$97.01
Rate for Payer: Cofinity Medicare Advantage	$78.96
Rate for Payer: Encore Health Key Benefits Commercial	$90.24
Rate for Payer: Healthscope Commercial	$101.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.88
Rate for Payer: PHP Commercial	$95.88
Rate for Payer: Priority Health Cigna Priority Health	$73.32
Rate for Payer: Priority Health SBD	$71.06

FAMOTIDINE 20 MG TABLET

Facility

$111.63

Service Code	NDC 00904719306
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$70.33
Max. Negotiated Rate	$100.47
Rate for Payer: Aetna Commercial	$94.89
Rate for Payer: Aetna New Business (MI Preferred)	$72.56
Rate for Payer: Cash Price	$89.30
Rate for Payer: Cofinity Commercial	$78.14
Rate for Payer: Cofinity Commercial	$96.00
Rate for Payer: Cofinity Medicare Advantage	$78.14
Rate for Payer: Encore Health Key Benefits Commercial	$89.30
Rate for Payer: Healthscope Commercial	$100.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.89
Rate for Payer: PHP Commercial	$94.89
Rate for Payer: Priority Health Cigna Priority Health	$72.56
Rate for Payer: Priority Health SBD	$70.33

FAMOTIDINE 20 MG TABLET

Facility

$4,550.26

Service Code	NDC 00187442010
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$2,866.66
Max. Negotiated Rate	$4,095.23
Rate for Payer: Aetna Commercial	$3,867.72
Rate for Payer: Aetna New Business (MI Preferred)	$2,957.67
Rate for Payer: Cash Price	$3,640.21
Rate for Payer: Cofinity Commercial	$3,185.18
Rate for Payer: Cofinity Commercial	$3,913.22
Rate for Payer: Cofinity Medicare Advantage	$3,185.18
Rate for Payer: Encore Health Key Benefits Commercial	$3,640.21
Rate for Payer: Healthscope Commercial	$4,095.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,867.72
Rate for Payer: PHP Commercial	$3,867.72
Rate for Payer: Priority Health Cigna Priority Health	$2,957.67
Rate for Payer: Priority Health SBD	$2,866.66

FAMOTIDINE 20 MG TABLET

Facility

$184.30

Service Code	NDC 16837085550
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$73.72
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 Commercial	$129.01
Rate for Payer: Cofinity Commercial	$158.50
Rate for Payer: Cofinity Medicare Advantage	$129.01
Rate for Payer: Encore Health Key Benefits Commercial	$147.44
Rate for Payer: Healthscope Commercial	$165.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.66
Rate for Payer: PHP Commercial	$156.66
Rate for Payer: Priority Health Cigna Priority Health	$119.80
Rate for Payer: Priority Health SBD	$116.11

FAMOTIDINE 20 MG TABLET

Facility

$1,386.50

Service Code	NDC 61442012110
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$873.50
Max. Negotiated Rate	$1,247.85
Rate for Payer: Aetna Commercial	$1,178.53
Rate for Payer: Aetna New Business (MI Preferred)	$901.23
Rate for Payer: Cash Price	$1,109.20
Rate for Payer: Cofinity Commercial	$1,192.39
Rate for Payer: Cofinity Commercial	$970.55
Rate for Payer: Cofinity Medicare Advantage	$970.55
Rate for Payer: Encore Health Key Benefits Commercial	$1,109.20
Rate for Payer: Healthscope Commercial	$1,247.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,178.53
Rate for Payer: PHP Commercial	$1,178.53
Rate for Payer: Priority Health Cigna Priority Health	$901.23
Rate for Payer: Priority Health SBD	$873.50

FAMOTIDINE 20 MG TABLET

Facility

$190.35

Service Code	NDC 00536129801
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$76.14
Max. Negotiated Rate	$171.31
Rate for Payer: Aetna Commercial	$161.80
Rate for Payer: Aetna Medicare	$95.17
Rate for Payer: Aetna New Business (MI Preferred)	$123.73
Rate for Payer: BCBS Complete	$76.14
Rate for Payer: Cash Price	$152.28
Rate for Payer: Cofinity Commercial	$133.25
Rate for Payer: Cofinity Commercial	$163.70
Rate for Payer: Cofinity Medicare Advantage	$133.25
Rate for Payer: Encore Health Key Benefits Commercial	$152.28
Rate for Payer: Healthscope Commercial	$171.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.80
Rate for Payer: PHP Commercial	$161.80
Rate for Payer: Priority Health Cigna Priority Health	$123.73
Rate for Payer: Priority Health SBD	$119.92

FAMOTIDINE 20 MG TABLET

Facility

$150.40

Service Code	NDC 61442012101
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$60.16
Max. Negotiated Rate	$135.36
Rate for Payer: Aetna Commercial	$127.84
Rate for Payer: Aetna Medicare	$75.20
Rate for Payer: Aetna New Business (MI Preferred)	$97.76
Rate for Payer: BCBS Complete	$60.16
Rate for Payer: Cash Price	$120.32
Rate for Payer: Cofinity Commercial	$105.28
Rate for Payer: Cofinity Commercial	$129.34
Rate for Payer: Cofinity Medicare Advantage	$105.28
Rate for Payer: Encore Health Key Benefits Commercial	$120.32
Rate for Payer: Healthscope Commercial	$135.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.84
Rate for Payer: PHP Commercial	$127.84
Rate for Payer: Priority Health Cigna Priority Health	$97.76
Rate for Payer: Priority Health SBD	$94.75

FAMOTIDINE 20 MG TABLET

Facility

$99.88

Service Code	NDC 00904578017
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$89.89
Rate for Payer: Aetna Commercial	$84.90
Rate for Payer: Aetna Medicare	$49.94
Rate for Payer: Aetna New Business (MI Preferred)	$64.92
Rate for Payer: BCBS Complete	$39.95
Rate for Payer: Cash Price	$79.90
Rate for Payer: Cofinity Commercial	$69.92
Rate for Payer: Cofinity Commercial	$85.90
Rate for Payer: Cofinity Medicare Advantage	$69.92
Rate for Payer: Encore Health Key Benefits Commercial	$79.90
Rate for Payer: Healthscope Commercial	$89.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.90
Rate for Payer: PHP Commercial	$84.90
Rate for Payer: Priority Health Cigna Priority Health	$64.92
Rate for Payer: Priority Health SBD	$62.92

FAMOTIDINE 20 MG TABLET

Facility

$110.45

Service Code	NDC 50268030315
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$44.18
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 Commercial	$77.31
Rate for Payer: Cofinity Commercial	$94.99
Rate for Payer: Cofinity Medicare Advantage	$77.31
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: PHP Commercial	$93.88
Rate for Payer: Priority Health Cigna Priority Health	$71.79
Rate for Payer: Priority Health SBD	$69.58

FAMOTIDINE 20 MG TABLET

Facility

$190.35

Service Code	NDC 00536129801
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$119.92
Max. Negotiated Rate	$171.31
Rate for Payer: Aetna Commercial	$161.80
Rate for Payer: Aetna New Business (MI Preferred)	$123.73
Rate for Payer: Cash Price	$152.28
Rate for Payer: Cofinity Commercial	$133.25
Rate for Payer: Cofinity Commercial	$163.70
Rate for Payer: Cofinity Medicare Advantage	$133.25
Rate for Payer: Encore Health Key Benefits Commercial	$152.28
Rate for Payer: Healthscope Commercial	$171.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.80
Rate for Payer: PHP Commercial	$161.80
Rate for Payer: Priority Health Cigna Priority Health	$123.73
Rate for Payer: Priority Health SBD	$119.92

FAMOTIDINE 20 MG TABLET

Facility

$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 Commercial	$152.99
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Cofinity Medicare Advantage	$152.99
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: PHP Commercial	$185.77
Rate for Payer: Priority Health Cigna Priority Health	$142.06
Rate for Payer: Priority Health SBD	$137.69

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 Commercial	$100.04
Rate for Payer: Cofinity Commercial	$81.43
Rate for Payer: Cofinity Medicare Advantage	$81.43
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: PHP Commercial	$98.88
Rate for Payer: Priority Health Cigna Priority Health	$75.61
Rate for Payer: Priority Health SBD	$73.29

FAMOTIDINE 20 MG TABLET

Facility

$1,365.08

Service Code	NDC 00187442030
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$546.03
Max. Negotiated Rate	$1,228.57
Rate for Payer: Aetna Commercial	$1,160.32
Rate for Payer: Aetna Medicare	$682.54
Rate for Payer: Aetna New Business (MI Preferred)	$887.30
Rate for Payer: BCBS Complete	$546.03
Rate for Payer: Cash Price	$1,092.06
Rate for Payer: Cofinity Commercial	$1,173.97
Rate for Payer: Cofinity Commercial	$955.56
Rate for Payer: Cofinity Medicare Advantage	$955.56
Rate for Payer: Encore Health Key Benefits Commercial	$1,092.06
Rate for Payer: Healthscope Commercial	$1,228.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,160.32
Rate for Payer: PHP Commercial	$1,160.32
Rate for Payer: Priority Health Cigna Priority Health	$887.30
Rate for Payer: Priority Health SBD	$860.00

FAMOTIDINE 20 MG TABLET

Facility

$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 Commercial	$103.64
Rate for Payer: Cofinity Commercial	$127.32
Rate for Payer: Cofinity Medicare Advantage	$103.64
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: PHP Commercial	$125.84
Rate for Payer: Priority Health Cigna Priority Health	$96.23
Rate for Payer: Priority Health SBD	$93.27

FAMOTIDINE 20 MG TABLET

Facility

$432.40

Service Code	NDC 60687059501
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$172.96
Max. Negotiated Rate	$389.16
Rate for Payer: Aetna Commercial	$367.54
Rate for Payer: Aetna Medicare	$216.20
Rate for Payer: Aetna New Business (MI Preferred)	$281.06
Rate for Payer: BCBS Complete	$172.96
Rate for Payer: Cash Price	$345.92
Rate for Payer: Cofinity Commercial	$302.68
Rate for Payer: Cofinity Commercial	$371.86
Rate for Payer: Cofinity Medicare Advantage	$302.68
Rate for Payer: Encore Health Key Benefits Commercial	$345.92
Rate for Payer: Healthscope Commercial	$389.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$367.54
Rate for Payer: PHP Commercial	$367.54
Rate for Payer: Priority Health Cigna Priority Health	$281.06
Rate for Payer: Priority Health SBD	$272.41

FAMOTIDINE 20 MG TABLET

Facility

$148.05

Service Code	NDC 51079096620
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$59.22
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 Commercial	$103.64
Rate for Payer: Cofinity Commercial	$127.32
Rate for Payer: Cofinity Medicare Advantage	$103.64
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: PHP Commercial	$125.84
Rate for Payer: Priority Health Cigna Priority Health	$96.23
Rate for Payer: Priority Health SBD	$93.27

FAMOTIDINE 20 MG TABLET

Facility

$399.50

Service Code	NDC 00172572870
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$359.55
Rate for Payer: Aetna Commercial	$339.57
Rate for Payer: Aetna Medicare	$199.75
Rate for Payer: Aetna New Business (MI Preferred)	$259.68
Rate for Payer: BCBS Complete	$159.80
Rate for Payer: Cash Price	$319.60
Rate for Payer: Cofinity Commercial	$279.65
Rate for Payer: Cofinity Commercial	$343.57
Rate for Payer: Cofinity Medicare Advantage	$279.65
Rate for Payer: Encore Health Key Benefits Commercial	$319.60
Rate for Payer: Healthscope Commercial	$359.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.57
Rate for Payer: PHP Commercial	$339.57
Rate for Payer: Priority Health Cigna Priority Health	$259.68
Rate for Payer: Priority Health SBD	$251.69

FAMOTIDINE 40 MG TABLET

Facility

$272.60

Service Code	NDC 61442012201
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$109.04
Max. Negotiated Rate	$245.34
Rate for Payer: Aetna Commercial	$231.71
Rate for Payer: Aetna Medicare	$136.30
Rate for Payer: Aetna New Business (MI Preferred)	$177.19
Rate for Payer: BCBS Complete	$109.04
Rate for Payer: Cash Price	$218.08
Rate for Payer: Cofinity Commercial	$190.82
Rate for Payer: Cofinity Commercial	$234.44
Rate for Payer: Cofinity Medicare Advantage	$190.82
Rate for Payer: Encore Health Key Benefits Commercial	$218.08
Rate for Payer: Healthscope Commercial	$245.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.71
Rate for Payer: PHP Commercial	$231.71
Rate for Payer: Priority Health Cigna Priority Health	$177.19
Rate for Payer: Priority Health SBD	$171.74

FAMOTIDINE 40 MG TABLET

Facility

$118.75

Service Code	NDC 50268030415
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$74.81
Max. Negotiated Rate	$106.88
Rate for Payer: Aetna Commercial	$100.94
Rate for Payer: Aetna New Business (MI Preferred)	$77.19
Rate for Payer: Cash Price	$95.00
Rate for Payer: Cofinity Commercial	$102.12
Rate for Payer: Cofinity Commercial	$83.12
Rate for Payer: Cofinity Medicare Advantage	$83.12
Rate for Payer: Encore Health Key Benefits Commercial	$95.00
Rate for Payer: Healthscope Commercial	$106.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.94
Rate for Payer: PHP Commercial	$100.94
Rate for Payer: Priority Health Cigna Priority Health	$77.19
Rate for Payer: Priority Health SBD	$74.81

FAMOTIDINE 40 MG TABLET

Facility

$206.80

Service Code	NDC 00172572960
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$130.28
Max. Negotiated Rate	$186.12
Rate for Payer: Aetna Commercial	$175.78
Rate for Payer: Aetna New Business (MI Preferred)	$134.42
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cofinity Commercial	$144.76
Rate for Payer: Cofinity Commercial	$177.85
Rate for Payer: Cofinity Medicare Advantage	$144.76
Rate for Payer: Encore Health Key Benefits Commercial	$165.44
Rate for Payer: Healthscope Commercial	$186.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.78
Rate for Payer: PHP Commercial	$175.78
Rate for Payer: Priority Health Cigna Priority Health	$134.42
Rate for Payer: Priority Health SBD	$130.28

FAMOTIDINE 40 MG TABLET

Facility

$893.00

Service Code	NDC 00172572970
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$357.20
Max. Negotiated Rate	$803.70
Rate for Payer: Aetna Commercial	$759.05
Rate for Payer: Aetna Medicare	$446.50
Rate for Payer: Aetna New Business (MI Preferred)	$580.45
Rate for Payer: BCBS Complete	$357.20
Rate for Payer: Cash Price	$714.40
Rate for Payer: Cofinity Commercial	$625.10
Rate for Payer: Cofinity Commercial	$767.98
Rate for Payer: Cofinity Medicare Advantage	$625.10
Rate for Payer: Encore Health Key Benefits Commercial	$714.40
Rate for Payer: Healthscope Commercial	$803.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$759.05
Rate for Payer: PHP Commercial	$759.05
Rate for Payer: Priority Health Cigna Priority Health	$580.45
Rate for Payer: Priority Health SBD	$562.59

Know your out-of-pocket cost for care.

All Charges