Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FAMOTIDINE 20 MG TABLET

Facility

$2.21

Service Code	NDC 50268-303-11
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 Commercial	$1.55
Rate for Payer: Cofinity Commercial	$1.90
Rate for Payer: Healthscope Commercial	$1.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.88
Rate for Payer: PHP Commercial	$1.88
Rate for Payer: Priority Health Cigna Priority Health	$1.55
Rate for Payer: Priority Health SBD	$1.39

FAMOTIDINE 20 MG TABLET

Facility

$109.28

Service Code	NDC 0904-7193-06
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$98.35
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna New Business (MI Preferred)	$71.03
Rate for Payer: Cash Price	$87.42
Rate for Payer: Cofinity Commercial	$76.50
Rate for Payer: Cofinity Commercial	$93.98
Rate for Payer: Healthscope Commercial	$98.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$92.89
Rate for Payer: PHP Commercial	$92.89
Rate for Payer: Priority Health Cigna Priority Health	$76.50
Rate for Payer: Priority Health SBD	$68.85

FAMOTIDINE 20 MG TABLET

Facility

$99.88

Service Code	NDC 0904-5780-17
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$89.89
Rate for Payer: Aetna Commercial	$84.90
Rate for Payer: Aetna New Business (MI Preferred)	$64.92
Rate for Payer: Cash Price	$79.90
Rate for Payer: Cofinity Commercial	$69.92
Rate for Payer: Cofinity Commercial	$85.90
Rate for Payer: Healthscope Commercial	$89.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$84.90
Rate for Payer: PHP Commercial	$84.90
Rate for Payer: Priority Health Cigna Priority Health	$69.92
Rate for Payer: Priority Health SBD	$62.92

FAMOTIDINE 20 MG TABLET

Facility

$218.55

Service Code	NDC 65862-859-01
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$137.69
Max. Negotiated Rate	$196.70
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	$152.98
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Healthscope Commercial	$196.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$185.77
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health Cigna Priority Health	$152.98
Rate for Payer: Priority Health SBD	$137.69

FAMOTIDINE 20 MG TABLET

Facility

$190.35

Service Code	NDC 0536-1298-01
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$119.92
Max. Negotiated Rate	$171.32
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	$133.24
Rate for Payer: Cofinity Commercial	$163.70
Rate for Payer: Healthscope Commercial	$171.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$161.80
Rate for Payer: PHP Commercial	$161.80
Rate for Payer: Priority Health Cigna Priority Health	$133.24
Rate for Payer: Priority Health SBD	$119.92

FAMOTIDINE 20 MG TABLET

Facility

$178.60

Service Code	NDC 0904-5780-51
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$112.52
Max. Negotiated Rate	$160.74
Rate for Payer: Aetna Commercial	$151.81
Rate for Payer: Aetna New Business (MI Preferred)	$116.09
Rate for Payer: Cash Price	$142.88
Rate for Payer: Cofinity Commercial	$125.02
Rate for Payer: Cofinity Commercial	$153.60
Rate for Payer: Healthscope Commercial	$160.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$151.81
Rate for Payer: PHP Commercial	$151.81
Rate for Payer: Priority Health Cigna Priority Health	$125.02
Rate for Payer: Priority Health SBD	$112.52

FAMOTIDINE 20 MG TABLET

Facility

$98.80

Service Code	NDC 16837-855-25
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$62.24
Max. Negotiated Rate	$88.92
Rate for Payer: Aetna Commercial	$83.98
Rate for Payer: Aetna New Business (MI Preferred)	$64.22
Rate for Payer: Cash Price	$79.04
Rate for Payer: Cofinity Commercial	$69.16
Rate for Payer: Cofinity Commercial	$84.97
Rate for Payer: Healthscope Commercial	$88.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$83.98
Rate for Payer: PHP Commercial	$83.98
Rate for Payer: Priority Health Cigna Priority Health	$69.16
Rate for Payer: Priority Health SBD	$62.24

FAMOTIDINE 20 MG TABLET

Facility

$399.50

Service Code	NDC 0172-5728-70
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$251.68
Max. Negotiated Rate	$359.55
Rate for Payer: Aetna Commercial	$339.58
Rate for Payer: Aetna New Business (MI Preferred)	$259.68
Rate for Payer: Cash Price	$319.60
Rate for Payer: Cofinity Commercial	$279.65
Rate for Payer: Cofinity Commercial	$343.57
Rate for Payer: Healthscope Commercial	$359.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$339.58
Rate for Payer: PHP Commercial	$339.58
Rate for Payer: Priority Health Cigna Priority Health	$279.65
Rate for Payer: Priority Health SBD	$251.68

FAMOTIDINE 20 MG TABLET

Facility

$148.05

Service Code	NDC 51079-966-20
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$93.27
Max. Negotiated Rate	$133.24
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: Healthscope Commercial	$133.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$125.84
Rate for Payer: PHP Commercial	$125.84
Rate for Payer: Priority Health Cigna Priority Health	$103.64
Rate for Payer: Priority Health SBD	$93.27

FAMOTIDINE 20 MG TABLET

Facility

$4.33

Service Code	NDC 60687-595-11
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Commercial	$3.68
Rate for Payer: Aetna New Business (MI Preferred)	$2.81
Rate for Payer: Cash Price	$3.46
Rate for Payer: Cofinity Commercial	$3.03
Rate for Payer: Cofinity Commercial	$3.72
Rate for Payer: Healthscope Commercial	$3.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.68
Rate for Payer: PHP Commercial	$3.68
Rate for Payer: Priority Health Cigna Priority Health	$3.03
Rate for Payer: Priority Health SBD	$2.73

FAMOTIDINE 20 MG TABLET

Facility

$265.55

Service Code	NDC 72606-509-02
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 Commercial	$185.88
Rate for Payer: Cofinity Commercial	$228.37
Rate for Payer: Healthscope Commercial	$239.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$225.72
Rate for Payer: PHP Commercial	$225.72
Rate for Payer: Priority Health Cigna Priority Health	$185.88
Rate for Payer: Priority Health SBD	$167.30

FAMOTIDINE 20 MG TABLET

Facility

$1,386.50

Service Code	NDC 61442-121-10
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$873.50
Max. Negotiated Rate	$1,247.85
Rate for Payer: Aetna Commercial	$1,178.52
Rate for Payer: Aetna New Business (MI Preferred)	$901.22
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: Healthscope Commercial	$1,247.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,178.52
Rate for Payer: PHP Commercial	$1,178.52
Rate for Payer: Priority Health Cigna Priority Health	$970.55
Rate for Payer: Priority Health SBD	$873.50

FAMOTIDINE 20 MG TABLET

Facility

$110.45

Service Code	NDC 50268-303-15
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$99.40
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 Commercial	$77.32
Rate for Payer: Cofinity Commercial	$94.99
Rate for Payer: Healthscope Commercial	$99.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.88
Rate for Payer: PHP Commercial	$93.88
Rate for Payer: Priority Health Cigna Priority Health	$77.32
Rate for Payer: Priority Health SBD	$69.58

FAMOTIDINE 20 MG TABLET

Facility

$150.40

Service Code	NDC 61442-121-01
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: Healthscope Commercial	$135.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.84
Rate for Payer: PHP Commercial	$127.84
Rate for Payer: Priority Health Cigna Priority Health	$105.28
Rate for Payer: Priority Health SBD	$94.75

FAMOTIDINE 20 MG TABLET

Facility

$218.55

Service Code	NDC 62332-001-31
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$137.69
Max. Negotiated Rate	$196.70
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	$187.95
Rate for Payer: Cofinity Commercial	$152.98
Rate for Payer: Healthscope Commercial	$196.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$185.77
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health Cigna Priority Health	$152.98
Rate for Payer: Priority Health SBD	$137.69

FAMOTIDINE 20 MG TABLET

Facility

$4,550.26

Service Code	NDC 0187-4420-10
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: Healthscope Commercial	$4,095.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,867.72
Rate for Payer: PHP Commercial	$3,867.72
Rate for Payer: Priority Health Cigna Priority Health	$3,185.18
Rate for Payer: Priority Health SBD	$2,866.66

FAMOTIDINE 20 MG TABLET

Facility

$1.49

Service Code	NDC 51079-966-01
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna New Business (MI Preferred)	$0.97
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cofinity Commercial	$1.04
Rate for Payer: Cofinity Commercial	$1.28
Rate for Payer: Healthscope Commercial	$1.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.27
Rate for Payer: PHP Commercial	$1.27
Rate for Payer: Priority Health Cigna Priority Health	$1.04
Rate for Payer: Priority Health SBD	$0.94

FAMOTIDINE 40 MG TABLET

Facility

$4.47

Service Code	NDC 50268-304-11
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna New Business (MI Preferred)	$2.91
Rate for Payer: Cash Price	$3.58
Rate for Payer: Cofinity Commercial	$3.13
Rate for Payer: Cofinity Commercial	$3.84
Rate for Payer: Healthscope Commercial	$4.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.80
Rate for Payer: PHP Commercial	$3.80
Rate for Payer: Priority Health Cigna Priority Health	$3.13
Rate for Payer: Priority Health SBD	$2.82

FAMOTIDINE 40 MG TABLET

Facility

$8,794.90

Service Code	NDC 0187-4440-10
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$5,540.79
Max. Negotiated Rate	$7,915.41
Rate for Payer: Aetna Commercial	$7,475.66
Rate for Payer: Aetna New Business (MI Preferred)	$5,716.68
Rate for Payer: Cash Price	$7,035.92
Rate for Payer: Cofinity Commercial	$6,156.43
Rate for Payer: Cofinity Commercial	$7,563.61
Rate for Payer: Healthscope Commercial	$7,915.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,475.66
Rate for Payer: PHP Commercial	$7,475.66
Rate for Payer: Priority Health Cigna Priority Health	$6,156.43
Rate for Payer: Priority Health SBD	$5,540.79

FAMOTIDINE 40 MG TABLET

Facility

$152.75

Service Code	NDC 0172-5729-60
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$96.23
Max. Negotiated Rate	$137.48
Rate for Payer: Aetna Commercial	$129.84
Rate for Payer: Aetna New Business (MI Preferred)	$99.29
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cofinity Commercial	$106.92
Rate for Payer: Cofinity Commercial	$131.36
Rate for Payer: Healthscope Commercial	$137.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$129.84
Rate for Payer: PHP Commercial	$129.84
Rate for Payer: Priority Health Cigna Priority Health	$106.92
Rate for Payer: Priority Health SBD	$96.23

FAMOTIDINE 40 MG TABLET

Facility

$223.25

Service Code	NDC 50268-304-15
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$140.65
Max. Negotiated Rate	$200.92
Rate for Payer: Aetna Commercial	$189.76
Rate for Payer: Aetna New Business (MI Preferred)	$145.11
Rate for Payer: Cash Price	$178.60
Rate for Payer: Cofinity Commercial	$156.28
Rate for Payer: Cofinity Commercial	$192.00
Rate for Payer: Healthscope Commercial	$200.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$189.76
Rate for Payer: PHP Commercial	$189.76
Rate for Payer: Priority Health Cigna Priority Health	$156.28
Rate for Payer: Priority Health SBD	$140.65

FAMOTIDINE 40 MG TABLET

Facility

$822.50

Service Code	NDC 0172-5729-70
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$518.18
Max. Negotiated Rate	$740.25
Rate for Payer: Aetna Commercial	$699.12
Rate for Payer: Aetna New Business (MI Preferred)	$534.62
Rate for Payer: Cash Price	$658.00
Rate for Payer: Cofinity Commercial	$575.75
Rate for Payer: Cofinity Commercial	$707.35
Rate for Payer: Healthscope Commercial	$740.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$699.12
Rate for Payer: PHP Commercial	$699.12
Rate for Payer: Priority Health Cigna Priority Health	$575.75
Rate for Payer: Priority Health SBD	$518.18

FAMOTIDINE 40 MG TABLET

Facility

$272.60

Service Code	NDC 61442-122-01
Hospital Charge Code	10012
Hospital Revenue Code	637
Min. Negotiated Rate	$171.74
Max. Negotiated Rate	$245.34
Rate for Payer: Aetna Commercial	$231.71
Rate for Payer: Aetna New Business (MI Preferred)	$177.19
Rate for Payer: Cash Price	$218.08
Rate for Payer: Cofinity Commercial	$190.82
Rate for Payer: Cofinity Commercial	$234.44
Rate for Payer: Healthscope Commercial	$245.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$231.71
Rate for Payer: PHP Commercial	$231.71
Rate for Payer: Priority Health Cigna Priority Health	$190.82
Rate for Payer: Priority Health SBD	$171.74

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$12.21

Service Code	NDC 0641-6022-01
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$10.99
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna New Business (MI Preferred)	$7.94
Rate for Payer: BCBS Complete	$4.88
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cofinity Commercial	$10.50
Rate for Payer: Cofinity Commercial	$8.55
Rate for Payer: Healthscope Commercial	$10.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.38
Rate for Payer: PHP Commercial	$10.38
Rate for Payer: Priority Health Cigna Priority Health	$8.55
Rate for Payer: Priority Health SBD	$7.69

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$16.05

Service Code	NDC 63323-739-12
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$14.44
Rate for Payer: Aetna Commercial	$13.64
Rate for Payer: Aetna New Business (MI Preferred)	$10.43
Rate for Payer: BCBS Complete	$6.42
Rate for Payer: Cash Price	$12.84
Rate for Payer: Cofinity Commercial	$11.24
Rate for Payer: Cofinity Commercial	$13.80
Rate for Payer: Healthscope Commercial	$14.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.64
Rate for Payer: PHP Commercial	$13.64
Rate for Payer: Priority Health Cigna Priority Health	$11.24
Rate for Payer: Priority Health SBD	$10.11

Know your out-of-pocket cost for care.

All Charges