|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$37.40
|
|
|
Service Code
|
NDC 63323073809
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.69
|
| Rate for Payer: BCBS Complete |
$14.96
|
| Rate for Payer: BCBS MAPPO |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$30.75
|
| Rate for Payer: BCN Commercial |
$29.08
|
| Rate for Payer: BCN Medicare Advantage |
$9.35
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.35
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Nomi Health Commercial |
$30.67
|
| Rate for Payer: PACE Senior Care Partners |
$8.88
|
| Rate for Payer: PACE SWMI |
$9.35
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: PHP Medicare Advantage |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.31
|
| Rate for Payer: Priority Health HMO/PPO |
$32.54
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.06
|
| Rate for Payer: Railroad Medicare Medicare |
$9.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.91
|
| Rate for Payer: UHC Core |
$31.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.35
|
| Rate for Payer: UHC Exchange |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$9.35
|
| Rate for Payer: VA VA |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$37.40
|
|
|
Service Code
|
NDC 63323073809
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: BCBS Trust/PPO |
$30.53
|
| Rate for Payer: BCN Commercial |
$28.90
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Nomi Health Commercial |
$30.67
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.31
|
| Rate for Payer: Priority Health HMO/PPO |
$32.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.91
|
| Rate for Payer: UHC Core |
$31.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
|
|
FAMOTIDINE 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$37.40
|
|
|
Service Code
|
NDC 63323073809
|
| Hospital Charge Code |
163732
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.69
|
| Rate for Payer: BCBS Complete |
$14.96
|
| Rate for Payer: BCBS MAPPO |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$30.75
|
| Rate for Payer: BCN Commercial |
$29.08
|
| Rate for Payer: BCN Medicare Advantage |
$9.35
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.35
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Nomi Health Commercial |
$30.67
|
| Rate for Payer: PACE Senior Care Partners |
$8.88
|
| Rate for Payer: PACE SWMI |
$9.35
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: PHP Medicare Advantage |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.31
|
| Rate for Payer: Priority Health HMO/PPO |
$32.54
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.06
|
| Rate for Payer: Railroad Medicare Medicare |
$9.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.91
|
| Rate for Payer: UHC Core |
$31.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.35
|
| Rate for Payer: UHC Exchange |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$9.35
|
| Rate for Payer: VA VA |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
|
|
FAMOTIDINE 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$37.40
|
|
|
Service Code
|
NDC 63323073809
|
| Hospital Charge Code |
163732
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: BCBS Trust/PPO |
$30.53
|
| Rate for Payer: BCN Commercial |
$28.90
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Nomi Health Commercial |
$30.67
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.31
|
| Rate for Payer: Priority Health HMO/PPO |
$32.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.91
|
| Rate for Payer: UHC Core |
$31.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 50268030315
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.79 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: BCBS Trust/PPO |
$90.16
|
| Rate for Payer: BCN Commercial |
$85.36
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.79
|
| Rate for Payer: Priority Health HMO/PPO |
$96.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.20
|
| Rate for Payer: UHC Core |
$92.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$432.40
|
|
|
Service Code
|
NDC 60687059501
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Medicare |
$112.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.12
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: BCBS MAPPO |
$108.10
|
| Rate for Payer: BCBS Trust/PPO |
$355.48
|
| Rate for Payer: BCN Commercial |
$336.19
|
| Rate for Payer: BCN Medicare Advantage |
$108.10
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.10
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: PACE Senior Care Partners |
$102.70
|
| Rate for Payer: PACE SWMI |
$108.10
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: PHP Medicare Advantage |
$108.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health HMO/PPO |
$376.19
|
| Rate for Payer: Priority Health Medicare |
$109.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.71
|
| Rate for Payer: Railroad Medicare Medicare |
$108.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.51
|
| Rate for Payer: UHC Core |
$361.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.10
|
| Rate for Payer: UHC Exchange |
$108.10
|
| Rate for Payer: UHC Medicare Advantage |
$108.10
|
| Rate for Payer: VA VA |
$108.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 51079096620
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.23 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: BCBS Trust/PPO |
$120.85
|
| Rate for Payer: BCN Commercial |
$114.41
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health HMO/PPO |
$128.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.28
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 60687059511
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna Medicare |
$1.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: BCBS MAPPO |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.56
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Medicare Advantage |
$1.08
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: Nomi Health Commercial |
$3.55
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.08
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: PHP Medicare Advantage |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.77
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.81
|
| Rate for Payer: UHC Core |
$3.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.08
|
| Rate for Payer: UHC Exchange |
$1.08
|
| Rate for Payer: UHC Medicare Advantage |
$1.08
|
| Rate for Payer: VA VA |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 60687059511
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: Nomi Health Commercial |
$3.55
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.81
|
| Rate for Payer: UHC Core |
$3.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$116.33
|
|
|
Service Code
|
NDC 00904578051
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$104.70 |
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: BCBS Trust/PPO |
$94.96
|
| Rate for Payer: BCN Commercial |
$89.90
|
| Rate for Payer: Cash Price |
$93.06
|
| 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: Lakeland Regional Health Systems Commercial |
$87.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.88
|
| Rate for Payer: Nomi Health Commercial |
$95.39
|
| Rate for Payer: PHP Commercial |
$98.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.61
|
| Rate for Payer: Priority Health HMO/PPO |
$101.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.37
|
| Rate for Payer: UHC Core |
$97.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.25
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 51079096620
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$38.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.27
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: BCBS MAPPO |
$37.01
|
| Rate for Payer: BCBS Trust/PPO |
$121.71
|
| Rate for Payer: BCN Commercial |
$115.11
|
| Rate for Payer: BCN Medicare Advantage |
$37.01
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.01
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: PACE Senior Care Partners |
$35.16
|
| Rate for Payer: PACE SWMI |
$37.01
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: PHP Medicare Advantage |
$37.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health HMO/PPO |
$128.80
|
| Rate for Payer: Priority Health Medicare |
$37.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.19
|
| Rate for Payer: Railroad Medicare Medicare |
$37.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.28
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.01
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicare Advantage |
$37.01
|
| Rate for Payer: VA VA |
$37.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$116.33
|
|
|
Service Code
|
NDC 00904578051
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$104.70 |
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: Aetna Medicare |
$30.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.35
|
| Rate for Payer: BCBS Complete |
$46.53
|
| Rate for Payer: BCBS MAPPO |
$29.08
|
| Rate for Payer: BCBS Trust/PPO |
$95.63
|
| Rate for Payer: BCN Commercial |
$90.45
|
| Rate for Payer: BCN Medicare Advantage |
$29.08
|
| Rate for Payer: Cash Price |
$93.06
|
| Rate for Payer: Cofinity Commercial |
$100.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.08
|
| Rate for Payer: Healthscope Commercial |
$104.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.88
|
| Rate for Payer: Nomi Health Commercial |
$95.39
|
| Rate for Payer: PACE Senior Care Partners |
$27.63
|
| Rate for Payer: PACE SWMI |
$29.08
|
| Rate for Payer: PHP Commercial |
$98.88
|
| Rate for Payer: PHP Medicare Advantage |
$29.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.61
|
| Rate for Payer: Priority Health HMO/PPO |
$101.21
|
| Rate for Payer: Priority Health Medicare |
$29.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.94
|
| Rate for Payer: Railroad Medicare Medicare |
$29.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.37
|
| Rate for Payer: UHC Core |
$97.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.08
|
| Rate for Payer: UHC Exchange |
$29.08
|
| Rate for Payer: UHC Medicare Advantage |
$29.08
|
| Rate for Payer: VA VA |
$29.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.25
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 00904719361
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: BCBS Trust/PPO |
$132.36
|
| Rate for Payer: BCN Commercial |
$125.31
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Nomi Health Commercial |
$132.96
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.40
|
| Rate for Payer: Priority Health HMO/PPO |
$141.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.69
|
| Rate for Payer: UHC Core |
$135.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 50268030315
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.23 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$28.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.52
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: BCBS MAPPO |
$27.61
|
| Rate for Payer: BCBS Trust/PPO |
$90.80
|
| Rate for Payer: BCN Commercial |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$27.61
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.61
|
| Rate for Payer: Healthscope Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: PACE Senior Care Partners |
$26.23
|
| Rate for Payer: PACE SWMI |
$27.61
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: PHP Medicare Advantage |
$27.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.79
|
| Rate for Payer: Priority Health HMO/PPO |
$96.09
|
| Rate for Payer: Priority Health Medicare |
$27.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.00
|
| Rate for Payer: Railroad Medicare Medicare |
$27.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.20
|
| Rate for Payer: UHC Core |
$92.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.61
|
| Rate for Payer: UHC Exchange |
$27.61
|
| Rate for Payer: UHC Medicare Advantage |
$27.61
|
| Rate for Payer: VA VA |
$27.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$162.15
|
|
|
Service Code
|
NDC 00904719361
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.51 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna Medicare |
$42.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.67
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: BCBS MAPPO |
$40.54
|
| Rate for Payer: BCBS Trust/PPO |
$133.30
|
| Rate for Payer: BCN Commercial |
$126.07
|
| Rate for Payer: BCN Medicare Advantage |
$40.54
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.54
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Nomi Health Commercial |
$132.96
|
| Rate for Payer: PACE Senior Care Partners |
$38.51
|
| Rate for Payer: PACE SWMI |
$40.54
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: PHP Medicare Advantage |
$40.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.40
|
| Rate for Payer: Priority Health HMO/PPO |
$141.07
|
| Rate for Payer: Priority Health Medicare |
$40.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.64
|
| Rate for Payer: Railroad Medicare Medicare |
$40.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.69
|
| Rate for Payer: UHC Core |
$135.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.54
|
| Rate for Payer: UHC Exchange |
$40.54
|
| Rate for Payer: UHC Medicare Advantage |
$40.54
|
| Rate for Payer: VA VA |
$40.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
NDC 51079096601
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.47
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: BCBS MAPPO |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: BCN Medicare Advantage |
$0.37
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.37
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: Nomi Health Commercial |
$1.22
|
| Rate for Payer: PACE Senior Care Partners |
$0.35
|
| Rate for Payer: PACE SWMI |
$0.37
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: PHP Medicare Advantage |
$0.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health HMO/PPO |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.00
|
| Rate for Payer: Railroad Medicare Medicare |
$0.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.31
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.37
|
| Rate for Payer: UHC Exchange |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: VA VA |
$0.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
NDC 51079096601
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$1.19
|
| 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: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: Nomi Health Commercial |
$1.22
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health HMO/PPO |
$1.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.31
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 63739064510
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: BCBS Trust/PPO |
$145.79
|
| Rate for Payer: BCN Commercial |
$138.02
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Nomi Health Commercial |
$146.45
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.09
|
| Rate for Payer: Priority Health HMO/PPO |
$155.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.17
|
| Rate for Payer: UHC Core |
$149.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$178.60
|
|
|
Service Code
|
NDC 63739064510
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna Medicare |
$46.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.81
|
| Rate for Payer: BCBS Complete |
$71.44
|
| Rate for Payer: BCBS MAPPO |
$44.65
|
| Rate for Payer: BCBS Trust/PPO |
$146.83
|
| Rate for Payer: BCN Commercial |
$138.86
|
| Rate for Payer: BCN Medicare Advantage |
$44.65
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.65
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Nomi Health Commercial |
$146.45
|
| Rate for Payer: PACE Senior Care Partners |
$42.42
|
| Rate for Payer: PACE SWMI |
$44.65
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: PHP Medicare Advantage |
$44.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.09
|
| Rate for Payer: Priority Health HMO/PPO |
$155.38
|
| Rate for Payer: Priority Health Medicare |
$45.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.66
|
| Rate for Payer: Railroad Medicare Medicare |
$44.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.17
|
| Rate for Payer: UHC Core |
$149.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.65
|
| Rate for Payer: UHC Exchange |
$44.65
|
| Rate for Payer: UHC Medicare Advantage |
$44.65
|
| Rate for Payer: VA VA |
$44.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$99.88
|
|
|
Service Code
|
NDC 00904578017
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$89.89 |
| Rate for Payer: Aetna Commercial |
$84.90
|
| Rate for Payer: Aetna Medicare |
$25.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.21
|
| Rate for Payer: BCBS Complete |
$39.95
|
| Rate for Payer: BCBS MAPPO |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$82.11
|
| Rate for Payer: BCN Commercial |
$77.66
|
| Rate for Payer: BCN Medicare Advantage |
$24.97
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Commercial |
$85.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$89.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: PACE Senior Care Partners |
$23.72
|
| Rate for Payer: PACE SWMI |
$24.97
|
| Rate for Payer: PHP Commercial |
$84.90
|
| Rate for Payer: PHP Medicare Advantage |
$24.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.92
|
| Rate for Payer: Priority Health HMO/PPO |
$86.90
|
| Rate for Payer: Priority Health Medicare |
$25.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.92
|
| Rate for Payer: Railroad Medicare Medicare |
$24.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.89
|
| Rate for Payer: UHC Core |
$83.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.97
|
| Rate for Payer: UHC Exchange |
$24.97
|
| Rate for Payer: UHC Medicare Advantage |
$24.97
|
| Rate for Payer: VA VA |
$24.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.91
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$99.88
|
|
|
Service Code
|
NDC 00904578017
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.92 |
| Max. Negotiated Rate |
$89.89 |
| Rate for Payer: Aetna Commercial |
$84.90
|
| Rate for Payer: BCBS Trust/PPO |
$81.53
|
| Rate for Payer: BCN Commercial |
$77.19
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Commercial |
$85.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Healthscope Commercial |
$89.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: PHP Commercial |
$84.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.92
|
| Rate for Payer: Priority Health HMO/PPO |
$86.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.89
|
| Rate for Payer: UHC Core |
$83.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.91
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
NDC 50268030311
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.69
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: BCBS MAPPO |
$0.55
|
| Rate for Payer: BCBS Trust/PPO |
$1.82
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Medicare Advantage |
$0.55
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.55
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: Nomi Health Commercial |
$1.81
|
| Rate for Payer: PACE Senior Care Partners |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.55
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: PHP Medicare Advantage |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1.92
|
| Rate for Payer: Priority Health Medicare |
$0.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.55
|
| Rate for Payer: UHC Exchange |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.55
|
| Rate for Payer: VA VA |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$432.40
|
|
|
Service Code
|
NDC 60687059501
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.06 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: BCBS Trust/PPO |
$352.97
|
| Rate for Payer: BCN Commercial |
$334.16
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health HMO/PPO |
$376.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.51
|
| Rate for Payer: UHC Core |
$361.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
NDC 50268030311
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.80
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.77
|
| 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: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: Nomi Health Commercial |
$1.81
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
NDC 67457043300
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: BCBS Trust/PPO |
$9.84
|
| Rate for Payer: BCN Commercial |
$9.31
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Nomi Health Commercial |
$9.88
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: Priority Health HMO/PPO |
$10.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$10.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
