|
FAMOTIDINE 10 MG TABLET
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 09900000880
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna American Axle |
$1.04
|
| Rate for Payer: Aetna Commercial |
$1.36
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.04
|
| Rate for Payer: BCBS Complete |
$0.64
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cofinity Advantage |
$1.12
|
| Rate for Payer: Cofinity Commercial |
$1.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.20
|
| Rate for Payer: PHP Commercial |
$1.36
|
| Rate for Payer: Priority Health SBD |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.04
|
| Rate for Payer: UHC Core |
$0.83
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UMR Bronson Commercial |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.20
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 70000004801
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.83
|
| Rate for Payer: UHC Core |
$36.73
|
| Rate for Payer: UHC Exchange |
$27.71
|
| Rate for Payer: UMR Bronson Commercial |
$26.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
IP
|
$64.16
|
|
|
Service Code
|
NDC 69230032630
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.23 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna American Axle |
$41.70
|
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.70
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Advantage |
$44.91
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.33
|
| Rate for Payer: Healthscope Commercial |
$57.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.12
|
| Rate for Payer: PHP Commercial |
$54.54
|
| Rate for Payer: Priority Health SBD |
$40.42
|
| Rate for Payer: UMR Bronson Commercial |
$28.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.12
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
OP
|
$59.93
|
|
|
Service Code
|
NDC 00904552987
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$53.94 |
| Rate for Payer: Aetna American Axle |
$38.95
|
| Rate for Payer: Aetna Commercial |
$50.94
|
| Rate for Payer: Aetna Medicare |
$29.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.95
|
| Rate for Payer: BCBS Complete |
$23.97
|
| Rate for Payer: Cash Price |
$47.94
|
| Rate for Payer: Cofinity Advantage |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$51.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.94
|
| Rate for Payer: Healthscope Commercial |
$53.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.95
|
| Rate for Payer: PHP Commercial |
$50.94
|
| Rate for Payer: Priority Health SBD |
$37.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.95
|
| Rate for Payer: UHC Core |
$31.22
|
| Rate for Payer: UHC Exchange |
$23.55
|
| Rate for Payer: UMR Bronson Commercial |
$22.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.95
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
OP
|
$66.27
|
|
|
Service Code
|
NDC 96295013963
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.52 |
| Max. Negotiated Rate |
$59.64 |
| Rate for Payer: Aetna American Axle |
$43.08
|
| Rate for Payer: Aetna Commercial |
$56.33
|
| Rate for Payer: Aetna Medicare |
$33.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.08
|
| Rate for Payer: BCBS Complete |
$26.51
|
| Rate for Payer: Cash Price |
$53.02
|
| Rate for Payer: Cofinity Advantage |
$46.39
|
| Rate for Payer: Cofinity Commercial |
$56.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.02
|
| Rate for Payer: Healthscope Commercial |
$59.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.70
|
| Rate for Payer: PHP Commercial |
$56.33
|
| Rate for Payer: Priority Health SBD |
$41.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.08
|
| Rate for Payer: UHC Core |
$34.53
|
| Rate for Payer: UHC Exchange |
$26.04
|
| Rate for Payer: UMR Bronson Commercial |
$24.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.70
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 70000004801
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UMR Bronson Commercial |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
OP
|
$64.16
|
|
|
Service Code
|
NDC 69230032630
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna American Axle |
$41.70
|
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare |
$32.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.70
|
| Rate for Payer: BCBS Complete |
$25.66
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Advantage |
$44.91
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.33
|
| Rate for Payer: Healthscope Commercial |
$57.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.12
|
| Rate for Payer: PHP Commercial |
$54.54
|
| Rate for Payer: Priority Health SBD |
$40.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.70
|
| Rate for Payer: UHC Core |
$33.43
|
| Rate for Payer: UHC Exchange |
$25.21
|
| Rate for Payer: UMR Bronson Commercial |
$23.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.12
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
IP
|
$59.93
|
|
|
Service Code
|
NDC 00904552987
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.37 |
| Max. Negotiated Rate |
$53.94 |
| Rate for Payer: Aetna American Axle |
$38.95
|
| Rate for Payer: Aetna Commercial |
$50.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.95
|
| Rate for Payer: Cash Price |
$47.94
|
| Rate for Payer: Cofinity Advantage |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$51.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.94
|
| Rate for Payer: Healthscope Commercial |
$53.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.95
|
| Rate for Payer: PHP Commercial |
$50.94
|
| Rate for Payer: Priority Health SBD |
$37.76
|
| Rate for Payer: UMR Bronson Commercial |
$26.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.95
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 09900000880
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna American Axle |
$1.04
|
| Rate for Payer: Aetna Commercial |
$1.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.04
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cofinity Advantage |
$1.12
|
| Rate for Payer: Cofinity Commercial |
$1.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.20
|
| Rate for Payer: PHP Commercial |
$1.36
|
| Rate for Payer: Priority Health SBD |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.20
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
OP
|
$198.81
|
|
|
Service Code
|
NDC 00363014175
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$178.93 |
| Rate for Payer: Aetna American Axle |
$129.23
|
| Rate for Payer: Aetna Commercial |
$168.99
|
| Rate for Payer: Aetna Medicare |
$99.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.23
|
| Rate for Payer: BCBS Complete |
$79.52
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cofinity Advantage |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$170.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.05
|
| Rate for Payer: Healthscope Commercial |
$178.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.11
|
| Rate for Payer: PHP Commercial |
$168.99
|
| Rate for Payer: Priority Health SBD |
$125.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.23
|
| Rate for Payer: UHC Core |
$103.58
|
| Rate for Payer: UHC Exchange |
$78.13
|
| Rate for Payer: UMR Bronson Commercial |
$73.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.11
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
IP
|
$66.27
|
|
|
Service Code
|
NDC 96295013963
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.16 |
| Max. Negotiated Rate |
$59.64 |
| Rate for Payer: Aetna American Axle |
$43.08
|
| Rate for Payer: Aetna Commercial |
$56.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.08
|
| Rate for Payer: Cash Price |
$53.02
|
| Rate for Payer: Cofinity Advantage |
$46.39
|
| Rate for Payer: Cofinity Commercial |
$56.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.02
|
| Rate for Payer: Healthscope Commercial |
$59.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.70
|
| Rate for Payer: PHP Commercial |
$56.33
|
| Rate for Payer: Priority Health SBD |
$41.75
|
| Rate for Payer: UMR Bronson Commercial |
$29.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.70
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$197.40
|
|
|
Service Code
|
NDC 904719361
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.04 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna American Axle |
$128.31
|
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna Medicare |
$98.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.31
|
| Rate for Payer: BCBS Complete |
$78.96
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Advantage |
$138.18
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.05
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health SBD |
$124.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.31
|
| Rate for Payer: UHC Core |
$102.85
|
| Rate for Payer: UHC Exchange |
$77.58
|
| Rate for Payer: UMR Bronson Commercial |
$73.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 61442012101
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| 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: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
NDC 60687059511
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna American Axle |
$2.63
|
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Advantage |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.63
|
| Rate for Payer: UHC Core |
$2.11
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 50268030315
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$55.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.79
|
| Rate for Payer: UHC Core |
$57.54
|
| Rate for Payer: UHC Exchange |
$43.41
|
| Rate for Payer: UMR Bronson Commercial |
$40.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 60687059501
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.73
|
| Rate for Payer: UHC Core |
$210.59
|
| Rate for Payer: UHC Exchange |
$158.85
|
| Rate for Payer: UMR Bronson Commercial |
$149.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 00536129801
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.43
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$116.33
|
|
|
Service Code
|
NDC 00904578051
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.04 |
| Max. Negotiated Rate |
$104.70 |
| Rate for Payer: Aetna American Axle |
$75.61
|
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: Aetna Medicare |
$58.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.61
|
| Rate for Payer: BCBS Complete |
$46.53
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$81.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.06
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.61
|
| Rate for Payer: UHC Core |
$60.61
|
| Rate for Payer: UHC Exchange |
$45.72
|
| Rate for Payer: UMR Bronson Commercial |
$43.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.25
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$4.05
|
|
|
Service Code
|
NDC 60687059511
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna American Axle |
$2.63
|
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Advantage |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 00172572860
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.43 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$90.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 61442012101
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$54.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
NDC 51079096601
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
NDC 50268030311
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna American Axle |
$1.44
|
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Advantage |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.66
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.15
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 51079096620
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| 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: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
NDC 50268030311
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna American Axle |
$1.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.66
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
