|
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 |
$162.15 |
| Rate for Payer: Aetna Commercial |
$145.94
|
| Rate for Payer: ASR ASR |
$157.29
|
| Rate for Payer: ASR Commercial |
$157.29
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$125.71
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$162.15
|
| Rate for Payer: Healthscope Whirlpool |
$157.29
|
| Rate for Payer: Mclaren Commercial |
$145.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Nomi Health Commercial |
$132.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.69
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 00536129801
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.32
|
| Rate for Payer: Aetna Medicare |
$95.18
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: ASR Commercial |
$184.64
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS Trust/PPO |
$155.88
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.78
|
| Rate for Payer: Priority Health Narrow Network |
$133.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 61442012101
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$150.40 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: ASR ASR |
$145.89
|
| Rate for Payer: ASR Commercial |
$145.89
|
| Rate for Payer: BCBS Trust/PPO |
$122.56
|
| Rate for Payer: BCN Commercial |
$116.61
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$141.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$150.40
|
| Rate for Payer: Healthscope Whirlpool |
$145.89
|
| Rate for Payer: Mclaren Commercial |
$135.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Nomi Health Commercial |
$123.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.35
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$150.40
|
|
|
Service Code
|
NDC 61442012101
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.16 |
| Max. Negotiated Rate |
$150.40 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: Aetna Medicare |
$75.20
|
| Rate for Payer: ASR ASR |
$145.89
|
| Rate for Payer: ASR Commercial |
$145.89
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS Trust/PPO |
$123.16
|
| Rate for Payer: BCN Commercial |
$116.61
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$141.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$150.40
|
| Rate for Payer: Healthscope Whirlpool |
$145.89
|
| Rate for Payer: Mclaren Commercial |
$135.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Nomi Health Commercial |
$123.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.78
|
| Rate for Payer: Priority Health Narrow Network |
$105.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.35
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 51079096620
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna Commercial |
$133.24
|
| Rate for Payer: Aetna Medicare |
$74.02
|
| Rate for Payer: ASR ASR |
$143.61
|
| Rate for Payer: ASR Commercial |
$143.61
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: BCBS Trust/PPO |
$121.24
|
| Rate for Payer: BCN Commercial |
$114.78
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Healthscope Whirlpool |
$143.61
|
| Rate for Payer: Mclaren Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.72
|
| Rate for Payer: Priority Health Narrow Network |
$103.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.28
|
|
|
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 |
$148.05 |
| Rate for Payer: Aetna Commercial |
$133.24
|
| Rate for Payer: ASR ASR |
$143.61
|
| Rate for Payer: ASR Commercial |
$143.61
|
| Rate for Payer: BCBS Trust/PPO |
$120.65
|
| Rate for Payer: BCN Commercial |
$114.78
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Healthscope Whirlpool |
$143.61
|
| Rate for Payer: Mclaren Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.28
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
NDC 51079096601
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: ASR ASR |
$1.44
|
| Rate for Payer: ASR Commercial |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Healthscope Whirlpool |
$1.44
|
| Rate for Payer: Mclaren Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$1.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.30
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 00536129801
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.32
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: ASR Commercial |
$184.64
|
| Rate for Payer: BCBS Trust/PPO |
$155.12
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 51079096601
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: ASR ASR |
$1.44
|
| Rate for Payer: ASR Commercial |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.21
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Healthscope Whirlpool |
$1.44
|
| Rate for Payer: Mclaren Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$1.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.30
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12.01
|
|
|
Service Code
|
NDC 67457043322
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$12.01 |
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: ASR ASR |
$11.65
|
| Rate for Payer: ASR Commercial |
$11.65
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.83
|
| Rate for Payer: BCN Commercial |
$9.31
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$12.01
|
| Rate for Payer: Healthscope Whirlpool |
$11.65
|
| Rate for Payer: Mclaren Commercial |
$10.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Nomi Health Commercial |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.52
|
| Rate for Payer: Priority Health Narrow Network |
$8.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.57
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 00641602225
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$11.66
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: ASR ASR |
$12.56
|
| Rate for Payer: ASR Commercial |
$12.56
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$10.60
|
| Rate for Payer: BCN Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Whirlpool |
$12.56
|
| Rate for Payer: Mclaren Commercial |
$11.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Nomi Health Commercial |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.35
|
| Rate for Payer: Priority Health Narrow Network |
$9.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.40
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 00641602225
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$11.66
|
| Rate for Payer: ASR ASR |
$12.56
|
| Rate for Payer: ASR Commercial |
$12.56
|
| Rate for Payer: BCBS Trust/PPO |
$10.55
|
| Rate for Payer: BCN Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Whirlpool |
$12.56
|
| Rate for Payer: Mclaren Commercial |
$11.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Nomi Health Commercial |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.40
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 00641602201
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$11.66
|
| Rate for Payer: ASR ASR |
$12.56
|
| Rate for Payer: ASR Commercial |
$12.56
|
| Rate for Payer: BCBS Trust/PPO |
$10.55
|
| Rate for Payer: BCN Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Whirlpool |
$12.56
|
| Rate for Payer: Mclaren Commercial |
$11.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Nomi Health Commercial |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.40
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.30
|
|
|
Service Code
|
NDC 63323073912
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$16.30 |
| Rate for Payer: Aetna Commercial |
$14.67
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: ASR ASR |
$15.81
|
| Rate for Payer: ASR Commercial |
$15.81
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCN Commercial |
$12.64
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Healthscope Commercial |
$16.30
|
| Rate for Payer: Healthscope Whirlpool |
$15.81
|
| Rate for Payer: Mclaren Commercial |
$14.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Nomi Health Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.28
|
| Rate for Payer: Priority Health Narrow Network |
$11.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.34
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
NDC 70860075102
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: ASR Commercial |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$12.47
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.30
|
|
|
Service Code
|
NDC 63323073912
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$16.30 |
| Rate for Payer: Aetna Commercial |
$14.67
|
| Rate for Payer: ASR ASR |
$15.81
|
| Rate for Payer: ASR Commercial |
$15.81
|
| Rate for Payer: BCBS Trust/PPO |
$13.28
|
| Rate for Payer: BCN Commercial |
$12.64
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Healthscope Commercial |
$16.30
|
| Rate for Payer: Healthscope Whirlpool |
$15.81
|
| Rate for Payer: Mclaren Commercial |
$14.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Nomi Health Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.34
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12.01
|
|
|
Service Code
|
NDC 67457043322
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$12.01 |
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: ASR ASR |
$11.65
|
| Rate for Payer: ASR Commercial |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$9.79
|
| Rate for Payer: BCN Commercial |
$9.31
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$12.01
|
| Rate for Payer: Healthscope Whirlpool |
$11.65
|
| Rate for Payer: Mclaren Commercial |
$10.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Nomi Health Commercial |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.57
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
NDC 70860075141
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$7.65
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: ASR Commercial |
$14.84
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$12.53
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.41
|
| Rate for Payer: Priority Health Narrow Network |
$10.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12.01
|
|
|
Service Code
|
NDC 67457043300
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$12.01 |
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: ASR ASR |
$11.65
|
| Rate for Payer: ASR Commercial |
$11.65
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.83
|
| Rate for Payer: BCN Commercial |
$9.31
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$12.01
|
| Rate for Payer: Healthscope Whirlpool |
$11.65
|
| Rate for Payer: Mclaren Commercial |
$10.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Nomi Health Commercial |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.52
|
| Rate for Payer: Priority Health Narrow Network |
$8.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.57
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
NDC 70860075102
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$7.65
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: ASR Commercial |
$14.84
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$12.53
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.41
|
| Rate for Payer: Priority Health Narrow Network |
$10.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
NDC 70860075141
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: ASR Commercial |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$12.47
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 00641602201
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$11.66
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: ASR ASR |
$12.56
|
| Rate for Payer: ASR Commercial |
$12.56
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$10.60
|
| Rate for Payer: BCN Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Whirlpool |
$12.56
|
| Rate for Payer: Mclaren Commercial |
$11.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Nomi Health Commercial |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.35
|
| Rate for Payer: Priority Health Narrow Network |
$9.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.40
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12.01
|
|
|
Service Code
|
NDC 67457043300
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$12.01 |
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: ASR ASR |
$11.65
|
| Rate for Payer: ASR Commercial |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$9.79
|
| Rate for Payer: BCN Commercial |
$9.31
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$12.01
|
| Rate for Payer: Healthscope Whirlpool |
$11.65
|
| Rate for Payer: Mclaren Commercial |
$10.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Nomi Health Commercial |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.57
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
OP
|
$12.90
|
|
|
Service Code
|
NDC 65219053110
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: Aetna Medicare |
$6.45
|
| Rate for Payer: ASR ASR |
$12.51
|
| Rate for Payer: ASR Commercial |
$12.51
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$10.56
|
| Rate for Payer: BCN Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.90
|
| Rate for Payer: Healthscope Whirlpool |
$12.51
|
| Rate for Payer: Mclaren Commercial |
$11.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: Nomi Health Commercial |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.30
|
| Rate for Payer: Priority Health Narrow Network |
$9.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.35
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
IP
|
$12.90
|
|
|
Service Code
|
NDC 65219053110
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: ASR ASR |
$12.51
|
| Rate for Payer: ASR Commercial |
$12.51
|
| Rate for Payer: BCBS Trust/PPO |
$10.51
|
| Rate for Payer: BCN Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.90
|
| Rate for Payer: Healthscope Whirlpool |
$12.51
|
| Rate for Payer: Mclaren Commercial |
$11.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: Nomi Health Commercial |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.35
|
|
