Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$118.44

Service Code	NDC 70000-0473-1
Hospital Charge Code	76472
Hospital Revenue Code	637
Min. Negotiated Rate	$74.62
Max. Negotiated Rate	$106.60
Rate for Payer: Aetna Commercial	$100.67
Rate for Payer: Aetna New Business (MI Preferred)	$76.99
Rate for Payer: Cash Price	$94.75
Rate for Payer: Cofinity Commercial	$101.86
Rate for Payer: Cofinity Commercial	$82.91
Rate for Payer: Healthscope Commercial	$106.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$100.67
Rate for Payer: PHP Commercial	$100.67
Rate for Payer: Priority Health Cigna Priority Health	$82.91
Rate for Payer: Priority Health SBD	$74.62

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$138.18

Service Code	NDC 51672-2073-8
Hospital Charge Code	76472
Hospital Revenue Code	637
Min. Negotiated Rate	$87.05
Max. Negotiated Rate	$124.36
Rate for Payer: Aetna Commercial	$117.45
Rate for Payer: Aetna New Business (MI Preferred)	$89.82
Rate for Payer: Cash Price	$110.54
Rate for Payer: Cofinity Commercial	$118.83
Rate for Payer: Cofinity Commercial	$96.73
Rate for Payer: Healthscope Commercial	$124.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$117.45
Rate for Payer: PHP Commercial	$117.45
Rate for Payer: Priority Health Cigna Priority Health	$96.73
Rate for Payer: Priority Health SBD	$87.05

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$122.02

Service Code	NDC 70000-0125-1
Hospital Charge Code	76472
Hospital Revenue Code	637
Min. Negotiated Rate	$76.87
Max. Negotiated Rate	$109.82
Rate for Payer: Aetna Commercial	$103.72
Rate for Payer: Aetna New Business (MI Preferred)	$79.31
Rate for Payer: Cash Price	$97.62
Rate for Payer: Cofinity Commercial	$104.94
Rate for Payer: Cofinity Commercial	$85.41
Rate for Payer: Healthscope Commercial	$109.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$103.72
Rate for Payer: PHP Commercial	$103.72
Rate for Payer: Priority Health Cigna Priority Health	$85.41
Rate for Payer: Priority Health SBD	$76.87

LORAZEPAM 0.5 MG TABLET

Facility

$194.25

Service Code	NDC 51079-417-20
Hospital Charge Code	4572
Hospital Revenue Code	637
Min. Negotiated Rate	$122.38
Max. Negotiated Rate	$174.82
Rate for Payer: Aetna Commercial	$165.11
Rate for Payer: Aetna New Business (MI Preferred)	$126.26
Rate for Payer: Cash Price	$155.40
Rate for Payer: Cofinity Commercial	$135.98
Rate for Payer: Cofinity Commercial	$167.06
Rate for Payer: Healthscope Commercial	$174.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$165.11
Rate for Payer: PHP Commercial	$165.11
Rate for Payer: Priority Health Cigna Priority Health	$135.98
Rate for Payer: Priority Health SBD	$122.38

LORAZEPAM 0.5 MG TABLET

Facility

$71.75

Service Code	NDC 69315-904-01
Hospital Charge Code	4572
Hospital Revenue Code	637
Min. Negotiated Rate	$45.20
Max. Negotiated Rate	$64.58
Rate for Payer: Aetna Commercial	$60.99
Rate for Payer: Aetna New Business (MI Preferred)	$46.64
Rate for Payer: Cash Price	$57.40
Rate for Payer: Cofinity Commercial	$50.22
Rate for Payer: Cofinity Commercial	$61.70
Rate for Payer: Healthscope Commercial	$64.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$60.99
Rate for Payer: PHP Commercial	$60.99
Rate for Payer: Priority Health Cigna Priority Health	$50.22
Rate for Payer: Priority Health SBD	$45.20

LORAZEPAM 0.5 MG TABLET

Facility

$129.50

Service Code	NDC 0904-6007-61
Hospital Charge Code	4572
Hospital Revenue Code	637
Min. Negotiated Rate	$81.58
Max. Negotiated Rate	$116.55
Rate for Payer: Aetna Commercial	$110.08
Rate for Payer: Aetna New Business (MI Preferred)	$84.18
Rate for Payer: Cash Price	$103.60
Rate for Payer: Cofinity Commercial	$111.37
Rate for Payer: Cofinity Commercial	$90.65
Rate for Payer: Healthscope Commercial	$116.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$110.08
Rate for Payer: PHP Commercial	$110.08
Rate for Payer: Priority Health Cigna Priority Health	$90.65
Rate for Payer: Priority Health SBD	$81.58

LORAZEPAM 1 MG TABLET

Facility

$187.25

Service Code	NDC 60687-355-01
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$117.97
Max. Negotiated Rate	$168.52
Rate for Payer: Aetna Commercial	$159.16
Rate for Payer: Aetna New Business (MI Preferred)	$121.71
Rate for Payer: Cash Price	$149.80
Rate for Payer: Cofinity Commercial	$131.08
Rate for Payer: Cofinity Commercial	$161.04
Rate for Payer: Healthscope Commercial	$168.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$159.16
Rate for Payer: PHP Commercial	$159.16
Rate for Payer: Priority Health Cigna Priority Health	$131.08
Rate for Payer: Priority Health SBD	$117.97

LORAZEPAM 1 MG TABLET

Facility

$113.75

Service Code	NDC 51079-386-20
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$71.66
Max. Negotiated Rate	$102.38
Rate for Payer: Aetna Commercial	$96.69
Rate for Payer: Aetna New Business (MI Preferred)	$73.94
Rate for Payer: Cash Price	$91.00
Rate for Payer: Cofinity Commercial	$79.62
Rate for Payer: Cofinity Commercial	$97.82
Rate for Payer: Healthscope Commercial	$102.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.69
Rate for Payer: PHP Commercial	$96.69
Rate for Payer: Priority Health Cigna Priority Health	$79.62
Rate for Payer: Priority Health SBD	$71.66

LORAZEPAM 1 MG TABLET

Facility

$1.88

Service Code	NDC 60687-355-11
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$1.69
Rate for Payer: Aetna Commercial	$1.60
Rate for Payer: Aetna New Business (MI Preferred)	$1.22
Rate for Payer: Cash Price	$1.50
Rate for Payer: Cofinity Commercial	$1.32
Rate for Payer: Cofinity Commercial	$1.62
Rate for Payer: Healthscope Commercial	$1.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.60
Rate for Payer: PHP Commercial	$1.60
Rate for Payer: Priority Health Cigna Priority Health	$1.32
Rate for Payer: Priority Health SBD	$1.18

LORAZEPAM 1 MG TABLET

Facility

$358.75

Service Code	NDC 69315-905-05
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$226.01
Max. Negotiated Rate	$322.88
Rate for Payer: Aetna Commercial	$304.94
Rate for Payer: Aetna New Business (MI Preferred)	$233.19
Rate for Payer: Cash Price	$287.00
Rate for Payer: Cofinity Commercial	$251.12
Rate for Payer: Cofinity Commercial	$308.52
Rate for Payer: Healthscope Commercial	$322.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$304.94
Rate for Payer: PHP Commercial	$304.94
Rate for Payer: Priority Health Cigna Priority Health	$251.12
Rate for Payer: Priority Health SBD	$226.01

LORAZEPAM 1 MG TABLET

Facility

$78.75

Service Code	NDC 69315-905-01
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$49.61
Max. Negotiated Rate	$70.88
Rate for Payer: Aetna Commercial	$66.94
Rate for Payer: Aetna New Business (MI Preferred)	$51.19
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cofinity Commercial	$67.72
Rate for Payer: Cofinity Commercial	$55.12
Rate for Payer: Healthscope Commercial	$70.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.94
Rate for Payer: PHP Commercial	$66.94
Rate for Payer: Priority Health Cigna Priority Health	$55.12
Rate for Payer: Priority Health SBD	$49.61

LORAZEPAM 1 MG TABLET

Facility

$150.50

Service Code	NDC 0904-6008-61
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$94.82
Max. Negotiated Rate	$135.45
Rate for Payer: Aetna Commercial	$127.92
Rate for Payer: Aetna New Business (MI Preferred)	$97.82
Rate for Payer: Cash Price	$120.40
Rate for Payer: Cofinity Commercial	$105.35
Rate for Payer: Cofinity Commercial	$129.43
Rate for Payer: Healthscope Commercial	$135.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.92
Rate for Payer: PHP Commercial	$127.92
Rate for Payer: Priority Health Cigna Priority Health	$105.35
Rate for Payer: Priority Health SBD	$94.82

LORAZEPAM 1 MG TABLET

Facility

$150.50

Service Code	NDC 0904-6008-61
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$135.45
Rate for Payer: Aetna Commercial	$127.92
Rate for Payer: Aetna New Business (MI Preferred)	$97.82
Rate for Payer: BCBS Complete	$60.20
Rate for Payer: Cash Price	$120.40
Rate for Payer: Cofinity Commercial	$105.35
Rate for Payer: Cofinity Commercial	$129.43
Rate for Payer: Healthscope Commercial	$135.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.92
Rate for Payer: PHP Commercial	$127.92
Rate for Payer: Priority Health Cigna Priority Health	$105.35
Rate for Payer: Priority Health SBD	$94.82

LORAZEPAM 2 MG/ML INJECTION SOLUTION

Facility

$31.08

Service Code	HCPCS J2060
Hospital Charge Code	10467
Hospital Revenue Code	636
Min. Negotiated Rate	$19.58
Max. Negotiated Rate	$27.97
Rate for Payer: Aetna Commercial	$26.42
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Commercial	$137.28
Rate for Payer: Aetna New Business (MI Preferred)	$104.98
Rate for Payer: Aetna New Business (MI Preferred)	$11.62
Rate for Payer: Aetna New Business (MI Preferred)	$20.20
Rate for Payer: Cash Price	$129.21
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$24.86
Rate for Payer: Cofinity Commercial	$15.38
Rate for Payer: Cofinity Commercial	$113.06
Rate for Payer: Cofinity Commercial	$138.90
Rate for Payer: Cofinity Commercial	$12.52
Rate for Payer: Cofinity Commercial	$21.76
Rate for Payer: Cofinity Commercial	$26.73
Rate for Payer: Healthscope Commercial	$16.09
Rate for Payer: Healthscope Commercial	$145.36
Rate for Payer: Healthscope Commercial	$27.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$137.28
Rate for Payer: PHP Commercial	$137.28
Rate for Payer: PHP Commercial	$26.42
Rate for Payer: PHP Commercial	$15.20
Rate for Payer: Priority Health Cigna Priority Health	$12.52
Rate for Payer: Priority Health Cigna Priority Health	$21.76
Rate for Payer: Priority Health Cigna Priority Health	$113.06
Rate for Payer: Priority Health SBD	$101.75
Rate for Payer: Priority Health SBD	$19.58
Rate for Payer: Priority Health SBD	$11.26

LORAZEPAM 2 MG/ML INJECTION SOLUTION

Facility

$31.08

Service Code	HCPCS J2060
Hospital Charge Code	10467
Hospital Revenue Code	636
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$27.97
Rate for Payer: Aetna Commercial	$26.42
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna New Business (MI Preferred)	$20.20
Rate for Payer: Aetna New Business (MI Preferred)	$11.62
Rate for Payer: BCBS Complete	$7.15
Rate for Payer: BCBS Complete	$12.43
Rate for Payer: BCBS Trust/PPO	$3.31
Rate for Payer: BCBS Trust/PPO	$3.31
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$24.86
Rate for Payer: Cash Price	$24.86
Rate for Payer: Cofinity Commercial	$21.76
Rate for Payer: Cofinity Commercial	$15.38
Rate for Payer: Cofinity Commercial	$12.52
Rate for Payer: Cofinity Commercial	$26.73
Rate for Payer: Healthscope Commercial	$27.97
Rate for Payer: Healthscope Commercial	$16.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.42
Rate for Payer: PHP Commercial	$26.42
Rate for Payer: PHP Commercial	$15.20
Rate for Payer: Priority Health Cigna Priority Health	$12.52
Rate for Payer: Priority Health Cigna Priority Health	$21.76
Rate for Payer: Priority Health SBD	$11.26
Rate for Payer: Priority Health SBD	$19.58

LORAZEPAM 2 MG/ML ORAL CONCENTRATE

Facility

$305.03

Service Code	NDC 0054-3532-44
Hospital Charge Code	4571
Hospital Revenue Code	637
Min. Negotiated Rate	$192.17
Max. Negotiated Rate	$274.53
Rate for Payer: Aetna Commercial	$259.28
Rate for Payer: Aetna New Business (MI Preferred)	$198.27
Rate for Payer: Cash Price	$244.02
Rate for Payer: Cofinity Commercial	$213.52
Rate for Payer: Cofinity Commercial	$262.33
Rate for Payer: Healthscope Commercial	$274.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$259.28
Rate for Payer: PHP Commercial	$259.28
Rate for Payer: Priority Health Cigna Priority Health	$213.52
Rate for Payer: Priority Health SBD	$192.17

LOSARTAN 100 MG TABLET

Facility

$195.23

Service Code	NDC 50268-506-15
Hospital Charge Code	22588
Hospital Revenue Code	637
Min. Negotiated Rate	$122.99
Max. Negotiated Rate	$175.71
Rate for Payer: Aetna Commercial	$165.95
Rate for Payer: Aetna New Business (MI Preferred)	$126.90
Rate for Payer: Cash Price	$156.18
Rate for Payer: Cofinity Commercial	$136.66
Rate for Payer: Cofinity Commercial	$167.90
Rate for Payer: Healthscope Commercial	$175.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$165.95
Rate for Payer: PHP Commercial	$165.95
Rate for Payer: Priority Health Cigna Priority Health	$136.66
Rate for Payer: Priority Health SBD	$122.99

LOSARTAN 100 MG TABLET

Facility

$3.91

Service Code	NDC 50268-506-11
Hospital Charge Code	22588
Hospital Revenue Code	637
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$3.52
Rate for Payer: Aetna Commercial	$3.32
Rate for Payer: Aetna New Business (MI Preferred)	$2.54
Rate for Payer: Cash Price	$3.13
Rate for Payer: Cofinity Commercial	$3.36
Rate for Payer: Cofinity Commercial	$2.74
Rate for Payer: Healthscope Commercial	$3.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.32
Rate for Payer: PHP Commercial	$3.32
Rate for Payer: Priority Health Cigna Priority Health	$2.74
Rate for Payer: Priority Health SBD	$2.46

LOSARTAN 25 MG TABLET

Facility

$3.05

Service Code	NDC 68084-346-11
Hospital Charge Code	14823
Hospital Revenue Code	637
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$2.74
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Aetna New Business (MI Preferred)	$1.98
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cofinity Commercial	$2.14
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Healthscope Commercial	$2.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.59
Rate for Payer: PHP Commercial	$2.59
Rate for Payer: Priority Health Cigna Priority Health	$2.14
Rate for Payer: Priority Health SBD	$1.92

LOSARTAN 25 MG TABLET

Facility

$304.95

Service Code	NDC 68084-346-01
Hospital Charge Code	14823
Hospital Revenue Code	637
Min. Negotiated Rate	$192.12
Max. Negotiated Rate	$274.46
Rate for Payer: Aetna Commercial	$259.21
Rate for Payer: Aetna New Business (MI Preferred)	$198.22
Rate for Payer: Cash Price	$243.96
Rate for Payer: Cofinity Commercial	$213.46
Rate for Payer: Cofinity Commercial	$262.26
Rate for Payer: Healthscope Commercial	$274.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$259.21
Rate for Payer: PHP Commercial	$259.21
Rate for Payer: Priority Health Cigna Priority Health	$213.46
Rate for Payer: Priority Health SBD	$192.12

LOSARTAN 50 MG TABLET

Facility

$225.15

Service Code	NDC 68084-347-01
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$141.84
Max. Negotiated Rate	$202.64
Rate for Payer: Aetna Commercial	$191.38
Rate for Payer: Aetna New Business (MI Preferred)	$146.35
Rate for Payer: Cash Price	$180.12
Rate for Payer: Cofinity Commercial	$157.60
Rate for Payer: Cofinity Commercial	$193.63
Rate for Payer: Healthscope Commercial	$202.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.38
Rate for Payer: PHP Commercial	$191.38
Rate for Payer: Priority Health Cigna Priority Health	$157.60
Rate for Payer: Priority Health SBD	$141.84

LOSARTAN 50 MG TABLET

Facility

$225.15

Service Code	NDC 68084-347-11
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$141.84
Max. Negotiated Rate	$202.64
Rate for Payer: Aetna Commercial	$191.38
Rate for Payer: Aetna New Business (MI Preferred)	$146.35
Rate for Payer: Cash Price	$180.12
Rate for Payer: Cofinity Commercial	$157.60
Rate for Payer: Cofinity Commercial	$193.63
Rate for Payer: Healthscope Commercial	$202.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.38
Rate for Payer: PHP Commercial	$191.38
Rate for Payer: Priority Health Cigna Priority Health	$157.60
Rate for Payer: Priority Health SBD	$141.84

LOSARTAN 50 MG TABLET

Facility

$1,152.85

Service Code	NDC 0006-0952-54
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$726.30
Max. Negotiated Rate	$1,037.56
Rate for Payer: Aetna Commercial	$979.92
Rate for Payer: Aetna New Business (MI Preferred)	$749.35
Rate for Payer: Cash Price	$922.28
Rate for Payer: Cofinity Commercial	$807.00
Rate for Payer: Cofinity Commercial	$991.45
Rate for Payer: Healthscope Commercial	$1,037.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$979.92
Rate for Payer: PHP Commercial	$979.92
Rate for Payer: Priority Health Cigna Priority Health	$807.00
Rate for Payer: Priority Health SBD	$726.30

LOSARTAN 50 MG TABLET

Facility

$99.41

Service Code	NDC 68180-377-09
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$62.63
Max. Negotiated Rate	$89.47
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna New Business (MI Preferred)	$64.62
Rate for Payer: Cash Price	$79.53
Rate for Payer: Cofinity Commercial	$69.59
Rate for Payer: Cofinity Commercial	$85.49
Rate for Payer: Healthscope Commercial	$89.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$84.50
Rate for Payer: PHP Commercial	$84.50
Rate for Payer: Priority Health Cigna Priority Health	$69.59
Rate for Payer: Priority Health SBD	$62.63

LOSARTAN 50 MG TABLET

Facility

$54.99

Service Code	NDC 65862-202-90
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$34.64
Max. Negotiated Rate	$49.49
Rate for Payer: Aetna Commercial	$46.74
Rate for Payer: Aetna New Business (MI Preferred)	$35.74
Rate for Payer: Cash Price	$43.99
Rate for Payer: Cofinity Commercial	$38.49
Rate for Payer: Cofinity Commercial	$47.29
Rate for Payer: Healthscope Commercial	$49.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$46.74
Rate for Payer: PHP Commercial	$46.74
Rate for Payer: Priority Health Cigna Priority Health	$38.49
Rate for Payer: Priority Health SBD	$34.64

Know your out-of-pocket cost for care.

All Charges