Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LORATADINE 10 MG TABLET

Facility

$62.04

Service Code	NDC 00904685207
Hospital Charge Code	10466
Hospital Revenue Code	637
Min. Negotiated Rate	$24.38
Max. Negotiated Rate	$55.84
Rate for Payer: Aetna Commercial	$52.73
Rate for Payer: Aetna Medicare	$31.02
Rate for Payer: Aetna New Business (MI Preferred)	$40.33
Rate for Payer: BCBS Complete	$24.82
Rate for Payer: Cash Price	$49.63
Rate for Payer: Cofinity Advantage	$43.43
Rate for Payer: Cofinity Commercial	$53.35
Rate for Payer: Encore Health Key Benefits Commercial	$49.63
Rate for Payer: Healthscope Commercial	$55.84
Rate for Payer: MI Amish Medical Board Commercial	$49.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.53
Rate for Payer: PHP Commercial	$52.73
Rate for Payer: Priority Health SBD	$39.09
Rate for Payer: UHC All Payor (Choice/PPO)	$40.33
Rate for Payer: UHC Core	$32.32
Rate for Payer: UHC Exchange	$24.38

LORATADINE 10 MG TABLET

Facility

$232.75

Service Code	NDC 68084024811
Hospital Charge Code	10466
Hospital Revenue Code	637
Min. Negotiated Rate	$91.47
Max. Negotiated Rate	$209.47
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna Medicare	$116.38
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: BCBS Complete	$93.10
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Advantage	$162.93
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.47
Rate for Payer: MI Amish Medical Board Commercial	$186.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.56
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health SBD	$146.63
Rate for Payer: UHC All Payor (Choice/PPO)	$151.29
Rate for Payer: UHC Core	$121.26
Rate for Payer: UHC Exchange	$91.47

LORATADINE 10 MG TABLET

Facility

$211.85

Service Code	NDC 00904751161
Hospital Charge Code	10466
Hospital Revenue Code	637
Min. Negotiated Rate	$83.26
Max. Negotiated Rate	$190.66
Rate for Payer: Aetna Commercial	$180.07
Rate for Payer: Aetna Medicare	$105.92
Rate for Payer: Aetna New Business (MI Preferred)	$137.70
Rate for Payer: BCBS Complete	$84.74
Rate for Payer: Cash Price	$169.48
Rate for Payer: Cofinity Advantage	$148.29
Rate for Payer: Cofinity Commercial	$182.19
Rate for Payer: Encore Health Key Benefits Commercial	$169.48
Rate for Payer: Healthscope Commercial	$190.66
Rate for Payer: MI Amish Medical Board Commercial	$169.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.89
Rate for Payer: PHP Commercial	$180.07
Rate for Payer: Priority Health SBD	$133.47
Rate for Payer: UHC All Payor (Choice/PPO)	$137.70
Rate for Payer: UHC Core	$110.37
Rate for Payer: UHC Exchange	$83.26

LORATADINE 10 MG TABLET

Facility

$62.04

Service Code	NDC 00904685207
Hospital Charge Code	10466
Hospital Revenue Code	637
Min. Negotiated Rate	$39.09
Max. Negotiated Rate	$55.84
Rate for Payer: Aetna Commercial	$52.73
Rate for Payer: Aetna New Business (MI Preferred)	$40.33
Rate for Payer: Cash Price	$49.63
Rate for Payer: Cofinity Advantage	$43.43
Rate for Payer: Cofinity Commercial	$53.35
Rate for Payer: Encore Health Key Benefits Commercial	$49.63
Rate for Payer: Healthscope Commercial	$55.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.53
Rate for Payer: PHP Commercial	$52.73
Rate for Payer: Priority Health SBD	$39.09

LORATADINE 10 MG TABLET

Facility

$232.75

Service Code	NDC 51079024620
Hospital Charge Code	10466
Hospital Revenue Code	637
Min. Negotiated Rate	$91.47
Max. Negotiated Rate	$209.47
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna Medicare	$116.38
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: BCBS Complete	$93.10
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Advantage	$162.93
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.47
Rate for Payer: MI Amish Medical Board Commercial	$186.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.56
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health SBD	$146.63
Rate for Payer: UHC All Payor (Choice/PPO)	$151.29
Rate for Payer: UHC Core	$121.26
Rate for Payer: UHC Exchange	$91.47

LORATADINE 10 MG TABLET

Facility

$232.75

Service Code	NDC 68084024801
Hospital Charge Code	10466
Hospital Revenue Code	637
Min. Negotiated Rate	$146.63
Max. Negotiated Rate	$209.47
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Advantage	$162.93
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.56
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health SBD	$146.63

LORATADINE 10 MG TABLET

Facility

$211.85

Service Code	NDC 00904685261
Hospital Charge Code	10466
Hospital Revenue Code	637
Min. Negotiated Rate	$133.47
Max. Negotiated Rate	$190.66
Rate for Payer: Aetna Commercial	$180.07
Rate for Payer: Aetna New Business (MI Preferred)	$137.70
Rate for Payer: Cash Price	$169.48
Rate for Payer: Cofinity Advantage	$148.29
Rate for Payer: Cofinity Commercial	$182.19
Rate for Payer: Encore Health Key Benefits Commercial	$169.48
Rate for Payer: Healthscope Commercial	$190.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.89
Rate for Payer: PHP Commercial	$180.07
Rate for Payer: Priority Health SBD	$133.47

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$118.44

Service Code	NDC 70000047301
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 Advantage	$82.91
Rate for Payer: Cofinity Commercial	$101.86
Rate for Payer: Encore Health Key Benefits Commercial	$94.75
Rate for Payer: Healthscope Commercial	$106.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.83
Rate for Payer: PHP Commercial	$100.67
Rate for Payer: Priority Health SBD	$74.62

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$118.44

Service Code	NDC 70000047301
Hospital Charge Code	76472
Hospital Revenue Code	637
Min. Negotiated Rate	$46.55
Max. Negotiated Rate	$106.60
Rate for Payer: Aetna Commercial	$100.67
Rate for Payer: Aetna Medicare	$59.22
Rate for Payer: Aetna New Business (MI Preferred)	$76.99
Rate for Payer: BCBS Complete	$47.38
Rate for Payer: Cash Price	$94.75
Rate for Payer: Cofinity Advantage	$82.91
Rate for Payer: Cofinity Commercial	$101.86
Rate for Payer: Encore Health Key Benefits Commercial	$94.75
Rate for Payer: Healthscope Commercial	$106.60
Rate for Payer: MI Amish Medical Board Commercial	$94.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.83
Rate for Payer: PHP Commercial	$100.67
Rate for Payer: Priority Health SBD	$74.62
Rate for Payer: UHC All Payor (Choice/PPO)	$76.99
Rate for Payer: UHC Core	$61.71
Rate for Payer: UHC Exchange	$46.55

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$122.02

Service Code	NDC 70000012501
Hospital Charge Code	76472
Hospital Revenue Code	637
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$109.82
Rate for Payer: Aetna Commercial	$103.72
Rate for Payer: Aetna Medicare	$61.01
Rate for Payer: Aetna New Business (MI Preferred)	$79.31
Rate for Payer: BCBS Complete	$48.81
Rate for Payer: Cash Price	$97.62
Rate for Payer: Cofinity Advantage	$85.41
Rate for Payer: Cofinity Commercial	$104.94
Rate for Payer: Encore Health Key Benefits Commercial	$97.62
Rate for Payer: Healthscope Commercial	$109.82
Rate for Payer: MI Amish Medical Board Commercial	$97.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$91.52
Rate for Payer: PHP Commercial	$103.72
Rate for Payer: Priority Health SBD	$76.87
Rate for Payer: UHC All Payor (Choice/PPO)	$79.31
Rate for Payer: UHC Core	$63.57
Rate for Payer: UHC Exchange	$47.95

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$101.52

Service Code	NDC 51672207308
Hospital Charge Code	76472
Hospital Revenue Code	637
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$91.37
Rate for Payer: Aetna Commercial	$86.29
Rate for Payer: Aetna Medicare	$50.76
Rate for Payer: Aetna New Business (MI Preferred)	$65.99
Rate for Payer: BCBS Complete	$40.61
Rate for Payer: Cash Price	$81.22
Rate for Payer: Cofinity Advantage	$71.06
Rate for Payer: Cofinity Commercial	$87.31
Rate for Payer: Encore Health Key Benefits Commercial	$81.22
Rate for Payer: Healthscope Commercial	$91.37
Rate for Payer: MI Amish Medical Board Commercial	$81.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$76.14
Rate for Payer: PHP Commercial	$86.29
Rate for Payer: Priority Health SBD	$63.96
Rate for Payer: UHC All Payor (Choice/PPO)	$65.99
Rate for Payer: UHC Core	$52.89
Rate for Payer: UHC Exchange	$39.90

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$122.02

Service Code	NDC 70000012501
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 Advantage	$85.41
Rate for Payer: Cofinity Commercial	$104.94
Rate for Payer: Encore Health Key Benefits Commercial	$97.62
Rate for Payer: Healthscope Commercial	$109.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$91.52
Rate for Payer: PHP Commercial	$103.72
Rate for Payer: Priority Health SBD	$76.87

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$101.52

Service Code	NDC 51672207308
Hospital Charge Code	76472
Hospital Revenue Code	637
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$91.37
Rate for Payer: Aetna Commercial	$86.29
Rate for Payer: Aetna New Business (MI Preferred)	$65.99
Rate for Payer: Cash Price	$81.22
Rate for Payer: Cofinity Advantage	$71.06
Rate for Payer: Cofinity Commercial	$87.31
Rate for Payer: Encore Health Key Benefits Commercial	$81.22
Rate for Payer: Healthscope Commercial	$91.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$76.14
Rate for Payer: PHP Commercial	$86.29
Rate for Payer: Priority Health SBD	$63.96

LORAZEPAM 0.5 MG TABLET

Facility

$73.50

Service Code	NDC 00093342501
Hospital Charge Code	4572
Hospital Revenue Code	637
Min. Negotiated Rate	$28.89
Max. Negotiated Rate	$66.15
Rate for Payer: Aetna Commercial	$62.48
Rate for Payer: Aetna Medicare	$36.75
Rate for Payer: Aetna New Business (MI Preferred)	$47.77
Rate for Payer: BCBS Complete	$29.40
Rate for Payer: Cash Price	$58.80
Rate for Payer: Cofinity Advantage	$51.45
Rate for Payer: Cofinity Commercial	$63.21
Rate for Payer: Encore Health Key Benefits Commercial	$58.80
Rate for Payer: Healthscope Commercial	$66.15
Rate for Payer: MI Amish Medical Board Commercial	$58.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.12
Rate for Payer: PHP Commercial	$62.48
Rate for Payer: Priority Health SBD	$46.30
Rate for Payer: UHC All Payor (Choice/PPO)	$47.77
Rate for Payer: UHC Core	$38.29
Rate for Payer: UHC Exchange	$28.89

LORAZEPAM 0.5 MG TABLET

Facility

$87.50

Service Code	NDC 69315090401
Hospital Charge Code	4572
Hospital Revenue Code	637
Min. Negotiated Rate	$55.12
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna Commercial	$74.38
Rate for Payer: Aetna New Business (MI Preferred)	$56.88
Rate for Payer: Cash Price	$70.00
Rate for Payer: Cofinity Advantage	$61.25
Rate for Payer: Cofinity Commercial	$75.25
Rate for Payer: Encore Health Key Benefits Commercial	$70.00
Rate for Payer: Healthscope Commercial	$78.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$65.62
Rate for Payer: PHP Commercial	$74.38
Rate for Payer: Priority Health SBD	$55.12

LORAZEPAM 0.5 MG TABLET

Facility

$73.50

Service Code	NDC 00093342501
Hospital Charge Code	4572
Hospital Revenue Code	637
Min. Negotiated Rate	$46.30
Max. Negotiated Rate	$66.15
Rate for Payer: Aetna Commercial	$62.48
Rate for Payer: Aetna New Business (MI Preferred)	$47.77
Rate for Payer: Cash Price	$58.80
Rate for Payer: Cofinity Advantage	$51.45
Rate for Payer: Cofinity Commercial	$63.21
Rate for Payer: Encore Health Key Benefits Commercial	$58.80
Rate for Payer: Healthscope Commercial	$66.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.12
Rate for Payer: PHP Commercial	$62.48
Rate for Payer: Priority Health SBD	$46.30

LORAZEPAM 0.5 MG TABLET

Facility

$129.50

Service Code	NDC 00904600761
Hospital Charge Code	4572
Hospital Revenue Code	637
Min. Negotiated Rate	$50.89
Max. Negotiated Rate	$116.55
Rate for Payer: Aetna Commercial	$110.08
Rate for Payer: Aetna Medicare	$64.75
Rate for Payer: Aetna New Business (MI Preferred)	$84.17
Rate for Payer: BCBS Complete	$51.80
Rate for Payer: Cash Price	$103.60
Rate for Payer: Cofinity Advantage	$90.65
Rate for Payer: Cofinity Commercial	$111.37
Rate for Payer: Encore Health Key Benefits Commercial	$103.60
Rate for Payer: Healthscope Commercial	$116.55
Rate for Payer: MI Amish Medical Board Commercial	$103.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$97.12
Rate for Payer: PHP Commercial	$110.08
Rate for Payer: Priority Health SBD	$81.58
Rate for Payer: UHC All Payor (Choice/PPO)	$84.17
Rate for Payer: UHC Core	$67.47
Rate for Payer: UHC Exchange	$50.89

LORAZEPAM 0.5 MG TABLET

Facility

$129.50

Service Code	NDC 00904600761
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)	$84.17
Rate for Payer: Cash Price	$103.60
Rate for Payer: Cofinity Advantage	$90.65
Rate for Payer: Cofinity Commercial	$111.37
Rate for Payer: Encore Health Key Benefits Commercial	$103.60
Rate for Payer: Healthscope Commercial	$116.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$97.12
Rate for Payer: PHP Commercial	$110.08
Rate for Payer: Priority Health SBD	$81.58

LORAZEPAM 0.5 MG TABLET

Facility

$87.50

Service Code	NDC 69315090401
Hospital Charge Code	4572
Hospital Revenue Code	637
Min. Negotiated Rate	$34.39
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna Commercial	$74.38
Rate for Payer: Aetna Medicare	$43.75
Rate for Payer: Aetna New Business (MI Preferred)	$56.88
Rate for Payer: BCBS Complete	$35.00
Rate for Payer: Cash Price	$70.00
Rate for Payer: Cofinity Advantage	$61.25
Rate for Payer: Cofinity Commercial	$75.25
Rate for Payer: Encore Health Key Benefits Commercial	$70.00
Rate for Payer: Healthscope Commercial	$78.75
Rate for Payer: MI Amish Medical Board Commercial	$70.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$65.62
Rate for Payer: PHP Commercial	$74.38
Rate for Payer: Priority Health SBD	$55.12
Rate for Payer: UHC All Payor (Choice/PPO)	$56.88
Rate for Payer: UHC Core	$45.59
Rate for Payer: UHC Exchange	$34.39

LORAZEPAM 1 MG TABLET

Facility

$150.50

Service Code	NDC 904600861
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$59.15
Max. Negotiated Rate	$135.45
Rate for Payer: Aetna Commercial	$127.92
Rate for Payer: Aetna Medicare	$75.25
Rate for Payer: Aetna New Business (MI Preferred)	$97.83
Rate for Payer: BCBS Complete	$60.20
Rate for Payer: Cash Price	$120.40
Rate for Payer: Cofinity Advantage	$105.35
Rate for Payer: Cofinity Commercial	$129.43
Rate for Payer: Encore Health Key Benefits Commercial	$120.40
Rate for Payer: Healthscope Commercial	$135.45
Rate for Payer: MI Amish Medical Board Commercial	$120.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$112.88
Rate for Payer: PHP Commercial	$127.92
Rate for Payer: Priority Health SBD	$94.81
Rate for Payer: UHC All Payor (Choice/PPO)	$97.83
Rate for Payer: UHC Core	$78.41
Rate for Payer: UHC Exchange	$59.15

LORAZEPAM 1 MG TABLET

Facility

$150.50

Service Code	NDC 00904600861
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$59.15
Max. Negotiated Rate	$135.45
Rate for Payer: Aetna Commercial	$127.92
Rate for Payer: Aetna Medicare	$75.25
Rate for Payer: Aetna New Business (MI Preferred)	$97.83
Rate for Payer: BCBS Complete	$60.20
Rate for Payer: Cash Price	$120.40
Rate for Payer: Cofinity Advantage	$105.35
Rate for Payer: Cofinity Commercial	$129.43
Rate for Payer: Encore Health Key Benefits Commercial	$120.40
Rate for Payer: Healthscope Commercial	$135.45
Rate for Payer: MI Amish Medical Board Commercial	$120.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$112.88
Rate for Payer: PHP Commercial	$127.92
Rate for Payer: Priority Health SBD	$94.81
Rate for Payer: UHC All Payor (Choice/PPO)	$97.83
Rate for Payer: UHC Core	$78.41
Rate for Payer: UHC Exchange	$59.15

LORAZEPAM 1 MG TABLET

Facility

$82.25

Service Code	NDC 00093342601
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$51.82
Max. Negotiated Rate	$74.03
Rate for Payer: Aetna Commercial	$69.91
Rate for Payer: Aetna New Business (MI Preferred)	$53.46
Rate for Payer: Cash Price	$65.80
Rate for Payer: Cofinity Advantage	$57.58
Rate for Payer: Cofinity Commercial	$70.73
Rate for Payer: Encore Health Key Benefits Commercial	$65.80
Rate for Payer: Healthscope Commercial	$74.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.69
Rate for Payer: PHP Commercial	$69.91
Rate for Payer: Priority Health SBD	$51.82

LORAZEPAM 1 MG TABLET

Facility

$133.00

Service Code	NDC 69315090501
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$83.79
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna Commercial	$113.05
Rate for Payer: Aetna New Business (MI Preferred)	$86.45
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cofinity Advantage	$93.10
Rate for Payer: Cofinity Commercial	$114.38
Rate for Payer: Encore Health Key Benefits Commercial	$106.40
Rate for Payer: Healthscope Commercial	$119.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$113.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.75
Rate for Payer: PHP Commercial	$113.05
Rate for Payer: Priority Health SBD	$83.79

LORAZEPAM 1 MG TABLET

Facility

$82.25

Service Code	NDC 00093342601
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$32.32
Max. Negotiated Rate	$74.03
Rate for Payer: Aetna Commercial	$69.91
Rate for Payer: Aetna Medicare	$41.12
Rate for Payer: Aetna New Business (MI Preferred)	$53.46
Rate for Payer: BCBS Complete	$32.90
Rate for Payer: Cash Price	$65.80
Rate for Payer: Cofinity Advantage	$57.58
Rate for Payer: Cofinity Commercial	$70.73
Rate for Payer: Encore Health Key Benefits Commercial	$65.80
Rate for Payer: Healthscope Commercial	$74.03
Rate for Payer: MI Amish Medical Board Commercial	$65.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.69
Rate for Payer: PHP Commercial	$69.91
Rate for Payer: Priority Health SBD	$51.82
Rate for Payer: UHC All Payor (Choice/PPO)	$53.46
Rate for Payer: UHC Core	$42.85
Rate for Payer: UHC Exchange	$32.32

LORAZEPAM 1 MG TABLET

Facility

$411.25

Service Code	NDC 69315090505
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$161.62
Max. Negotiated Rate	$370.12
Rate for Payer: Aetna Commercial	$349.56
Rate for Payer: Aetna Medicare	$205.62
Rate for Payer: Aetna New Business (MI Preferred)	$267.31
Rate for Payer: BCBS Complete	$164.50
Rate for Payer: Cash Price	$329.00
Rate for Payer: Cofinity Advantage	$287.88
Rate for Payer: Cofinity Commercial	$353.68
Rate for Payer: Encore Health Key Benefits Commercial	$329.00
Rate for Payer: Healthscope Commercial	$370.12
Rate for Payer: MI Amish Medical Board Commercial	$329.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$349.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$308.44
Rate for Payer: PHP Commercial	$349.56
Rate for Payer: Priority Health SBD	$259.09
Rate for Payer: UHC All Payor (Choice/PPO)	$267.31
Rate for Payer: UHC Core	$214.26
Rate for Payer: UHC Exchange	$161.62

Know your out-of-pocket cost for care.

All Charges