Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LORATADINE 10 MG TABLET

Facility

$256.50

Service Code	NDC 51079024620
Hospital Charge Code	10466
Hospital Revenue Code	637
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$230.85
Rate for Payer: Aetna Commercial	$218.03
Rate for Payer: Aetna Medicare	$128.25
Rate for Payer: Aetna New Business (MI Preferred)	$166.72
Rate for Payer: BCBS Complete	$102.60
Rate for Payer: Cash Price	$205.20
Rate for Payer: Cofinity Commercial	$179.55
Rate for Payer: Cofinity Commercial	$220.59
Rate for Payer: Cofinity Medicare Advantage	$179.55
Rate for Payer: Encore Health Key Benefits Commercial	$205.20
Rate for Payer: Healthscope Commercial	$230.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$218.03
Rate for Payer: PHP Commercial	$218.03
Rate for Payer: Priority Health Cigna Priority Health	$166.72
Rate for Payer: Priority Health SBD	$161.59

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$107.16

Service Code	NDC 51672207308
Hospital Charge Code	76472
Hospital Revenue Code	637
Min. Negotiated Rate	$42.86
Max. Negotiated Rate	$96.44
Rate for Payer: Aetna Commercial	$91.09
Rate for Payer: Aetna Medicare	$53.58
Rate for Payer: Aetna New Business (MI Preferred)	$69.65
Rate for Payer: BCBS Complete	$42.86
Rate for Payer: Cash Price	$85.73
Rate for Payer: Cofinity Commercial	$75.01
Rate for Payer: Cofinity Commercial	$92.16
Rate for Payer: Cofinity Medicare Advantage	$75.01
Rate for Payer: Encore Health Key Benefits Commercial	$85.73
Rate for Payer: Healthscope Commercial	$96.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.09
Rate for Payer: PHP Commercial	$91.09
Rate for Payer: Priority Health Cigna Priority Health	$69.65
Rate for Payer: Priority Health SBD	$67.51

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 Commercial	$104.94
Rate for Payer: Cofinity Commercial	$85.41
Rate for Payer: Cofinity Medicare Advantage	$85.41
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: PHP Commercial	$103.72
Rate for Payer: Priority Health Cigna Priority Health	$79.31
Rate for Payer: Priority Health SBD	$76.87

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 Commercial	$101.86
Rate for Payer: Cofinity Commercial	$82.91
Rate for Payer: Cofinity Medicare Advantage	$82.91
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: PHP Commercial	$100.67
Rate for Payer: Priority Health Cigna Priority Health	$76.99
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	$47.38
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 Commercial	$101.86
Rate for Payer: Cofinity Commercial	$82.91
Rate for Payer: Cofinity Medicare Advantage	$82.91
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: PHP Commercial	$100.67
Rate for Payer: Priority Health Cigna Priority Health	$76.99
Rate for Payer: Priority Health SBD	$74.62

LORATADINE 5 MG/5 ML ORAL SOLUTION

Facility

$107.16

Service Code	NDC 51672207308
Hospital Charge Code	76472
Hospital Revenue Code	637
Min. Negotiated Rate	$67.51
Max. Negotiated Rate	$96.44
Rate for Payer: Aetna Commercial	$91.09
Rate for Payer: Aetna New Business (MI Preferred)	$69.65
Rate for Payer: Cash Price	$85.73
Rate for Payer: Cofinity Commercial	$75.01
Rate for Payer: Cofinity Commercial	$92.16
Rate for Payer: Cofinity Medicare Advantage	$75.01
Rate for Payer: Encore Health Key Benefits Commercial	$85.73
Rate for Payer: Healthscope Commercial	$96.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.09
Rate for Payer: PHP Commercial	$91.09
Rate for Payer: Priority Health Cigna Priority Health	$69.65
Rate for Payer: Priority Health SBD	$67.51

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	$48.81
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 Commercial	$104.94
Rate for Payer: Cofinity Commercial	$85.41
Rate for Payer: Cofinity Medicare Advantage	$85.41
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: PHP Commercial	$103.72
Rate for Payer: Priority Health Cigna Priority Health	$79.31
Rate for Payer: Priority Health SBD	$76.87

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 Commercial	$111.37
Rate for Payer: Cofinity Commercial	$90.65
Rate for Payer: Cofinity Medicare Advantage	$90.65
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: PHP Commercial	$110.08
Rate for Payer: Priority Health Cigna Priority Health	$84.17
Rate for Payer: Priority Health SBD	$81.58

LORAZEPAM 0.5 MG TABLET

Facility

$129.50

Service Code	NDC 00904600761
Hospital Charge Code	4572
Hospital Revenue Code	637
Min. Negotiated Rate	$51.80
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 Commercial	$111.37
Rate for Payer: Cofinity Commercial	$90.65
Rate for Payer: Cofinity Medicare Advantage	$90.65
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: PHP Commercial	$110.08
Rate for Payer: Priority Health Cigna Priority Health	$84.17
Rate for Payer: Priority Health SBD	$81.58

LORAZEPAM 0.5 MG TABLET

Facility

$73.50

Service Code	NDC 69315090401
Hospital Charge Code	4572
Hospital Revenue Code	637
Min. Negotiated Rate	$29.40
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 Commercial	$51.45
Rate for Payer: Cofinity Commercial	$63.21
Rate for Payer: Cofinity Medicare Advantage	$51.45
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: PHP Commercial	$62.48
Rate for Payer: Priority Health Cigna Priority Health	$47.77
Rate for Payer: Priority Health SBD	$46.30

LORAZEPAM 0.5 MG TABLET

Facility

$73.50

Service Code	NDC 69315090401
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 Commercial	$51.45
Rate for Payer: Cofinity Commercial	$63.21
Rate for Payer: Cofinity Medicare Advantage	$51.45
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: PHP Commercial	$62.48
Rate for Payer: Priority Health Cigna Priority Health	$47.77
Rate for Payer: Priority Health SBD	$46.30

LORAZEPAM 1 MG TABLET

Facility

$150.50

Service Code	NDC 00904600861
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 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 Commercial	$105.35
Rate for Payer: Cofinity Commercial	$129.43
Rate for Payer: Cofinity Medicare Advantage	$105.35
Rate for Payer: Encore Health Key Benefits Commercial	$120.40
Rate for Payer: Healthscope Commercial	$135.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.92
Rate for Payer: PHP Commercial	$127.92
Rate for Payer: Priority Health Cigna Priority Health	$97.83
Rate for Payer: Priority Health SBD	$94.81

LORAZEPAM 1 MG TABLET

Facility

$110.25

Service Code	NDC 69315090501
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$99.22
Rate for Payer: Aetna Commercial	$93.71
Rate for Payer: Aetna Medicare	$55.12
Rate for Payer: Aetna New Business (MI Preferred)	$71.66
Rate for Payer: BCBS Complete	$44.10
Rate for Payer: Cash Price	$88.20
Rate for Payer: Cofinity Commercial	$77.17
Rate for Payer: Cofinity Commercial	$94.81
Rate for Payer: Cofinity Medicare Advantage	$77.17
Rate for Payer: Encore Health Key Benefits Commercial	$88.20
Rate for Payer: Healthscope Commercial	$99.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.71
Rate for Payer: PHP Commercial	$93.71
Rate for Payer: Priority Health Cigna Priority Health	$71.66
Rate for Payer: Priority Health SBD	$69.46

LORAZEPAM 1 MG TABLET

Facility

$187.25

Service Code	NDC 60687035501
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$117.97
Max. Negotiated Rate	$168.53
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	$131.07
Rate for Payer: Cofinity Commercial	$161.03
Rate for Payer: Cofinity Medicare Advantage	$131.07
Rate for Payer: Encore Health Key Benefits Commercial	$149.80
Rate for Payer: Healthscope Commercial	$168.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.16
Rate for Payer: PHP Commercial	$159.16
Rate for Payer: Priority Health Cigna Priority Health	$121.71
Rate for Payer: Priority Health SBD	$117.97

LORAZEPAM 1 MG TABLET

Facility

$1.88

Service Code	NDC 60687035511
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: Cofinity Medicare Advantage	$1.32
Rate for Payer: Encore Health Key Benefits Commercial	$1.50
Rate for Payer: Healthscope Commercial	$1.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.60
Rate for Payer: PHP Commercial	$1.60
Rate for Payer: Priority Health Cigna Priority Health	$1.22
Rate for Payer: Priority Health SBD	$1.18

LORAZEPAM 1 MG TABLET

Facility

$187.25

Service Code	NDC 60687035501
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$74.90
Max. Negotiated Rate	$168.53
Rate for Payer: Aetna Commercial	$159.16
Rate for Payer: Aetna Medicare	$93.62
Rate for Payer: Aetna New Business (MI Preferred)	$121.71
Rate for Payer: BCBS Complete	$74.90
Rate for Payer: Cash Price	$149.80
Rate for Payer: Cofinity Commercial	$131.07
Rate for Payer: Cofinity Commercial	$161.03
Rate for Payer: Cofinity Medicare Advantage	$131.07
Rate for Payer: Encore Health Key Benefits Commercial	$149.80
Rate for Payer: Healthscope Commercial	$168.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.16
Rate for Payer: PHP Commercial	$159.16
Rate for Payer: Priority Health Cigna Priority Health	$121.71
Rate for Payer: Priority Health SBD	$117.97

LORAZEPAM 1 MG TABLET

Facility

$150.50

Service Code	NDC 00904600861
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$94.81
Max. Negotiated Rate	$135.45
Rate for Payer: Aetna Commercial	$127.92
Rate for Payer: Aetna New Business (MI Preferred)	$97.83
Rate for Payer: Cash Price	$120.40
Rate for Payer: Cofinity Commercial	$105.35
Rate for Payer: Cofinity Commercial	$129.43
Rate for Payer: Cofinity Medicare Advantage	$105.35
Rate for Payer: Encore Health Key Benefits Commercial	$120.40
Rate for Payer: Healthscope Commercial	$135.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.92
Rate for Payer: PHP Commercial	$127.92
Rate for Payer: Priority Health Cigna Priority Health	$97.83
Rate for Payer: Priority Health SBD	$94.81

LORAZEPAM 1 MG TABLET

Facility

$110.25

Service Code	NDC 69315090501
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$69.46
Max. Negotiated Rate	$99.22
Rate for Payer: Aetna Commercial	$93.71
Rate for Payer: Aetna New Business (MI Preferred)	$71.66
Rate for Payer: Cash Price	$88.20
Rate for Payer: Cofinity Commercial	$77.17
Rate for Payer: Cofinity Commercial	$94.81
Rate for Payer: Cofinity Medicare Advantage	$77.17
Rate for Payer: Encore Health Key Benefits Commercial	$88.20
Rate for Payer: Healthscope Commercial	$99.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.71
Rate for Payer: PHP Commercial	$93.71
Rate for Payer: Priority Health Cigna Priority Health	$71.66
Rate for Payer: Priority Health SBD	$69.46

LORAZEPAM 1 MG TABLET

Facility

$1.88

Service Code	NDC 60687035511
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.69
Rate for Payer: Aetna Commercial	$1.60
Rate for Payer: Aetna Medicare	$0.94
Rate for Payer: Aetna New Business (MI Preferred)	$1.22
Rate for Payer: BCBS Complete	$0.75
Rate for Payer: Cash Price	$1.50
Rate for Payer: Cofinity Commercial	$1.32
Rate for Payer: Cofinity Commercial	$1.62
Rate for Payer: Cofinity Medicare Advantage	$1.32
Rate for Payer: Encore Health Key Benefits Commercial	$1.50
Rate for Payer: Healthscope Commercial	$1.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.60
Rate for Payer: PHP Commercial	$1.60
Rate for Payer: Priority Health Cigna Priority Health	$1.22
Rate for Payer: Priority Health SBD	$1.18

LORAZEPAM 1 MG TABLET

Facility

$402.50

Service Code	NDC 69315090505
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$362.25
Rate for Payer: Aetna Commercial	$342.12
Rate for Payer: Aetna Medicare	$201.25
Rate for Payer: Aetna New Business (MI Preferred)	$261.62
Rate for Payer: BCBS Complete	$161.00
Rate for Payer: Cash Price	$322.00
Rate for Payer: Cofinity Commercial	$281.75
Rate for Payer: Cofinity Commercial	$346.15
Rate for Payer: Cofinity Medicare Advantage	$281.75
Rate for Payer: Encore Health Key Benefits Commercial	$322.00
Rate for Payer: Healthscope Commercial	$362.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$342.12
Rate for Payer: PHP Commercial	$342.12
Rate for Payer: Priority Health Cigna Priority Health	$261.62
Rate for Payer: Priority Health SBD	$253.57

LORAZEPAM 1 MG TABLET

Facility

$402.50

Service Code	NDC 69315090505
Hospital Charge Code	4573
Hospital Revenue Code	637
Min. Negotiated Rate	$253.57
Max. Negotiated Rate	$362.25
Rate for Payer: Aetna Commercial	$342.12
Rate for Payer: Aetna New Business (MI Preferred)	$261.62
Rate for Payer: Cash Price	$322.00
Rate for Payer: Cofinity Commercial	$281.75
Rate for Payer: Cofinity Commercial	$346.15
Rate for Payer: Cofinity Medicare Advantage	$281.75
Rate for Payer: Encore Health Key Benefits Commercial	$322.00
Rate for Payer: Healthscope Commercial	$362.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$342.12
Rate for Payer: PHP Commercial	$342.12
Rate for Payer: Priority Health Cigna Priority Health	$261.62
Rate for Payer: Priority Health SBD	$253.57

LORAZEPAM 2 MG/ML INJECTION SOLUTION

Facility

$161.51

Service Code	HCPCS J2060
Hospital Charge Code	10467
Hospital Revenue Code	636
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$145.36
Rate for Payer: Aetna Commercial	$137.28
Rate for Payer: Aetna Commercial	$27.67
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare	$16.27
Rate for Payer: Aetna Medicare	$80.75
Rate for Payer: Aetna Medicare	$8.94
Rate for Payer: Aetna New Business (MI Preferred)	$21.16
Rate for Payer: Aetna New Business (MI Preferred)	$104.98
Rate for Payer: Aetna New Business (MI Preferred)	$11.62
Rate for Payer: BCBS Complete	$7.15
Rate for Payer: BCBS Complete	$64.60
Rate for Payer: BCBS Complete	$13.02
Rate for Payer: Cash Price	$26.04
Rate for Payer: Cash Price	$129.21
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cofinity Commercial	$27.99
Rate for Payer: Cofinity Commercial	$138.90
Rate for Payer: Cofinity Commercial	$113.06
Rate for Payer: Cofinity Commercial	$15.38
Rate for Payer: Cofinity Commercial	$12.52
Rate for Payer: Cofinity Commercial	$22.79
Rate for Payer: Cofinity Medicare Advantage	$12.52
Rate for Payer: Cofinity Medicare Advantage	$113.06
Rate for Payer: Cofinity Medicare Advantage	$22.79
Rate for Payer: Encore Health Key Benefits Commercial	$14.30
Rate for Payer: Encore Health Key Benefits Commercial	$26.04
Rate for Payer: Encore Health Key Benefits Commercial	$129.21
Rate for Payer: Healthscope Commercial	$16.09
Rate for Payer: Healthscope Commercial	$145.36
Rate for Payer: Healthscope Commercial	$29.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.28
Rate for Payer: PHP Commercial	$15.20
Rate for Payer: PHP Commercial	$137.28
Rate for Payer: PHP Commercial	$27.67
Rate for Payer: Priority Health Cigna Priority Health	$104.98
Rate for Payer: Priority Health Cigna Priority Health	$21.16
Rate for Payer: Priority Health Cigna Priority Health	$11.62
Rate for Payer: Priority Health SBD	$20.51
Rate for Payer: Priority Health SBD	$11.26
Rate for Payer: Priority Health SBD	$101.75

LORAZEPAM 2 MG/ML INJECTION SOLUTION

Facility

$161.51

Service Code	HCPCS J2060
Hospital Charge Code	10467
Hospital Revenue Code	636
Min. Negotiated Rate	$101.75
Max. Negotiated Rate	$145.36
Rate for Payer: Aetna Commercial	$137.28
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Commercial	$27.67
Rate for Payer: Aetna New Business (MI Preferred)	$11.62
Rate for Payer: Aetna New Business (MI Preferred)	$104.98
Rate for Payer: Aetna New Business (MI Preferred)	$21.16
Rate for Payer: Cash Price	$129.21
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$26.04
Rate for Payer: Cofinity Commercial	$22.79
Rate for Payer: Cofinity Commercial	$113.06
Rate for Payer: Cofinity Commercial	$138.90
Rate for Payer: Cofinity Commercial	$27.99
Rate for Payer: Cofinity Commercial	$12.52
Rate for Payer: Cofinity Commercial	$15.38
Rate for Payer: Cofinity Medicare Advantage	$12.52
Rate for Payer: Cofinity Medicare Advantage	$22.79
Rate for Payer: Cofinity Medicare Advantage	$113.06
Rate for Payer: Encore Health Key Benefits Commercial	$14.30
Rate for Payer: Encore Health Key Benefits Commercial	$129.21
Rate for Payer: Encore Health Key Benefits Commercial	$26.04
Rate for Payer: Healthscope Commercial	$16.09
Rate for Payer: Healthscope Commercial	$29.30
Rate for Payer: Healthscope Commercial	$145.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.67
Rate for Payer: PHP Commercial	$27.67
Rate for Payer: PHP Commercial	$137.28
Rate for Payer: PHP Commercial	$15.20
Rate for Payer: Priority Health Cigna Priority Health	$104.98
Rate for Payer: Priority Health Cigna Priority Health	$21.16
Rate for Payer: Priority Health Cigna Priority Health	$11.62
Rate for Payer: Priority Health SBD	$20.51
Rate for Payer: Priority Health SBD	$101.75
Rate for Payer: Priority Health SBD	$11.26

LORAZEPAM 2 MG/ML ORAL CONCENTRATE

Facility

$311.33

Service Code	NDC 00054353244
Hospital Charge Code	4571
Hospital Revenue Code	637
Min. Negotiated Rate	$124.53
Max. Negotiated Rate	$280.20
Rate for Payer: Aetna Commercial	$264.63
Rate for Payer: Aetna Medicare	$155.66
Rate for Payer: Aetna New Business (MI Preferred)	$202.36
Rate for Payer: BCBS Complete	$124.53
Rate for Payer: Cash Price	$249.06
Rate for Payer: Cofinity Commercial	$217.93
Rate for Payer: Cofinity Commercial	$267.74
Rate for Payer: Cofinity Medicare Advantage	$217.93
Rate for Payer: Encore Health Key Benefits Commercial	$249.06
Rate for Payer: Healthscope Commercial	$280.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$264.63
Rate for Payer: PHP Commercial	$264.63
Rate for Payer: Priority Health Cigna Priority Health	$202.36
Rate for Payer: Priority Health SBD	$196.14

LORAZEPAM 2 MG/ML ORAL CONCENTRATE

Facility

$311.33

Service Code	NDC 00054353244
Hospital Charge Code	4571
Hospital Revenue Code	637
Min. Negotiated Rate	$196.14
Max. Negotiated Rate	$280.20
Rate for Payer: Aetna Commercial	$264.63
Rate for Payer: Aetna New Business (MI Preferred)	$202.36
Rate for Payer: Cash Price	$249.06
Rate for Payer: Cofinity Commercial	$217.93
Rate for Payer: Cofinity Commercial	$267.74
Rate for Payer: Cofinity Medicare Advantage	$217.93
Rate for Payer: Encore Health Key Benefits Commercial	$249.06
Rate for Payer: Healthscope Commercial	$280.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$264.63
Rate for Payer: PHP Commercial	$264.63
Rate for Payer: Priority Health Cigna Priority Health	$202.36
Rate for Payer: Priority Health SBD	$196.14

Know your out-of-pocket cost for care.

All Charges