Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DIPHTH,PERTUS(ACEL)TETANUS(PF)2LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SUSP

Facility

$170.37

Service Code	HCPCS 90715
Hospital Charge Code	41628
Hospital Revenue Code	636
Min. Negotiated Rate	$107.33
Max. Negotiated Rate	$153.33
Rate for Payer: Aetna Commercial	$144.81
Rate for Payer: Aetna New Business (MI Preferred)	$110.74
Rate for Payer: Cash Price	$136.30
Rate for Payer: Cofinity Advantage	$119.26
Rate for Payer: Cofinity Commercial	$146.52
Rate for Payer: Encore Health Key Benefits Commercial	$136.30
Rate for Payer: Healthscope Commercial	$153.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$144.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$127.78
Rate for Payer: PHP Commercial	$144.81
Rate for Payer: Priority Health SBD	$107.33

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$5,641.85

Service Code	APR-DRG 2842
Min. Negotiated Rate	$5,373.19
Max. Negotiated Rate	$5,641.85
Rate for Payer: BCBS Complete	$5,641.85
Rate for Payer: Mclaren Medicaid	$5,373.19
Rate for Payer: Meridian Medicaid	$5,641.85
Rate for Payer: Priority Health Choice Medicaid	$5,373.19
Rate for Payer: UHC Medicaid	$5,373.19
Rate for Payer: UHCCP Medicaid	$5,373.19

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$9,463.46

Service Code	APR-DRG 2844
Min. Negotiated Rate	$9,012.82
Max. Negotiated Rate	$9,463.46
Rate for Payer: BCBS Complete	$9,463.46
Rate for Payer: Mclaren Medicaid	$9,012.82
Rate for Payer: Meridian Medicaid	$9,463.46
Rate for Payer: Priority Health Choice Medicaid	$9,012.82
Rate for Payer: UHC Medicaid	$9,012.82
Rate for Payer: UHCCP Medicaid	$9,012.82

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$3,676.57

Service Code	APR-DRG 2841
Min. Negotiated Rate	$3,501.50
Max. Negotiated Rate	$3,676.57
Rate for Payer: BCBS Complete	$3,676.57
Rate for Payer: Mclaren Medicaid	$3,501.50
Rate for Payer: Meridian Medicaid	$3,676.57
Rate for Payer: Priority Health Choice Medicaid	$3,501.50
Rate for Payer: UHC Medicaid	$3,501.50
Rate for Payer: UHCCP Medicaid	$3,501.50

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$7,180.58

Service Code	APR-DRG 2843
Min. Negotiated Rate	$6,838.65
Max. Negotiated Rate	$7,180.58
Rate for Payer: BCBS Complete	$7,180.58
Rate for Payer: Mclaren Medicaid	$6,838.65
Rate for Payer: Meridian Medicaid	$7,180.58
Rate for Payer: Priority Health Choice Medicaid	$6,838.65
Rate for Payer: UHC Medicaid	$6,838.65
Rate for Payer: UHCCP Medicaid	$6,838.65

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC

Facility

$17,577.07

Service Code	MSDRG 442
Min. Negotiated Rate	$7,637.11
Max. Negotiated Rate	$17,577.07
Rate for Payer: Aetna Medicare	$8,360.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,048.83
Rate for Payer: Amish Plain Church Group Commercial	$10,048.83
Rate for Payer: BCBS MAPPO	$8,039.06
Rate for Payer: BCBS Trust/PPO	$17,577.07
Rate for Payer: BCN Commercial	$17,577.07
Rate for Payer: BCN Medicare Advantage	$8,039.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,039.06
Rate for Payer: Mclaren Medicare	$8,039.06
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,441.01
Rate for Payer: MI Amish Medical Board Commercial	$9,244.92
Rate for Payer: Molina Medicare/Medicaid	$8,842.97
Rate for Payer: Nomi Health Commercial	$12,452.37
Rate for Payer: PACE Medicare	$7,637.11
Rate for Payer: PACE SWMI	$8,039.06
Rate for Payer: PHP Medicare Advantage	$8,039.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$15,562.70
Rate for Payer: Priority Health Medicare	$8,039.06
Rate for Payer: Priority Health Tiered Network	$12,450.16
Rate for Payer: Railroad Medicare Medicare	$8,039.06
Rate for Payer: UHC All Payor (Choice/PPO)	$15,734.39
Rate for Payer: UHC Core	$13,163.80
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,039.06
Rate for Payer: UHC Exchange	$10,750.55
Rate for Payer: VA VA	$8,039.06

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC

Facility

$46,958.79

Service Code	MSDRG 441
Min. Negotiated Rate	$13,726.39
Max. Negotiated Rate	$46,958.79
Rate for Payer: Aetna Medicare	$15,026.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,061.04
Rate for Payer: Amish Plain Church Group Commercial	$18,061.04
Rate for Payer: BCBS MAPPO	$14,448.83
Rate for Payer: BCBS Trust/PPO	$46,958.79
Rate for Payer: BCN Commercial	$46,958.79
Rate for Payer: BCN Medicare Advantage	$14,448.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,448.83
Rate for Payer: Mclaren Medicare	$14,448.83
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,171.27
Rate for Payer: MI Amish Medical Board Commercial	$16,616.15
Rate for Payer: Molina Medicare/Medicaid	$15,893.71
Rate for Payer: Nomi Health Commercial	$23,151.63
Rate for Payer: PACE Medicare	$13,726.39
Rate for Payer: PACE SWMI	$14,448.83
Rate for Payer: PHP Medicare Advantage	$14,448.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$28,934.40
Rate for Payer: Priority Health Medicare	$14,448.83
Rate for Payer: Priority Health Tiered Network	$23,147.52
Rate for Payer: Railroad Medicare Medicare	$14,448.83
Rate for Payer: UHC All Payor (Choice/PPO)	$29,253.61
Rate for Payer: UHC Core	$24,474.32
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,448.83
Rate for Payer: UHC Exchange	$19,987.57
Rate for Payer: VA VA	$14,448.83

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$13,967.55

Service Code	MSDRG 443
Min. Negotiated Rate	$5,687.12
Max. Negotiated Rate	$13,967.55
Rate for Payer: Aetna Medicare	$6,225.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,483.05
Rate for Payer: Amish Plain Church Group Commercial	$7,483.05
Rate for Payer: BCBS MAPPO	$5,986.44
Rate for Payer: BCBS Trust/PPO	$13,967.55
Rate for Payer: BCN Commercial	$13,967.55
Rate for Payer: BCN Medicare Advantage	$5,986.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,986.44
Rate for Payer: Mclaren Medicare	$5,986.44
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,285.76
Rate for Payer: MI Amish Medical Board Commercial	$6,884.41
Rate for Payer: Molina Medicare/Medicaid	$6,585.08
Rate for Payer: Nomi Health Commercial	$9,026.13
Rate for Payer: PACE Medicare	$5,687.12
Rate for Payer: PACE SWMI	$5,986.44
Rate for Payer: PHP Medicare Advantage	$5,986.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$11,280.66
Rate for Payer: Priority Health Medicare	$5,986.44
Rate for Payer: Priority Health Tiered Network	$9,024.53
Rate for Payer: Railroad Medicare Medicare	$5,986.44
Rate for Payer: UHC All Payor (Choice/PPO)	$11,405.11
Rate for Payer: UHC Core	$9,541.81
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,986.44
Rate for Payer: UHC Exchange	$7,792.56
Rate for Payer: VA VA	$5,986.44

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$13,423.25

Service Code	APR-DRG 2824
Min. Negotiated Rate	$12,784.04
Max. Negotiated Rate	$13,423.25
Rate for Payer: BCBS Complete	$13,423.25
Rate for Payer: Mclaren Medicaid	$12,784.04
Rate for Payer: Meridian Medicaid	$13,423.25
Rate for Payer: Priority Health Choice Medicaid	$12,784.04
Rate for Payer: UHC Medicaid	$12,784.04
Rate for Payer: UHCCP Medicaid	$12,784.04

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$6,686.40

Service Code	APR-DRG 2823
Min. Negotiated Rate	$6,368.00
Max. Negotiated Rate	$6,686.40
Rate for Payer: BCBS Complete	$6,686.40
Rate for Payer: Mclaren Medicaid	$6,368.00
Rate for Payer: Meridian Medicaid	$6,686.40
Rate for Payer: Priority Health Choice Medicaid	$6,368.00
Rate for Payer: UHC Medicaid	$6,368.00
Rate for Payer: UHCCP Medicaid	$6,368.00

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$3,275.84

Service Code	APR-DRG 2821
Min. Negotiated Rate	$3,119.84
Max. Negotiated Rate	$3,275.84
Rate for Payer: BCBS Complete	$3,275.84
Rate for Payer: Mclaren Medicaid	$3,119.84
Rate for Payer: Meridian Medicaid	$3,275.84
Rate for Payer: Priority Health Choice Medicaid	$3,119.84
Rate for Payer: UHC Medicaid	$3,119.84
Rate for Payer: UHCCP Medicaid	$3,119.84

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$4,445.94

Service Code	APR-DRG 2822
Min. Negotiated Rate	$4,234.23
Max. Negotiated Rate	$4,445.94
Rate for Payer: BCBS Complete	$4,445.94
Rate for Payer: Mclaren Medicaid	$4,234.23
Rate for Payer: Meridian Medicaid	$4,445.94
Rate for Payer: Priority Health Choice Medicaid	$4,234.23
Rate for Payer: UHC Medicaid	$4,234.23
Rate for Payer: UHCCP Medicaid	$4,234.23

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$15,634.20

Service Code	MSDRG 439
Min. Negotiated Rate	$6,725.99
Max. Negotiated Rate	$15,634.20
Rate for Payer: Aetna Medicare	$7,363.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,849.99
Rate for Payer: Amish Plain Church Group Commercial	$8,849.99
Rate for Payer: BCBS MAPPO	$7,079.99
Rate for Payer: BCBS Trust/PPO	$15,634.20
Rate for Payer: BCN Commercial	$15,634.20
Rate for Payer: BCN Medicare Advantage	$7,079.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,079.99
Rate for Payer: Mclaren Medicare	$7,079.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,433.99
Rate for Payer: MI Amish Medical Board Commercial	$8,141.99
Rate for Payer: Molina Medicare/Medicaid	$7,787.99
Rate for Payer: Nomi Health Commercial	$10,851.48
Rate for Payer: PACE Medicare	$6,725.99
Rate for Payer: PACE SWMI	$7,079.99
Rate for Payer: PHP Medicare Advantage	$7,079.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$13,561.94
Rate for Payer: Priority Health Medicare	$7,079.99
Rate for Payer: Priority Health Tiered Network	$10,849.55
Rate for Payer: Railroad Medicare Medicare	$7,079.99
Rate for Payer: UHC All Payor (Choice/PPO)	$13,711.56
Rate for Payer: UHC Core	$11,471.44
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,079.99
Rate for Payer: UHC Exchange	$9,368.44
Rate for Payer: VA VA	$7,079.99

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$30,374.22

Service Code	MSDRG 438
Min. Negotiated Rate	$12,518.67
Max. Negotiated Rate	$30,374.22
Rate for Payer: Aetna Medicare	$13,704.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,471.94
Rate for Payer: Amish Plain Church Group Commercial	$16,471.94
Rate for Payer: BCBS MAPPO	$13,177.55
Rate for Payer: BCBS Trust/PPO	$30,374.22
Rate for Payer: BCN Commercial	$30,374.22
Rate for Payer: BCN Medicare Advantage	$13,177.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,177.55
Rate for Payer: Mclaren Medicare	$13,177.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,836.43
Rate for Payer: MI Amish Medical Board Commercial	$15,154.18
Rate for Payer: Molina Medicare/Medicaid	$14,495.31
Rate for Payer: Nomi Health Commercial	$21,029.58
Rate for Payer: PACE Medicare	$12,518.67
Rate for Payer: PACE SWMI	$13,177.55
Rate for Payer: PHP Medicare Advantage	$13,177.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$26,282.31
Rate for Payer: Priority Health Medicare	$13,177.55
Rate for Payer: Priority Health Tiered Network	$21,025.85
Rate for Payer: Railroad Medicare Medicare	$13,177.55
Rate for Payer: UHC All Payor (Choice/PPO)	$26,572.26
Rate for Payer: UHC Core	$22,231.04
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,177.55
Rate for Payer: UHC Exchange	$18,155.54
Rate for Payer: VA VA	$13,177.55

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$11,455.88

Service Code	MSDRG 440
Min. Negotiated Rate	$5,112.24
Max. Negotiated Rate	$11,455.88
Rate for Payer: Aetna Medicare	$5,596.56
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,726.64
Rate for Payer: Amish Plain Church Group Commercial	$6,726.64
Rate for Payer: BCBS MAPPO	$5,381.31
Rate for Payer: BCBS Trust/PPO	$11,455.88
Rate for Payer: BCN Commercial	$11,455.88
Rate for Payer: BCN Medicare Advantage	$5,381.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,381.31
Rate for Payer: Mclaren Medicare	$5,381.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,650.38
Rate for Payer: MI Amish Medical Board Commercial	$6,188.51
Rate for Payer: Molina Medicare/Medicaid	$5,919.44
Rate for Payer: Nomi Health Commercial	$8,016.06
Rate for Payer: PACE Medicare	$5,112.24
Rate for Payer: PACE SWMI	$5,381.31
Rate for Payer: PHP Medicare Advantage	$5,381.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,018.30
Rate for Payer: Priority Health Medicare	$5,381.31
Rate for Payer: Priority Health Tiered Network	$8,014.64
Rate for Payer: Railroad Medicare Medicare	$5,381.31
Rate for Payer: UHC All Payor (Choice/PPO)	$10,128.82
Rate for Payer: UHC Core	$8,474.03
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,381.31
Rate for Payer: UHC Exchange	$6,920.53
Rate for Payer: VA VA	$5,381.31

DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$32,050.69

Service Code	MSDRG 883
Min. Negotiated Rate	$1,069.00
Max. Negotiated Rate	$32,050.69
Rate for Payer: Aetna Medicare	$16,406.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,718.76
Rate for Payer: Amish Plain Church Group Commercial	$19,718.76
Rate for Payer: BCBS MAPPO	$15,775.01
Rate for Payer: BCBS Trust/PPO	$18,969.84
Rate for Payer: BCN Commercial	$18,969.84
Rate for Payer: BCN Medicare Advantage	$15,775.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,775.01
Rate for Payer: Mclaren Medicare	$15,775.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16,563.76
Rate for Payer: MI Amish Medical Board Commercial	$18,141.26
Rate for Payer: Molina Medicare/Medicaid	$17,352.51
Rate for Payer: Nomi Health Commercial	$1,069.00
Rate for Payer: PACE Medicare	$14,986.26
Rate for Payer: PACE SWMI	$15,775.01
Rate for Payer: PHP Medicare Advantage	$15,775.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$31,700.96
Rate for Payer: Priority Health Medicare	$15,775.01
Rate for Payer: Priority Health Tiered Network	$25,360.77
Rate for Payer: Railroad Medicare Medicare	$15,775.01
Rate for Payer: UHC All Payor (Choice/PPO)	$32,050.69
Rate for Payer: UHC Core	$26,814.43
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15,775.01
Rate for Payer: UHC Exchange	$21,898.68
Rate for Payer: VA VA	$15,775.01

DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$18,450.19

Service Code	MSDRG 445
Min. Negotiated Rate	$8,584.93
Max. Negotiated Rate	$18,450.19
Rate for Payer: Aetna Medicare	$9,398.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,295.96
Rate for Payer: Amish Plain Church Group Commercial	$11,295.96
Rate for Payer: BCBS MAPPO	$9,036.77
Rate for Payer: BCBS Trust/PPO	$18,450.19
Rate for Payer: BCN Commercial	$18,450.19
Rate for Payer: BCN Medicare Advantage	$9,036.77
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,036.77
Rate for Payer: Mclaren Medicare	$9,036.77
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,488.61
Rate for Payer: MI Amish Medical Board Commercial	$10,392.29
Rate for Payer: Molina Medicare/Medicaid	$9,940.45
Rate for Payer: Nomi Health Commercial	$14,117.76
Rate for Payer: PACE Medicare	$8,584.93
Rate for Payer: PACE SWMI	$9,036.77
Rate for Payer: PHP Medicare Advantage	$9,036.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$17,644.07
Rate for Payer: Priority Health Medicare	$9,036.77
Rate for Payer: Priority Health Tiered Network	$14,115.25
Rate for Payer: Railroad Medicare Medicare	$9,036.77
Rate for Payer: UHC All Payor (Choice/PPO)	$17,838.72
Rate for Payer: UHC Core	$14,924.33
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,036.77
Rate for Payer: UHC Exchange	$12,188.33
Rate for Payer: VA VA	$9,036.77

DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$31,357.36

Service Code	MSDRG 444
Min. Negotiated Rate	$12,817.48
Max. Negotiated Rate	$31,357.36
Rate for Payer: Aetna Medicare	$14,031.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,865.10
Rate for Payer: Amish Plain Church Group Commercial	$16,865.10
Rate for Payer: BCBS MAPPO	$13,492.08
Rate for Payer: BCBS Trust/PPO	$31,357.36
Rate for Payer: BCN Commercial	$31,357.36
Rate for Payer: BCN Medicare Advantage	$13,492.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,492.08
Rate for Payer: Mclaren Medicare	$13,492.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,166.68
Rate for Payer: MI Amish Medical Board Commercial	$15,515.89
Rate for Payer: Molina Medicare/Medicaid	$14,841.29
Rate for Payer: Nomi Health Commercial	$21,554.61
Rate for Payer: PACE Medicare	$12,817.48
Rate for Payer: PACE SWMI	$13,492.08
Rate for Payer: PHP Medicare Advantage	$13,492.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$26,938.48
Rate for Payer: Priority Health Medicare	$13,492.08
Rate for Payer: Priority Health Tiered Network	$21,550.78
Rate for Payer: Railroad Medicare Medicare	$13,492.08
Rate for Payer: UHC All Payor (Choice/PPO)	$27,235.67
Rate for Payer: UHC Core	$22,786.06
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,492.08
Rate for Payer: UHC Exchange	$18,608.81
Rate for Payer: VA VA	$13,492.08

DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$15,599.09

Service Code	MSDRG 446
Min. Negotiated Rate	$6,623.93
Max. Negotiated Rate	$15,599.09
Rate for Payer: Aetna Medicare	$7,251.46
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,715.70
Rate for Payer: Amish Plain Church Group Commercial	$8,715.70
Rate for Payer: BCBS MAPPO	$6,972.56
Rate for Payer: BCBS Trust/PPO	$15,599.09
Rate for Payer: BCN Commercial	$15,599.09
Rate for Payer: BCN Medicare Advantage	$6,972.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,972.56
Rate for Payer: Mclaren Medicare	$6,972.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,321.19
Rate for Payer: MI Amish Medical Board Commercial	$8,018.44
Rate for Payer: Molina Medicare/Medicaid	$7,669.82
Rate for Payer: Nomi Health Commercial	$10,672.17
Rate for Payer: PACE Medicare	$6,623.93
Rate for Payer: PACE SWMI	$6,972.56
Rate for Payer: PHP Medicare Advantage	$6,972.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$13,337.85
Rate for Payer: Priority Health Medicare	$6,972.56
Rate for Payer: Priority Health Tiered Network	$10,670.28
Rate for Payer: Railroad Medicare Medicare	$6,972.56
Rate for Payer: UHC All Payor (Choice/PPO)	$13,484.99
Rate for Payer: UHC Core	$11,281.89
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,972.56
Rate for Payer: UHC Exchange	$9,213.64
Rate for Payer: VA VA	$6,972.56

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$302.10

Service Code	NDC 68382010601
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$190.32
Max. Negotiated Rate	$271.89
Rate for Payer: Aetna Commercial	$256.79
Rate for Payer: Aetna New Business (MI Preferred)	$196.37
Rate for Payer: Cash Price	$241.68
Rate for Payer: Cofinity Advantage	$211.47
Rate for Payer: Cofinity Commercial	$259.81
Rate for Payer: Encore Health Key Benefits Commercial	$241.68
Rate for Payer: Healthscope Commercial	$271.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$226.57
Rate for Payer: PHP Commercial	$256.79
Rate for Payer: Priority Health SBD	$190.32

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$302.10

Service Code	NDC 68382010601
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$118.73
Max. Negotiated Rate	$271.89
Rate for Payer: Aetna Commercial	$256.79
Rate for Payer: Aetna Medicare	$151.05
Rate for Payer: Aetna New Business (MI Preferred)	$196.37
Rate for Payer: BCBS Complete	$120.84
Rate for Payer: Cash Price	$241.68
Rate for Payer: Cofinity Advantage	$211.47
Rate for Payer: Cofinity Commercial	$259.81
Rate for Payer: Encore Health Key Benefits Commercial	$241.68
Rate for Payer: Healthscope Commercial	$271.89
Rate for Payer: MI Amish Medical Board Commercial	$241.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$226.57
Rate for Payer: PHP Commercial	$256.79
Rate for Payer: Priority Health SBD	$190.32
Rate for Payer: UHC All Payor (Choice/PPO)	$196.37
Rate for Payer: UHC Core	$157.39
Rate for Payer: UHC Exchange	$118.73

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$4.52

Service Code	NDC 68084031311
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$4.07
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna New Business (MI Preferred)	$2.94
Rate for Payer: Cash Price	$3.62
Rate for Payer: Cofinity Advantage	$3.16
Rate for Payer: Cofinity Commercial	$3.89
Rate for Payer: Encore Health Key Benefits Commercial	$3.62
Rate for Payer: Healthscope Commercial	$4.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.39
Rate for Payer: PHP Commercial	$3.84
Rate for Payer: Priority Health SBD	$2.85

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$451.20

Service Code	NDC 68084031301
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$177.32
Max. Negotiated Rate	$406.08
Rate for Payer: Aetna Commercial	$383.52
Rate for Payer: Aetna Medicare	$225.60
Rate for Payer: Aetna New Business (MI Preferred)	$293.28
Rate for Payer: BCBS Complete	$180.48
Rate for Payer: Cash Price	$360.96
Rate for Payer: Cofinity Advantage	$315.84
Rate for Payer: Cofinity Commercial	$388.03
Rate for Payer: Encore Health Key Benefits Commercial	$360.96
Rate for Payer: Healthscope Commercial	$406.08
Rate for Payer: MI Amish Medical Board Commercial	$360.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$383.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$338.40
Rate for Payer: PHP Commercial	$383.52
Rate for Payer: Priority Health SBD	$284.26
Rate for Payer: UHC All Payor (Choice/PPO)	$293.28
Rate for Payer: UHC Core	$235.08
Rate for Payer: UHC Exchange	$177.32

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$4.52

Service Code	NDC 68084031311
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$4.07
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna Medicare	$2.26
Rate for Payer: Aetna New Business (MI Preferred)	$2.94
Rate for Payer: BCBS Complete	$1.81
Rate for Payer: Cash Price	$3.62
Rate for Payer: Cofinity Advantage	$3.16
Rate for Payer: Cofinity Commercial	$3.89
Rate for Payer: Encore Health Key Benefits Commercial	$3.62
Rate for Payer: Healthscope Commercial	$4.07
Rate for Payer: MI Amish Medical Board Commercial	$3.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.39
Rate for Payer: PHP Commercial	$3.84
Rate for Payer: Priority Health SBD	$2.85
Rate for Payer: UHC All Payor (Choice/PPO)	$2.94
Rate for Payer: UHC Core	$2.35
Rate for Payer: UHC Exchange	$1.78

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$451.20

Service Code	NDC 68084031301
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$284.26
Max. Negotiated Rate	$406.08
Rate for Payer: Aetna Commercial	$383.52
Rate for Payer: Aetna New Business (MI Preferred)	$293.28
Rate for Payer: Cash Price	$360.96
Rate for Payer: Cofinity Advantage	$315.84
Rate for Payer: Cofinity Commercial	$388.03
Rate for Payer: Encore Health Key Benefits Commercial	$360.96
Rate for Payer: Healthscope Commercial	$406.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$383.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$338.40
Rate for Payer: PHP Commercial	$383.52
Rate for Payer: Priority Health SBD	$284.26

Know your out-of-pocket cost for care.

All Charges