Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$87.99

Service Code	NDC 60687021121
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$79.19
Rate for Payer: Aetna Commercial	$74.79
Rate for Payer: Aetna Medicare	$43.99
Rate for Payer: Aetna New Business (MI Preferred)	$57.19
Rate for Payer: BCBS Complete	$35.20
Rate for Payer: Cash Price	$70.39
Rate for Payer: Cofinity Advantage	$61.59
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Encore Health Key Benefits Commercial	$70.39
Rate for Payer: Healthscope Commercial	$79.19
Rate for Payer: MI Amish Medical Board Commercial	$70.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$65.99
Rate for Payer: PHP Commercial	$74.79
Rate for Payer: Priority Health SBD	$55.43
Rate for Payer: UHC All Payor (Choice/PPO)	$57.19
Rate for Payer: UHC Core	$45.84
Rate for Payer: UHC Exchange	$34.58

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$138.65

Service Code	NDC 62756079688
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$54.49
Max. Negotiated Rate	$124.78
Rate for Payer: Aetna Commercial	$117.85
Rate for Payer: Aetna Medicare	$69.33
Rate for Payer: Aetna New Business (MI Preferred)	$90.12
Rate for Payer: BCBS Complete	$55.46
Rate for Payer: Cash Price	$110.92
Rate for Payer: Cofinity Advantage	$97.06
Rate for Payer: Cofinity Commercial	$119.24
Rate for Payer: Encore Health Key Benefits Commercial	$110.92
Rate for Payer: Healthscope Commercial	$124.78
Rate for Payer: MI Amish Medical Board Commercial	$110.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.99
Rate for Payer: PHP Commercial	$117.85
Rate for Payer: Priority Health SBD	$87.35
Rate for Payer: UHC All Payor (Choice/PPO)	$90.12
Rate for Payer: UHC Core	$72.24
Rate for Payer: UHC Exchange	$54.49

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$138.65

Service Code	NDC 62756079688
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$87.35
Max. Negotiated Rate	$124.78
Rate for Payer: Aetna Commercial	$117.85
Rate for Payer: Aetna New Business (MI Preferred)	$90.12
Rate for Payer: Cash Price	$110.92
Rate for Payer: Cofinity Advantage	$97.06
Rate for Payer: Cofinity Commercial	$119.24
Rate for Payer: Encore Health Key Benefits Commercial	$110.92
Rate for Payer: Healthscope Commercial	$124.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.99
Rate for Payer: PHP Commercial	$117.85
Rate for Payer: Priority Health SBD	$87.35

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$87.99

Service Code	NDC 60687021121
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$55.43
Max. Negotiated Rate	$79.19
Rate for Payer: Aetna Commercial	$74.79
Rate for Payer: Aetna New Business (MI Preferred)	$57.19
Rate for Payer: Cash Price	$70.39
Rate for Payer: Cofinity Advantage	$61.59
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Encore Health Key Benefits Commercial	$70.39
Rate for Payer: Healthscope Commercial	$79.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$65.99
Rate for Payer: PHP Commercial	$74.79
Rate for Payer: Priority Health SBD	$55.43

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$2.94

Service Code	NDC 60687021111
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$2.50
Rate for Payer: Aetna New Business (MI Preferred)	$1.91
Rate for Payer: Cash Price	$2.35
Rate for Payer: Cofinity Advantage	$2.06
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Encore Health Key Benefits Commercial	$2.35
Rate for Payer: Healthscope Commercial	$2.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.21
Rate for Payer: PHP Commercial	$2.50
Rate for Payer: Priority Health SBD	$1.85

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$2.94

Service Code	NDC 60687021111
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$2.50
Rate for Payer: Aetna Medicare	$1.47
Rate for Payer: Aetna New Business (MI Preferred)	$1.91
Rate for Payer: BCBS Complete	$1.18
Rate for Payer: Cash Price	$2.35
Rate for Payer: Cofinity Advantage	$2.06
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Encore Health Key Benefits Commercial	$2.35
Rate for Payer: Healthscope Commercial	$2.65
Rate for Payer: MI Amish Medical Board Commercial	$2.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.21
Rate for Payer: PHP Commercial	$2.50
Rate for Payer: Priority Health SBD	$1.85
Rate for Payer: UHC All Payor (Choice/PPO)	$1.91
Rate for Payer: UHC Core	$1.53
Rate for Payer: UHC Exchange	$1.16

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$373.65

Service Code	NDC 68084077601
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$146.84
Max. Negotiated Rate	$336.29
Rate for Payer: Aetna Commercial	$317.60
Rate for Payer: Aetna Medicare	$186.82
Rate for Payer: Aetna New Business (MI Preferred)	$242.87
Rate for Payer: BCBS Complete	$149.46
Rate for Payer: Cash Price	$298.92
Rate for Payer: Cofinity Advantage	$261.56
Rate for Payer: Cofinity Commercial	$321.34
Rate for Payer: Encore Health Key Benefits Commercial	$298.92
Rate for Payer: Healthscope Commercial	$336.29
Rate for Payer: MI Amish Medical Board Commercial	$298.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.24
Rate for Payer: PHP Commercial	$317.60
Rate for Payer: Priority Health SBD	$235.40
Rate for Payer: UHC All Payor (Choice/PPO)	$242.87
Rate for Payer: UHC Core	$194.67
Rate for Payer: UHC Exchange	$146.84

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$192.85

Service Code	NDC 00832712301
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$75.79
Max. Negotiated Rate	$173.56
Rate for Payer: Aetna Commercial	$163.92
Rate for Payer: Aetna Medicare	$96.42
Rate for Payer: Aetna New Business (MI Preferred)	$125.35
Rate for Payer: BCBS Complete	$77.14
Rate for Payer: Cash Price	$154.28
Rate for Payer: Cofinity Advantage	$135.00
Rate for Payer: Cofinity Commercial	$165.85
Rate for Payer: Encore Health Key Benefits Commercial	$154.28
Rate for Payer: Healthscope Commercial	$173.56
Rate for Payer: MI Amish Medical Board Commercial	$154.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$163.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$144.64
Rate for Payer: PHP Commercial	$163.92
Rate for Payer: Priority Health SBD	$121.50
Rate for Payer: UHC All Payor (Choice/PPO)	$125.35
Rate for Payer: UHC Core	$100.47
Rate for Payer: UHC Exchange	$75.79

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$333.70

Service Code	NDC 00904686061
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$210.23
Max. Negotiated Rate	$300.33
Rate for Payer: Aetna Commercial	$283.64
Rate for Payer: Aetna New Business (MI Preferred)	$216.91
Rate for Payer: Cash Price	$266.96
Rate for Payer: Cofinity Advantage	$233.59
Rate for Payer: Cofinity Commercial	$286.98
Rate for Payer: Encore Health Key Benefits Commercial	$266.96
Rate for Payer: Healthscope Commercial	$300.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$283.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$250.28
Rate for Payer: PHP Commercial	$283.64
Rate for Payer: Priority Health SBD	$210.23

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$1.93

Service Code	NDC 00832712389
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.74
Rate for Payer: Aetna Commercial	$1.64
Rate for Payer: Aetna Medicare	$0.97
Rate for Payer: Aetna New Business (MI Preferred)	$1.25
Rate for Payer: BCBS Complete	$0.77
Rate for Payer: Cash Price	$1.54
Rate for Payer: Cofinity Advantage	$1.35
Rate for Payer: Cofinity Commercial	$1.66
Rate for Payer: Encore Health Key Benefits Commercial	$1.54
Rate for Payer: Healthscope Commercial	$1.74
Rate for Payer: MI Amish Medical Board Commercial	$1.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.45
Rate for Payer: PHP Commercial	$1.64
Rate for Payer: Priority Health SBD	$1.22
Rate for Payer: UHC All Payor (Choice/PPO)	$1.25
Rate for Payer: UHC Core	$1.01
Rate for Payer: UHC Exchange	$0.76

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$162.15

Service Code	NDC 57237004701
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$145.94
Rate for Payer: Aetna Commercial	$137.83
Rate for Payer: Aetna New Business (MI Preferred)	$105.40
Rate for Payer: Cash Price	$129.72
Rate for Payer: Cofinity Advantage	$113.50
Rate for Payer: Cofinity Commercial	$139.45
Rate for Payer: Encore Health Key Benefits Commercial	$129.72
Rate for Payer: Healthscope Commercial	$145.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$121.61
Rate for Payer: PHP Commercial	$137.83
Rate for Payer: Priority Health SBD	$102.15

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$3.74

Service Code	NDC 68084077611
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.37
Rate for Payer: Aetna Commercial	$3.18
Rate for Payer: Aetna New Business (MI Preferred)	$2.43
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cofinity Advantage	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Encore Health Key Benefits Commercial	$2.99
Rate for Payer: Healthscope Commercial	$3.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.81
Rate for Payer: PHP Commercial	$3.18
Rate for Payer: Priority Health SBD	$2.36

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$162.15

Service Code	NDC 57237004701
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$63.72
Max. Negotiated Rate	$145.94
Rate for Payer: Aetna Commercial	$137.83
Rate for Payer: Aetna Medicare	$81.08
Rate for Payer: Aetna New Business (MI Preferred)	$105.40
Rate for Payer: BCBS Complete	$64.86
Rate for Payer: Cash Price	$129.72
Rate for Payer: Cofinity Advantage	$113.50
Rate for Payer: Cofinity Commercial	$139.45
Rate for Payer: Encore Health Key Benefits Commercial	$129.72
Rate for Payer: Healthscope Commercial	$145.94
Rate for Payer: MI Amish Medical Board Commercial	$129.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$121.61
Rate for Payer: PHP Commercial	$137.83
Rate for Payer: Priority Health SBD	$102.15
Rate for Payer: UHC All Payor (Choice/PPO)	$105.40
Rate for Payer: UHC Core	$84.48
Rate for Payer: UHC Exchange	$63.72

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$3.74

Service Code	NDC 68084077611
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.37
Rate for Payer: Aetna Commercial	$3.18
Rate for Payer: Aetna Medicare	$1.87
Rate for Payer: Aetna New Business (MI Preferred)	$2.43
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cofinity Advantage	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Encore Health Key Benefits Commercial	$2.99
Rate for Payer: Healthscope Commercial	$3.37
Rate for Payer: MI Amish Medical Board Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.81
Rate for Payer: PHP Commercial	$3.18
Rate for Payer: Priority Health SBD	$2.36
Rate for Payer: UHC All Payor (Choice/PPO)	$2.43
Rate for Payer: UHC Core	$1.95
Rate for Payer: UHC Exchange	$1.47

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$1.93

Service Code	NDC 00832712389
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.74
Rate for Payer: Aetna Commercial	$1.64
Rate for Payer: Aetna New Business (MI Preferred)	$1.25
Rate for Payer: Cash Price	$1.54
Rate for Payer: Cofinity Advantage	$1.35
Rate for Payer: Cofinity Commercial	$1.66
Rate for Payer: Encore Health Key Benefits Commercial	$1.54
Rate for Payer: Healthscope Commercial	$1.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.45
Rate for Payer: PHP Commercial	$1.64
Rate for Payer: Priority Health SBD	$1.22

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$373.65

Service Code	NDC 68084077601
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$235.40
Max. Negotiated Rate	$336.29
Rate for Payer: Aetna Commercial	$317.60
Rate for Payer: Aetna New Business (MI Preferred)	$242.87
Rate for Payer: Cash Price	$298.92
Rate for Payer: Cofinity Advantage	$261.56
Rate for Payer: Cofinity Commercial	$321.34
Rate for Payer: Encore Health Key Benefits Commercial	$298.92
Rate for Payer: Healthscope Commercial	$336.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.24
Rate for Payer: PHP Commercial	$317.60
Rate for Payer: Priority Health SBD	$235.40

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$1,316.00

Service Code	NDC 62756079713
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$829.08
Max. Negotiated Rate	$1,184.40
Rate for Payer: Aetna Commercial	$1,118.60
Rate for Payer: Aetna New Business (MI Preferred)	$855.40
Rate for Payer: Cash Price	$1,052.80
Rate for Payer: Cofinity Advantage	$921.20
Rate for Payer: Cofinity Commercial	$1,131.76
Rate for Payer: Encore Health Key Benefits Commercial	$1,052.80
Rate for Payer: Healthscope Commercial	$1,184.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,118.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$987.00
Rate for Payer: PHP Commercial	$1,118.60
Rate for Payer: Priority Health SBD	$829.08

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$1,316.00

Service Code	NDC 62756079713
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$517.19
Max. Negotiated Rate	$1,184.40
Rate for Payer: Aetna Commercial	$1,118.60
Rate for Payer: Aetna Medicare	$658.00
Rate for Payer: Aetna New Business (MI Preferred)	$855.40
Rate for Payer: BCBS Complete	$526.40
Rate for Payer: Cash Price	$1,052.80
Rate for Payer: Cofinity Advantage	$921.20
Rate for Payer: Cofinity Commercial	$1,131.76
Rate for Payer: Encore Health Key Benefits Commercial	$1,052.80
Rate for Payer: Healthscope Commercial	$1,184.40
Rate for Payer: MI Amish Medical Board Commercial	$1,052.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,118.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$987.00
Rate for Payer: PHP Commercial	$1,118.60
Rate for Payer: Priority Health SBD	$829.08
Rate for Payer: UHC All Payor (Choice/PPO)	$855.40
Rate for Payer: UHC Core	$685.64
Rate for Payer: UHC Exchange	$517.19

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$333.70

Service Code	NDC 00904686061
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$131.14
Max. Negotiated Rate	$300.33
Rate for Payer: Aetna Commercial	$283.64
Rate for Payer: Aetna Medicare	$166.85
Rate for Payer: Aetna New Business (MI Preferred)	$216.91
Rate for Payer: BCBS Complete	$133.48
Rate for Payer: Cash Price	$266.96
Rate for Payer: Cofinity Advantage	$233.59
Rate for Payer: Cofinity Commercial	$286.98
Rate for Payer: Encore Health Key Benefits Commercial	$266.96
Rate for Payer: Healthscope Commercial	$300.33
Rate for Payer: MI Amish Medical Board Commercial	$266.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$283.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$250.28
Rate for Payer: PHP Commercial	$283.64
Rate for Payer: Priority Health SBD	$210.23
Rate for Payer: UHC All Payor (Choice/PPO)	$216.91
Rate for Payer: UHC Core	$173.86
Rate for Payer: UHC Exchange	$131.14

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$192.85

Service Code	NDC 00832712301
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$173.56
Rate for Payer: Aetna Commercial	$163.92
Rate for Payer: Aetna New Business (MI Preferred)	$125.35
Rate for Payer: Cash Price	$154.28
Rate for Payer: Cofinity Advantage	$135.00
Rate for Payer: Cofinity Commercial	$165.85
Rate for Payer: Encore Health Key Benefits Commercial	$154.28
Rate for Payer: Healthscope Commercial	$173.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$163.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$144.64
Rate for Payer: PHP Commercial	$163.92
Rate for Payer: Priority Health SBD	$121.50

DIVALPROEX 500 MG TABLET,DELAYED RELEASE

Facility

$236.84

Service Code	NDC 68084078261
Hospital Charge Code	2553
Hospital Revenue Code	637
Min. Negotiated Rate	$149.21
Max. Negotiated Rate	$213.16
Rate for Payer: Aetna Commercial	$201.31
Rate for Payer: Aetna New Business (MI Preferred)	$153.95
Rate for Payer: Cash Price	$189.47
Rate for Payer: Cofinity Advantage	$165.79
Rate for Payer: Cofinity Commercial	$203.68
Rate for Payer: Encore Health Key Benefits Commercial	$189.47
Rate for Payer: Healthscope Commercial	$213.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$201.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$177.63
Rate for Payer: PHP Commercial	$201.31
Rate for Payer: Priority Health SBD	$149.21

DIVALPROEX 500 MG TABLET,DELAYED RELEASE

Facility

$305.50

Service Code	NDC 57237004801
Hospital Charge Code	2553
Hospital Revenue Code	637
Min. Negotiated Rate	$120.06
Max. Negotiated Rate	$274.95
Rate for Payer: Aetna Commercial	$259.68
Rate for Payer: Aetna Medicare	$152.75
Rate for Payer: Aetna New Business (MI Preferred)	$198.57
Rate for Payer: BCBS Complete	$122.20
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cofinity Advantage	$213.85
Rate for Payer: Cofinity Commercial	$262.73
Rate for Payer: Encore Health Key Benefits Commercial	$244.40
Rate for Payer: Healthscope Commercial	$274.95
Rate for Payer: MI Amish Medical Board Commercial	$244.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$229.12
Rate for Payer: PHP Commercial	$259.68
Rate for Payer: Priority Health SBD	$192.47
Rate for Payer: UHC All Payor (Choice/PPO)	$198.57
Rate for Payer: UHC Core	$159.17
Rate for Payer: UHC Exchange	$120.06

DIVALPROEX 500 MG TABLET,DELAYED RELEASE

Facility

$221.35

Service Code	NDC 62756079888
Hospital Charge Code	2553
Hospital Revenue Code	637
Min. Negotiated Rate	$86.99
Max. Negotiated Rate	$199.22
Rate for Payer: Aetna Commercial	$188.15
Rate for Payer: Aetna Medicare	$110.67
Rate for Payer: Aetna New Business (MI Preferred)	$143.88
Rate for Payer: BCBS Complete	$88.54
Rate for Payer: Cash Price	$177.08
Rate for Payer: Cofinity Advantage	$154.94
Rate for Payer: Cofinity Commercial	$190.36
Rate for Payer: Encore Health Key Benefits Commercial	$177.08
Rate for Payer: Healthscope Commercial	$199.22
Rate for Payer: MI Amish Medical Board Commercial	$177.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$166.01
Rate for Payer: PHP Commercial	$188.15
Rate for Payer: Priority Health SBD	$139.45
Rate for Payer: UHC All Payor (Choice/PPO)	$143.88
Rate for Payer: UHC Core	$115.32
Rate for Payer: UHC Exchange	$86.99

DIVALPROEX 500 MG TABLET,DELAYED RELEASE

Facility

$305.50

Service Code	NDC 57237004801
Hospital Charge Code	2553
Hospital Revenue Code	637
Min. Negotiated Rate	$192.47
Max. Negotiated Rate	$274.95
Rate for Payer: Aetna Commercial	$259.68
Rate for Payer: Aetna New Business (MI Preferred)	$198.57
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cofinity Advantage	$213.85
Rate for Payer: Cofinity Commercial	$262.73
Rate for Payer: Encore Health Key Benefits Commercial	$244.40
Rate for Payer: Healthscope Commercial	$274.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$229.12
Rate for Payer: PHP Commercial	$259.68
Rate for Payer: Priority Health SBD	$192.47

DIVALPROEX 500 MG TABLET,DELAYED RELEASE

Facility

$380.70

Service Code	NDC 00904686161
Hospital Charge Code	2553
Hospital Revenue Code	637
Min. Negotiated Rate	$239.84
Max. Negotiated Rate	$342.63
Rate for Payer: Aetna Commercial	$323.60
Rate for Payer: Aetna New Business (MI Preferred)	$247.46
Rate for Payer: Cash Price	$304.56
Rate for Payer: Cofinity Advantage	$266.49
Rate for Payer: Cofinity Commercial	$327.40
Rate for Payer: Encore Health Key Benefits Commercial	$304.56
Rate for Payer: Healthscope Commercial	$342.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$323.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$285.52
Rate for Payer: PHP Commercial	$323.60
Rate for Payer: Priority Health SBD	$239.84

Know your out-of-pocket cost for care.

All Charges