Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET

Facility

$312.48

Service Code	NDC 00378041501
Hospital Charge Code	2516
Hospital Revenue Code	637
Min. Negotiated Rate	$196.86
Max. Negotiated Rate	$281.23
Rate for Payer: Aetna Commercial	$265.61
Rate for Payer: Aetna New Business (MI Preferred)	$203.11
Rate for Payer: Cash Price	$249.98
Rate for Payer: Cofinity Commercial	$218.74
Rate for Payer: Cofinity Commercial	$268.73
Rate for Payer: Cofinity Medicare Advantage	$218.74
Rate for Payer: Encore Health Key Benefits Commercial	$249.98
Rate for Payer: Healthscope Commercial	$281.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$265.61
Rate for Payer: PHP Commercial	$265.61
Rate for Payer: Priority Health Cigna Priority Health	$203.11
Rate for Payer: Priority Health SBD	$196.86

DIPH,PERTUS(ACEL),TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE

Facility

$118.78

Service Code	HCPCS 90700
Hospital Charge Code	19451
Hospital Revenue Code	250
Min. Negotiated Rate	$74.83
Max. Negotiated Rate	$106.90
Rate for Payer: Aetna Commercial	$100.96
Rate for Payer: Aetna New Business (MI Preferred)	$77.21
Rate for Payer: Cash Price	$95.02
Rate for Payer: Cofinity Commercial	$102.15
Rate for Payer: Cofinity Commercial	$83.15
Rate for Payer: Cofinity Medicare Advantage	$83.15
Rate for Payer: Encore Health Key Benefits Commercial	$95.02
Rate for Payer: Healthscope Commercial	$106.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.96
Rate for Payer: PHP Commercial	$100.96
Rate for Payer: Priority Health Cigna Priority Health	$77.21
Rate for Payer: Priority Health SBD	$74.83

DIPH,PERTUS(ACEL),TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE

Facility

$118.78

Service Code	HCPCS 90700
Hospital Charge Code	19451
Hospital Revenue Code	250
Min. Negotiated Rate	$47.51
Max. Negotiated Rate	$106.90
Rate for Payer: Aetna Commercial	$100.96
Rate for Payer: Aetna Medicare	$59.39
Rate for Payer: Aetna New Business (MI Preferred)	$77.21
Rate for Payer: BCBS Complete	$47.51
Rate for Payer: Cash Price	$95.02
Rate for Payer: Cofinity Commercial	$102.15
Rate for Payer: Cofinity Commercial	$83.15
Rate for Payer: Cofinity Medicare Advantage	$83.15
Rate for Payer: Encore Health Key Benefits Commercial	$95.02
Rate for Payer: Healthscope Commercial	$106.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.96
Rate for Payer: PHP Commercial	$100.96
Rate for Payer: Priority Health Cigna Priority Health	$77.21
Rate for Payer: Priority Health SBD	$74.83

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

Facility

$165.70

Service Code	HCPCS 90715
Hospital Charge Code	41628
Hospital Revenue Code	636
Min. Negotiated Rate	$104.39
Max. Negotiated Rate	$149.13
Rate for Payer: Aetna Commercial	$140.84
Rate for Payer: Aetna New Business (MI Preferred)	$107.70
Rate for Payer: Cash Price	$132.56
Rate for Payer: Cofinity Commercial	$142.50
Rate for Payer: Cofinity Commercial	$115.99
Rate for Payer: Cofinity Medicare Advantage	$115.99
Rate for Payer: Encore Health Key Benefits Commercial	$132.56
Rate for Payer: Healthscope Commercial	$149.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$140.84
Rate for Payer: PHP Commercial	$140.84
Rate for Payer: Priority Health Cigna Priority Health	$107.70
Rate for Payer: Priority Health SBD	$104.39

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

Facility

$165.70

Service Code	HCPCS 90715
Hospital Charge Code	41628
Hospital Revenue Code	636
Min. Negotiated Rate	$66.28
Max. Negotiated Rate	$149.13
Rate for Payer: Aetna Commercial	$140.84
Rate for Payer: Aetna Medicare	$82.85
Rate for Payer: Aetna New Business (MI Preferred)	$107.70
Rate for Payer: BCBS Complete	$66.28
Rate for Payer: Cash Price	$132.56
Rate for Payer: Cofinity Commercial	$115.99
Rate for Payer: Cofinity Commercial	$142.50
Rate for Payer: Cofinity Medicare Advantage	$115.99
Rate for Payer: Encore Health Key Benefits Commercial	$132.56
Rate for Payer: Healthscope Commercial	$149.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$140.84
Rate for Payer: PHP Commercial	$140.84
Rate for Payer: Priority Health Cigna Priority Health	$107.70
Rate for Payer: Priority Health SBD	$104.39

DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND GRAFT INSERTION, WITH OR WITHOUT PATCH GRAFT; FOR ANEURYSM AND ASSOCIATED OCCLUSIVE DISEASE, AXILLARY-BRACHIAL ARTERY, BY ARM INCISION

Facility

$14,840.35

Service Code	CPT 35011
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.83
Max. Negotiated Rate	$14,840.35
Rate for Payer: Aetna Medicare	$5,482.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,590.09
Rate for Payer: Amish Plain Church Group Commercial	$6,590.09
Rate for Payer: BCBS Complete	$2,967.12
Rate for Payer: BCBS MAPPO	$5,272.07
Rate for Payer: BCN Medicare Advantage	$5,272.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,272.07
Rate for Payer: Mclaren Medicaid	$2,825.83
Rate for Payer: Mclaren Medicare	$5,272.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,535.67
Rate for Payer: Meridian Medicaid	$2,967.12
Rate for Payer: MI Amish Medical Board Commercial	$6,062.88
Rate for Payer: PACE Medicare	$5,008.47
Rate for Payer: PACE SWMI	$5,272.07
Rate for Payer: PHP Medicare Advantage	$5,272.07
Rate for Payer: Priority Health Choice Medicaid	$2,825.83
Rate for Payer: Priority Health Medicare	$5,272.07
Rate for Payer: Railroad Medicare Medicare	$5,272.07
Rate for Payer: UHC All Payor (Choice/PPO)	$14,840.35
Rate for Payer: UHC Dual Complete DSNP	$5,272.07
Rate for Payer: UHC Medicare Advantage	$5,272.07
Rate for Payer: UHCCP Medicaid	$2,968.18
Rate for Payer: VA VA	$5,272.07

DISTAL REVASCULARIZATION AND INTERVAL LIGATION (DRIL), UPPER EXTREMITY HEMODIALYSIS ACCESS (STEAL SYNDROME)

Facility

$14,840.35

Service Code	CPT 36838
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.83
Max. Negotiated Rate	$14,840.35
Rate for Payer: Aetna Medicare	$5,482.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,590.09
Rate for Payer: Amish Plain Church Group Commercial	$6,590.09
Rate for Payer: BCBS Complete	$2,967.12
Rate for Payer: BCBS MAPPO	$5,272.07
Rate for Payer: BCN Medicare Advantage	$5,272.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,272.07
Rate for Payer: Mclaren Medicaid	$2,825.83
Rate for Payer: Mclaren Medicare	$5,272.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,535.67
Rate for Payer: Meridian Medicaid	$2,967.12
Rate for Payer: MI Amish Medical Board Commercial	$6,062.88
Rate for Payer: PACE Medicare	$5,008.47
Rate for Payer: PACE SWMI	$5,272.07
Rate for Payer: PHP Medicare Advantage	$5,272.07
Rate for Payer: Priority Health Choice Medicaid	$2,825.83
Rate for Payer: Priority Health Medicare	$5,272.07
Rate for Payer: Railroad Medicare Medicare	$5,272.07
Rate for Payer: UHC All Payor (Choice/PPO)	$14,840.35
Rate for Payer: UHC Dual Complete DSNP	$5,272.07
Rate for Payer: UHC Medicare Advantage	$5,272.07
Rate for Payer: UHCCP Medicaid	$2,968.18
Rate for Payer: VA VA	$5,272.07

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$373.92

Service Code	NDC 68084031301
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$235.57
Max. Negotiated Rate	$336.53
Rate for Payer: Aetna Commercial	$317.83
Rate for Payer: Aetna New Business (MI Preferred)	$243.05
Rate for Payer: Cash Price	$299.14
Rate for Payer: Cofinity Commercial	$261.74
Rate for Payer: Cofinity Commercial	$321.57
Rate for Payer: Cofinity Medicare Advantage	$261.74
Rate for Payer: Encore Health Key Benefits Commercial	$299.14
Rate for Payer: Healthscope Commercial	$336.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.83
Rate for Payer: PHP Commercial	$317.83
Rate for Payer: Priority Health Cigna Priority Health	$243.05
Rate for Payer: Priority Health SBD	$235.57

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$3.74

Service Code	NDC 68084031311
Hospital Charge Code	27631
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 Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Cofinity Medicare Advantage	$2.62
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: PHP Commercial	$3.18
Rate for Payer: Priority Health Cigna Priority Health	$2.43
Rate for Payer: Priority Health SBD	$2.36

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$3.74

Service Code	NDC 68084031311
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
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 Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Cofinity Medicare Advantage	$2.62
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: PHP Commercial	$3.18
Rate for Payer: Priority Health Cigna Priority Health	$2.43
Rate for Payer: Priority Health SBD	$2.36

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$373.92

Service Code	NDC 68084031301
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$149.57
Max. Negotiated Rate	$336.53
Rate for Payer: Aetna Commercial	$317.83
Rate for Payer: Aetna Medicare	$186.96
Rate for Payer: Aetna New Business (MI Preferred)	$243.05
Rate for Payer: BCBS Complete	$149.57
Rate for Payer: Cash Price	$299.14
Rate for Payer: Cofinity Commercial	$261.74
Rate for Payer: Cofinity Commercial	$321.57
Rate for Payer: Cofinity Medicare Advantage	$261.74
Rate for Payer: Encore Health Key Benefits Commercial	$299.14
Rate for Payer: Healthscope Commercial	$336.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.83
Rate for Payer: PHP Commercial	$317.83
Rate for Payer: Priority Health Cigna Priority Health	$243.05
Rate for Payer: Priority Health SBD	$235.57

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$371.45

Service Code	NDC 68382010601
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$148.58
Max. Negotiated Rate	$334.31
Rate for Payer: Aetna Commercial	$315.73
Rate for Payer: Aetna Medicare	$185.72
Rate for Payer: Aetna New Business (MI Preferred)	$241.44
Rate for Payer: BCBS Complete	$148.58
Rate for Payer: Cash Price	$297.16
Rate for Payer: Cofinity Commercial	$260.01
Rate for Payer: Cofinity Commercial	$319.45
Rate for Payer: Cofinity Medicare Advantage	$260.01
Rate for Payer: Encore Health Key Benefits Commercial	$297.16
Rate for Payer: Healthscope Commercial	$334.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.73
Rate for Payer: PHP Commercial	$315.73
Rate for Payer: Priority Health Cigna Priority Health	$241.44
Rate for Payer: Priority Health SBD	$234.01

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$371.45

Service Code	NDC 68382010601
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$234.01
Max. Negotiated Rate	$334.31
Rate for Payer: Aetna Commercial	$315.73
Rate for Payer: Aetna New Business (MI Preferred)	$241.44
Rate for Payer: Cash Price	$297.16
Rate for Payer: Cofinity Commercial	$260.01
Rate for Payer: Cofinity Commercial	$319.45
Rate for Payer: Cofinity Medicare Advantage	$260.01
Rate for Payer: Encore Health Key Benefits Commercial	$297.16
Rate for Payer: Healthscope Commercial	$334.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.73
Rate for Payer: PHP Commercial	$315.73
Rate for Payer: Priority Health Cigna Priority Health	$241.44
Rate for Payer: Priority Health SBD	$234.01

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 Commercial	$61.59
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Medicare Advantage	$61.59
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: PHP Commercial	$74.79
Rate for Payer: Priority Health Cigna Priority Health	$57.19
Rate for Payer: Priority Health SBD	$55.43

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 Commercial	$119.24
Rate for Payer: Cofinity Commercial	$97.06
Rate for Payer: Cofinity Medicare Advantage	$97.06
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: PHP Commercial	$117.85
Rate for Payer: Priority Health Cigna Priority Health	$90.12
Rate for Payer: Priority Health SBD	$87.35

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 Commercial	$2.06
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Medicare Advantage	$2.06
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: PHP Commercial	$2.50
Rate for Payer: Priority Health Cigna Priority Health	$1.91
Rate for Payer: Priority Health SBD	$1.85

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$87.99

Service Code	NDC 60687021121
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$35.20
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 Commercial	$61.59
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Medicare Advantage	$61.59
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: PHP Commercial	$74.79
Rate for Payer: Priority Health Cigna Priority Health	$57.19
Rate for Payer: Priority Health SBD	$55.43

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$138.65

Service Code	NDC 62756079688
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$55.46
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 Commercial	$119.24
Rate for Payer: Cofinity Commercial	$97.06
Rate for Payer: Cofinity Medicare Advantage	$97.06
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: PHP Commercial	$117.85
Rate for Payer: Priority Health Cigna Priority Health	$90.12
Rate for Payer: Priority Health SBD	$87.35

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$2.94

Service Code	NDC 60687021111
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$1.18
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 Commercial	$2.06
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Medicare Advantage	$2.06
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: PHP Commercial	$2.50
Rate for Payer: Priority Health Cigna Priority Health	$1.91
Rate for Payer: Priority Health SBD	$1.85

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$373.65

Service Code	NDC 00832712301
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$149.46
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 Commercial	$261.56
Rate for Payer: Cofinity Commercial	$321.34
Rate for Payer: Cofinity Medicare Advantage	$261.56
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: PHP Commercial	$317.60
Rate for Payer: Priority Health Cigna Priority Health	$242.87
Rate for Payer: Priority Health SBD	$235.40

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$373.65

Service Code	NDC 00832712301
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 Commercial	$261.56
Rate for Payer: Cofinity Commercial	$321.34
Rate for Payer: Cofinity Medicare Advantage	$261.56
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: PHP Commercial	$317.60
Rate for Payer: Priority Health Cigna Priority Health	$242.87
Rate for Payer: Priority Health SBD	$235.40

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$373.65

Service Code	NDC 68084077601
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$149.46
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 Commercial	$261.56
Rate for Payer: Cofinity Commercial	$321.34
Rate for Payer: Cofinity Medicare Advantage	$261.56
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: PHP Commercial	$317.60
Rate for Payer: Priority Health Cigna Priority Health	$242.87
Rate for Payer: Priority Health SBD	$235.40

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$3.74

Service Code	NDC 68084077611
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
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 Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Cofinity Medicare Advantage	$2.62
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: PHP Commercial	$3.18
Rate for Payer: Priority Health Cigna Priority Health	$2.43
Rate for Payer: Priority Health SBD	$2.36

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$3.74

Service Code	NDC 00832712389
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 Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Cofinity Medicare Advantage	$2.62
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: PHP Commercial	$3.18
Rate for Payer: Priority Health Cigna Priority Health	$2.43
Rate for Payer: Priority Health SBD	$2.36

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$3.74

Service Code	NDC 00832712389
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
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 Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Cofinity Medicare Advantage	$2.62
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: PHP Commercial	$3.18
Rate for Payer: Priority Health Cigna Priority Health	$2.43
Rate for Payer: Priority Health SBD	$2.36

Know your out-of-pocket cost for care.

All Charges