Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG/5 ML ORAL LIQUID

Facility

$273.89

Service Code	NDC 0054-3194-46
Hospital Charge Code	2515
Hospital Revenue Code	637
Min. Negotiated Rate	$172.55
Max. Negotiated Rate	$246.50
Rate for Payer: Aetna Commercial	$232.81
Rate for Payer: Aetna New Business (MI Preferred)	$178.03
Rate for Payer: Cash Price	$219.11
Rate for Payer: Cofinity Commercial	$191.72
Rate for Payer: Cofinity Commercial	$235.55
Rate for Payer: Healthscope Commercial	$246.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$232.81
Rate for Payer: PHP Commercial	$232.81
Rate for Payer: Priority Health Cigna Priority Health	$191.72
Rate for Payer: Priority Health SBD	$172.55

DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET

Facility

$312.48

Service Code	NDC 0378-0415-01
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: Healthscope Commercial	$281.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$265.61
Rate for Payer: PHP Commercial	$265.61
Rate for Payer: Priority Health Cigna Priority Health	$218.74
Rate for Payer: Priority Health SBD	$196.86

DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET

Facility

$361.95

Service Code	NDC 59762-1061-1
Hospital Charge Code	2516
Hospital Revenue Code	637
Min. Negotiated Rate	$228.03
Max. Negotiated Rate	$325.76
Rate for Payer: Aetna Commercial	$307.66
Rate for Payer: Aetna New Business (MI Preferred)	$235.27
Rate for Payer: Cash Price	$289.56
Rate for Payer: Cofinity Commercial	$253.36
Rate for Payer: Cofinity Commercial	$311.28
Rate for Payer: Healthscope Commercial	$325.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$307.66
Rate for Payer: PHP Commercial	$307.66
Rate for Payer: Priority Health Cigna Priority Health	$253.36
Rate for Payer: Priority Health SBD	$228.03

DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET

Facility

$312.48

Service Code	NDC 0378-0415-01
Hospital Charge Code	2516
Hospital Revenue Code	637
Min. Negotiated Rate	$124.99
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: BCBS Complete	$124.99
Rate for Payer: Cash Price	$249.98
Rate for Payer: Cofinity Commercial	$218.74
Rate for Payer: Cofinity Commercial	$268.73
Rate for Payer: Healthscope Commercial	$281.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$265.61
Rate for Payer: PHP Commercial	$265.61
Rate for Payer: Priority Health Cigna Priority Health	$218.74
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

$115.61

Service Code	HCPCS 90700
Hospital Charge Code	19451
Hospital Revenue Code	250
Min. Negotiated Rate	$72.83
Max. Negotiated Rate	$104.05
Rate for Payer: Aetna Commercial	$98.27
Rate for Payer: Aetna New Business (MI Preferred)	$75.15
Rate for Payer: Cash Price	$92.49
Rate for Payer: Cofinity Commercial	$80.93
Rate for Payer: Cofinity Commercial	$99.42
Rate for Payer: Healthscope Commercial	$104.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.27
Rate for Payer: PHP Commercial	$98.27
Rate for Payer: Priority Health Cigna Priority Health	$80.93
Rate for Payer: Priority Health SBD	$72.83

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

Facility

$161.17

Service Code	HCPCS 90715
Hospital Charge Code	41628
Hospital Revenue Code	636
Min. Negotiated Rate	$101.54
Max. Negotiated Rate	$145.05
Rate for Payer: Aetna Commercial	$136.99
Rate for Payer: Aetna New Business (MI Preferred)	$104.76
Rate for Payer: Cash Price	$128.94
Rate for Payer: Cofinity Commercial	$112.82
Rate for Payer: Cofinity Commercial	$138.61
Rate for Payer: Healthscope Commercial	$145.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$136.99
Rate for Payer: PHP Commercial	$136.99
Rate for Payer: Priority Health Cigna Priority Health	$112.82
Rate for Payer: Priority Health SBD	$101.54

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

Facility

$16,489.01

Service Code	MS-DRG 442
Min. Negotiated Rate	$6,977.98
Max. Negotiated Rate	$16,489.01
Rate for Payer: Aetna Medicare	$7,639.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,181.55
Rate for Payer: Amish Plain Church Group Commercial	$9,181.55
Rate for Payer: BCBS MAPPO	$7,345.24
Rate for Payer: BCBS Trust/PPO	$16,489.01
Rate for Payer: BCN Medicare Advantage	$7,345.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,345.24
Rate for Payer: Mclaren Medicare	$7,345.24
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,712.50
Rate for Payer: MI Amish Medical Board Commercial	$8,447.03
Rate for Payer: PACE Medicare	$6,977.98
Rate for Payer: PACE SWMI	$7,345.24
Rate for Payer: PHP Medicare Advantage	$7,345.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13,653.95
Rate for Payer: Priority Health Medicare	$7,345.24
Rate for Payer: Priority Health Narrow Network	$10,923.16
Rate for Payer: Railroad Medicare Medicare	$7,345.24
Rate for Payer: UHC All Payor (Choice/PPO)	$14,514.18
Rate for Payer: UHC Core	$8,906.04
Rate for Payer: UHC Dual Complete DSNP	$7,345.24
Rate for Payer: UHC Exchange	$9,538.79
Rate for Payer: UHC Medicare Advantage	$7,565.60
Rate for Payer: VA VA	$7,345.24

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

Facility

$44,051.95

Service Code	MS-DRG 441
Min. Negotiated Rate	$12,976.11
Max. Negotiated Rate	$44,051.95
Rate for Payer: Aetna Medicare	$14,205.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,073.82
Rate for Payer: Amish Plain Church Group Commercial	$17,073.82
Rate for Payer: BCBS MAPPO	$13,659.06
Rate for Payer: BCBS Trust/PPO	$44,051.95
Rate for Payer: BCN Medicare Advantage	$13,659.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,659.06
Rate for Payer: Mclaren Medicare	$13,659.06
Rate for Payer: Meridian Wellcare - Medicare Advantage	$14,342.01
Rate for Payer: MI Amish Medical Board Commercial	$15,707.92
Rate for Payer: PACE Medicare	$12,976.11
Rate for Payer: PACE SWMI	$13,659.06
Rate for Payer: PHP Medicare Advantage	$13,659.06
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26,234.52
Rate for Payer: Priority Health Medicare	$13,659.06
Rate for Payer: Priority Health Narrow Network	$20,987.62
Rate for Payer: Railroad Medicare Medicare	$13,659.06
Rate for Payer: UHC All Payor (Choice/PPO)	$27,887.36
Rate for Payer: UHC Core	$17,111.95
Rate for Payer: UHC Dual Complete DSNP	$13,659.06
Rate for Payer: UHC Exchange	$18,327.71
Rate for Payer: UHC Medicare Advantage	$14,068.83
Rate for Payer: VA VA	$13,659.06

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

Facility

$13,102.94

Service Code	MS-DRG 443
Min. Negotiated Rate	$5,357.85
Max. Negotiated Rate	$13,102.94
Rate for Payer: Aetna Medicare	$5,865.43
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,049.80
Rate for Payer: Amish Plain Church Group Commercial	$7,049.80
Rate for Payer: BCBS MAPPO	$5,639.84
Rate for Payer: BCBS Trust/PPO	$13,102.94
Rate for Payer: BCN Medicare Advantage	$5,639.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,639.84
Rate for Payer: Mclaren Medicare	$5,639.84
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,921.83
Rate for Payer: MI Amish Medical Board Commercial	$6,485.82
Rate for Payer: PACE Medicare	$5,357.85
Rate for Payer: PACE SWMI	$5,639.84
Rate for Payer: PHP Medicare Advantage	$5,639.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,255.89
Rate for Payer: Priority Health Medicare	$5,639.84
Rate for Payer: Priority Health Narrow Network	$8,204.71
Rate for Payer: Railroad Medicare Medicare	$5,639.84
Rate for Payer: UHC All Payor (Choice/PPO)	$10,902.03
Rate for Payer: UHC Core	$6,689.59
Rate for Payer: UHC Dual Complete DSNP	$5,639.84
Rate for Payer: UHC Exchange	$7,164.87
Rate for Payer: UHC Medicare Advantage	$5,809.04
Rate for Payer: VA VA	$5,639.84

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$14,666.42

Service Code	MS-DRG 439
Min. Negotiated Rate	$6,319.12
Max. Negotiated Rate	$14,666.42
Rate for Payer: Aetna Medicare	$6,917.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,314.62
Rate for Payer: Amish Plain Church Group Commercial	$8,314.62
Rate for Payer: BCBS MAPPO	$6,651.70
Rate for Payer: BCBS Trust/PPO	$14,666.42
Rate for Payer: BCN Medicare Advantage	$6,651.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,651.70
Rate for Payer: Mclaren Medicare	$6,651.70
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,984.28
Rate for Payer: MI Amish Medical Board Commercial	$7,649.46
Rate for Payer: PACE Medicare	$6,319.12
Rate for Payer: PACE SWMI	$6,651.70
Rate for Payer: PHP Medicare Advantage	$6,651.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12,272.05
Rate for Payer: Priority Health Medicare	$6,651.70
Rate for Payer: Priority Health Narrow Network	$9,817.64
Rate for Payer: Railroad Medicare Medicare	$6,651.70
Rate for Payer: UHC All Payor (Choice/PPO)	$13,045.22
Rate for Payer: UHC Core	$8,004.67
Rate for Payer: UHC Dual Complete DSNP	$6,651.70
Rate for Payer: UHC Exchange	$8,573.38
Rate for Payer: UHC Medicare Advantage	$6,851.25
Rate for Payer: VA VA	$6,651.70

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$28,494.00

Service Code	MS-DRG 438
Min. Negotiated Rate	$11,885.53
Max. Negotiated Rate	$28,494.00
Rate for Payer: Aetna Medicare	$13,011.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,638.85
Rate for Payer: Amish Plain Church Group Commercial	$15,638.85
Rate for Payer: BCBS MAPPO	$12,511.08
Rate for Payer: BCBS Trust/PPO	$28,494.00
Rate for Payer: BCN Medicare Advantage	$12,511.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,511.08
Rate for Payer: Mclaren Medicare	$12,511.08
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13,136.63
Rate for Payer: MI Amish Medical Board Commercial	$14,387.74
Rate for Payer: PACE Medicare	$11,885.53
Rate for Payer: PACE SWMI	$12,511.08
Rate for Payer: PHP Medicare Advantage	$12,511.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23,947.15
Rate for Payer: Priority Health Medicare	$12,511.08
Rate for Payer: Priority Health Narrow Network	$19,157.72
Rate for Payer: Railroad Medicare Medicare	$12,511.08
Rate for Payer: UHC All Payor (Choice/PPO)	$25,455.88
Rate for Payer: UHC Core	$15,619.97
Rate for Payer: UHC Dual Complete DSNP	$12,511.08
Rate for Payer: UHC Exchange	$16,729.72
Rate for Payer: UHC Medicare Advantage	$12,886.41
Rate for Payer: VA VA	$12,511.08

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$10,746.73

Service Code	MS-DRG 440
Min. Negotiated Rate	$4,679.85
Max. Negotiated Rate	$10,746.73
Rate for Payer: Aetna Medicare	$5,123.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,157.70
Rate for Payer: Amish Plain Church Group Commercial	$6,157.70
Rate for Payer: BCBS MAPPO	$4,926.16
Rate for Payer: BCBS Trust/PPO	$10,746.73
Rate for Payer: BCN Medicare Advantage	$4,926.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,926.16
Rate for Payer: Mclaren Medicare	$4,926.16
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,172.47
Rate for Payer: MI Amish Medical Board Commercial	$5,665.08
Rate for Payer: PACE Medicare	$4,679.85
Rate for Payer: PACE SWMI	$4,926.16
Rate for Payer: PHP Medicare Advantage	$4,926.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,833.81
Rate for Payer: Priority Health Medicare	$4,926.16
Rate for Payer: Priority Health Narrow Network	$7,067.05
Rate for Payer: Railroad Medicare Medicare	$4,926.16
Rate for Payer: UHC All Payor (Choice/PPO)	$9,390.36
Rate for Payer: UHC Core	$5,762.02
Rate for Payer: UHC Dual Complete DSNP	$4,926.16
Rate for Payer: UHC Exchange	$6,171.39
Rate for Payer: UHC Medicare Advantage	$5,073.94
Rate for Payer: VA VA	$4,926.16

DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$28,607.35

Service Code	MS-DRG 883
Min. Negotiated Rate	$13,299.03
Max. Negotiated Rate	$28,607.35
Rate for Payer: Aetna Medicare	$14,558.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,498.72
Rate for Payer: Amish Plain Church Group Commercial	$17,498.72
Rate for Payer: BCBS MAPPO	$13,998.98
Rate for Payer: BCBS Trust/PPO	$17,795.57
Rate for Payer: BCN Medicare Advantage	$13,998.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,998.98
Rate for Payer: Mclaren Medicare	$13,998.98
Rate for Payer: Meridian Wellcare - Medicare Advantage	$14,698.93
Rate for Payer: MI Amish Medical Board Commercial	$16,098.83
Rate for Payer: PACE Medicare	$13,299.03
Rate for Payer: PACE SWMI	$13,998.98
Rate for Payer: PHP Medicare Advantage	$13,998.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26,911.84
Rate for Payer: Priority Health Medicare	$13,998.98
Rate for Payer: Priority Health Narrow Network	$21,529.47
Rate for Payer: Railroad Medicare Medicare	$13,998.98
Rate for Payer: UHC All Payor (Choice/PPO)	$28,607.35
Rate for Payer: UHC Core	$17,553.74
Rate for Payer: UHC Dual Complete DSNP	$13,998.98
Rate for Payer: UHC Exchange	$18,800.89
Rate for Payer: UHC Medicare Advantage	$14,418.95
Rate for Payer: VA VA	$13,998.98

DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$17,308.08

Service Code	MS-DRG 445
Min. Negotiated Rate	$7,903.67
Max. Negotiated Rate	$17,308.08
Rate for Payer: Aetna Medicare	$8,652.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,399.56
Rate for Payer: Amish Plain Church Group Commercial	$10,399.56
Rate for Payer: BCBS MAPPO	$8,319.65
Rate for Payer: BCBS Trust/PPO	$17,308.08
Rate for Payer: BCN Medicare Advantage	$8,319.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,319.65
Rate for Payer: Mclaren Medicare	$8,319.65
Rate for Payer: Meridian Wellcare - Medicare Advantage	$8,735.63
Rate for Payer: MI Amish Medical Board Commercial	$9,567.60
Rate for Payer: PACE Medicare	$7,903.67
Rate for Payer: PACE SWMI	$8,319.65
Rate for Payer: PHP Medicare Advantage	$8,319.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,595.49
Rate for Payer: Priority Health Medicare	$8,319.65
Rate for Payer: Priority Health Narrow Network	$12,476.39
Rate for Payer: Railroad Medicare Medicare	$8,319.65
Rate for Payer: UHC All Payor (Choice/PPO)	$16,578.05
Rate for Payer: UHC Core	$10,172.45
Rate for Payer: UHC Dual Complete DSNP	$8,319.65
Rate for Payer: UHC Exchange	$10,895.17
Rate for Payer: UHC Medicare Advantage	$8,569.24
Rate for Payer: VA VA	$8,319.65

DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$29,416.28

Service Code	MS-DRG 444
Min. Negotiated Rate	$11,641.96
Max. Negotiated Rate	$29,416.28
Rate for Payer: Aetna Medicare	$12,744.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,318.36
Rate for Payer: Amish Plain Church Group Commercial	$15,318.36
Rate for Payer: BCBS MAPPO	$12,254.69
Rate for Payer: BCBS Trust/PPO	$29,416.28
Rate for Payer: BCN Medicare Advantage	$12,254.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,254.69
Rate for Payer: Mclaren Medicare	$12,254.69
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,867.42
Rate for Payer: MI Amish Medical Board Commercial	$14,092.89
Rate for Payer: PACE Medicare	$11,641.96
Rate for Payer: PACE SWMI	$12,254.69
Rate for Payer: PHP Medicare Advantage	$12,254.69
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23,436.29
Rate for Payer: Priority Health Medicare	$12,254.69
Rate for Payer: Priority Health Narrow Network	$18,749.03
Rate for Payer: Railroad Medicare Medicare	$12,254.69
Rate for Payer: UHC All Payor (Choice/PPO)	$24,912.83
Rate for Payer: UHC Core	$15,286.75
Rate for Payer: UHC Dual Complete DSNP	$12,254.69
Rate for Payer: UHC Exchange	$16,372.83
Rate for Payer: UHC Medicare Advantage	$12,622.33
Rate for Payer: VA VA	$12,254.69

DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$14,633.48

Service Code	MS-DRG 446
Min. Negotiated Rate	$5,951.72
Max. Negotiated Rate	$14,633.48
Rate for Payer: Aetna Medicare	$6,515.57
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,831.21
Rate for Payer: Amish Plain Church Group Commercial	$7,831.21
Rate for Payer: BCBS MAPPO	$6,264.97
Rate for Payer: BCBS Trust/PPO	$14,633.48
Rate for Payer: BCN Medicare Advantage	$6,264.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,264.97
Rate for Payer: Mclaren Medicare	$6,264.97
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,578.22
Rate for Payer: MI Amish Medical Board Commercial	$7,204.72
Rate for Payer: PACE Medicare	$5,951.72
Rate for Payer: PACE SWMI	$6,264.97
Rate for Payer: PHP Medicare Advantage	$6,264.97
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,501.46
Rate for Payer: Priority Health Medicare	$6,264.97
Rate for Payer: Priority Health Narrow Network	$9,201.17
Rate for Payer: Railroad Medicare Medicare	$6,264.97
Rate for Payer: UHC All Payor (Choice/PPO)	$12,226.08
Rate for Payer: UHC Core	$7,502.04
Rate for Payer: UHC Dual Complete DSNP	$6,264.97
Rate for Payer: UHC Exchange	$8,035.04
Rate for Payer: UHC Medicare Advantage	$6,452.92
Rate for Payer: VA VA	$6,264.97

DISPOSABLE PAIN PUMP

Facility

$1,530.00

Service Code	HCPCS C2626
Hospital Charge Code	154972
Min. Negotiated Rate	$963.90
Max. Negotiated Rate	$1,377.00
Rate for Payer: Aetna Commercial	$1,300.50
Rate for Payer: Aetna Commercial	$573.75
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna New Business (MI Preferred)	$438.75
Rate for Payer: Aetna New Business (MI Preferred)	$390.00
Rate for Payer: Aetna New Business (MI Preferred)	$994.50
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cofinity Commercial	$1,315.80
Rate for Payer: Cofinity Commercial	$580.50
Rate for Payer: Cofinity Commercial	$1,071.00
Rate for Payer: Cofinity Commercial	$472.50
Rate for Payer: Cofinity Commercial	$420.00
Rate for Payer: Cofinity Commercial	$516.00
Rate for Payer: Healthscope Commercial	$607.50
Rate for Payer: Healthscope Commercial	$1,377.00
Rate for Payer: Healthscope Commercial	$540.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$510.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,300.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$573.75
Rate for Payer: PHP Commercial	$510.00
Rate for Payer: PHP Commercial	$1,300.50
Rate for Payer: PHP Commercial	$573.75
Rate for Payer: Priority Health Cigna Priority Health	$420.00
Rate for Payer: Priority Health Cigna Priority Health	$472.50
Rate for Payer: Priority Health Cigna Priority Health	$1,071.00
Rate for Payer: Priority Health SBD	$963.90
Rate for Payer: Priority Health SBD	$425.25
Rate for Payer: Priority Health SBD	$378.00

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

Facility

$15,411.76

Service Code	CPT 36838
Hospital Revenue Code	360
Min. Negotiated Rate	$1,093.66
Max. Negotiated Rate	$15,411.76
Rate for Payer: Aetna Medicare	$5,085.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,112.15
Rate for Payer: Amish Plain Church Group Commercial	$6,112.15
Rate for Payer: BCBS Complete	$2,808.66
Rate for Payer: BCBS MAPPO	$4,889.72
Rate for Payer: BCBS Trust/PPO	$2,042.73
Rate for Payer: BCN Medicare Advantage	$4,889.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,889.72
Rate for Payer: Mclaren Medicaid	$2,674.68
Rate for Payer: Mclaren Medicare	$4,889.72
Rate for Payer: Meridian Medicaid	$2,808.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,134.21
Rate for Payer: MI Amish Medical Board Commercial	$5,623.18
Rate for Payer: PACE Medicare	$4,645.23
Rate for Payer: PACE SWMI	$4,889.72
Rate for Payer: PHP Medicare Advantage	$4,889.72
Rate for Payer: Priority Health Choice Medicaid	$2,674.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,411.76
Rate for Payer: Priority Health Medicare	$4,889.72
Rate for Payer: Priority Health Narrow Network	$12,329.41
Rate for Payer: Railroad Medicare Medicare	$4,889.72
Rate for Payer: UHC All Payor (Choice/PPO)	$1,203.03
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$4,889.72
Rate for Payer: UHC Exchange	$1,093.66
Rate for Payer: UHC Medicare Advantage	$5,036.41
Rate for Payer: VA VA	$4,889.72

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$327.84

Service Code	NDC 68084-313-11
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$206.54
Max. Negotiated Rate	$295.06
Rate for Payer: Aetna Commercial	$278.66
Rate for Payer: Aetna New Business (MI Preferred)	$213.10
Rate for Payer: Cash Price	$262.27
Rate for Payer: Cofinity Commercial	$229.49
Rate for Payer: Cofinity Commercial	$281.94
Rate for Payer: Healthscope Commercial	$295.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$278.66
Rate for Payer: PHP Commercial	$278.66
Rate for Payer: Priority Health Cigna Priority Health	$229.49
Rate for Payer: Priority Health SBD	$206.54

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$327.84

Service Code	NDC 68084-313-01
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$206.54
Max. Negotiated Rate	$295.06
Rate for Payer: Aetna Commercial	$278.66
Rate for Payer: Aetna New Business (MI Preferred)	$213.10
Rate for Payer: Cash Price	$262.27
Rate for Payer: Cofinity Commercial	$229.49
Rate for Payer: Cofinity Commercial	$281.94
Rate for Payer: Healthscope Commercial	$295.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$278.66
Rate for Payer: PHP Commercial	$278.66
Rate for Payer: Priority Health Cigna Priority Health	$229.49
Rate for Payer: Priority Health SBD	$206.54

DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE

Facility

$202.35

Service Code	NDC 68382-106-01
Hospital Charge Code	27631
Hospital Revenue Code	637
Min. Negotiated Rate	$127.48
Max. Negotiated Rate	$182.12
Rate for Payer: Aetna Commercial	$172.00
Rate for Payer: Aetna New Business (MI Preferred)	$131.53
Rate for Payer: Cash Price	$161.88
Rate for Payer: Cofinity Commercial	$141.64
Rate for Payer: Cofinity Commercial	$174.02
Rate for Payer: Healthscope Commercial	$182.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$172.00
Rate for Payer: PHP Commercial	$172.00
Rate for Payer: Priority Health Cigna Priority Health	$141.64
Rate for Payer: Priority Health SBD	$127.48

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$2.92

Service Code	NDC 60687-211-11
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$2.63
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: Aetna New Business (MI Preferred)	$1.90
Rate for Payer: Cash Price	$2.34
Rate for Payer: Cofinity Commercial	$2.04
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.48
Rate for Payer: PHP Commercial	$2.48
Rate for Payer: Priority Health Cigna Priority Health	$2.04
Rate for Payer: Priority Health SBD	$1.84

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$138.65

Service Code	NDC 62756-796-88
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: Healthscope Commercial	$124.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$117.85
Rate for Payer: PHP Commercial	$117.85
Rate for Payer: Priority Health Cigna Priority Health	$97.06
Rate for Payer: Priority Health SBD	$87.35

DIVALPROEX 125 MG TABLET,DELAYED RELEASE

Facility

$87.56

Service Code	NDC 60687-211-21
Hospital Charge Code	2551
Hospital Revenue Code	637
Min. Negotiated Rate	$55.16
Max. Negotiated Rate	$78.80
Rate for Payer: Aetna Commercial	$74.43
Rate for Payer: Aetna New Business (MI Preferred)	$56.91
Rate for Payer: Cash Price	$70.05
Rate for Payer: Cofinity Commercial	$61.29
Rate for Payer: Cofinity Commercial	$75.30
Rate for Payer: Healthscope Commercial	$78.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$74.43
Rate for Payer: PHP Commercial	$74.43
Rate for Payer: Priority Health Cigna Priority Health	$61.29
Rate for Payer: Priority Health SBD	$55.16

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$3.34

Service Code	NDC 68084-776-11
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$3.01
Rate for Payer: Aetna Commercial	$2.84
Rate for Payer: Aetna New Business (MI Preferred)	$2.17
Rate for Payer: Cash Price	$2.67
Rate for Payer: Cofinity Commercial	$2.34
Rate for Payer: Cofinity Commercial	$2.87
Rate for Payer: Healthscope Commercial	$3.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.84
Rate for Payer: PHP Commercial	$2.84
Rate for Payer: Priority Health Cigna Priority Health	$2.34
Rate for Payer: Priority Health SBD	$2.10

Know your out-of-pocket cost for care.

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