Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

IP

$3.21

Service Code	NDC 5723704805
Hospital Charge Code	5723704805
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.61

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

IP

$3.25

Service Code	NDC 2930014005
Hospital Charge Code	2930014005
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.62

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

IP

$0.29

Service Code	NDC 6068787911
Hospital Charge Code	6068787911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

OP

$3.21

Service Code	NDC 5723704805
Hospital Charge Code	5723704805
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$2.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.61
Rate for Payer: Aetna Government	$1.61
Rate for Payer: Brighton Health Commercial	$2.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.19
Rate for Payer: EmblemHealth Commercial	$1.61
Rate for Payer: Group Health Inc Commercial	$1.61
Rate for Payer: Group Health Inc Medicare	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.61
Rate for Payer: Hamaspik Choice Inc Medicare	$1.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.09

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

OP

$0.29

Service Code	NDC 6068787911
Hospital Charge Code	6068787911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

OP

$1.42

Service Code	NDC 0832712401
Hospital Charge Code	0832712401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.71
Rate for Payer: Aetna Government	$0.71
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: EmblemHealth Commercial	$0.71
Rate for Payer: Group Health Inc Commercial	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.92

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

OP

$0.23

Service Code	NDC 0904686161
Hospital Charge Code	0904686161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: EmblemHealth Commercial	$0.12
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

IP

$0.39

Service Code	NDC 0904686190
Hospital Charge Code	0904686190
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

IP

$1.42

Service Code	NDC 0832712489
Hospital Charge Code	0832712489
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

IP

$3.21

Service Code	NDC 5723704801
Hospital Charge Code	5723704801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.61

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

IP

$3.21

Service Code	NDC 6275679888
Hospital Charge Code	6275679888
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.61

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

OP

$3.21

Service Code	NDC 5723704801
Hospital Charge Code	5723704801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$2.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.61
Rate for Payer: Aetna Government	$1.61
Rate for Payer: Brighton Health Commercial	$2.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.19
Rate for Payer: EmblemHealth Commercial	$1.61
Rate for Payer: Group Health Inc Commercial	$1.61
Rate for Payer: Group Health Inc Medicare	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.61
Rate for Payer: Hamaspik Choice Inc Medicare	$1.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.09

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

IP

$1.42

Service Code	NDC 0832712401
Hospital Charge Code	0832712401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

IP

$0.23

Service Code	NDC 0904686161
Hospital Charge Code	0904686161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

OP

$0.39

Service Code	NDC 0904686190
Hospital Charge Code	0904686190
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: EmblemHealth Commercial	$0.19
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

OP

$1.42

Service Code	NDC 0832712489
Hospital Charge Code	0832712489
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.71
Rate for Payer: Aetna Government	$0.71
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: EmblemHealth Commercial	$0.71
Rate for Payer: Group Health Inc Commercial	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.92

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

OP

$3.25

Service Code	NDC 2930014005
Hospital Charge Code	2930014005
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.62
Rate for Payer: Aetna Government	$1.62
Rate for Payer: Brighton Health Commercial	$2.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.21
Rate for Payer: EmblemHealth Commercial	$1.62
Rate for Payer: Group Health Inc Commercial	$1.62
Rate for Payer: Group Health Inc Medicare	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.11

DIVALPROEX SODIUM 500 MG PO TBEC

Facility

OP

$3.21

Service Code	NDC 6275679888
Hospital Charge Code	6275679888
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$2.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.61
Rate for Payer: Aetna Government	$1.61
Rate for Payer: Brighton Health Commercial	$2.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.19
Rate for Payer: EmblemHealth Commercial	$1.61
Rate for Payer: Group Health Inc Commercial	$1.61
Rate for Payer: Group Health Inc Medicare	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.61
Rate for Payer: Hamaspik Choice Inc Medicare	$1.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.09

DIVALPROEX SODIUM ER 250 MG PO TB24

Facility

OP

$2.46

Service Code	NDC 0378047201
Hospital Charge Code	0378047201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.23
Rate for Payer: Aetna Government	$1.23
Rate for Payer: Brighton Health Commercial	$1.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.67
Rate for Payer: EmblemHealth Commercial	$1.23
Rate for Payer: Group Health Inc Commercial	$1.23
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23
Rate for Payer: Hamaspik Choice Inc Medicare	$1.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.60

DIVALPROEX SODIUM ER 250 MG PO TB24

Facility

IP

$2.46

Service Code	NDC 0378047201
Hospital Charge Code	0378047201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23

DIVALPROEX SODIUM ER 500 MG PO TB24

Facility

OP

$4.08

Service Code	NDC 6516275750
Hospital Charge Code	6516275750
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.77
Rate for Payer: EmblemHealth Commercial	$2.04
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.65

DIVALPROEX SODIUM ER 500 MG PO TB24

Facility

IP

$4.08

Service Code	NDC 6516275750
Hospital Charge Code	6516275750
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04

DIVERTICULITIS AND DIVERTICULOSIS

Facility

OP

$168.94

Service Code	EAPG 00616
Min. Negotiated Rate	$168.94
Max. Negotiated Rate	$168.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$168.94

Diverticulitis & diverticulosis

Facility

IP

$52,448.02

Service Code	APR-DRG 2443
Min. Negotiated Rate	$11,589.00
Max. Negotiated Rate	$52,448.02
Rate for Payer: Affinity Essential Plan 1&2	$52,448.02
Rate for Payer: Affinity Essential Plan 3&4	$52,448.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,310.23
Rate for Payer: Amida Care Medicaid	$23,310.23
Rate for Payer: EmblemHealth Essential Plan 1&2	$52,448.02
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,310.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,310.23
Rate for Payer: Fidelis Qualified Health Plan	$27,972.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,310.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,310.23
Rate for Payer: Healthfirst Commercial	$20,937.00
Rate for Payer: Healthfirst Essential Plan	$52,448.02
Rate for Payer: Healthfirst QHP	$11,589.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,310.23
Rate for Payer: SOMOS Essential	$52,448.02
Rate for Payer: United Healthcare Essential Plan 1&2	$52,448.02
Rate for Payer: United Healthcare Essential Plan 3&4	$52,448.02
Rate for Payer: United Healthcare Medicaid	$23,310.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,310.23

Diverticulitis & diverticulosis

Facility

IP

$86,061.17

Service Code	APR-DRG 2444
Min. Negotiated Rate	$23,236.00
Max. Negotiated Rate	$86,061.17
Rate for Payer: Affinity Essential Plan 1&2	$86,061.17
Rate for Payer: Affinity Essential Plan 3&4	$86,061.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,249.41
Rate for Payer: Amida Care Medicaid	$38,249.41
Rate for Payer: EmblemHealth Essential Plan 1&2	$86,061.17
Rate for Payer: EmblemHealth Essential Plan 3&4	$38,249.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,249.41
Rate for Payer: Fidelis Qualified Health Plan	$45,899.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,249.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,249.41
Rate for Payer: Healthfirst Commercial	$47,285.00
Rate for Payer: Healthfirst Essential Plan	$86,061.17
Rate for Payer: Healthfirst QHP	$23,236.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,249.41
Rate for Payer: SOMOS Essential	$86,061.17
Rate for Payer: United Healthcare Essential Plan 1&2	$86,061.17
Rate for Payer: United Healthcare Essential Plan 3&4	$86,061.17
Rate for Payer: United Healthcare Medicaid	$38,249.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,249.41

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