St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DISTAL SPACER 12MM

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	64904611
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.75
Rate for Payer: EmblemHealth Commercial	$225.00
Rate for Payer: Fidelis Medicare Advantage	$472.50
Rate for Payer: Group Health Inc Commercial	$225.00
Rate for Payer: Group Health Inc Medicare	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.50

DISTAL SPACER 12MM

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	64904611
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00

DISTILLED WATER 1000CC

Facility

$9.22

Hospital Charge Code	40505000
Hospital Revenue Code	270
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$7.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$6.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.27
Rate for Payer: Group Health Inc Commercial	$4.61
Rate for Payer: Group Health Inc Medicare	$3.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.61
Rate for Payer: Hamaspik Choice Inc Medicare	$4.61

DISTILLED WATER 250CC

Facility

$6.73

Hospital Charge Code	40505002
Hospital Revenue Code	260
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.58
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36
Rate for Payer: United Healthcare Commercial	$76.00

DISTILLED WATER 500 CC

Facility

$7.44

Hospital Charge Code	40505001
Hospital Revenue Code	270
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$5.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.72
Rate for Payer: Aetna Government	$3.72
Rate for Payer: Brighton Health Commercial	$5.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.06
Rate for Payer: Group Health Inc Commercial	$3.72
Rate for Payer: Group Health Inc Medicare	$2.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.72
Rate for Payer: Hamaspik Choice Inc Medicare	$3.72

DIST NEURO PERIPH NERVE

Facility

$2,459.50

Service Code	HCPCS 64640
Hospital Charge Code	30305728
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Affinity Essential Plan 1&2	$737.84
Rate for Payer: Affinity Essential Plan 3&4	$737.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$737.84
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: Humana Medicare	$1,075.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

DIST NEURO PERIPH NERVE

Facility

$2,459.50

Service Code	HCPCS 64640
Hospital Charge Code	30305728
Hospital Revenue Code	510
Rate for Payer: Cash Price	$1,054.06

DISTRACTOR M/T TRIAX DYN TB

Facility

$4,598.75

Hospital Charge Code	64904095
Hospital Revenue Code	270
Min. Negotiated Rate	$1,609.56
Max. Negotiated Rate	$3,679.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,529.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,299.38
Rate for Payer: Aetna Government	$2,299.38
Rate for Payer: Brighton Health Commercial	$3,449.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,679.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,127.15
Rate for Payer: Group Health Inc Commercial	$2,299.38
Rate for Payer: Group Health Inc Medicare	$1,609.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,299.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,299.38

DIST WEDGE 15MM SZ6

Facility

$3,900.00

Hospital Charge Code	64903972
Hospital Revenue Code	270
Min. Negotiated Rate	$1,365.00
Max. Negotiated Rate	$3,120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,950.00
Rate for Payer: Aetna Government	$1,950.00
Rate for Payer: Brighton Health Commercial	$2,925.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,652.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

DIVALPROEX 125 MG SPRINKLES DRC

Facility

$0.97

Hospital Charge Code	41641240
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.66
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.63

DIVALPROEX 125 MG SPRINKLES DRC

Facility

$0.97

Hospital Charge Code	41651240
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.66
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.63

DIVALPROEX 250MG DR TAB

Facility

$0.03

Hospital Charge Code	41657997
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

DIVALPROEX 250MG DR TAB

Facility

$0.03

Hospital Charge Code	41647997
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

DIVALPROEX 250 MG ERT

Facility

$0.52

Hospital Charge Code	41653118
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

DIVALPROEX 250 MG ERT

Facility

$0.52

Hospital Charge Code	41643118
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

DIVALPROEX 500MG DR TAB

Facility

$0.18

Hospital Charge Code	41647995
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

DIVALPROEX 500MG DR TAB

Facility

$0.18

Hospital Charge Code	41657995
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

DIVALPROEX 500 MG ERT

Facility

$1.00

Hospital Charge Code	41643119
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

DIVALPROEX 500 MG ERT

Facility

$1.00

Hospital Charge Code	41653119
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

DIVALPROEX SODIUM 125 MG PO CSDR [131636]

Facility

$2.24

Service Code	NDC 00074611413
Hospital Charge Code	00074611413
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Brighton Health Commercial	$1.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.52
Rate for Payer: Group Health Inc Commercial	$1.12
Rate for Payer: Group Health Inc Medicare	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.46

DIVALPROEX SODIUM 125 MG PO CSDR [131636]

Facility

$1.07

Service Code	NDC 00904661561
Hospital Charge Code	00904661561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.54
Rate for Payer: Aetna Government	$0.54
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.70

DIVALPROEX SODIUM 125 MG PO CSDR [131636]

Facility

$1.42

Service Code	NDC 68084031301
Hospital Charge Code	68084031301
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	$1.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.96
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 125 MG PO CSDR [131636]

Facility

$1.42

Service Code	NDC 68084031311
Hospital Charge Code	68084031311
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	$1.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
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 125 MG PO CSDR [131636]

Facility

$1.12

Service Code	NDC 55111053201
Hospital Charge Code	55111053201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.56
Rate for Payer: Aetna Government	$0.56
Rate for Payer: Brighton Health Commercial	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.76
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.73

DIVALPROEX SODIUM 125 MG PO CSDR [131636]

Facility

$1.12

Service Code	NDC 68382010601
Hospital Charge Code	68382010601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.56
Rate for Payer: Aetna Government	$0.56
Rate for Payer: Brighton Health Commercial	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.76
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.73

Know your out-of-pocket cost for care.

All Charges