Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC DEXAMETHASONE SODIUM PHOS, PER 1 MG

Facility

$10.40

Service Code	HCPCS J1100
Hospital Charge Code	63600138
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$9.36
Rate for Payer: Aetna Commercial	$8.84
Rate for Payer: Aetna Medicare	$5.20
Rate for Payer: Aetna New Business (MI Preferred)	$6.76
Rate for Payer: BCBS Complete	$4.16
Rate for Payer: BCBS Trust/PPO	$0.30
Rate for Payer: BCN Commercial	$0.30
Rate for Payer: Cash Price	$8.32
Rate for Payer: Cash Price	$8.32
Rate for Payer: Cofinity Commercial	$7.28
Rate for Payer: Cofinity Commercial	$8.94
Rate for Payer: Cofinity Medicare Advantage	$7.28
Rate for Payer: Encore Health Key Benefits Commercial	$8.32
Rate for Payer: Healthscope Commercial	$9.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.84
Rate for Payer: PHP Commercial	$8.84
Rate for Payer: Priority Health Cigna Priority Health	$6.76
Rate for Payer: Priority Health SBD	$6.55

HC DEXAMETHASONE SODIUM PHOS, PER 1 MG

Facility

$10.40

Service Code	HCPCS J1100
Hospital Charge Code	63600138
Hospital Revenue Code	636
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$9.36
Rate for Payer: Aetna Commercial	$8.84
Rate for Payer: Aetna New Business (MI Preferred)	$6.76
Rate for Payer: Cash Price	$8.32
Rate for Payer: Cofinity Commercial	$7.28
Rate for Payer: Cofinity Commercial	$8.94
Rate for Payer: Cofinity Medicare Advantage	$7.28
Rate for Payer: Encore Health Key Benefits Commercial	$8.32
Rate for Payer: Healthscope Commercial	$9.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.84
Rate for Payer: PHP Commercial	$8.84
Rate for Payer: Priority Health Cigna Priority Health	$6.76
Rate for Payer: Priority Health SBD	$6.55

HC DGTZ GLS MCRSCP MPHMTRC ALYS

Facility

$18.72

Service Code	CPT 0763T
Hospital Charge Code	31200021
Hospital Revenue Code	312
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare	$9.36
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: BCBS Complete	$7.49
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79
Rate for Payer: UHC Core	$7.81
Rate for Payer: UHC Exchange	$7.81

HC DGTZ GLS MCRSCP MPHMTRC ALYS

Facility

$18.72

Service Code	CPT 0763T
Hospital Charge Code	31200021
Hospital Revenue Code	312
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79

HC DGTZ GLS MCRSCP SLD LEVEL II

Facility

$18.72

Service Code	CPT 0751T
Hospital Charge Code	31200009
Hospital Revenue Code	312
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$20.95
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare	$9.36
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: BCBS Complete	$7.49
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79
Rate for Payer: UHC Core	$20.95
Rate for Payer: UHC Exchange	$20.95

HC DGTZ GLS MCRSCP SLD LEVEL II

Facility

$18.72

Service Code	CPT 0751T
Hospital Charge Code	31200009
Hospital Revenue Code	312
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79

HC DGTZ GLS MCRSCP SLD LEVEL IV

Facility

$18.72

Service Code	CPT 0753T
Hospital Charge Code	31200011
Hospital Revenue Code	312
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79

HC DGTZ GLS MCRSCP SLD LEVEL IV

Facility

$18.72

Service Code	CPT 0753T
Hospital Charge Code	31200011
Hospital Revenue Code	312
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$32.24
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare	$9.36
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: BCBS Complete	$7.49
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79
Rate for Payer: UHC Core	$32.24
Rate for Payer: UHC Exchange	$32.24

HC DGTZ GLS MCRSCP SLD LEVEL V

Facility

$37.41

Service Code	CPT 0754T
Hospital Charge Code	31200012
Hospital Revenue Code	312
Min. Negotiated Rate	$23.57
Max. Negotiated Rate	$33.67
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna New Business (MI Preferred)	$24.32
Rate for Payer: Cash Price	$29.93
Rate for Payer: Cofinity Commercial	$26.19
Rate for Payer: Cofinity Commercial	$32.17
Rate for Payer: Cofinity Medicare Advantage	$26.19
Rate for Payer: Encore Health Key Benefits Commercial	$29.93
Rate for Payer: Healthscope Commercial	$33.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.80
Rate for Payer: PHP Commercial	$31.80
Rate for Payer: Priority Health Cigna Priority Health	$24.32
Rate for Payer: Priority Health SBD	$23.57

HC DGTZ GLS MCRSCP SLD LEVEL V

Facility

$37.41

Service Code	CPT 0754T
Hospital Charge Code	31200012
Hospital Revenue Code	312
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$33.67
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna Medicare	$18.70
Rate for Payer: Aetna New Business (MI Preferred)	$24.32
Rate for Payer: BCBS Complete	$14.96
Rate for Payer: Cash Price	$29.93
Rate for Payer: Cash Price	$29.93
Rate for Payer: Cofinity Commercial	$26.19
Rate for Payer: Cofinity Commercial	$32.17
Rate for Payer: Cofinity Medicare Advantage	$26.19
Rate for Payer: Encore Health Key Benefits Commercial	$29.93
Rate for Payer: Healthscope Commercial	$33.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.80
Rate for Payer: PHP Commercial	$31.80
Rate for Payer: Priority Health Cigna Priority Health	$24.32
Rate for Payer: Priority Health SBD	$23.57
Rate for Payer: UHC Core	$28.67
Rate for Payer: UHC Exchange	$28.67

HC DGTZ GLS MCRSCP SLD LEVEL VI

Facility

$37.41

Service Code	CPT 0755T
Hospital Charge Code	31200013
Hospital Revenue Code	312
Min. Negotiated Rate	$23.57
Max. Negotiated Rate	$33.67
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna New Business (MI Preferred)	$24.32
Rate for Payer: Cash Price	$29.93
Rate for Payer: Cofinity Commercial	$26.19
Rate for Payer: Cofinity Commercial	$32.17
Rate for Payer: Cofinity Medicare Advantage	$26.19
Rate for Payer: Encore Health Key Benefits Commercial	$29.93
Rate for Payer: Healthscope Commercial	$33.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.80
Rate for Payer: PHP Commercial	$31.80
Rate for Payer: Priority Health Cigna Priority Health	$24.32
Rate for Payer: Priority Health SBD	$23.57

HC DGTZ GLS MCRSCP SLD LEVEL VI

Facility

$37.41

Service Code	CPT 0755T
Hospital Charge Code	31200013
Hospital Revenue Code	312
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$33.67
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna Medicare	$18.70
Rate for Payer: Aetna New Business (MI Preferred)	$24.32
Rate for Payer: BCBS Complete	$14.96
Rate for Payer: Cash Price	$29.93
Rate for Payer: Cash Price	$29.93
Rate for Payer: Cofinity Commercial	$26.19
Rate for Payer: Cofinity Commercial	$32.17
Rate for Payer: Cofinity Medicare Advantage	$26.19
Rate for Payer: Encore Health Key Benefits Commercial	$29.93
Rate for Payer: Healthscope Commercial	$33.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.80
Rate for Payer: PHP Commercial	$31.80
Rate for Payer: Priority Health Cigna Priority Health	$24.32
Rate for Payer: Priority Health SBD	$23.57
Rate for Payer: UHC Core	$15.67
Rate for Payer: UHC Exchange	$15.67

HC DGTZ GLS MCRSCP SLD LVL III

Facility

$18.72

Service Code	CPT 0752T
Hospital Charge Code	31200010
Hospital Revenue Code	312
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79

HC DGTZ GLS MCRSCP SLD LVL III

Facility

$18.72

Service Code	CPT 0752T
Hospital Charge Code	31200010
Hospital Revenue Code	312
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare	$9.36
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: BCBS Complete	$7.49
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79
Rate for Payer: UHC Core	$10.19
Rate for Payer: UHC Exchange	$10.19

HC DGTZ GLS MCRSCP SLD SPC GRPI

Facility

$18.72

Service Code	CPT 0756T
Hospital Charge Code	31200014
Hospital Revenue Code	312
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$29.22
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare	$9.36
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: BCBS Complete	$7.49
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79
Rate for Payer: UHC Core	$29.22
Rate for Payer: UHC Exchange	$29.22

HC DGTZ GLS MCRSCP SLD SPC GRPI

Facility

$18.72

Service Code	CPT 0756T
Hospital Charge Code	31200014
Hospital Revenue Code	312
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79

HC DGTZ GLS MCRSCP SL IMM 1ST

Facility

$18.72

Service Code	CPT 0760T
Hospital Charge Code	31200018
Hospital Revenue Code	312
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79

HC DGTZ GLS MCRSCP SL IMM 1ST

Facility

$18.72

Service Code	CPT 0760T
Hospital Charge Code	31200018
Hospital Revenue Code	312
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$18.25
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare	$9.36
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: BCBS Complete	$7.49
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79
Rate for Payer: UHC Core	$18.25
Rate for Payer: UHC Exchange	$18.25

HC DGTZ GLS MCRSCP SL IMM EA 1

Facility

$18.72

Service Code	CPT 0761T
Hospital Charge Code	31200019
Hospital Revenue Code	312
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79

HC DGTZ GLS MCRSCP SL IMM EA 1

Facility

$18.72

Service Code	CPT 0761T
Hospital Charge Code	31200019
Hospital Revenue Code	312
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$24.01
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare	$9.36
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: BCBS Complete	$7.49
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79
Rate for Payer: UHC Core	$24.01
Rate for Payer: UHC Exchange	$24.01

HC DGTZ GLS MCRSCP SL IMM EA M

Facility

$18.72

Service Code	CPT 0762T
Hospital Charge Code	31200020
Hospital Revenue Code	312
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$21.54
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare	$9.36
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: BCBS Complete	$7.49
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79
Rate for Payer: UHC Core	$21.54
Rate for Payer: UHC Exchange	$21.54

HC DGTZ GLS MCRSCP SL IMM EA M

Facility

$18.72

Service Code	CPT 0762T
Hospital Charge Code	31200020
Hospital Revenue Code	312
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79

HC DGTZ GLS MCRSCP SL SPC GRPII

Facility

$18.72

Service Code	CPT 0757T
Hospital Charge Code	31200015
Hospital Revenue Code	312
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79

HC DGTZ GLS MCRSCP SL SPC GRPII

Facility

$18.72

Service Code	CPT 0757T
Hospital Charge Code	31200015
Hospital Revenue Code	312
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$42.59
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare	$9.36
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: BCBS Complete	$7.49
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79
Rate for Payer: UHC Core	$42.59
Rate for Payer: UHC Exchange	$42.59

HC DGTZ GLS MCRSCP SL SPC HCHEM

Facility

$18.72

Service Code	CPT 0758T
Hospital Charge Code	31200016
Hospital Revenue Code	312
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$42.91
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare	$9.36
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: BCBS Complete	$7.49
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Cofinity Medicare Advantage	$13.10
Rate for Payer: Encore Health Key Benefits Commercial	$14.98
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$12.17
Rate for Payer: Priority Health SBD	$11.79
Rate for Payer: UHC Core	$42.91
Rate for Payer: UHC Exchange	$42.91

Know your out-of-pocket cost for care.

All Charges