Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHG X-RAY ABDOMEN 1 VW

Professional

Both

$36.00

Service Code	HCPCS 74000
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.15
Rate for Payer: Priority Health Cigna Priority Health	$20.15
Rate for Payer: Priority Health Cigna Priority Health	$23.40

CHG X-RAY ABDOMEN 2 VW

Professional

Both

$53.00

Service Code	HCPCS 74020
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$34.45
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: Cash Price	$42.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.45
Rate for Payer: Priority Health Cigna Priority Health	$34.45

CHG X-RAY FEMUR 2 VW

Professional

Both

$38.00

Service Code	HCPCS 73550
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Medicare	$19.00
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: Aetna Medicare	$15.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Complete	$37.60
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$30.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.10
Rate for Payer: Priority Health Cigna Priority Health	$24.70
Rate for Payer: Priority Health Cigna Priority Health	$19.50
Rate for Payer: Priority Health Cigna Priority Health	$61.10

CHG X-RAY HIPS 4 VW + PELVIS

Professional

Both

$47.00

Service Code	HCPCS 73520
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$30.55
Rate for Payer: Aetna Medicare	$23.50
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$37.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.10
Rate for Payer: Priority Health Cigna Priority Health	$35.10
Rate for Payer: Priority Health Cigna Priority Health	$78.65
Rate for Payer: Priority Health Cigna Priority Health	$30.55

CHG X-RAY HIP UNI 2+ VW

Professional

Both

$100.00

Service Code	HCPCS 73510
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Medicare	$50.00
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$43.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.05
Rate for Payer: Priority Health Cigna Priority Health	$24.05
Rate for Payer: Priority Health Cigna Priority Health	$65.00
Rate for Payer: Priority Health Cigna Priority Health	$35.10

CHG X-RAY HIP UNILAT 1 VW

Professional

Both

$31.00

Service Code	HCPCS 73500
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: Aetna Medicare	$50.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$24.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.00
Rate for Payer: Priority Health Cigna Priority Health	$65.00
Rate for Payer: Priority Health Cigna Priority Health	$20.15

CHG X-RAY PELVIS/HIPS CHILD/INFANT

Professional

Both

$35.00

Service Code	HCPCS 73540
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$22.75
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: Aetna Medicare	$48.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Complete	$38.80
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$77.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.75
Rate for Payer: Priority Health Cigna Priority Health	$22.75
Rate for Payer: Priority Health Cigna Priority Health	$63.05

CHG X-RAY SPINE SURVEY

Professional

Both

$73.00

Service Code	HCPCS 72010
Min. Negotiated Rate	$29.20
Max. Negotiated Rate	$47.45
Rate for Payer: Aetna Medicare	$36.50
Rate for Payer: BCBS Complete	$29.20
Rate for Payer: Cash Price	$58.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.45
Rate for Payer: Priority Health Cigna Priority Health	$47.45

CHG X-RAY THOR-LUMB SP SCOLIOSIS

Professional

Both

$71.00

Service Code	HCPCS 72090
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$46.15
Rate for Payer: Aetna Medicare	$35.50
Rate for Payer: Aetna Medicare	$50.00
Rate for Payer: Aetna Medicare	$66.50
Rate for Payer: BCBS Complete	$28.40
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Complete	$53.20
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cash Price	$80.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.15
Rate for Payer: Priority Health Cigna Priority Health	$86.45
Rate for Payer: Priority Health Cigna Priority Health	$46.15
Rate for Payer: Priority Health Cigna Priority Health	$65.00

CHG X-RAY TRUNK SPINE SCOLIOSIS

Professional

Both

$60.00

Service Code	HCPCS 72069
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Medicare	$30.00
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.00
Rate for Payer: Priority Health Cigna Priority Health	$39.00
Rate for Payer: Priority Health Cigna Priority Health	$29.25

CHLORDIAZEPOXIDE 10 MG CAPSULE

Facility

$4.36

Service Code	NDC 51079037501
Hospital Charge Code	1622
Hospital Revenue Code	637
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$3.71
Rate for Payer: Aetna Medicare	$2.18
Rate for Payer: Aetna New Business (MI Preferred)	$2.83
Rate for Payer: BCBS Complete	$1.74
Rate for Payer: Cash Price	$3.49
Rate for Payer: Cofinity Commercial	$3.05
Rate for Payer: Cofinity Commercial	$3.75
Rate for Payer: Cofinity Medicare Advantage	$3.05
Rate for Payer: Encore Health Key Benefits Commercial	$3.49
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.71
Rate for Payer: PHP Commercial	$3.71
Rate for Payer: Priority Health Cigna Priority Health	$2.83
Rate for Payer: Priority Health SBD	$2.75

CHLORDIAZEPOXIDE 10 MG CAPSULE

Facility

$435.10

Service Code	NDC 51079037520
Hospital Charge Code	1622
Hospital Revenue Code	637
Min. Negotiated Rate	$174.04
Max. Negotiated Rate	$391.59
Rate for Payer: Aetna Commercial	$369.84
Rate for Payer: Aetna Medicare	$217.55
Rate for Payer: Aetna New Business (MI Preferred)	$282.82
Rate for Payer: BCBS Complete	$174.04
Rate for Payer: Cash Price	$348.08
Rate for Payer: Cofinity Commercial	$304.57
Rate for Payer: Cofinity Commercial	$374.19
Rate for Payer: Cofinity Medicare Advantage	$304.57
Rate for Payer: Encore Health Key Benefits Commercial	$348.08
Rate for Payer: Healthscope Commercial	$391.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$369.84
Rate for Payer: PHP Commercial	$369.84
Rate for Payer: Priority Health Cigna Priority Health	$282.82
Rate for Payer: Priority Health SBD	$274.11

CHLORDIAZEPOXIDE 10 MG CAPSULE

Facility

$286.70

Service Code	NDC 00555003302
Hospital Charge Code	1622
Hospital Revenue Code	637
Min. Negotiated Rate	$180.62
Max. Negotiated Rate	$258.03
Rate for Payer: Aetna Commercial	$243.70
Rate for Payer: Aetna New Business (MI Preferred)	$186.36
Rate for Payer: Cash Price	$229.36
Rate for Payer: Cofinity Commercial	$200.69
Rate for Payer: Cofinity Commercial	$246.56
Rate for Payer: Cofinity Medicare Advantage	$200.69
Rate for Payer: Encore Health Key Benefits Commercial	$229.36
Rate for Payer: Healthscope Commercial	$258.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.70
Rate for Payer: PHP Commercial	$243.70
Rate for Payer: Priority Health Cigna Priority Health	$186.36
Rate for Payer: Priority Health SBD	$180.62

CHLORDIAZEPOXIDE 10 MG CAPSULE

Facility

$4.36

Service Code	NDC 51079037501
Hospital Charge Code	1622
Hospital Revenue Code	637
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$3.71
Rate for Payer: Aetna New Business (MI Preferred)	$2.83
Rate for Payer: Cash Price	$3.49
Rate for Payer: Cofinity Commercial	$3.05
Rate for Payer: Cofinity Commercial	$3.75
Rate for Payer: Cofinity Medicare Advantage	$3.05
Rate for Payer: Encore Health Key Benefits Commercial	$3.49
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.71
Rate for Payer: PHP Commercial	$3.71
Rate for Payer: Priority Health Cigna Priority Health	$2.83
Rate for Payer: Priority Health SBD	$2.75

CHLORDIAZEPOXIDE 10 MG CAPSULE

Facility

$286.70

Service Code	NDC 00555003302
Hospital Charge Code	1622
Hospital Revenue Code	637
Min. Negotiated Rate	$114.68
Max. Negotiated Rate	$258.03
Rate for Payer: Aetna Commercial	$243.70
Rate for Payer: Aetna Medicare	$143.35
Rate for Payer: Aetna New Business (MI Preferred)	$186.36
Rate for Payer: BCBS Complete	$114.68
Rate for Payer: Cash Price	$229.36
Rate for Payer: Cofinity Commercial	$200.69
Rate for Payer: Cofinity Commercial	$246.56
Rate for Payer: Cofinity Medicare Advantage	$200.69
Rate for Payer: Encore Health Key Benefits Commercial	$229.36
Rate for Payer: Healthscope Commercial	$258.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.70
Rate for Payer: PHP Commercial	$243.70
Rate for Payer: Priority Health Cigna Priority Health	$186.36
Rate for Payer: Priority Health SBD	$180.62

CHLORDIAZEPOXIDE 10 MG CAPSULE

Facility

$435.10

Service Code	NDC 51079037520
Hospital Charge Code	1622
Hospital Revenue Code	637
Min. Negotiated Rate	$274.11
Max. Negotiated Rate	$391.59
Rate for Payer: Aetna Commercial	$369.84
Rate for Payer: Aetna New Business (MI Preferred)	$282.82
Rate for Payer: Cash Price	$348.08
Rate for Payer: Cofinity Commercial	$304.57
Rate for Payer: Cofinity Commercial	$374.19
Rate for Payer: Cofinity Medicare Advantage	$304.57
Rate for Payer: Encore Health Key Benefits Commercial	$348.08
Rate for Payer: Healthscope Commercial	$391.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$369.84
Rate for Payer: PHP Commercial	$369.84
Rate for Payer: Priority Health Cigna Priority Health	$282.82
Rate for Payer: Priority Health SBD	$274.11

CHLORDIAZEPOXIDE 25 MG CAPSULE

Facility

$354.85

Service Code	NDC 00555015902
Hospital Charge Code	1623
Hospital Revenue Code	637
Min. Negotiated Rate	$141.94
Max. Negotiated Rate	$319.36
Rate for Payer: Aetna Commercial	$301.62
Rate for Payer: Aetna Medicare	$177.42
Rate for Payer: Aetna New Business (MI Preferred)	$230.65
Rate for Payer: BCBS Complete	$141.94
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Commercial	$248.40
Rate for Payer: Cofinity Commercial	$305.17
Rate for Payer: Cofinity Medicare Advantage	$248.40
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$319.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: PHP Commercial	$301.62
Rate for Payer: Priority Health Cigna Priority Health	$230.65
Rate for Payer: Priority Health SBD	$223.56

CHLORDIAZEPOXIDE 25 MG CAPSULE

Facility

$1,527.50

Service Code	NDC 00555015904
Hospital Charge Code	1623
Hospital Revenue Code	637
Min. Negotiated Rate	$962.32
Max. Negotiated Rate	$1,374.75
Rate for Payer: Aetna Commercial	$1,298.38
Rate for Payer: Aetna New Business (MI Preferred)	$992.88
Rate for Payer: Cash Price	$1,222.00
Rate for Payer: Cofinity Commercial	$1,069.25
Rate for Payer: Cofinity Commercial	$1,313.65
Rate for Payer: Cofinity Medicare Advantage	$1,069.25
Rate for Payer: Encore Health Key Benefits Commercial	$1,222.00
Rate for Payer: Healthscope Commercial	$1,374.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,298.38
Rate for Payer: PHP Commercial	$1,298.38
Rate for Payer: Priority Health Cigna Priority Health	$992.88
Rate for Payer: Priority Health SBD	$962.32

CHLORDIAZEPOXIDE 25 MG CAPSULE

Facility

$1,527.50

Service Code	NDC 00555015904
Hospital Charge Code	1623
Hospital Revenue Code	637
Min. Negotiated Rate	$611.00
Max. Negotiated Rate	$1,374.75
Rate for Payer: Aetna Commercial	$1,298.38
Rate for Payer: Aetna Medicare	$763.75
Rate for Payer: Aetna New Business (MI Preferred)	$992.88
Rate for Payer: BCBS Complete	$611.00
Rate for Payer: Cash Price	$1,222.00
Rate for Payer: Cofinity Commercial	$1,069.25
Rate for Payer: Cofinity Commercial	$1,313.65
Rate for Payer: Cofinity Medicare Advantage	$1,069.25
Rate for Payer: Encore Health Key Benefits Commercial	$1,222.00
Rate for Payer: Healthscope Commercial	$1,374.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,298.38
Rate for Payer: PHP Commercial	$1,298.38
Rate for Payer: Priority Health Cigna Priority Health	$992.88
Rate for Payer: Priority Health SBD	$962.32

CHLORDIAZEPOXIDE 25 MG CAPSULE

Facility

$354.85

Service Code	NDC 00555015902
Hospital Charge Code	1623
Hospital Revenue Code	637
Min. Negotiated Rate	$223.56
Max. Negotiated Rate	$319.36
Rate for Payer: Aetna Commercial	$301.62
Rate for Payer: Aetna New Business (MI Preferred)	$230.65
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Commercial	$305.17
Rate for Payer: Cofinity Commercial	$248.40
Rate for Payer: Cofinity Medicare Advantage	$248.40
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$319.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: PHP Commercial	$301.62
Rate for Payer: Priority Health Cigna Priority Health	$230.65
Rate for Payer: Priority Health SBD	$223.56

CHLORDIAZEPOXIDE 5 MG CAPSULE

Facility

$406.55

Service Code	NDC 00555015802
Hospital Charge Code	1624
Hospital Revenue Code	637
Min. Negotiated Rate	$256.13
Max. Negotiated Rate	$365.90
Rate for Payer: Aetna Commercial	$345.57
Rate for Payer: Aetna New Business (MI Preferred)	$264.26
Rate for Payer: Cash Price	$325.24
Rate for Payer: Cofinity Commercial	$284.58
Rate for Payer: Cofinity Commercial	$349.63
Rate for Payer: Cofinity Medicare Advantage	$284.58
Rate for Payer: Encore Health Key Benefits Commercial	$325.24
Rate for Payer: Healthscope Commercial	$365.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.57
Rate for Payer: PHP Commercial	$345.57
Rate for Payer: Priority Health Cigna Priority Health	$264.26
Rate for Payer: Priority Health SBD	$256.13

CHLORDIAZEPOXIDE 5 MG CAPSULE

Facility

$406.55

Service Code	NDC 00555015802
Hospital Charge Code	1624
Hospital Revenue Code	637
Min. Negotiated Rate	$162.62
Max. Negotiated Rate	$365.90
Rate for Payer: Aetna Commercial	$345.57
Rate for Payer: Aetna Medicare	$203.28
Rate for Payer: Aetna New Business (MI Preferred)	$264.26
Rate for Payer: BCBS Complete	$162.62
Rate for Payer: Cash Price	$325.24
Rate for Payer: Cofinity Commercial	$284.58
Rate for Payer: Cofinity Commercial	$349.63
Rate for Payer: Cofinity Medicare Advantage	$284.58
Rate for Payer: Encore Health Key Benefits Commercial	$325.24
Rate for Payer: Healthscope Commercial	$365.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.57
Rate for Payer: PHP Commercial	$345.57
Rate for Payer: Priority Health Cigna Priority Health	$264.26
Rate for Payer: Priority Health SBD	$256.13

CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH

Facility

$27.15

Service Code	NDC 69339013817
Hospital Charge Code	9516
Hospital Revenue Code	637
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$24.44
Rate for Payer: Aetna Commercial	$23.08
Rate for Payer: Aetna New Business (MI Preferred)	$17.65
Rate for Payer: Cash Price	$21.72
Rate for Payer: Cofinity Commercial	$19.00
Rate for Payer: Cofinity Commercial	$23.35
Rate for Payer: Cofinity Medicare Advantage	$19.00
Rate for Payer: Encore Health Key Benefits Commercial	$21.72
Rate for Payer: Healthscope Commercial	$24.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.08
Rate for Payer: PHP Commercial	$23.08
Rate for Payer: Priority Health Cigna Priority Health	$17.65
Rate for Payer: Priority Health SBD	$17.10

CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH

Facility

$3.88

Service Code	NDC 09900000023
Hospital Charge Code	9516
Hospital Revenue Code	637
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$3.49
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna Medicare	$1.94
Rate for Payer: Aetna New Business (MI Preferred)	$2.52
Rate for Payer: BCBS Complete	$1.55
Rate for Payer: Cash Price	$3.10
Rate for Payer: Cofinity Commercial	$2.72
Rate for Payer: Cofinity Commercial	$3.34
Rate for Payer: Cofinity Medicare Advantage	$2.72
Rate for Payer: Encore Health Key Benefits Commercial	$3.10
Rate for Payer: Healthscope Commercial	$3.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.30
Rate for Payer: PHP Commercial	$3.30
Rate for Payer: Priority Health Cigna Priority Health	$2.52
Rate for Payer: Priority Health SBD	$2.44

CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH

Facility

$27.15

Service Code	NDC 69339013815
Hospital Charge Code	9516
Hospital Revenue Code	637
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$24.44
Rate for Payer: Aetna Commercial	$23.08
Rate for Payer: Aetna New Business (MI Preferred)	$17.65
Rate for Payer: Cash Price	$21.72
Rate for Payer: Cofinity Commercial	$19.00
Rate for Payer: Cofinity Commercial	$23.35
Rate for Payer: Cofinity Medicare Advantage	$19.00
Rate for Payer: Encore Health Key Benefits Commercial	$21.72
Rate for Payer: Healthscope Commercial	$24.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.08
Rate for Payer: PHP Commercial	$23.08
Rate for Payer: Priority Health Cigna Priority Health	$17.65
Rate for Payer: Priority Health SBD	$17.10

Know your out-of-pocket cost for care.

All Charges