Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION

Professional

Both

$44.00

Service Code	HCPCS 76376
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$1,774.03
Rate for Payer: Aetna Commercial	$27.49
Rate for Payer: Aetna Commercial	$27.49
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Trust/PPO	$1,774.03
Rate for Payer: BCBS Trust/PPO	$1,774.03
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$35.20
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.34
Rate for Payer: Priority Health Narrow Network	$14.34
Rate for Payer: Priority Health Narrow Network	$14.34
Rate for Payer: Priority Health SBD	$36.88
Rate for Payer: Priority Health SBD	$36.88

CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING

Professional

Both

$673.00

Service Code	HCPCS 78278
Min. Negotiated Rate	$70.17
Max. Negotiated Rate	$674.64
Rate for Payer: Aetna Commercial	$394.55
Rate for Payer: BCBS Complete	$269.20
Rate for Payer: BCBS Trust/PPO	$674.64
Rate for Payer: Cash Price	$538.40
Rate for Payer: Cash Price	$538.40
Rate for Payer: Priority Health Cigna Priority Health	$471.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.17
Rate for Payer: Priority Health Narrow Network	$70.17
Rate for Payer: Priority Health SBD	$497.82

CHG ANGIO ARCH ANGIOGRAM W CATH

Professional

Both

$262.00

Service Code	HCPCS 75650
Min. Negotiated Rate	$104.80
Max. Negotiated Rate	$183.40
Rate for Payer: BCBS Complete	$104.80
Rate for Payer: Cash Price	$209.60
Rate for Payer: Priority Health Cigna Priority Health	$183.40

CHG ANGIO AV SHUNT COMPLETE EVAL

Professional

Both

$302.00

Service Code	HCPCS 75791
Min. Negotiated Rate	$120.80
Max. Negotiated Rate	$211.40
Rate for Payer: BCBS Complete	$120.80
Rate for Payer: BCBS Complete	$198.80
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cash Price	$397.60
Rate for Payer: Priority Health Cigna Priority Health	$347.90
Rate for Payer: Priority Health Cigna Priority Health	$211.40

CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I

Professional

Both

$194.00

Service Code	HCPCS 75716
Min. Negotiated Rate	$77.60
Max. Negotiated Rate	$248.91
Rate for Payer: Aetna Commercial	$198.34
Rate for Payer: BCBS Complete	$77.60
Rate for Payer: BCBS Trust/PPO	$112.00
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Priority Health Cigna Priority Health	$135.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$110.12
Rate for Payer: Priority Health Narrow Network	$110.12
Rate for Payer: Priority Health SBD	$248.91

CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I

Professional

Both

$422.00

Service Code	HCPCS 75710
Min. Negotiated Rate	$106.02
Max. Negotiated Rate	$295.40
Rate for Payer: Aetna Commercial	$184.17
Rate for Payer: Aetna Commercial	$184.17
Rate for Payer: BCBS Complete	$71.20
Rate for Payer: BCBS Complete	$168.80
Rate for Payer: BCBS Trust/PPO	$183.32
Rate for Payer: BCBS Trust/PPO	$183.32
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cash Price	$142.40
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cash Price	$142.40
Rate for Payer: Priority Health Cigna Priority Health	$124.60
Rate for Payer: Priority Health Cigna Priority Health	$295.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$106.02
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$106.02
Rate for Payer: Priority Health Narrow Network	$106.02
Rate for Payer: Priority Health Narrow Network	$106.02
Rate for Payer: Priority Health SBD	$230.47
Rate for Payer: Priority Health SBD	$230.47

CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I

Professional

Both

$186.00

Service Code	HCPCS 75756
Min. Negotiated Rate	$74.40
Max. Negotiated Rate	$247.88
Rate for Payer: Aetna Commercial	$184.66
Rate for Payer: BCBS Complete	$74.40
Rate for Payer: BCBS Trust/PPO	$177.51
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Priority Health Cigna Priority Health	$130.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$83.49
Rate for Payer: Priority Health Narrow Network	$83.49
Rate for Payer: Priority Health SBD	$247.88

CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I

Professional

Both

$313.00

Service Code	HCPCS 75736
Min. Negotiated Rate	$79.39
Max. Negotiated Rate	$219.21
Rate for Payer: Aetna Commercial	$167.44
Rate for Payer: BCBS Complete	$125.20
Rate for Payer: BCBS Trust/PPO	$182.79
Rate for Payer: Cash Price	$250.40
Rate for Payer: Cash Price	$250.40
Rate for Payer: Priority Health Cigna Priority Health	$219.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$79.39
Rate for Payer: Priority Health Narrow Network	$79.39
Rate for Payer: Priority Health SBD	$219.21

CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I

Professional

Both

$123.00

Service Code	HCPCS 75741
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$200.77
Rate for Payer: Aetna Commercial	$158.51
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: BCBS Trust/PPO	$104.08
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Priority Health Cigna Priority Health	$86.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$91.68
Rate for Payer: Priority Health Narrow Network	$91.68
Rate for Payer: Priority Health SBD	$200.77

CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I

Professional

Both

$427.00

Service Code	HCPCS 75705
Min. Negotiated Rate	$162.19
Max. Negotiated Rate	$381.05
Rate for Payer: Aetna Commercial	$287.69
Rate for Payer: BCBS Complete	$170.80
Rate for Payer: BCBS Trust/PPO	$162.19
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cash Price	$341.60
Rate for Payer: Priority Health Cigna Priority Health	$298.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$176.18
Rate for Payer: Priority Health Narrow Network	$176.18
Rate for Payer: Priority Health SBD	$381.05

CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I

Professional

Both

$268.00

Service Code	HCPCS 75726
Min. Negotiated Rate	$107.20
Max. Negotiated Rate	$262.74
Rate for Payer: Aetna Commercial	$206.42
Rate for Payer: BCBS Complete	$107.20
Rate for Payer: BCBS Trust/PPO	$145.81
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cash Price	$214.40
Rate for Payer: Priority Health Cigna Priority Health	$187.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$119.34
Rate for Payer: Priority Health Narrow Network	$119.34
Rate for Payer: Priority Health SBD	$262.74

CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS

Professional

Both

$159.00

Service Code	HCPCS 75898
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$3,164.58
Rate for Payer: Aetna Commercial	$3,164.58
Rate for Payer: BCBS Complete	$63.60
Rate for Payer: BCBS Trust/PPO	$328.07
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Priority Health Cigna Priority Health	$111.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.60
Rate for Payer: Priority Health Narrow Network	$67.60
Rate for Payer: Priority Health SBD	$204.36

CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I

Professional

Both

$296.00

Service Code	HCPCS 75774
Min. Negotiated Rate	$70.17
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna Commercial	$120.01
Rate for Payer: BCBS Complete	$118.40
Rate for Payer: BCBS Trust/PPO	$186.49
Rate for Payer: Cash Price	$236.80
Rate for Payer: Cash Price	$236.80
Rate for Payer: Priority Health Cigna Priority Health	$207.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.17
Rate for Payer: Priority Health Narrow Network	$70.17
Rate for Payer: Priority Health SBD	$149.04

CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I

Professional

Both

$466.00

Service Code	HCPCS 75630
Min. Negotiated Rate	$98.84
Max. Negotiated Rate	$326.20
Rate for Payer: Aetna Commercial	$192.70
Rate for Payer: Aetna Commercial	$192.70
Rate for Payer: BCBS Complete	$114.80
Rate for Payer: BCBS Complete	$186.40
Rate for Payer: BCBS Trust/PPO	$166.41
Rate for Payer: BCBS Trust/PPO	$166.41
Rate for Payer: Cash Price	$372.80
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$372.80
Rate for Payer: Priority Health Cigna Priority Health	$326.20
Rate for Payer: Priority Health Cigna Priority Health	$200.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$98.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$98.84
Rate for Payer: Priority Health Narrow Network	$98.84
Rate for Payer: Priority Health Narrow Network	$98.84
Rate for Payer: Priority Health SBD	$240.21
Rate for Payer: Priority Health SBD	$240.21

CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I

Professional

Both

$113.00

Service Code	HCPCS 75625
Min. Negotiated Rate	$45.20
Max. Negotiated Rate	$193.59
Rate for Payer: Aetna Commercial	$155.85
Rate for Payer: Aetna Commercial	$155.85
Rate for Payer: BCBS Complete	$45.20
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: BCBS Trust/PPO	$133.13
Rate for Payer: BCBS Trust/PPO	$133.13
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$90.40
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health Cigna Priority Health	$79.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$92.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$92.19
Rate for Payer: Priority Health Narrow Network	$92.19
Rate for Payer: Priority Health Narrow Network	$92.19
Rate for Payer: Priority Health SBD	$193.59
Rate for Payer: Priority Health SBD	$193.59

CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I

Professional

Both

$260.00

Service Code	HCPCS 75605
Min. Negotiated Rate	$80.41
Max. Negotiated Rate	$184.89
Rate for Payer: Aetna Commercial	$145.70
Rate for Payer: BCBS Complete	$104.00
Rate for Payer: BCBS Trust/PPO	$157.43
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Priority Health Cigna Priority Health	$182.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.41
Rate for Payer: Priority Health Narrow Network	$80.41
Rate for Payer: Priority Health SBD	$184.89

CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I

Professional

Both

$105.00

Service Code	HCPCS 75600
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$283.75
Rate for Payer: Aetna Commercial	$227.46
Rate for Payer: BCBS Complete	$42.00
Rate for Payer: BCBS Trust/PPO	$114.11
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Priority Health Cigna Priority Health	$73.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.85
Rate for Payer: Priority Health Narrow Network	$35.85
Rate for Payer: Priority Health SBD	$283.75

CHG ASSAY OF LEAD

Professional

Both

$20.00

Service Code	HCPCS 83655
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$365.58
Rate for Payer: Aetna Commercial	$11.50
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$365.58
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.65
Rate for Payer: Priority Health Narrow Network	$12.65
Rate for Payer: Priority Health SBD	$12.65

CHG ASSAY OF PHOSPHATASE ALKALINE

Professional

Both

$12.00

Service Code	HCPCS 84075
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$1,760.30
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: BCBS Trust/PPO	$1,760.30
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.27
Rate for Payer: Priority Health Narrow Network	$5.27
Rate for Payer: Priority Health SBD	$5.27

CHG ASSAY OF PROGESTERONE

Professional

Both

$92.00

Service Code	HCPCS 84144
Min. Negotiated Rate	$19.82
Max. Negotiated Rate	$2,469.80
Rate for Payer: Aetna Commercial	$19.82
Rate for Payer: BCBS Complete	$36.80
Rate for Payer: BCBS Trust/PPO	$2,469.80
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Priority Health Cigna Priority Health	$64.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$21.79
Rate for Payer: Priority Health Narrow Network	$21.79
Rate for Payer: Priority Health SBD	$21.79

CHG ASSAY OF PYRUVATE KINASE

Professional

Both

$93.00

Service Code	HCPCS 84220
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$2,574.93
Rate for Payer: Aetna Commercial	$8.97
Rate for Payer: BCBS Complete	$37.20
Rate for Payer: BCBS Trust/PPO	$2,574.93
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cash Price	$74.40
Rate for Payer: Priority Health Cigna Priority Health	$65.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9.84
Rate for Payer: Priority Health Narrow Network	$9.84
Rate for Payer: Priority Health SBD	$9.84

CHG ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE

Professional

Both

$78.00

Service Code	HCPCS 84588
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$4,901.57
Rate for Payer: Aetna Commercial	$32.24
Rate for Payer: BCBS Complete	$31.20
Rate for Payer: BCBS Trust/PPO	$4,901.57
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.15
Rate for Payer: Priority Health Narrow Network	$35.15
Rate for Payer: Priority Health SBD	$35.15

CHG BALLOON ANGIOPLASTY VISCERAL

Professional

Both

$157.00

Service Code	HCPCS 75966
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$109.90
Rate for Payer: BCBS Complete	$62.80
Rate for Payer: Cash Price	$125.60
Rate for Payer: Priority Health Cigna Priority Health	$109.90

CHG BALLOON ANGIO VENOUS

Professional

Both

$389.00

Service Code	HCPCS 75978
Min. Negotiated Rate	$155.60
Max. Negotiated Rate	$272.30
Rate for Payer: BCBS Complete	$155.60
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$311.20
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$272.30
Rate for Payer: Priority Health Cigna Priority Health	$35.00

CHG BASIC RADIATION DOSIMETRY CALCULATION

Professional

Both

$74.00

Service Code	HCPCS 77300
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$205.51
Rate for Payer: Aetna Commercial	$76.02
Rate for Payer: Aetna Commercial	$76.02
Rate for Payer: BCBS Complete	$29.60
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: BCBS Trust/PPO	$205.51
Rate for Payer: BCBS Trust/PPO	$205.51
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Priority Health Cigna Priority Health	$89.60
Rate for Payer: Priority Health Cigna Priority Health	$51.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.19
Rate for Payer: Priority Health Narrow Network	$50.19
Rate for Payer: Priority Health Narrow Network	$50.19
Rate for Payer: Priority Health SBD	$100.90
Rate for Payer: Priority Health SBD	$100.90

Know your out-of-pocket cost for care.

All Charges