Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT

Professional

Both

$316.00

Service Code	HCPCS 77014
Min. Negotiated Rate	$68.12
Max. Negotiated Rate	$1,757.13
Rate for Payer: Aetna Commercial	$149.64
Rate for Payer: Aetna Commercial	$149.64
Rate for Payer: BCBS Complete	$95.20
Rate for Payer: BCBS Complete	$126.40
Rate for Payer: BCBS Trust/PPO	$1,757.13
Rate for Payer: BCBS Trust/PPO	$1,757.13
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$190.40
Rate for Payer: Priority Health Cigna Priority Health	$166.60
Rate for Payer: Priority Health Cigna Priority Health	$221.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.12
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.12
Rate for Payer: Priority Health Narrow Network	$68.12
Rate for Payer: Priority Health Narrow Network	$68.12
Rate for Payer: Priority Health SBD	$184.89
Rate for Payer: Priority Health SBD	$184.89

CHG CT GUIDANCE STEREOTACTIC LOCALIZATION

Professional

Both

$457.00

Service Code	HCPCS 77011
Min. Negotiated Rate	$93.72
Max. Negotiated Rate	$344.17
Rate for Payer: Aetna Commercial	$283.63
Rate for Payer: BCBS Complete	$182.80
Rate for Payer: BCBS Trust/PPO	$284.23
Rate for Payer: Cash Price	$365.60
Rate for Payer: Cash Price	$365.60
Rate for Payer: Priority Health Cigna Priority Health	$319.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$93.72
Rate for Payer: Priority Health Narrow Network	$93.72
Rate for Payer: Priority Health SBD	$344.17

CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY

Professional

Both

$150.00

Service Code	HCPCS 76380
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$954.11
Rate for Payer: Aetna Commercial	$152.20
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$954.11
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.15
Rate for Payer: Priority Health Narrow Network	$69.15
Rate for Payer: Priority Health SBD	$208.96

CHG CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL

Professional

Both

$36.00

Service Code	HCPCS 87070
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$2,125.88
Rate for Payer: Aetna Commercial	$8.19
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCBS Trust/PPO	$2,125.88
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Priority Health Cigna Priority Health	$25.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.78
Rate for Payer: Priority Health Narrow Network	$8.78
Rate for Payer: Priority Health SBD	$8.78

CHG CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ

Professional

Both

$21.00

Service Code	HCPCS 87081
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$2,824.29
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCBS Trust/PPO	$2,824.29
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.03
Rate for Payer: Priority Health Narrow Network	$7.03
Rate for Payer: Priority Health SBD	$7.03

CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE

Professional

Both

$19.00

Service Code	HCPCS 87086
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$2,635.16
Rate for Payer: Aetna Commercial	$7.67
Rate for Payer: BCBS Complete	$7.60
Rate for Payer: BCBS Trust/PPO	$2,635.16
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cash Price	$15.20
Rate for Payer: Priority Health Cigna Priority Health	$13.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.43
Rate for Payer: Priority Health Narrow Network	$8.43
Rate for Payer: Priority Health SBD	$8.43

CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I

Professional

Both

$102.00

Service Code	HCPCS 74430
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$1,300.67
Rate for Payer: Aetna Commercial	$46.64
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: BCBS Trust/PPO	$1,300.67
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Priority Health Cigna Priority Health	$71.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.05
Rate for Payer: Priority Health Narrow Network	$23.05
Rate for Payer: Priority Health SBD	$63.51

CHG CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN

Professional

Both

$63.00

Service Code	HCPCS 88141
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$19.81
Rate for Payer: BCBS Complete	$16.11
Rate for Payer: BCBS Trust/PPO	$168.00
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Mclaren Medicaid	$15.34
Rate for Payer: Meridian Medicaid	$16.11
Rate for Payer: Priority Health Choice Medicaid	$15.34
Rate for Payer: Priority Health Cigna Priority Health	$44.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.31
Rate for Payer: Priority Health Narrow Network	$35.31
Rate for Payer: Priority Health SBD	$35.31

CHG CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN

Professional

Both

$46.00

Service Code	HCPCS 88142
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$129.43
Rate for Payer: Aetna Commercial	$19.25
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$129.43
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Priority Health Cigna Priority Health	$32.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.16
Rate for Payer: Priority Health Narrow Network	$31.16
Rate for Payer: Priority Health SBD	$31.16

CHG DEXA,BONE DENSITY,VERTEB FRACT

Professional

Both

$19.00

Service Code	HCPCS 77082
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$13.30
Rate for Payer: BCBS Complete	$7.60
Rate for Payer: Cash Price	$15.20
Rate for Payer: Priority Health Cigna Priority Health	$13.30

CHG DISKOGRAPY LUMBAR RS&I

Professional

Both

$103.00

Service Code	HCPCS 72295
Min. Negotiated Rate	$41.20
Max. Negotiated Rate	$2,771.99
Rate for Payer: Aetna Commercial	$128.76
Rate for Payer: BCBS Complete	$41.20
Rate for Payer: BCBS Trust/PPO	$2,771.99
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Priority Health Cigna Priority Health	$72.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.44
Rate for Payer: Priority Health Narrow Network	$60.44
Rate for Payer: Priority Health SBD	$170.55

CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT

Professional

Both

$142.00

Service Code	HCPCS 76828
Min. Negotiated Rate	$35.34
Max. Negotiated Rate	$563.70
Rate for Payer: Aetna Commercial	$59.77
Rate for Payer: BCBS Complete	$56.80
Rate for Payer: BCBS Trust/PPO	$563.70
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Priority Health Cigna Priority Health	$99.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.34
Rate for Payer: Priority Health Narrow Network	$35.34
Rate for Payer: Priority Health SBD	$75.28

CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE

Professional

Both

$237.00

Service Code	HCPCS 76827
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$506.11
Rate for Payer: Aetna Commercial	$84.26
Rate for Payer: BCBS Complete	$94.80
Rate for Payer: BCBS Trust/PPO	$506.11
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cash Price	$189.60
Rate for Payer: Priority Health Cigna Priority Health	$165.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$42.00
Rate for Payer: Priority Health Narrow Network	$42.00
Rate for Payer: Priority Health SBD	$107.04

CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART

Professional

Both

$141.00

Service Code	HCPCS 76821
Min. Negotiated Rate	$50.71
Max. Negotiated Rate	$192.30
Rate for Payer: Aetna Commercial	$104.92
Rate for Payer: BCBS Complete	$56.40
Rate for Payer: BCBS Trust/PPO	$192.30
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Priority Health Cigna Priority Health	$98.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.71
Rate for Payer: Priority Health Narrow Network	$50.71
Rate for Payer: Priority Health SBD	$136.24

CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY

Professional

Both

$244.00

Service Code	HCPCS 76820
Min. Negotiated Rate	$32.78
Max. Negotiated Rate	$536.22
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: BCBS Complete	$97.60
Rate for Payer: BCBS Trust/PPO	$536.22
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cash Price	$195.20
Rate for Payer: Priority Health Cigna Priority Health	$170.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$32.78
Rate for Payer: Priority Health Narrow Network	$32.78
Rate for Payer: Priority Health SBD	$68.63

CHG DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES

Professional

Both

$38.00

Service Code	HCPCS 80300
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$26.60
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60

CHG DRUG SCREEN MULT CLASSES

Professional

Both

$30.00

Service Code	HCPCS 80100
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00

CHG DRUG SCREEN, QUAL,1+ DRUG CLASS,NON-CHROMOTOGRAPHIC,EACH

Professional

Both

$38.00

Service Code	HCPCS 80104
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$26.60
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60

CHG DRUG SCREEN SINGL CLASS

Professional

Both

$30.00

Service Code	HCPCS 80101
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00

CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE

Professional

Both

$38.00

Service Code	HCPCS 80305
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$2,169.73
Rate for Payer: Aetna Commercial	$11.97
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCBS Trust/PPO	$2,169.73
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.01
Rate for Payer: Priority Health Narrow Network	$13.01
Rate for Payer: Priority Health SBD	$13.01

CHG DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE

Professional

Both

$80.00

Service Code	HCPCS 80307
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$2,739.76
Rate for Payer: Aetna Commercial	$59.03
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: BCBS Trust/PPO	$2,739.76
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.31
Rate for Payer: Priority Health Narrow Network	$64.31
Rate for Payer: Priority Health SBD	$64.31

CHG DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS

Professional

Both

$26.00

Service Code	HCPCS 80306
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$1,676.30
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$1,676.30
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.92
Rate for Payer: Priority Health Narrow Network	$17.92
Rate for Payer: Priority Health SBD	$17.92

CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL

Professional

Both

$158.00

Service Code	HCPCS 77081
Min. Negotiated Rate	$14.86
Max. Negotiated Rate	$1,182.34
Rate for Payer: Aetna Commercial	$35.90
Rate for Payer: Aetna Commercial	$35.90
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$1,182.34
Rate for Payer: BCBS Trust/PPO	$1,182.34
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$110.60
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.86
Rate for Payer: Priority Health Narrow Network	$14.86
Rate for Payer: Priority Health Narrow Network	$14.86
Rate for Payer: Priority Health SBD	$48.14
Rate for Payer: Priority Health SBD	$48.14

CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL

Professional

Both

$168.00

Service Code	HCPCS 77080
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$6,131.98
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: BCBS Complete	$93.60
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: BCBS Trust/PPO	$6,131.98
Rate for Payer: BCBS Trust/PPO	$6,131.98
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$187.20
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health Cigna Priority Health	$117.60
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	$58.38
Rate for Payer: Priority Health SBD	$58.38

CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING

Professional

Both

$314.00

Service Code	HCPCS 76506
Min. Negotiated Rate	$46.10
Max. Negotiated Rate	$1,651.99
Rate for Payer: Aetna Commercial	$133.74
Rate for Payer: BCBS Complete	$125.60
Rate for Payer: BCBS Trust/PPO	$1,651.99
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cash Price	$251.20
Rate for Payer: Priority Health Cigna Priority Health	$219.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$46.10
Rate for Payer: Priority Health Narrow Network	$46.10
Rate for Payer: Priority Health SBD	$174.66

Know your out-of-pocket cost for care.

All Charges