Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING

Professional

Both

$273.00

Service Code	HCPCS 76825
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$403.07
Rate for Payer: Aetna Commercial	$314.31
Rate for Payer: BCBS Complete	$109.20
Rate for Payer: BCBS Trust/PPO	$244.94
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$119.85
Rate for Payer: Priority Health Narrow Network	$119.85
Rate for Payer: Priority Health SBD	$403.07

CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD

Professional

Both

$128.00

Service Code	HCPCS 76826
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$273.66
Rate for Payer: Aetna Commercial	$187.89
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: BCBS Trust/PPO	$273.66
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$102.40
Rate for Payer: Priority Health Cigna Priority Health	$89.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$59.41
Rate for Payer: Priority Health Narrow Network	$59.41
Rate for Payer: Priority Health SBD	$241.23

CHG ENDOVASC REPAIR AAA

Professional

Both

$502.00

Service Code	HCPCS 75952
Min. Negotiated Rate	$200.80
Max. Negotiated Rate	$351.40
Rate for Payer: BCBS Complete	$200.80
Rate for Payer: Cash Price	$401.60
Rate for Payer: Priority Health Cigna Priority Health	$351.40

CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I

Professional

Both

$581.00

Service Code	HCPCS 75957
Min. Negotiated Rate	$232.40
Max. Negotiated Rate	$429.19
Rate for Payer: Aetna Commercial	$345.53
Rate for Payer: BCBS Complete	$232.40
Rate for Payer: BCBS Trust/PPO	$399.39
Rate for Payer: Cash Price	$464.80
Rate for Payer: Cash Price	$464.80
Rate for Payer: Priority Health Cigna Priority Health	$406.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$429.19
Rate for Payer: Priority Health Narrow Network	$429.19
Rate for Payer: Priority Health SBD	$429.19

CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I

Professional

Both

$679.00

Service Code	HCPCS 75956
Min. Negotiated Rate	$271.60
Max. Negotiated Rate	$514.56
Rate for Payer: Aetna Commercial	$403.09
Rate for Payer: BCBS Complete	$271.60
Rate for Payer: BCBS Trust/PPO	$514.56
Rate for Payer: Cash Price	$543.20
Rate for Payer: Cash Price	$543.20
Rate for Payer: Priority Health Cigna Priority Health	$475.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$500.90
Rate for Payer: Priority Health Narrow Network	$500.90
Rate for Payer: Priority Health SBD	$500.90

CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING

Professional

Both

$328.00

Service Code	HCPCS 76818
Min. Negotiated Rate	$76.82
Max. Negotiated Rate	$250.41
Rate for Payer: Aetna Commercial	$134.54
Rate for Payer: BCBS Complete	$131.20
Rate for Payer: BCBS Trust/PPO	$250.41
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cash Price	$262.40
Rate for Payer: Priority Health Cigna Priority Health	$229.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$76.82
Rate for Payer: Priority Health Narrow Network	$76.82
Rate for Payer: Priority Health SBD	$179.27

CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING

Professional

Both

$225.00

Service Code	HCPCS 76819
Min. Negotiated Rate	$55.32
Max. Negotiated Rate	$173.81
Rate for Payer: Aetna Commercial	$99.52
Rate for Payer: BCBS Complete	$90.00
Rate for Payer: BCBS Trust/PPO	$173.81
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.32
Rate for Payer: Priority Health Narrow Network	$55.32
Rate for Payer: Priority Health SBD	$129.07

CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON

Professional

Both

$294.00

Service Code	HCPCS 77003
Min. Negotiated Rate	$43.53
Max. Negotiated Rate	$909.73
Rate for Payer: Aetna Commercial	$119.48
Rate for Payer: BCBS Complete	$117.60
Rate for Payer: BCBS Trust/PPO	$909.73
Rate for Payer: Cash Price	$235.20
Rate for Payer: Cash Price	$235.20
Rate for Payer: Priority Health Cigna Priority Health	$205.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.53
Rate for Payer: Priority Health Narrow Network	$43.53
Rate for Payer: Priority Health SBD	$162.87

CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT

Professional

Both

$146.00

Service Code	HCPCS 77001
Min. Negotiated Rate	$27.14
Max. Negotiated Rate	$154.68
Rate for Payer: Aetna Commercial	$116.38
Rate for Payer: Aetna Commercial	$116.38
Rate for Payer: BCBS Complete	$58.40
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: BCBS Trust/PPO	$101.43
Rate for Payer: BCBS Trust/PPO	$101.43
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cash Price	$134.40
Rate for Payer: Priority Health Cigna Priority Health	$117.60
Rate for Payer: Priority Health Cigna Priority Health	$102.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.14
Rate for Payer: Priority Health Narrow Network	$27.14
Rate for Payer: Priority Health Narrow Network	$27.14
Rate for Payer: Priority Health SBD	$154.68
Rate for Payer: Priority Health SBD	$154.68

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Professional

Both

$112.00

Service Code	HCPCS 77002
Hospital Charge Code	77002
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$1,036.52
Rate for Payer: Aetna Commercial	$132.23
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: BCBS Trust/PPO	$1,036.52
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.97
Rate for Payer: Priority Health Narrow Network	$40.97
Rate for Payer: Priority Health SBD	$179.27

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Facility

$112.00

Service Code	CPT 77002
Hospital Charge Code	77002
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna Commercial	$95.20
Rate for Payer: Aetna New Business (MI Preferred)	$72.80
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cofinity Commercial	$78.40
Rate for Payer: Cofinity Commercial	$96.32
Rate for Payer: Healthscope Commercial	$100.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$95.20
Rate for Payer: PHP Commercial	$95.20
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health SBD	$70.56

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Facility

$112.00

Service Code	CPT 77002
Hospital Charge Code	77002
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$148.93
Rate for Payer: Aetna Commercial	$95.20
Rate for Payer: Aetna New Business (MI Preferred)	$72.80
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: BCBS Trust/PPO	$148.93
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cofinity Commercial	$78.40
Rate for Payer: Cofinity Commercial	$96.32
Rate for Payer: Healthscope Commercial	$100.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$95.20
Rate for Payer: PHP Commercial	$95.20
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health SBD	$70.56
Rate for Payer: UHC All Payor (Choice/PPO)	$125.34
Rate for Payer: UHC Exchange	$113.95

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Professional

Both

$112.00

Service Code	HCPCS 77002
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$1,036.52
Rate for Payer: Aetna Commercial	$132.23
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: BCBS Trust/PPO	$1,036.52
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Priority Health Cigna Priority Health	$78.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.97
Rate for Payer: Priority Health Narrow Network	$40.97
Rate for Payer: Priority Health SBD	$179.27

CHG FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME

Professional

Both

$66.00

Service Code	HCPCS 76001
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$46.20
Rate for Payer: BCBS Complete	$26.40
Rate for Payer: Cash Price	$52.80
Rate for Payer: Priority Health Cigna Priority Health	$46.20

CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME

Professional

Both

$54.00

Service Code	HCPCS 76000
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$366.11
Rate for Payer: Aetna Commercial	$48.94
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: BCBS Trust/PPO	$366.11
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Priority Health Cigna Priority Health	$37.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.56
Rate for Payer: Priority Health Narrow Network	$23.56
Rate for Payer: Priority Health SBD	$66.58

CHG GASTROESOPHAGEAL REFLUX STUDY

Professional

Both

$101.00

Service Code	HCPCS 78262
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$653.51
Rate for Payer: Aetna Commercial	$274.74
Rate for Payer: BCBS Complete	$40.40
Rate for Payer: BCBS Trust/PPO	$653.51
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cash Price	$80.80
Rate for Payer: Priority Health Cigna Priority Health	$70.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.68
Rate for Payer: Priority Health Narrow Network	$49.68
Rate for Payer: Priority Health SBD	$353.39

CHG GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE

Professional

Both

$12.00

Service Code	HCPCS 82962
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$1,864.90
Rate for Payer: Aetna Commercial	$3.12
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: BCBS Trust/PPO	$1,864.90
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	$3.52
Rate for Payer: Priority Health Narrow Network	$3.52
Rate for Payer: Priority Health SBD	$3.52

CHG GLUCOSE BLOOD REAGENT STRIP

Professional

Both

$14.00

Service Code	HCPCS 82948
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$2,965.35
Rate for Payer: Aetna Commercial	$4.79
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$2,965.35
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Priority Health Cigna Priority Health	$9.80
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 GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP

Professional

Both

$17.00

Service Code	HCPCS 82947
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$2,179.24
Rate for Payer: Aetna Commercial	$3.73
Rate for Payer: BCBS Complete	$6.80
Rate for Payer: BCBS Trust/PPO	$2,179.24
Rate for Payer: Cash Price	$13.60
Rate for Payer: Cash Price	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.22
Rate for Payer: Priority Health Narrow Network	$4.22
Rate for Payer: Priority Health SBD	$4.22

CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS

Professional

Both

$46.00

Service Code	HCPCS 82951
Min. Negotiated Rate	$12.23
Max. Negotiated Rate	$3,628.36
Rate for Payer: Aetna Commercial	$12.23
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$3,628.36
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	$13.36
Rate for Payer: Priority Health Narrow Network	$13.36
Rate for Payer: Priority Health SBD	$13.36

CHG GONADOTROPIN CHORIONIC QUALITATIVE

Professional

Both

$25.00

Service Code	HCPCS 84703
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$4,545.49
Rate for Payer: Aetna Commercial	$7.14
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: BCBS Trust/PPO	$4,545.49
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.74
Rate for Payer: Priority Health Narrow Network	$7.74
Rate for Payer: Priority Health SBD	$7.74

CHG GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR

Professional

Both

$59.00

Service Code	HCPCS 77387
Min. Negotiated Rate	$23.60
Max. Negotiated Rate	$2,278.56
Rate for Payer: Aetna Commercial	$130.08
Rate for Payer: BCBS Complete	$23.60
Rate for Payer: BCBS Trust/PPO	$2,278.56
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cash Price	$47.20
Rate for Payer: Priority Health Cigna Priority Health	$41.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$39.95
Rate for Payer: Priority Health Narrow Network	$39.95
Rate for Payer: Priority Health SBD	$195.65

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL

Professional

Both

$627.00

Service Code	HCPCS 77770
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$529.58
Rate for Payer: Aetna Commercial	$393.99
Rate for Payer: Aetna Commercial	$393.99
Rate for Payer: BCBS Complete	$250.80
Rate for Payer: BCBS Complete	$81.20
Rate for Payer: BCBS Trust/PPO	$406.79
Rate for Payer: BCBS Trust/PPO	$406.79
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$501.60
Rate for Payer: Cash Price	$501.60
Rate for Payer: Priority Health Cigna Priority Health	$142.10
Rate for Payer: Priority Health Cigna Priority Health	$438.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.70
Rate for Payer: Priority Health Narrow Network	$155.70
Rate for Payer: Priority Health Narrow Network	$155.70
Rate for Payer: Priority Health SBD	$529.58
Rate for Payer: Priority Health SBD	$529.58

CHG HEMOGLOBIN GLYCOSYLATED A1C

Professional

Both

$23.00

Service Code	HCPCS 83036
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$1,402.11
Rate for Payer: Aetna Commercial	$9.22
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$1,402.11
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.20
Rate for Payer: Priority Health Narrow Network	$10.20
Rate for Payer: Priority Health SBD	$10.20

CHG HETEROPHILE ANTIBODIES SCREEN

Professional

Both

$15.00

Service Code	HCPCS 86308
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$1,818.41
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCBS Trust/PPO	$1,818.41
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50
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

Know your out-of-pocket cost for care.

All Charges