Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHG HYSTEROSALPINGOGRAPHY RS&I

Professional

Both

$150.00

Service Code	HCPCS 74740
Min. Negotiated Rate	$27.66
Max. Negotiated Rate	$147.51
Rate for Payer: Aetna Commercial	$110.60
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$133.66
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	$27.66
Rate for Payer: Priority Health Narrow Network	$27.66
Rate for Payer: Priority Health SBD	$147.51

CHG IAADIADOO INFLUENZA

Professional

Both

$29.00

Service Code	HCPCS 87804
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$1,216.15
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: BCBS Complete	$11.60
Rate for Payer: BCBS Trust/PPO	$1,216.15
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Priority Health Cigna Priority Health	$20.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.22
Rate for Payer: Priority Health Narrow Network	$17.22
Rate for Payer: Priority Health SBD	$17.22

CHG IAADIADOO RESPIRATORY SYNCTIAL VIRUS

Professional

Both

$18.00

Service Code	HCPCS 87807
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.11
Rate for Payer: Aetna Commercial	$12.45
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: BCBS Trust/PPO	$114.11
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Priority Health Cigna Priority Health	$12.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.71
Rate for Payer: Priority Health Narrow Network	$13.71
Rate for Payer: Priority Health SBD	$13.71

CHG IAADIADOO STREPTOCOCCUS GROUP A

Professional

Both

$28.00

Service Code	HCPCS 87880
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$164.83
Rate for Payer: Aetna Commercial	$15.70
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCBS Trust/PPO	$164.83
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Priority Health Cigna Priority Health	$19.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.22
Rate for Payer: Priority Health Narrow Network	$17.22
Rate for Payer: Priority Health SBD	$17.22

CHG IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS

Professional

Both

$40.00

Service Code	HCPCS 87426
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$1,641.96
Rate for Payer: Aetna Commercial	$45.23
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$1,641.96
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.55
Rate for Payer: Priority Health Narrow Network	$36.55
Rate for Payer: Priority Health SBD	$36.55

CHG IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS

Professional

Both

$43.00

Service Code	HCPCS 87265
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$1,212.98
Rate for Payer: Aetna Commercial	$11.38
Rate for Payer: BCBS Complete	$17.20
Rate for Payer: BCBS Trust/PPO	$1,212.98
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cash Price	$34.40
Rate for Payer: Priority Health Cigna Priority Health	$30.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.30
Rate for Payer: Priority Health Narrow Network	$12.30
Rate for Payer: Priority Health SBD	$12.30

CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ

Professional

Both

$75.00

Service Code	HCPCS 87491
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$1,449.13
Rate for Payer: Aetna Commercial	$33.34
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: BCBS Trust/PPO	$1,449.13
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.55
Rate for Payer: Priority Health Narrow Network	$36.55
Rate for Payer: Priority Health SBD	$36.55

CHG IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ

Professional

Both

$81.00

Service Code	HCPCS 87800
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$1,724.37
Rate for Payer: Aetna Commercial	$41.49
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: BCBS Trust/PPO	$1,724.37
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Priority Health Cigna Priority Health	$56.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.33
Rate for Payer: Priority Health Narrow Network	$45.33
Rate for Payer: Priority Health SBD	$45.33

CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ

Professional

Both

$75.00

Service Code	HCPCS 87591
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$593.81
Rate for Payer: Aetna Commercial	$33.34
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: BCBS Trust/PPO	$593.81
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Priority Health Cigna Priority Health	$52.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.55
Rate for Payer: Priority Health Narrow Network	$36.55
Rate for Payer: Priority Health SBD	$36.55

CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ

Professional

Both

$145.00

Service Code	HCPCS 87635
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$2,508.37
Rate for Payer: Aetna Commercial	$51.31
Rate for Payer: BCBS Complete	$58.00
Rate for Payer: BCBS Trust/PPO	$2,508.37
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Priority Health Cigna Priority Health	$101.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$53.07
Rate for Payer: Priority Health Narrow Network	$53.07
Rate for Payer: Priority Health SBD	$53.07

CHG IA INFECTIOUS AGT ANTIBODY QUAL/SEMIQ 1STEP METH

Professional

Both

$46.00

Service Code	HCPCS 86318
Min. Negotiated Rate	$17.19
Max. Negotiated Rate	$1,735.47
Rate for Payer: Aetna Commercial	$17.19
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$1,735.47
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	$18.63
Rate for Payer: Priority Health Narrow Network	$18.63
Rate for Payer: Priority Health SBD	$18.63

CHG IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE

Professional

Both

$39.00

Service Code	HCPCS 86294
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$167.47
Rate for Payer: Aetna Commercial	$24.29
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: BCBS Trust/PPO	$167.47
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.36
Rate for Payer: Priority Health Narrow Network	$26.36
Rate for Payer: Priority Health SBD	$26.36

CHG INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES

Professional

Both

$144.00

Service Code	HCPCS 87502
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$713.73
Rate for Payer: Aetna Commercial	$91.01
Rate for Payer: BCBS Complete	$57.60
Rate for Payer: BCBS Trust/PPO	$713.73
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Priority Health Cigna Priority Health	$100.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$99.46
Rate for Payer: Priority Health Narrow Network	$99.46
Rate for Payer: Priority Health SBD	$99.46

CHG INTEN MOD RADIOTHER PLAN, SIN/MULT FIELD

Professional

Both

$922.00

Service Code	HCPCS 77418
Min. Negotiated Rate	$368.80
Max. Negotiated Rate	$645.40
Rate for Payer: BCBS Complete	$368.80
Rate for Payer: Cash Price	$737.60
Rate for Payer: Priority Health Cigna Priority Health	$645.40

CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX

Professional

Both

$1,675.00

Service Code	HCPCS 77778
Min. Negotiated Rate	$301.66
Max. Negotiated Rate	$1,395.66
Rate for Payer: Aetna Commercial	$1,018.17
Rate for Payer: Aetna Commercial	$1,018.17
Rate for Payer: BCBS Complete	$670.00
Rate for Payer: BCBS Complete	$208.80
Rate for Payer: BCBS Trust/PPO	$301.66
Rate for Payer: BCBS Trust/PPO	$301.66
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Priority Health Cigna Priority Health	$1,172.50
Rate for Payer: Priority Health Cigna Priority Health	$365.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$695.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$695.01
Rate for Payer: Priority Health Narrow Network	$695.01
Rate for Payer: Priority Health Narrow Network	$695.01
Rate for Payer: Priority Health SBD	$1,395.66
Rate for Payer: Priority Health SBD	$1,395.66

CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE

Professional

Both

$456.00

Service Code	HCPCS 77761
Min. Negotiated Rate	$182.40
Max. Negotiated Rate	$639.70
Rate for Payer: Aetna Commercial	$469.99
Rate for Payer: BCBS Complete	$182.40
Rate for Payer: BCBS Trust/PPO	$324.38
Rate for Payer: Cash Price	$364.80
Rate for Payer: Cash Price	$364.80
Rate for Payer: Priority Health Cigna Priority Health	$319.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$308.84
Rate for Payer: Priority Health Narrow Network	$308.84
Rate for Payer: Priority Health SBD	$639.70

CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I

Professional

Both

$89.00

Service Code	HCPCS 74360
Min. Negotiated Rate	$35.60
Max. Negotiated Rate	$2,791.54
Rate for Payer: Aetna Commercial	$128.38
Rate for Payer: BCBS Complete	$35.60
Rate for Payer: BCBS Trust/PPO	$2,791.54
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$71.20
Rate for Payer: Priority Health Cigna Priority Health	$62.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.46
Rate for Payer: Priority Health Narrow Network	$40.46
Rate for Payer: Priority Health SBD	$169.02

CHG INTRAVASC ULTRASOUND,1ST VESSEL

Professional

Both

$220.00

Service Code	HCPCS 75945
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$154.00
Rate for Payer: BCBS Complete	$88.00
Rate for Payer: BCBS Complete	$33.20
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$176.00
Rate for Payer: Priority Health Cigna Priority Health	$154.00
Rate for Payer: Priority Health Cigna Priority Health	$58.10

CHG INTRAVASC US, RAD SUPERISE/ INTERP, EA ADDN VESSEL

Professional

Both

$45.00

Service Code	HCPCS 75946
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$31.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$31.50
Rate for Payer: Priority Health Cigna Priority Health	$107.10

CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I

Professional

Both

$206.00

Service Code	HCPCS 74340
Min. Negotiated Rate	$39.43
Max. Negotiated Rate	$2,030.79
Rate for Payer: Aetna Commercial	$119.95
Rate for Payer: BCBS Complete	$82.40
Rate for Payer: BCBS Trust/PPO	$2,030.79
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$164.80
Rate for Payer: Priority Health Cigna Priority Health	$144.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$39.43
Rate for Payer: Priority Health Narrow Network	$39.43
Rate for Payer: Priority Health SBD	$157.74

CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS

Professional

Both

$135.00

Service Code	HCPCS 77077
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$3,952.74
Rate for Payer: Aetna Commercial	$53.57
Rate for Payer: Aetna Commercial	$53.57
Rate for Payer: BCBS Complete	$54.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$3,952.74
Rate for Payer: BCBS Trust/PPO	$3,952.74
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$94.50
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.09
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.09
Rate for Payer: Priority Health Narrow Network	$25.09
Rate for Payer: Priority Health Narrow Network	$25.09
Rate for Payer: Priority Health SBD	$72.21
Rate for Payer: Priority Health SBD	$72.21

CHG LIPID PANEL

Professional

Both

$44.00

Service Code	HCPCS 80061
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$2,009.65
Rate for Payer: Aetna Commercial	$12.72
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Trust/PPO	$2,009.65
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.05
Rate for Payer: Priority Health Narrow Network	$14.05
Rate for Payer: Priority Health SBD	$14.05

CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS

Professional

Both

$92.00

Service Code	HCPCS 77071
Min. Negotiated Rate	$35.15
Max. Negotiated Rate	$882.79
Rate for Payer: Aetna Commercial	$62.73
Rate for Payer: Aetna Commercial	$62.73
Rate for Payer: BCBS Complete	$36.91
Rate for Payer: BCBS Complete	$36.91
Rate for Payer: BCBS Trust/PPO	$882.79
Rate for Payer: BCBS Trust/PPO	$882.79
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Mclaren Medicaid	$35.15
Rate for Payer: Mclaren Medicaid	$35.15
Rate for Payer: Meridian Medicaid	$36.91
Rate for Payer: Meridian Medicaid	$36.91
Rate for Payer: Priority Health Choice Medicaid	$35.15
Rate for Payer: Priority Health Choice Medicaid	$35.15
Rate for Payer: Priority Health Cigna Priority Health	$64.40
Rate for Payer: Priority Health Cigna Priority Health	$60.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.00
Rate for Payer: Priority Health Narrow Network	$84.00
Rate for Payer: Priority Health Narrow Network	$84.00
Rate for Payer: Priority Health SBD	$84.00
Rate for Payer: Priority Health SBD	$84.00

CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I

Professional

Both

$37.00

Service Code	HCPCS 75902
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$449.58
Rate for Payer: Aetna Commercial	$104.59
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: BCBS Trust/PPO	$449.58
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$29.60
Rate for Payer: Priority Health Cigna Priority Health	$25.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.17
Rate for Payer: Priority Health Narrow Network	$28.17
Rate for Payer: Priority Health SBD	$139.30

CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I

Professional

Both

$332.00

Service Code	HCPCS 75901
Min. Negotiated Rate	$34.31
Max. Negotiated Rate	$420.00
Rate for Payer: Aetna Commercial	$267.87
Rate for Payer: BCBS Complete	$132.80
Rate for Payer: BCBS Trust/PPO	$420.00
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cash Price	$265.60
Rate for Payer: Priority Health Cigna Priority Health	$232.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.31
Rate for Payer: Priority Health Narrow Network	$34.31
Rate for Payer: Priority Health SBD	$355.45

Know your out-of-pocket cost for care.

All Charges