Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN

Professional

Both

$515.00

Service Code	HCPCS 77338
Min. Negotiated Rate	$206.00
Max. Negotiated Rate	$2,953.73
Rate for Payer: Aetna Commercial	$541.84
Rate for Payer: Aetna Commercial	$541.84
Rate for Payer: Aetna Commercial	$541.84
Rate for Payer: BCBS Complete	$373.60
Rate for Payer: BCBS Complete	$380.80
Rate for Payer: BCBS Complete	$206.00
Rate for Payer: BCBS Trust/PPO	$2,953.73
Rate for Payer: BCBS Trust/PPO	$2,953.73
Rate for Payer: BCBS Trust/PPO	$2,953.73
Rate for Payer: Cash Price	$761.60
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cash Price	$747.20
Rate for Payer: Cash Price	$747.20
Rate for Payer: Cash Price	$761.60
Rate for Payer: Priority Health Cigna Priority Health	$360.50
Rate for Payer: Priority Health Cigna Priority Health	$666.40
Rate for Payer: Priority Health Cigna Priority Health	$653.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.15
Rate for Payer: Priority Health Narrow Network	$343.15
Rate for Payer: Priority Health Narrow Network	$343.15
Rate for Payer: Priority Health Narrow Network	$343.15
Rate for Payer: Priority Health SBD	$709.87
Rate for Payer: Priority Health SBD	$709.87
Rate for Payer: Priority Health SBD	$709.87

CHG MRA HEAD W/O CONTRST MATERIAL

Professional

Both

$234.00

Service Code	HCPCS 70544
Min. Negotiated Rate	$87.07
Max. Negotiated Rate	$1,742.33
Rate for Payer: Aetna Commercial	$349.94
Rate for Payer: Aetna Commercial	$349.94
Rate for Payer: BCBS Complete	$93.60
Rate for Payer: BCBS Complete	$269.20
Rate for Payer: BCBS Trust/PPO	$1,742.33
Rate for Payer: BCBS Trust/PPO	$1,742.33
Rate for Payer: Cash Price	$538.40
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$538.40
Rate for Payer: Priority Health Cigna Priority Health	$471.10
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$87.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$87.07
Rate for Payer: Priority Health Narrow Network	$87.07
Rate for Payer: Priority Health Narrow Network	$87.07
Rate for Payer: Priority Health SBD	$344.17
Rate for Payer: Priority Health SBD	$344.17

CHG MRA NECK W/O CONTRST MATERIAL

Professional

Both

$231.00

Service Code	HCPCS 70547
Min. Negotiated Rate	$87.07
Max. Negotiated Rate	$1,605.50
Rate for Payer: Aetna Commercial	$351.42
Rate for Payer: BCBS Complete	$92.40
Rate for Payer: BCBS Trust/PPO	$1,605.50
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cash Price	$184.80
Rate for Payer: Priority Health Cigna Priority Health	$161.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$87.07
Rate for Payer: Priority Health Narrow Network	$87.07
Rate for Payer: Priority Health SBD	$344.69

CHG MRA NECK W/O &W/CONTRAST MATERIAL

Professional

Both

$275.00

Service Code	HCPCS 70549
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$2,120.07
Rate for Payer: Aetna Commercial	$560.98
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: BCBS Trust/PPO	$2,120.07
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$130.60
Rate for Payer: Priority Health Narrow Network	$130.60
Rate for Payer: Priority Health SBD	$552.62

CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL

Professional

Both

$370.00

Service Code	HCPCS 70552
Min. Negotiated Rate	$129.57
Max. Negotiated Rate	$1,113.66
Rate for Payer: Aetna Commercial	$442.56
Rate for Payer: BCBS Complete	$148.00
Rate for Payer: BCBS Trust/PPO	$1,113.66
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Priority Health Cigna Priority Health	$259.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$129.57
Rate for Payer: Priority Health Narrow Network	$129.57
Rate for Payer: Priority Health SBD	$433.30

CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL

Professional

Both

$319.00

Service Code	HCPCS 70551
Min. Negotiated Rate	$107.55
Max. Negotiated Rate	$2,070.41
Rate for Payer: Aetna Commercial	$318.81
Rate for Payer: BCBS Complete	$127.60
Rate for Payer: BCBS Trust/PPO	$2,070.41
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Priority Health Cigna Priority Health	$223.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$107.55
Rate for Payer: Priority Health Narrow Network	$107.55
Rate for Payer: Priority Health SBD	$312.93

CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL

Professional

Both

$341.00

Service Code	HCPCS 70553
Min. Negotiated Rate	$136.40
Max. Negotiated Rate	$968.37
Rate for Payer: Aetna Commercial	$523.42
Rate for Payer: BCBS Complete	$136.40
Rate for Payer: BCBS Trust/PPO	$968.37
Rate for Payer: Cash Price	$272.80
Rate for Payer: Cash Price	$272.80
Rate for Payer: Priority Health Cigna Priority Health	$238.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.94
Rate for Payer: Priority Health Narrow Network	$165.94
Rate for Payer: Priority Health SBD	$510.12

CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL

Professional

Both

$296.00

Service Code	HCPCS 72141
Min. Negotiated Rate	$107.55
Max. Negotiated Rate	$3,028.22
Rate for Payer: Aetna Commercial	$311.87
Rate for Payer: BCBS Complete	$118.40
Rate for Payer: BCBS Trust/PPO	$3,028.22
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	$107.55
Rate for Payer: Priority Health Narrow Network	$107.55
Rate for Payer: Priority Health SBD	$304.23

CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL

Professional

Both

$308.00

Service Code	HCPCS 72156
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$3,620.44
Rate for Payer: Aetna Commercial	$528.35
Rate for Payer: BCBS Complete	$123.20
Rate for Payer: BCBS Trust/PPO	$3,620.44
Rate for Payer: Cash Price	$246.40
Rate for Payer: Cash Price	$246.40
Rate for Payer: Priority Health Cigna Priority Health	$215.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.94
Rate for Payer: Priority Health Narrow Network	$165.94
Rate for Payer: Priority Health SBD	$512.68

CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL

Professional

Both

$321.00

Service Code	HCPCS 72149
Min. Negotiated Rate	$128.40
Max. Negotiated Rate	$3,237.95
Rate for Payer: Aetna Commercial	$446.00
Rate for Payer: BCBS Complete	$128.40
Rate for Payer: BCBS Trust/PPO	$3,237.95
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cash Price	$256.80
Rate for Payer: Priority Health Cigna Priority Health	$224.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$129.57
Rate for Payer: Priority Health Narrow Network	$129.57
Rate for Payer: Priority Health SBD	$433.30

CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL

Professional

Both

$242.00

Service Code	HCPCS 72148
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$3,385.35
Rate for Payer: Aetna Commercial	$312.37
Rate for Payer: BCBS Complete	$96.80
Rate for Payer: BCBS Trust/PPO	$3,385.35
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$193.60
Rate for Payer: Priority Health Cigna Priority Health	$169.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$107.55
Rate for Payer: Priority Health Narrow Network	$107.55
Rate for Payer: Priority Health SBD	$305.26

CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL

Professional

Both

$293.00

Service Code	HCPCS 72158
Min. Negotiated Rate	$117.20
Max. Negotiated Rate	$3,525.87
Rate for Payer: Aetna Commercial	$527.37
Rate for Payer: BCBS Complete	$117.20
Rate for Payer: BCBS Trust/PPO	$3,525.87
Rate for Payer: Cash Price	$234.40
Rate for Payer: Cash Price	$234.40
Rate for Payer: Priority Health Cigna Priority Health	$205.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.94
Rate for Payer: Priority Health Narrow Network	$165.94
Rate for Payer: Priority Health SBD	$511.65

CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL

Professional

Both

$267.00

Service Code	HCPCS 72146
Min. Negotiated Rate	$106.80
Max. Negotiated Rate	$2,911.46
Rate for Payer: Aetna Commercial	$311.87
Rate for Payer: BCBS Complete	$106.80
Rate for Payer: BCBS Trust/PPO	$2,911.46
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Priority Health Cigna Priority Health	$186.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$107.55
Rate for Payer: Priority Health Narrow Network	$107.55
Rate for Payer: Priority Health SBD	$304.23

CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL

Professional

Both

$324.00

Service Code	HCPCS 72157
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$3,439.76
Rate for Payer: Aetna Commercial	$529.34
Rate for Payer: BCBS Complete	$129.60
Rate for Payer: BCBS Trust/PPO	$3,439.76
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cash Price	$259.20
Rate for Payer: Priority Health Cigna Priority Health	$226.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.94
Rate for Payer: Priority Health Narrow Network	$165.94
Rate for Payer: Priority Health SBD	$513.71

CHG MYELOGRAPY LUMBOSACRAL RS&I

Professional

Both

$160.00

Service Code	HCPCS 72265
Min. Negotiated Rate	$60.44
Max. Negotiated Rate	$3,085.27
Rate for Payer: Aetna Commercial	$124.16
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: BCBS Trust/PPO	$3,085.27
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Priority Health Cigna Priority Health	$112.00
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	$168.50

CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS

Professional

Both

$120.00

Service Code	HCPCS 78453
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$417.93
Rate for Payer: Aetna Commercial	$339.63
Rate for Payer: BCBS Complete	$48.00
Rate for Payer: BCBS Trust/PPO	$240.38
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Priority Health Cigna Priority Health	$84.00
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	$417.93

CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES

Professional

Both

$155.00

Service Code	HCPCS 78454
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$623.31
Rate for Payer: Aetna Commercial	$490.87
Rate for Payer: BCBS Complete	$62.00
Rate for Payer: BCBS Trust/PPO	$256.75
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Priority Health Cigna Priority Health	$108.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$96.80
Rate for Payer: Priority Health Narrow Network	$96.80
Rate for Payer: Priority Health SBD	$623.31

CHG MYOCARDIAL SPECT MULTIPLE STUDIES

Professional

Both

$898.00

Service Code	HCPCS 78452
Min. Negotiated Rate	$114.73
Max. Negotiated Rate	$671.45
Rate for Payer: Aetna Commercial	$538.09
Rate for Payer: Aetna Commercial	$538.09
Rate for Payer: BCBS Complete	$359.20
Rate for Payer: BCBS Complete	$75.20
Rate for Payer: BCBS Trust/PPO	$209.21
Rate for Payer: BCBS Trust/PPO	$209.21
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Priority Health Cigna Priority Health	$131.60
Rate for Payer: Priority Health Cigna Priority Health	$628.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$114.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$114.73
Rate for Payer: Priority Health Narrow Network	$114.73
Rate for Payer: Priority Health Narrow Network	$114.73
Rate for Payer: Priority Health SBD	$671.45
Rate for Payer: Priority Health SBD	$671.45

CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS

Professional

Both

$165.00

Service Code	HCPCS 78451
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$517.21
Rate for Payer: Aetna Commercial	$387.26
Rate for Payer: BCBS Complete	$66.00
Rate for Payer: BCBS Trust/PPO	$517.21
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Priority Health Cigna Priority Health	$115.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$96.80
Rate for Payer: Priority Health Narrow Network	$96.80
Rate for Payer: Priority Health SBD	$483.99

CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS

Professional

Both

$700.00

Service Code	HCPCS 78491
Min. Negotiated Rate	$106.54
Max. Negotiated Rate	$1,378.75
Rate for Payer: Aetna Commercial	$1,378.75
Rate for Payer: BCBS Complete	$280.00
Rate for Payer: BCBS Trust/PPO	$431.09
Rate for Payer: Cash Price	$560.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Priority Health Cigna Priority Health	$490.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$106.54
Rate for Payer: Priority Health Narrow Network	$106.54
Rate for Payer: Priority Health SBD	$665.81

CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS

Professional

Both

$3,011.00

Service Code	HCPCS 77301
Min. Negotiated Rate	$603.85
Max. Negotiated Rate	$2,813.85
Rate for Payer: Aetna Commercial	$2,146.90
Rate for Payer: Aetna Commercial	$2,146.90
Rate for Payer: Aetna Commercial	$2,146.90
Rate for Payer: BCBS Complete	$1,498.00
Rate for Payer: BCBS Complete	$1,204.40
Rate for Payer: BCBS Complete	$687.20
Rate for Payer: BCBS Trust/PPO	$603.85
Rate for Payer: BCBS Trust/PPO	$603.85
Rate for Payer: BCBS Trust/PPO	$603.85
Rate for Payer: Cash Price	$1,374.40
Rate for Payer: Cash Price	$1,374.40
Rate for Payer: Cash Price	$2,408.80
Rate for Payer: Cash Price	$2,996.00
Rate for Payer: Cash Price	$2,996.00
Rate for Payer: Cash Price	$2,408.80
Rate for Payer: Priority Health Cigna Priority Health	$2,621.50
Rate for Payer: Priority Health Cigna Priority Health	$1,202.60
Rate for Payer: Priority Health Cigna Priority Health	$2,107.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$639.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$639.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$639.70
Rate for Payer: Priority Health Narrow Network	$639.70
Rate for Payer: Priority Health Narrow Network	$639.70
Rate for Payer: Priority Health Narrow Network	$639.70
Rate for Payer: Priority Health SBD	$2,813.85
Rate for Payer: Priority Health SBD	$2,813.85
Rate for Payer: Priority Health SBD	$2,813.85

CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL

Professional

Both

$48.00

Service Code	HCPCS 76519
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$2,288.07
Rate for Payer: Aetna Commercial	$76.83
Rate for Payer: BCBS Complete	$19.20
Rate for Payer: BCBS Trust/PPO	$2,288.07
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Priority Health Cigna Priority Health	$33.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.58
Rate for Payer: Priority Health Narrow Network	$45.58
Rate for Payer: Priority Health SBD	$102.94

CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI

Professional

Both

$23.00

Service Code	HCPCS 76514
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$1,479.24
Rate for Payer: Aetna Commercial	$13.55
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$1,479.24
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	$5.64
Rate for Payer: Priority Health Narrow Network	$5.64
Rate for Payer: Priority Health SBD	$17.41

CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY

Professional

Both

$21.00

Service Code	HCPCS 86403
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$1,738.64
Rate for Payer: Aetna Commercial	$10.96
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCBS Trust/PPO	$1,738.64
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	$11.95
Rate for Payer: Priority Health Narrow Network	$11.95
Rate for Payer: Priority Health SBD	$11.95

CHG PERCUTANEOUS VERTEBROPLASTY, CT GUIDE

Professional

Both

$262.00

Service Code	HCPCS 72292
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

Know your out-of-pocket cost for care.

All Charges