Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHG SEMEN ALYS MOTILITY&CNT X W/HUHNER TST

Professional

Both

$21.00

Service Code	HCPCS 89310
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$940.90
Rate for Payer: Aetna Commercial	$8.18
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCBS Trust/PPO	$940.90
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	$12.98
Rate for Payer: Priority Health Narrow Network	$12.98
Rate for Payer: Priority Health SBD	$12.98

CHG SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER

Professional

Both

$46.00

Service Code	HCPCS 89300
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$3,455.08
Rate for Payer: Aetna Commercial	$9.35
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$3,455.08
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	$15.07
Rate for Payer: Priority Health Narrow Network	$15.07
Rate for Payer: Priority Health SBD	$15.07

CHG SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM

Professional

Both

$28.00

Service Code	HCPCS 89321
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$1,251.54
Rate for Payer: Aetna Commercial	$11.45
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCBS Trust/PPO	$1,251.54
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	$18.70
Rate for Payer: Priority Health Narrow Network	$18.70
Rate for Payer: Priority Health SBD	$18.70

CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I

Professional

Both

$188.00

Service Code	HCPCS 75809
Min. Negotiated Rate	$35.34
Max. Negotiated Rate	$131.60
Rate for Payer: Aetna Commercial	$101.45
Rate for Payer: BCBS Complete	$75.20
Rate for Payer: BCBS Trust/PPO	$122.04
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cash Price	$150.40
Rate for Payer: Priority Health Cigna Priority Health	$131.60
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	$126.50

CHG SKIN TEST TUBERCULOSIS INTRADERMAL

Professional

Both

$16.00

Service Code	HCPCS 86580
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$2,063.01
Rate for Payer: Aetna Commercial	$8.78
Rate for Payer: BCBS Complete	$6.40
Rate for Payer: BCBS Trust/PPO	$2,063.01
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.55
Rate for Payer: Priority Health Narrow Network	$10.55
Rate for Payer: Priority Health SBD	$10.55

CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS

Professional

Both

$48.00

Service Code	HCPCS 87209
Min. Negotiated Rate	$17.08
Max. Negotiated Rate	$378.81
Rate for Payer: Aetna Commercial	$17.08
Rate for Payer: BCBS Complete	$19.20
Rate for Payer: BCBS Trust/PPO	$378.81
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	$18.63
Rate for Payer: Priority Health Narrow Network	$18.63
Rate for Payer: Priority Health SBD	$18.63

CHG SMR PRIM SRC WET MOUNT NFCT AGT

Professional

Both

$18.00

Service Code	HCPCS 87210
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$368.23
Rate for Payer: Aetna Commercial	$5.53
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: BCBS Trust/PPO	$368.23
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	$5.97
Rate for Payer: Priority Health Narrow Network	$5.97
Rate for Payer: Priority Health SBD	$5.97

CHG SONO GUIDE PERICARD TAP

Professional

Both

$119.00

Service Code	HCPCS 76930
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$83.30
Rate for Payer: BCBS Complete	$47.60
Rate for Payer: Cash Price	$95.20
Rate for Payer: Priority Health Cigna Priority Health	$83.30

CHG SONO GUIDE RAD THERAPY FIELDS

Professional

Both

$135.00

Service Code	HCPCS 76950
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$94.50
Rate for Payer: BCBS Complete	$54.00
Rate for Payer: BCBS Complete	$29.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$59.20
Rate for Payer: Priority Health Cigna Priority Health	$94.50
Rate for Payer: Priority Health Cigna Priority Health	$51.80

CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS

Professional

Both

$123.00

Service Code	HCPCS 77331
Min. Negotiated Rate	$29.20
Max. Negotiated Rate	$5,193.72
Rate for Payer: Aetna Commercial	$75.48
Rate for Payer: Aetna Commercial	$75.48
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$5,193.72
Rate for Payer: BCBS Trust/PPO	$5,193.72
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$98.40
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health Cigna Priority Health	$86.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29.20
Rate for Payer: Priority Health Narrow Network	$29.20
Rate for Payer: Priority Health Narrow Network	$29.20
Rate for Payer: Priority Health SBD	$98.84
Rate for Payer: Priority Health SBD	$98.84

CHG SPECIAL TREATMENT PROCEDURE

Professional

Both

$691.00

Service Code	HCPCS 77470
Min. Negotiated Rate	$49.68
Max. Negotiated Rate	$519.32
Rate for Payer: Aetna Commercial	$155.09
Rate for Payer: Aetna Commercial	$155.09
Rate for Payer: BCBS Complete	$208.80
Rate for Payer: BCBS Complete	$276.40
Rate for Payer: BCBS Trust/PPO	$519.32
Rate for Payer: BCBS Trust/PPO	$519.32
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$552.80
Rate for Payer: Cash Price	$552.80
Rate for Payer: Priority Health Cigna Priority Health	$483.70
Rate for Payer: Priority Health Cigna Priority Health	$365.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.68
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 Narrow Network	$49.68
Rate for Payer: Priority Health SBD	$212.55
Rate for Payer: Priority Health SBD	$212.55

CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ

Professional

Both

$212.00

Service Code	HCPCS 77370
Min. Negotiated Rate	$84.80
Max. Negotiated Rate	$1,979.54
Rate for Payer: Aetna Commercial	$143.41
Rate for Payer: BCBS Complete	$84.80
Rate for Payer: BCBS Trust/PPO	$1,979.54
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Priority Health Cigna Priority Health	$148.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$212.55
Rate for Payer: Priority Health Narrow Network	$212.55
Rate for Payer: Priority Health SBD	$212.55

CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY

Professional

Both

$199.00

Service Code	HCPCS 77321
Min. Negotiated Rate	$67.09
Max. Negotiated Rate	$5,378.09
Rate for Payer: Aetna Commercial	$108.58
Rate for Payer: Aetna Commercial	$108.58
Rate for Payer: BCBS Complete	$79.60
Rate for Payer: BCBS Complete	$110.40
Rate for Payer: BCBS Trust/PPO	$5,378.09
Rate for Payer: BCBS Trust/PPO	$5,378.09
Rate for Payer: Cash Price	$159.20
Rate for Payer: Cash Price	$159.20
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$220.80
Rate for Payer: Priority Health Cigna Priority Health	$139.30
Rate for Payer: Priority Health Cigna Priority Health	$193.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.09
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.09
Rate for Payer: Priority Health Narrow Network	$67.09
Rate for Payer: Priority Health Narrow Network	$67.09
Rate for Payer: Priority Health SBD	$143.40
Rate for Payer: Priority Health SBD	$143.40

CHG STEREOSCOPIC X-RAY GUIDANCE

Professional

Both

$202.00

Service Code	HCPCS 77421
Min. Negotiated Rate	$80.80
Max. Negotiated Rate	$141.40
Rate for Payer: BCBS Complete	$80.80
Rate for Payer: BCBS Complete	$68.40
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$161.60
Rate for Payer: Priority Health Cigna Priority Health	$119.70
Rate for Payer: Priority Health Cigna Priority Health	$141.40

CHG STEREOTACTIC BODY RADIATION DELIVERY

Professional

Both

$2,653.00

Service Code	HCPCS 77373
Min. Negotiated Rate	$1,061.20
Max. Negotiated Rate	$1,987.99
Rate for Payer: Aetna Commercial	$1,281.89
Rate for Payer: BCBS Complete	$1,061.20
Rate for Payer: BCBS Trust/PPO	$1,987.99
Rate for Payer: Cash Price	$2,122.40
Rate for Payer: Cash Price	$2,122.40
Rate for Payer: Priority Health Cigna Priority Health	$1,857.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,540.09
Rate for Payer: Priority Health Narrow Network	$1,540.09
Rate for Payer: Priority Health SBD	$1,540.09

CHG STEREOTACTIC BODY RADIATION MANAGEMENT

Professional

Both

$1,236.00

Service Code	HCPCS 77435
Min. Negotiated Rate	$408.11
Max. Negotiated Rate	$1,387.84
Rate for Payer: Aetna Commercial	$753.89
Rate for Payer: BCBS Complete	$428.52
Rate for Payer: BCBS Trust/PPO	$1,387.84
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cash Price	$988.80
Rate for Payer: Mclaren Medicaid	$408.11
Rate for Payer: Meridian Medicaid	$428.52
Rate for Payer: Priority Health Choice Medicaid	$408.11
Rate for Payer: Priority Health Cigna Priority Health	$865.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$977.73
Rate for Payer: Priority Health Narrow Network	$977.73
Rate for Payer: Priority Health SBD	$977.73

CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION

Professional

Both

$855.00

Service Code	HCPCS 77432
Min. Negotiated Rate	$269.87
Max. Negotiated Rate	$2,005.43
Rate for Payer: Aetna Commercial	$499.97
Rate for Payer: BCBS Complete	$283.36
Rate for Payer: BCBS Trust/PPO	$2,005.43
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Mclaren Medicaid	$269.87
Rate for Payer: Meridian Medicaid	$283.36
Rate for Payer: Priority Health Choice Medicaid	$269.87
Rate for Payer: Priority Health Cigna Priority Health	$598.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$572.76
Rate for Payer: Priority Health Narrow Network	$572.76
Rate for Payer: Priority Health SBD	$647.37

CHG SUPERVISION HANDLING LOADING RADIATION SOURCE

Professional

Both

$184.00

Service Code	HCPCS 77790
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$148.98
Rate for Payer: Aetna Commercial	$17.19
Rate for Payer: Aetna Commercial	$17.19
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: BCBS Complete	$31.60
Rate for Payer: BCBS Trust/PPO	$148.98
Rate for Payer: BCBS Trust/PPO	$148.98
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Priority Health Cigna Priority Health	$55.30
Rate for Payer: Priority Health Cigna Priority Health	$128.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.76
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.76
Rate for Payer: Priority Health Narrow Network	$10.76
Rate for Payer: Priority Health Narrow Network	$10.76
Rate for Payer: Priority Health SBD	$26.63
Rate for Payer: Priority Health SBD	$26.63

CHG TELETHER ISODOSE PLAN COMPLX

Professional

Both

$269.00

Service Code	HCPCS 77315
Min. Negotiated Rate	$107.60
Max. Negotiated Rate	$188.30
Rate for Payer: BCBS Complete	$107.60
Rate for Payer: BCBS Complete	$56.80
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$215.20
Rate for Payer: Priority Health Cigna Priority Health	$99.40
Rate for Payer: Priority Health Cigna Priority Health	$188.30

CHG TELETHER ISODOSE PLAN SIMPLE

Professional

Both

$152.00

Service Code	HCPCS 77305
Min. Negotiated Rate	$60.80
Max. Negotiated Rate	$106.40
Rate for Payer: BCBS Complete	$60.80
Rate for Payer: BCBS Complete	$38.00
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cash Price	$76.00
Rate for Payer: Priority Health Cigna Priority Health	$66.50
Rate for Payer: Priority Health Cigna Priority Health	$106.40

CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY

Professional

Both

$822.00

Service Code	HCPCS 77307
Min. Negotiated Rate	$205.38
Max. Negotiated Rate	$1,915.09
Rate for Payer: Aetna Commercial	$330.89
Rate for Payer: Aetna Commercial	$330.89
Rate for Payer: BCBS Complete	$172.00
Rate for Payer: BCBS Complete	$328.80
Rate for Payer: BCBS Trust/PPO	$1,915.09
Rate for Payer: BCBS Trust/PPO	$1,915.09
Rate for Payer: Cash Price	$344.00
Rate for Payer: Cash Price	$344.00
Rate for Payer: Cash Price	$657.60
Rate for Payer: Cash Price	$657.60
Rate for Payer: Priority Health Cigna Priority Health	$301.00
Rate for Payer: Priority Health Cigna Priority Health	$575.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$205.38
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$205.38
Rate for Payer: Priority Health Narrow Network	$205.38
Rate for Payer: Priority Health Narrow Network	$205.38
Rate for Payer: Priority Health SBD	$437.40
Rate for Payer: Priority Health SBD	$437.40

CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION

Professional

Both

$388.00

Service Code	HCPCS 77306
Min. Negotiated Rate	$112.16
Max. Negotiated Rate	$271.60
Rate for Payer: Aetna Commercial	$169.82
Rate for Payer: Aetna Commercial	$169.82
Rate for Payer: BCBS Complete	$91.20
Rate for Payer: BCBS Complete	$155.20
Rate for Payer: BCBS Trust/PPO	$150.66
Rate for Payer: BCBS Trust/PPO	$150.66
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$310.40
Rate for Payer: Priority Health Cigna Priority Health	$271.60
Rate for Payer: Priority Health Cigna Priority Health	$159.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$112.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$112.16
Rate for Payer: Priority Health Narrow Network	$112.16
Rate for Payer: Priority Health Narrow Network	$112.16
Rate for Payer: Priority Health SBD	$225.86
Rate for Payer: Priority Health SBD	$225.86

CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ

Professional

Both

$272.00

Service Code	HCPCS 74283
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$1,701.65
Rate for Payer: Aetna Commercial	$302.67
Rate for Payer: BCBS Complete	$108.80
Rate for Payer: BCBS Trust/PPO	$1,701.65
Rate for Payer: Cash Price	$217.60
Rate for Payer: Cash Price	$217.60
Rate for Payer: Priority Health Cigna Priority Health	$190.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$151.61
Rate for Payer: Priority Health Narrow Network	$151.61
Rate for Payer: Priority Health SBD	$394.37

CHG THERAPEUTIC RADIOLOGY PORT IMAGES(S)

Professional

Both

$33.00

Service Code	HCPCS 77417
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$3,385.87
Rate for Payer: Aetna Commercial	$13.00
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: BCBS Trust/PPO	$3,385.87
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Priority Health Cigna Priority Health	$23.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.99
Rate for Payer: Priority Health Narrow Network	$20.99
Rate for Payer: Priority Health SBD	$20.99

CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX

Professional

Both

$296.00

Service Code	HCPCS 77263
Min. Negotiated Rate	$106.71
Max. Negotiated Rate	$1,737.05
Rate for Payer: Aetna Commercial	$198.09
Rate for Payer: BCBS Complete	$112.05
Rate for Payer: BCBS Trust/PPO	$1,737.05
Rate for Payer: Cash Price	$236.80
Rate for Payer: Cash Price	$236.80
Rate for Payer: Mclaren Medicaid	$106.71
Rate for Payer: Meridian Medicaid	$112.05
Rate for Payer: Priority Health Choice Medicaid	$106.71
Rate for Payer: Priority Health Cigna Priority Health	$207.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$257.10
Rate for Payer: Priority Health Narrow Network	$257.10
Rate for Payer: Priority Health SBD	$257.10

Know your out-of-pocket cost for care.

All Charges