Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY

Professional

Both

$17.00

Service Code	HCPCS 81000
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$2,458.18
Rate for Payer: Aetna Commercial	$3.82
Rate for Payer: BCBS Complete	$6.80
Rate for Payer: BCBS Trust/PPO	$2,458.18
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 URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY

Professional

Both

$30.00

Service Code	HCPCS 81001
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$3,145.50
Rate for Payer: Aetna Commercial	$3.01
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$3,145.50
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.16
Rate for Payer: Priority Health Narrow Network	$3.16
Rate for Payer: Priority Health SBD	$3.16

CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY

Professional

Both

$14.00

Service Code	HCPCS 81003
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$1,827.92
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$1,827.92
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	$2.46
Rate for Payer: Priority Health Narrow Network	$2.46
Rate for Payer: Priority Health SBD	$2.46

CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP

Professional

Both

$12.00

Service Code	HCPCS 81002
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$2,102.11
Rate for Payer: Aetna Commercial	$3.31
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: BCBS Trust/PPO	$2,102.11
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 UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY

Professional

Both

$137.00

Service Code	HCPCS 74400
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$673.05
Rate for Payer: Aetna Commercial	$153.73
Rate for Payer: Aetna Commercial	$153.73
Rate for Payer: BCBS Complete	$54.80
Rate for Payer: BCBS Complete	$83.60
Rate for Payer: BCBS Trust/PPO	$673.05
Rate for Payer: BCBS Trust/PPO	$673.05
Rate for Payer: Cash Price	$109.60
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cash Price	$109.60
Rate for Payer: Cash Price	$167.20
Rate for Payer: Priority Health Cigna Priority Health	$146.30
Rate for Payer: Priority Health Cigna Priority Health	$95.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.85
Rate for Payer: Priority Health Narrow Network	$35.85
Rate for Payer: Priority Health Narrow Network	$35.85
Rate for Payer: Priority Health SBD	$209.99
Rate for Payer: Priority Health SBD	$209.99

CHG UROGRAPHY RETROGRADE WITH/WO KUB

Professional

Both

$58.00

Service Code	HCPCS 74420
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$978.41
Rate for Payer: Aetna Commercial	$87.47
Rate for Payer: BCBS Complete	$23.20
Rate for Payer: BCBS Trust/PPO	$978.41
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Priority Health Cigna Priority Health	$40.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.88
Rate for Payer: Priority Health Narrow Network	$36.88
Rate for Payer: Priority Health SBD	$118.31

CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION

Professional

Both

$209.00

Service Code	HCPCS 76700
Min. Negotiated Rate	$58.38
Max. Negotiated Rate	$2,008.07
Rate for Payer: Aetna Commercial	$139.34
Rate for Payer: BCBS Complete	$83.60
Rate for Payer: BCBS Trust/PPO	$2,008.07
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cash Price	$167.20
Rate for Payer: Priority Health Cigna Priority Health	$146.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$58.38
Rate for Payer: Priority Health Narrow Network	$58.38
Rate for Payer: Priority Health SBD	$179.76

CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED

Professional

Both

$176.00

Service Code	HCPCS 76705
Min. Negotiated Rate	$43.03
Max. Negotiated Rate	$2,317.65
Rate for Payer: Aetna Commercial	$104.19
Rate for Payer: Aetna Commercial	$104.19
Rate for Payer: BCBS Complete	$42.40
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: BCBS Trust/PPO	$2,317.65
Rate for Payer: BCBS Trust/PPO	$2,317.65
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Priority Health Cigna Priority Health	$74.20
Rate for Payer: Priority Health Cigna Priority Health	$123.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.03
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.03
Rate for Payer: Priority Health Narrow Network	$43.03
Rate for Payer: Priority Health Narrow Network	$43.03
Rate for Payer: Priority Health SBD	$135.72
Rate for Payer: Priority Health SBD	$135.72

CHG US, BREAST(S), REAL TIME

Professional

Both

$147.00

Service Code	HCPCS 76645
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$102.90
Rate for Payer: BCBS Complete	$58.80
Rate for Payer: Cash Price	$117.60
Rate for Payer: Priority Health Cigna Priority Health	$102.90

CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION

Professional

Both

$56.00

Service Code	HCPCS 76604
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$2,617.20
Rate for Payer: Aetna Commercial	$77.11
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: BCBS Trust/PPO	$2,617.20
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Priority Health Cigna Priority Health	$39.20
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	$87.07

CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL

Professional

Both

$421.00

Service Code	HCPCS 76936
Min. Negotiated Rate	$141.36
Max. Negotiated Rate	$397.44
Rate for Payer: Aetna Commercial	$310.24
Rate for Payer: BCBS Complete	$168.40
Rate for Payer: BCBS Trust/PPO	$293.21
Rate for Payer: Cash Price	$336.80
Rate for Payer: Cash Price	$336.80
Rate for Payer: Priority Health Cigna Priority Health	$294.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$141.36
Rate for Payer: Priority Health Narrow Network	$141.36
Rate for Payer: Priority Health SBD	$397.44

CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION

Professional

Both

$304.00

Service Code	HCPCS 76881
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$763.39
Rate for Payer: Aetna Commercial	$76.43
Rate for Payer: Aetna Commercial	$76.43
Rate for Payer: BCBS Complete	$121.60
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: BCBS Trust/PPO	$763.39
Rate for Payer: BCBS Trust/PPO	$763.39
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$243.20
Rate for Payer: Cash Price	$243.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Priority Health Cigna Priority Health	$58.80
Rate for Payer: Priority Health Cigna Priority Health	$212.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.90
Rate for Payer: Priority Health Narrow Network	$16.90
Rate for Payer: Priority Health Narrow Network	$16.90
Rate for Payer: Priority Health SBD	$82.46
Rate for Payer: Priority Health SBD	$82.46

CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION

Professional

Both

$286.00

Service Code	HCPCS 76813
Min. Negotiated Rate	$86.04
Max. Negotiated Rate	$675.17
Rate for Payer: Aetna Commercial	$140.72
Rate for Payer: BCBS Complete	$114.40
Rate for Payer: BCBS Trust/PPO	$675.17
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Priority Health Cigna Priority Health	$200.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$86.04
Rate for Payer: Priority Health Narrow Network	$86.04
Rate for Payer: Priority Health SBD	$180.28

CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION

Professional

Both

$191.00

Service Code	HCPCS 76814
Min. Negotiated Rate	$43.53
Max. Negotiated Rate	$696.30
Rate for Payer: Aetna Commercial	$91.18
Rate for Payer: BCBS Complete	$76.40
Rate for Payer: BCBS Trust/PPO	$696.30
Rate for Payer: Cash Price	$152.80
Rate for Payer: Cash Price	$152.80
Rate for Payer: Priority Health Cigna Priority Health	$133.70
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	$114.73

CHG US GUIDANCE AMNIOCENTESIS IMG S&I

Professional

Both

$314.00

Service Code	HCPCS 76946
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$219.80
Rate for Payer: Aetna Commercial	$37.71
Rate for Payer: BCBS Complete	$125.60
Rate for Payer: BCBS Trust/PPO	$194.41
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	$22.53
Rate for Payer: Priority Health Narrow Network	$22.53
Rate for Payer: Priority Health SBD	$50.19

CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION

Professional

Both

$372.00

Service Code	HCPCS 76965
Min. Negotiated Rate	$41.49
Max. Negotiated Rate	$260.40
Rate for Payer: Aetna Commercial	$108.13
Rate for Payer: Aetna Commercial	$108.13
Rate for Payer: BCBS Complete	$104.80
Rate for Payer: BCBS Complete	$148.80
Rate for Payer: BCBS Trust/PPO	$133.13
Rate for Payer: BCBS Trust/PPO	$133.13
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$209.60
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$209.60
Rate for Payer: Priority Health Cigna Priority Health	$260.40
Rate for Payer: Priority Health Cigna Priority Health	$183.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.49
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.49
Rate for Payer: Priority Health Narrow Network	$41.49
Rate for Payer: Priority Health Narrow Network	$41.49
Rate for Payer: Priority Health SBD	$142.90
Rate for Payer: Priority Health SBD	$142.90

CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I

Professional

Both

$457.00

Service Code	HCPCS 76942
Min. Negotiated Rate	$43.03
Max. Negotiated Rate	$319.90
Rate for Payer: Aetna Commercial	$67.10
Rate for Payer: Aetna Commercial	$67.10
Rate for Payer: BCBS Complete	$182.80
Rate for Payer: BCBS Complete	$44.40
Rate for Payer: BCBS Trust/PPO	$103.55
Rate for Payer: BCBS Trust/PPO	$103.55
Rate for Payer: Cash Price	$365.60
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cash Price	$365.60
Rate for Payer: Priority Health Cigna Priority Health	$77.70
Rate for Payer: Priority Health Cigna Priority Health	$319.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.03
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.03
Rate for Payer: Priority Health Narrow Network	$43.03
Rate for Payer: Priority Health Narrow Network	$43.03
Rate for Payer: Priority Health SBD	$89.11
Rate for Payer: Priority Health SBD	$89.11

CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I

Professional

Both

$183.00

Service Code	HCPCS 76941
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$180.28
Rate for Payer: Aetna Commercial	$138.84
Rate for Payer: BCBS Complete	$73.20
Rate for Payer: BCBS Trust/PPO	$145.81
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cash Price	$146.40
Rate for Payer: Priority Health Cigna Priority Health	$128.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$82.98
Rate for Payer: Priority Health Narrow Network	$82.98
Rate for Payer: Priority Health SBD	$180.28

CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG

Professional

Both

$66.00

Service Code	HCPCS 76882
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$884.90
Rate for Payer: Aetna Commercial	$64.85
Rate for Payer: Aetna Commercial	$64.85
Rate for Payer: BCBS Complete	$26.40
Rate for Payer: BCBS Complete	$34.80
Rate for Payer: BCBS Trust/PPO	$884.90
Rate for Payer: BCBS Trust/PPO	$884.90
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$52.80
Rate for Payer: Priority Health Cigna Priority Health	$46.20
Rate for Payer: Priority Health Cigna Priority Health	$60.90
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	$64.54
Rate for Payer: Priority Health SBD	$64.54

CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U

Professional

Both

$221.00

Service Code	HCPCS 76857
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$839.47
Rate for Payer: Aetna Commercial	$55.35
Rate for Payer: BCBS Complete	$88.40
Rate for Payer: BCBS Trust/PPO	$839.47
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cash Price	$176.80
Rate for Payer: Priority Health Cigna Priority Health	$154.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.85
Rate for Payer: Priority Health Narrow Network	$35.85
Rate for Payer: Priority Health SBD	$74.78

CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE

Professional

Both

$295.00

Service Code	HCPCS 76856
Min. Negotiated Rate	$50.19
Max. Negotiated Rate	$764.98
Rate for Payer: Aetna Commercial	$125.54
Rate for Payer: BCBS Complete	$118.00
Rate for Payer: BCBS Trust/PPO	$764.98
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cash Price	$236.00
Rate for Payer: Priority Health Cigna Priority Health	$206.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.19
Rate for Payer: Priority Health Narrow Network	$50.19
Rate for Payer: Priority Health SBD	$162.87

CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT

Professional

Both

$279.00

Service Code	HCPCS 76801
Min. Negotiated Rate	$71.70
Max. Negotiated Rate	$269.43
Rate for Payer: Aetna Commercial	$139.63
Rate for Payer: BCBS Complete	$111.60
Rate for Payer: BCBS Trust/PPO	$269.43
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Priority Health Cigna Priority Health	$195.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$71.70
Rate for Payer: Priority Health Narrow Network	$71.70
Rate for Payer: Priority Health SBD	$181.31

CHG US PREGNANT UTERUS LIMITED 1/> FETUSES

Professional

Both

$260.00

Service Code	HCPCS 76815
Min. Negotiated Rate	$47.64
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$96.78
Rate for Payer: BCBS Complete	$104.00
Rate for Payer: BCBS Trust/PPO	$160.60
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Priority Health Cigna Priority Health	$182.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$47.64
Rate for Payer: Priority Health Narrow Network	$47.64
Rate for Payer: Priority Health SBD	$125.48

CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION

Professional

Both

$140.00

Service Code	HCPCS 76802
Min. Negotiated Rate	$32.78
Max. Negotiated Rate	$304.83
Rate for Payer: Aetna Commercial	$73.01
Rate for Payer: BCBS Complete	$56.00
Rate for Payer: BCBS Trust/PPO	$304.83
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Priority Health Cigna Priority Health	$98.00
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	$93.72

CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO

Professional

Both

$415.00

Service Code	HCPCS 76810
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$290.50
Rate for Payer: Aetna Commercial	$105.64
Rate for Payer: BCBS Complete	$166.00
Rate for Payer: BCBS Trust/PPO	$164.30
Rate for Payer: Cash Price	$332.00
Rate for Payer: Cash Price	$332.00
Rate for Payer: Priority Health Cigna Priority Health	$290.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.02
Rate for Payer: Priority Health Narrow Network	$64.02
Rate for Payer: Priority Health SBD	$135.72

Know your out-of-pocket cost for care.

All Charges