Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS

Professional

Both

$24.00

Service Code	HCPCS 74019
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$55.68
Rate for Payer: Aetna Commercial	$42.11
Rate for Payer: Aetna Commercial	$42.11
Rate for Payer: Aetna Medicare	$12.00
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCN Commercial	$55.28
Rate for Payer: BCN Commercial	$55.28
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$55.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$55.68
Rate for Payer: Priority Health Narrow/Tiered Network	$55.68
Rate for Payer: Priority Health Narrow/Tiered Network	$55.68

CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS

Professional

Both

$29.00

Service Code	HCPCS 74021
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$64.22
Rate for Payer: Aetna Commercial	$48.74
Rate for Payer: Aetna Medicare	$14.50
Rate for Payer: BCN Commercial	$63.74
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$64.22
Rate for Payer: Priority Health Narrow/Tiered Network	$64.22

CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST

Professional

Both

$52.00

Service Code	HCPCS 73565
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$60.21
Rate for Payer: Aetna Commercial	$46.05
Rate for Payer: Aetna Commercial	$46.05
Rate for Payer: Aetna Commercial	$46.05
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: Aetna Medicare	$26.00
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCN Commercial	$59.76
Rate for Payer: BCN Commercial	$59.76
Rate for Payer: BCN Commercial	$59.76
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$60.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$60.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$60.21
Rate for Payer: Priority Health Narrow/Tiered Network	$60.21
Rate for Payer: Priority Health Narrow/Tiered Network	$60.21
Rate for Payer: Priority Health Narrow/Tiered Network	$60.21

CHG RADIOLOGIC EXAM CHEST 2 VIEWS

Professional

Both

$60.00

Service Code	HCPCS 71046
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$50.67
Rate for Payer: Aetna Commercial	$38.26
Rate for Payer: Aetna Medicare	$30.00
Rate for Payer: BCN Commercial	$50.29
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$50.67
Rate for Payer: Priority Health Narrow/Tiered Network	$50.67

CHG RADIOLOGIC EXAM CHEST 3 VIEWS

Professional

Both

$50.00

Service Code	HCPCS 71047
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$63.22
Rate for Payer: Aetna Commercial	$48.36
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: BCN Commercial	$62.75
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$63.22
Rate for Payer: Priority Health Narrow/Tiered Network	$63.22

CHG RADIOLOGIC EXAM CHEST SINGLE VIEW

Professional

Both

$19.00

Service Code	HCPCS 71045
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$39.13
Rate for Payer: Aetna Commercial	$29.34
Rate for Payer: Aetna Commercial	$29.34
Rate for Payer: Aetna Medicare	$9.50
Rate for Payer: Aetna Medicare	$16.50
Rate for Payer: BCN Commercial	$38.84
Rate for Payer: BCN Commercial	$38.84
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$15.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$39.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$39.13
Rate for Payer: Priority Health Narrow/Tiered Network	$39.13
Rate for Payer: Priority Health Narrow/Tiered Network	$39.13

CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES

Professional

Both

$35.00

Service Code	HCPCS 74022
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$75.26
Rate for Payer: Aetna Commercial	$56.56
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: BCN Commercial	$74.70
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$75.26
Rate for Payer: Priority Health Narrow/Tiered Network	$75.26

CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS

Professional

Both

$81.00

Service Code	HCPCS 73600
Min. Negotiated Rate	$36.89
Max. Negotiated Rate	$60.75
Rate for Payer: Aetna Commercial	$36.89
Rate for Payer: Aetna Commercial	$36.89
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: Aetna Medicare	$14.50
Rate for Payer: BCN Commercial	$47.81
Rate for Payer: BCN Commercial	$47.81
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$48.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$48.16
Rate for Payer: Priority Health Narrow/Tiered Network	$48.16
Rate for Payer: Priority Health Narrow/Tiered Network	$48.16

CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY

Professional

Both

$44.00

Service Code	HCPCS 70030
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$49.67
Rate for Payer: Aetna Commercial	$36.58
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCN Commercial	$49.30
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$49.67
Rate for Payer: Priority Health Narrow/Tiered Network	$49.67

CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW

Professional

Both

$33.00

Service Code	HCPCS 73551
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$44.66
Rate for Payer: Aetna Commercial	$33.46
Rate for Payer: Aetna Medicare	$16.50
Rate for Payer: BCN Commercial	$44.32
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$44.66
Rate for Payer: Priority Health Narrow/Tiered Network	$44.66

CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS

Professional

Both

$21.00

Service Code	HCPCS 73552
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$53.68
Rate for Payer: Aetna Commercial	$40.02
Rate for Payer: Aetna Commercial	$40.02
Rate for Payer: Aetna Medicare	$32.50
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: BCN Commercial	$53.29
Rate for Payer: BCN Commercial	$53.29
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$52.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$53.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$53.68
Rate for Payer: Priority Health Narrow/Tiered Network	$53.68
Rate for Payer: Priority Health Narrow/Tiered Network	$53.68

CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS

Professional

Both

$28.00

Service Code	HCPCS 73620
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$42.64
Rate for Payer: Aetna Commercial	$32.31
Rate for Payer: Aetna Commercial	$32.31
Rate for Payer: Aetna Commercial	$32.31
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: Aetna Medicare	$40.00
Rate for Payer: Aetna Medicare	$14.00
Rate for Payer: BCN Commercial	$42.33
Rate for Payer: BCN Commercial	$42.33
Rate for Payer: BCN Commercial	$42.33
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.64
Rate for Payer: Priority Health Narrow/Tiered Network	$42.64
Rate for Payer: Priority Health Narrow/Tiered Network	$42.64
Rate for Payer: Priority Health Narrow/Tiered Network	$42.64

CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS

Professional

Both

$88.00

Service Code	HCPCS 73560
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$66.00
Rate for Payer: Aetna Commercial	$38.80
Rate for Payer: Aetna Commercial	$38.80
Rate for Payer: Aetna Commercial	$38.80
Rate for Payer: Aetna Medicare	$21.50
Rate for Payer: Aetna Medicare	$44.00
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCN Commercial	$50.80
Rate for Payer: BCN Commercial	$50.80
Rate for Payer: BCN Commercial	$50.80
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$51.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$51.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$51.17
Rate for Payer: Priority Health Narrow/Tiered Network	$51.17
Rate for Payer: Priority Health Narrow/Tiered Network	$51.17
Rate for Payer: Priority Health Narrow/Tiered Network	$51.17

CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS

Professional

Both

$33.00

Service Code	HCPCS 73562
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$61.21
Rate for Payer: Aetna Commercial	$45.74
Rate for Payer: Aetna Commercial	$45.74
Rate for Payer: Aetna Commercial	$45.74
Rate for Payer: Aetna Medicare	$27.50
Rate for Payer: Aetna Medicare	$49.00
Rate for Payer: Aetna Medicare	$16.50
Rate for Payer: BCN Commercial	$60.76
Rate for Payer: BCN Commercial	$60.76
Rate for Payer: BCN Commercial	$60.76
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$78.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$73.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$41.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$61.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$61.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$61.21
Rate for Payer: Priority Health Narrow/Tiered Network	$61.21
Rate for Payer: Priority Health Narrow/Tiered Network	$61.21
Rate for Payer: Priority Health Narrow/Tiered Network	$61.21

CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS

Professional

Both

$19.00

Service Code	HCPCS 70100
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$58.20
Rate for Payer: Aetna Commercial	$43.45
Rate for Payer: Aetna Medicare	$9.50
Rate for Payer: BCN Commercial	$57.76
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cash Price	$15.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$58.20
Rate for Payer: Priority Health Narrow/Tiered Network	$58.20

CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE

Professional

Both

$34.00

Service Code	HCPCS 70360
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$47.17
Rate for Payer: Aetna Commercial	$35.82
Rate for Payer: Aetna Medicare	$17.00
Rate for Payer: BCN Commercial	$46.81
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$47.17
Rate for Payer: Priority Health Narrow/Tiered Network	$47.17

CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPLETE

Professional

Both

$59.00

Service Code	HCPCS 77075
Min. Negotiated Rate	$29.50
Max. Negotiated Rate	$149.02
Rate for Payer: Aetna Commercial	$112.43
Rate for Payer: Aetna Medicare	$29.50
Rate for Payer: BCN Commercial	$147.90
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cash Price	$47.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$44.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$149.02
Rate for Payer: Priority Health Narrow/Tiered Network	$149.02

CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS

Professional

Both

$123.00

Service Code	HCPCS 72170
Min. Negotiated Rate	$31.59
Max. Negotiated Rate	$92.25
Rate for Payer: Aetna Commercial	$31.59
Rate for Payer: Aetna Commercial	$31.59
Rate for Payer: Aetna Commercial	$31.59
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: Aetna Medicare	$61.50
Rate for Payer: BCN Commercial	$41.83
Rate for Payer: BCN Commercial	$41.83
Rate for Payer: BCN Commercial	$41.83
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$36.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$92.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.14
Rate for Payer: Priority Health Narrow/Tiered Network	$42.14
Rate for Payer: Priority Health Narrow/Tiered Network	$42.14
Rate for Payer: Priority Health Narrow/Tiered Network	$42.14

CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS

Professional

Both

$44.00

Service Code	HCPCS 72200
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$50.67
Rate for Payer: Aetna Commercial	$37.31
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCN Commercial	$50.29
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$50.67
Rate for Payer: Priority Health Narrow/Tiered Network	$50.67

CHG RADIOLOGIC EXAMINATION SKULL 4< VIEWS

Professional

Both

$19.00

Service Code	HCPCS 70250
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$54.18
Rate for Payer: Aetna Commercial	$40.40
Rate for Payer: Aetna Commercial	$40.40
Rate for Payer: Aetna Medicare	$24.50
Rate for Payer: Aetna Medicare	$9.50
Rate for Payer: BCN Commercial	$53.78
Rate for Payer: BCN Commercial	$53.78
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$54.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$54.18
Rate for Payer: Priority Health Narrow/Tiered Network	$54.18
Rate for Payer: Priority Health Narrow/Tiered Network	$54.18

CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS

Professional

Both

$31.00

Service Code	HCPCS 73590
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$47.67
Rate for Payer: Aetna Commercial	$35.75
Rate for Payer: Aetna Commercial	$35.75
Rate for Payer: Aetna Commercial	$35.75
Rate for Payer: Aetna Medicare	$19.00
Rate for Payer: Aetna Medicare	$43.50
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCN Commercial	$47.31
Rate for Payer: BCN Commercial	$47.31
Rate for Payer: BCN Commercial	$47.31
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$69.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$65.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$47.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$47.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$47.67
Rate for Payer: Priority Health Narrow/Tiered Network	$47.67
Rate for Payer: Priority Health Narrow/Tiered Network	$47.67
Rate for Payer: Priority Health Narrow/Tiered Network	$47.67

CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS

Professional

Both

$41.00

Service Code	HCPCS 73564
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$71.24
Rate for Payer: Aetna Commercial	$51.99
Rate for Payer: Aetna Commercial	$51.99
Rate for Payer: Aetna Commercial	$51.99
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: Aetna Medicare	$58.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCN Commercial	$70.71
Rate for Payer: BCN Commercial	$70.71
Rate for Payer: BCN Commercial	$70.71
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$50.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$71.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$71.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$71.24
Rate for Payer: Priority Health Narrow/Tiered Network	$71.24
Rate for Payer: Priority Health Narrow/Tiered Network	$71.24
Rate for Payer: Priority Health Narrow/Tiered Network	$71.24

CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS

Professional

Both

$55.00

Service Code	HCPCS 72190
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$63.22
Rate for Payer: Aetna Commercial	$47.53
Rate for Payer: Aetna Commercial	$47.53
Rate for Payer: Aetna Medicare	$27.50
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCN Commercial	$62.75
Rate for Payer: BCN Commercial	$62.75
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$44.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$41.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$63.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$63.22
Rate for Payer: Priority Health Narrow/Tiered Network	$63.22
Rate for Payer: Priority Health Narrow/Tiered Network	$63.22

CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS

Professional

Both

$41.00

Service Code	HCPCS 72202
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$59.21
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: Aetna Medicare	$26.00
Rate for Payer: BCN Commercial	$58.76
Rate for Payer: BCN Commercial	$58.76
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$32.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$59.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$59.21
Rate for Payer: Priority Health Narrow/Tiered Network	$59.21
Rate for Payer: Priority Health Narrow/Tiered Network	$59.21

CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS

Professional

Both

$61.00

Service Code	HCPCS 70260
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$67.23
Rate for Payer: Aetna Commercial	$51.07
Rate for Payer: Aetna Medicare	$30.50
Rate for Payer: BCN Commercial	$66.73
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$67.23
Rate for Payer: Priority Health Narrow/Tiered Network	$67.23

Know your out-of-pocket cost for care.

All Charges