Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

CHG ASSAY OF PYRUVATE KINASE

Professional

Both

$95.00

Service Code	HCPCS 84220
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$2,574.93
Rate for Payer: Aetna Commercial	$8.97
Rate for Payer: Aetna Medicare	$47.50
Rate for Payer: BCBS Complete	$38.00
Rate for Payer: BCBS Trust/PPO	$2,574.93
Rate for Payer: BCN Commercial	$7.08
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$76.00
Rate for Payer: Priority Health Cigna Priority Health	$61.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9.32
Rate for Payer: Priority Health Narrow Network	$9.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8.11
Rate for Payer: UHC Exchange	$8.11

CHG ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE

Professional

Both

$80.00

Service Code	HCPCS 84588
Min. Negotiated Rate	$25.46
Max. Negotiated Rate	$4,901.57
Rate for Payer: Aetna Commercial	$32.24
Rate for Payer: Aetna Medicare	$40.00
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: BCBS Trust/PPO	$4,901.57
Rate for Payer: BCN Commercial	$25.46
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Priority Health Cigna Priority Health	$52.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$33.95
Rate for Payer: Priority Health Narrow Network	$33.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$29.17
Rate for Payer: UHC Exchange	$29.17

CHG BALLOON ANGIOPLASTY VISCERAL

Professional

Both

$160.00

Service Code	HCPCS 75966
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Priority Health Cigna Priority Health	$104.00

CHG BALLOON ANGIO VENOUS

Professional

Both

$397.00

Service Code	HCPCS 75978
Min. Negotiated Rate	$158.80
Max. Negotiated Rate	$258.05
Rate for Payer: Aetna Medicare	$198.50
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: BCBS Complete	$158.80
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$317.60
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health Cigna Priority Health	$258.05

CHG BASIC RADIATION DOSIMETRY CALCULATION

Professional

Both

$75.00

Service Code	HCPCS 77300
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$205.51
Rate for Payer: Aetna Commercial	$76.02
Rate for Payer: Aetna Commercial	$76.02
Rate for Payer: Aetna Medicare	$65.50
Rate for Payer: Aetna Medicare	$37.50
Rate for Payer: BCBS Complete	$22.14
Rate for Payer: BCBS Complete	$22.14
Rate for Payer: BCBS Trust/PPO	$205.51
Rate for Payer: BCBS Trust/PPO	$205.51
Rate for Payer: BCN Commercial	$96.27
Rate for Payer: BCN Commercial	$96.27
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$104.80
Rate for Payer: Meridian Medicaid	$22.14
Rate for Payer: Meridian Medicaid	$22.14
Rate for Payer: Priority Health Choice Medicaid	$21.09
Rate for Payer: Priority Health Choice Medicaid	$21.09
Rate for Payer: Priority Health Cigna Priority Health	$48.75
Rate for Payer: Priority Health Cigna Priority Health	$85.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.79
Rate for Payer: Priority Health Narrow Network	$49.79
Rate for Payer: Priority Health Narrow Network	$49.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$92.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$92.34
Rate for Payer: UHC Exchange	$92.34
Rate for Payer: UHC Exchange	$92.34
Rate for Payer: UHCCP Medicaid	$21.09
Rate for Payer: UHCCP Medicaid	$21.09

CHG BILIRUBIN TOTAL

Professional

Both

$23.00

Service Code	HCPCS 82247
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$4,644.29
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: Aetna Medicare	$11.50
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCBS Trust/PPO	$4,644.29
Rate for Payer: BCN Commercial	$1.08
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Priority Health Cigna Priority Health	$14.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.99
Rate for Payer: Priority Health Narrow Network	$4.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.31
Rate for Payer: UHC Exchange	$4.31

CHG BILIRUBIN TOTAL TRANSCUTANEOUS

Professional

Both

$13.00

Service Code	HCPCS 88720
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$1,883.39
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: BCBS Trust/PPO	$1,883.39
Rate for Payer: BCN Commercial	$3.77
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.73
Rate for Payer: Priority Health Narrow Network	$7.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.19
Rate for Payer: UHC Exchange	$7.19

CHG BLOOD COUNT HEMOGLOBIN

Professional

Both

$14.00

Service Code	HCPCS 85018
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$4,885.72
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$4,885.72
Rate for Payer: BCN Commercial	$2.37
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Priority Health Cigna Priority Health	$9.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2.33
Rate for Payer: Priority Health Narrow Network	$2.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.39
Rate for Payer: UHC Exchange	$3.39

CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3

Professional

Both

$44.00

Service Code	HCPCS 82274
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$2,456.07
Rate for Payer: Aetna Commercial	$15.12
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Trust/PPO	$2,456.07
Rate for Payer: BCN Commercial	$15.92
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Priority Health Cigna Priority Health	$28.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.98
Rate for Payer: Priority Health Narrow Network	$15.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$22.78
Rate for Payer: UHC Exchange	$22.78

CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC

Professional

Both

$10.00

Service Code	HCPCS 82272
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$5,089.64
Rate for Payer: Aetna Commercial	$4.02
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$5,089.64
Rate for Payer: BCN Commercial	$4.23
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.33
Rate for Payer: Priority Health Narrow Network	$4.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.73
Rate for Payer: UHC Exchange	$3.73

CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER

Professional

Both

$14.00

Service Code	HCPCS 82270
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3,891.99
Rate for Payer: Aetna Commercial	$4.16
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$3,891.99
Rate for Payer: BCN Commercial	$4.38
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Priority Health Cigna Priority Health	$9.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.33
Rate for Payer: Priority Health Narrow Network	$4.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.73
Rate for Payer: UHC Exchange	$3.73

CHG BONE AGE STUDIES

Professional

Both

$36.00

Service Code	HCPCS 77072
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$3,140.74
Rate for Payer: Aetna Commercial	$29.76
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$6.04
Rate for Payer: BCBS Trust/PPO	$3,140.74
Rate for Payer: BCN Commercial	$38.12
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Meridian Medicaid	$6.04
Rate for Payer: Priority Health Choice Medicaid	$5.75
Rate for Payer: Priority Health Cigna Priority Health	$23.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.86
Rate for Payer: Priority Health Narrow Network	$13.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$24.97
Rate for Payer: UHC Exchange	$24.97
Rate for Payer: UHCCP Medicaid	$5.75

CHG BONE LENGTH STUDIES

Professional

Both

$58.00

Service Code	HCPCS 77073
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$3,610.40
Rate for Payer: Aetna Commercial	$51.41
Rate for Payer: Aetna Commercial	$51.41
Rate for Payer: Aetna Medicare	$29.00
Rate for Payer: Aetna Medicare	$67.00
Rate for Payer: BCBS Complete	$8.73
Rate for Payer: BCBS Complete	$8.73
Rate for Payer: BCBS Trust/PPO	$3,610.40
Rate for Payer: BCBS Trust/PPO	$3,610.40
Rate for Payer: BCN Commercial	$65.97
Rate for Payer: BCN Commercial	$65.97
Rate for Payer: Cash Price	$107.20
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$107.20
Rate for Payer: Meridian Medicaid	$8.73
Rate for Payer: Meridian Medicaid	$8.73
Rate for Payer: Priority Health Choice Medicaid	$8.31
Rate for Payer: Priority Health Choice Medicaid	$8.31
Rate for Payer: Priority Health Cigna Priority Health	$87.10
Rate for Payer: Priority Health Cigna Priority Health	$37.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.01
Rate for Payer: Priority Health Narrow Network	$20.01
Rate for Payer: Priority Health Narrow Network	$20.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.41
Rate for Payer: UHC Exchange	$40.41
Rate for Payer: UHC Exchange	$40.41
Rate for Payer: UHCCP Medicaid	$8.31
Rate for Payer: UHCCP Medicaid	$8.31

CHG BRACHYTHER DOSE PLAN COMPLX

Professional

Both

$526.00

Service Code	HCPCS 77328
Min. Negotiated Rate	$210.40
Max. Negotiated Rate	$341.90
Rate for Payer: Aetna Medicare	$263.00
Rate for Payer: Aetna Medicare	$154.50
Rate for Payer: BCBS Complete	$123.60
Rate for Payer: BCBS Complete	$210.40
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$420.80
Rate for Payer: Priority Health Cigna Priority Health	$341.90
Rate for Payer: Priority Health Cigna Priority Health	$200.85

CHG BRACHYTHER DOSE PLAN SIMPLE

Professional

Both

$184.00

Service Code	HCPCS 77326
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$119.60
Rate for Payer: Aetna Medicare	$92.00
Rate for Payer: Aetna Medicare	$139.50
Rate for Payer: BCBS Complete	$111.60
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Priority Health Cigna Priority Health	$119.60
Rate for Payer: Priority Health Cigna Priority Health	$181.35

CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL

Professional

Both

$709.00

Service Code	HCPCS 77318
Min. Negotiated Rate	$98.19
Max. Negotiated Rate	$1,342.41
Rate for Payer: Aetna Commercial	$494.97
Rate for Payer: Aetna Commercial	$494.97
Rate for Payer: Aetna Medicare	$354.50
Rate for Payer: Aetna Medicare	$321.50
Rate for Payer: BCBS Complete	$103.10
Rate for Payer: BCBS Complete	$103.10
Rate for Payer: BCBS Trust/PPO	$1,342.41
Rate for Payer: BCBS Trust/PPO	$1,342.41
Rate for Payer: BCN Commercial	$666.06
Rate for Payer: BCN Commercial	$666.06
Rate for Payer: Cash Price	$514.40
Rate for Payer: Cash Price	$567.20
Rate for Payer: Cash Price	$567.20
Rate for Payer: Cash Price	$514.40
Rate for Payer: Meridian Medicaid	$103.10
Rate for Payer: Meridian Medicaid	$103.10
Rate for Payer: Priority Health Choice Medicaid	$98.19
Rate for Payer: Priority Health Choice Medicaid	$98.19
Rate for Payer: Priority Health Cigna Priority Health	$417.95
Rate for Payer: Priority Health Cigna Priority Health	$460.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$231.99
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$231.99
Rate for Payer: Priority Health Narrow Network	$231.99
Rate for Payer: Priority Health Narrow Network	$231.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$479.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$479.28
Rate for Payer: UHC Exchange	$479.28
Rate for Payer: UHC Exchange	$479.28
Rate for Payer: UHCCP Medicaid	$98.19
Rate for Payer: UHCCP Medicaid	$98.19

CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS

Professional

Both

$255.00

Service Code	HCPCS 78472
Min. Negotiated Rate	$28.76
Max. Negotiated Rate	$429.51
Rate for Payer: Aetna Commercial	$259.45
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCBS Complete	$30.20
Rate for Payer: BCBS Trust/PPO	$429.51
Rate for Payer: BCN Commercial	$311.29
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Meridian Medicaid	$30.20
Rate for Payer: Priority Health Choice Medicaid	$28.76
Rate for Payer: Priority Health Cigna Priority Health	$165.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.29
Rate for Payer: Priority Health Narrow Network	$69.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$251.22
Rate for Payer: UHC Exchange	$251.22
Rate for Payer: UHCCP Medicaid	$28.76

CHG CELL COUNT MISCELLANEOUS BODY FLUIDS

Professional

Both

$11.00

Service Code	HCPCS 89050
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$2,396.37
Rate for Payer: Aetna Commercial	$4.48
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS Trust/PPO	$2,396.37
Rate for Payer: BCN Commercial	$3.54
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.22
Rate for Payer: Priority Health Narrow Network	$7.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.06
Rate for Payer: UHC Exchange	$4.06

CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY

Professional

Both

$658.00

Service Code	HCPCS 78630
Min. Negotiated Rate	$20.02
Max. Negotiated Rate	$694.71
Rate for Payer: Aetna Commercial	$381.57
Rate for Payer: Aetna Medicare	$329.00
Rate for Payer: BCBS Complete	$21.02
Rate for Payer: BCBS Trust/PPO	$694.71
Rate for Payer: BCN Commercial	$459.36
Rate for Payer: Cash Price	$526.40
Rate for Payer: Cash Price	$526.40
Rate for Payer: Meridian Medicaid	$21.02
Rate for Payer: Priority Health Choice Medicaid	$20.02
Rate for Payer: Priority Health Cigna Priority Health	$427.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$47.74
Rate for Payer: Priority Health Narrow Network	$47.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$318.15
Rate for Payer: UHC Exchange	$318.15
Rate for Payer: UHCCP Medicaid	$20.02

CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I

Professional

Both

$138.00

Service Code	HCPCS 75984
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$389.89
Rate for Payer: Aetna Commercial	$119.58
Rate for Payer: Aetna Commercial	$119.58
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: Aetna Medicare	$69.00
Rate for Payer: BCBS Complete	$25.05
Rate for Payer: BCBS Complete	$25.05
Rate for Payer: BCBS Trust/PPO	$389.89
Rate for Payer: BCBS Trust/PPO	$389.89
Rate for Payer: BCN Commercial	$140.74
Rate for Payer: BCN Commercial	$140.74
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$128.00
Rate for Payer: Meridian Medicaid	$25.05
Rate for Payer: Meridian Medicaid	$25.05
Rate for Payer: Priority Health Choice Medicaid	$23.86
Rate for Payer: Priority Health Choice Medicaid	$23.86
Rate for Payer: Priority Health Cigna Priority Health	$89.70
Rate for Payer: Priority Health Cigna Priority Health	$104.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$57.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$57.48
Rate for Payer: Priority Health Narrow Network	$57.48
Rate for Payer: Priority Health Narrow Network	$57.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$119.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$119.92
Rate for Payer: UHC Exchange	$119.92
Rate for Payer: UHC Exchange	$119.92
Rate for Payer: UHCCP Medicaid	$23.86
Rate for Payer: UHCCP Medicaid	$23.86

CHG CHEST X-RAY 1 VW

Professional

Both

$29.00

Service Code	HCPCS 71010
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$18.85
Rate for Payer: Aetna Medicare	$14.50
Rate for Payer: Aetna Medicare	$36.50
Rate for Payer: BCBS Complete	$29.20
Rate for Payer: BCBS Complete	$11.60
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$58.40
Rate for Payer: Priority Health Cigna Priority Health	$18.85
Rate for Payer: Priority Health Cigna Priority Health	$47.45

CHG CHEST X-RAY 2 VW

Professional

Both

$39.00

Service Code	HCPCS 71020
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$28.60
Rate for Payer: Priority Health Cigna Priority Health	$25.35

CHG CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I

Professional

Both

$28.00

Service Code	HCPCS 74300
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$79.16
Rate for Payer: Aetna Commercial	$45.81
Rate for Payer: Aetna Medicare	$14.00
Rate for Payer: BCBS Complete	$8.73
Rate for Payer: BCN Commercial	$79.16
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Meridian Medicaid	$8.73
Rate for Payer: Priority Health Choice Medicaid	$8.31
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.01
Rate for Payer: Priority Health Narrow Network	$20.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$58.33
Rate for Payer: UHC Exchange	$58.33
Rate for Payer: UHCCP Medicaid	$8.31

CHG CHOLESTEROL SERUM/WHOLE BLOOD TOTAL

Professional

Both

$14.00

Service Code	HCPCS 82465
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1,764.52
Rate for Payer: Aetna Commercial	$4.13
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$1,764.52
Rate for Payer: BCN Commercial	$1.08
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Priority Health Cigna Priority Health	$9.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.33
Rate for Payer: Priority Health Narrow Network	$4.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.74
Rate for Payer: UHC Exchange	$3.74

CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-

Professional

Both

$112.00

Service Code	HCPCS 71271
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$208.66
Rate for Payer: Aetna Commercial	$178.84
Rate for Payer: Aetna Medicare	$56.00
Rate for Payer: BCBS Complete	$34.00
Rate for Payer: BCN Commercial	$208.66
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Meridian Medicaid	$34.00
Rate for Payer: Priority Health Choice Medicaid	$32.38
Rate for Payer: Priority Health Cigna Priority Health	$72.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$78.02
Rate for Payer: Priority Health Narrow Network	$78.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$165.01
Rate for Payer: UHC Exchange	$165.01
Rate for Payer: UHCCP Medicaid	$32.38

Know your out-of-pocket cost for care.

All Charges