Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHEST PAIN

Facility

$4,393.92

Service Code	APR-DRG 2032
Min. Negotiated Rate	$4,184.68
Max. Negotiated Rate	$4,393.92
Rate for Payer: BCBS Complete	$4,393.92
Rate for Payer: Mclaren Medicaid	$4,184.68
Rate for Payer: Meridian Medicaid	$4,393.92
Rate for Payer: Priority Health Choice Medicaid	$4,184.68
Rate for Payer: UHC Medicaid	$4,184.68
Rate for Payer: UHCCP Medicaid	$4,184.68

CHEST PAIN

Facility

$4,929.22

Service Code	APR-DRG 2033
Min. Negotiated Rate	$4,694.50
Max. Negotiated Rate	$4,929.22
Rate for Payer: BCBS Complete	$4,929.22
Rate for Payer: Mclaren Medicaid	$4,694.50
Rate for Payer: Meridian Medicaid	$4,929.22
Rate for Payer: Priority Health Choice Medicaid	$4,694.50
Rate for Payer: UHC Medicaid	$4,694.50
Rate for Payer: UHCCP Medicaid	$4,694.50

CHEST PAIN

Facility

$8,107.93

Service Code	APR-DRG 2034
Min. Negotiated Rate	$7,721.84
Max. Negotiated Rate	$8,107.93
Rate for Payer: BCBS Complete	$8,107.93
Rate for Payer: Mclaren Medicaid	$7,721.84
Rate for Payer: Meridian Medicaid	$8,107.93
Rate for Payer: Priority Health Choice Medicaid	$7,721.84
Rate for Payer: UHC Medicaid	$7,721.84
Rate for Payer: UHCCP Medicaid	$7,721.84

CHEST PAIN

Facility

$3,912.78

Service Code	APR-DRG 2031
Min. Negotiated Rate	$3,726.45
Max. Negotiated Rate	$3,912.78
Rate for Payer: BCBS Complete	$3,912.78
Rate for Payer: Mclaren Medicaid	$3,726.45
Rate for Payer: Meridian Medicaid	$3,912.78
Rate for Payer: Priority Health Choice Medicaid	$3,726.45
Rate for Payer: UHC Medicaid	$3,726.45
Rate for Payer: UHCCP Medicaid	$3,726.45

CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

Professional

Both

$1,414.00

Service Code	HCPCS 77295
Min. Negotiated Rate	$553.26
Max. Negotiated Rate	$1,060.50
Rate for Payer: Aetna Commercial	$553.26
Rate for Payer: Aetna Commercial	$553.26
Rate for Payer: Aetna Medicare	$707.00
Rate for Payer: Aetna Medicare	$900.00
Rate for Payer: BCN Commercial	$707.55
Rate for Payer: BCN Commercial	$707.55
Rate for Payer: Cash Price	$1,131.20
Rate for Payer: Cash Price	$1,131.20
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,060.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,350.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$732.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$732.03
Rate for Payer: Priority Health Narrow/Tiered Network	$732.03
Rate for Payer: Priority Health Narrow/Tiered Network	$732.03

CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION

Professional

Both

$141.00

Service Code	HCPCS 76377
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$119.40
Rate for Payer: Aetna Commercial	$87.24
Rate for Payer: Aetna Medicare	$70.50
Rate for Payer: BCN Commercial	$118.52
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$105.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$119.40
Rate for Payer: Priority Health Narrow/Tiered Network	$119.40

CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION

Professional

Both

$46.00

Service Code	HCPCS 76376
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$38.64
Rate for Payer: Aetna Commercial	$27.49
Rate for Payer: Aetna Commercial	$27.49
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: BCN Commercial	$38.34
Rate for Payer: BCN Commercial	$38.34
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$38.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$38.64
Rate for Payer: Priority Health Narrow/Tiered Network	$38.64
Rate for Payer: Priority Health Narrow/Tiered Network	$38.64

CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING

Professional

Both

$707.00

Service Code	HCPCS 78278
Min. Negotiated Rate	$353.50
Max. Negotiated Rate	$530.25
Rate for Payer: Aetna Commercial	$394.55
Rate for Payer: Aetna Medicare	$353.50
Rate for Payer: BCN Commercial	$466.61
Rate for Payer: Cash Price	$565.60
Rate for Payer: Cash Price	$565.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$530.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$470.13
Rate for Payer: Priority Health Narrow/Tiered Network	$470.13

CHG ANGIO ARCH ANGIOGRAM W CATH

Professional

Both

$275.00

Service Code	HCPCS 75650
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$206.25
Rate for Payer: Aetna Medicare	$137.50
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$206.25

CHG ANGIO AV SHUNT COMPLETE EVAL

Professional

Both

$522.00

Service Code	HCPCS 75791
Min. Negotiated Rate	$208.80
Max. Negotiated Rate	$391.50
Rate for Payer: Aetna Medicare	$261.00
Rate for Payer: Aetna Medicare	$158.50
Rate for Payer: BCBS Complete	$126.80
Rate for Payer: BCBS Complete	$208.80
Rate for Payer: Cash Price	$253.60
Rate for Payer: Cash Price	$417.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$391.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$237.75

CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I

Professional

Both

$204.00

Service Code	HCPCS 75716
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$244.35
Rate for Payer: Aetna Commercial	$198.34
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: BCN Commercial	$242.52
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cash Price	$163.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$244.35
Rate for Payer: Priority Health Narrow/Tiered Network	$244.35

CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I

Professional

Both

$443.00

Service Code	HCPCS 75710
Min. Negotiated Rate	$184.17
Max. Negotiated Rate	$332.25
Rate for Payer: Aetna Commercial	$184.17
Rate for Payer: Aetna Commercial	$184.17
Rate for Payer: Aetna Medicare	$93.50
Rate for Payer: Aetna Medicare	$221.50
Rate for Payer: BCN Commercial	$221.10
Rate for Payer: BCN Commercial	$221.10
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$354.40
Rate for Payer: Cash Price	$354.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$332.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$140.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$222.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$222.77
Rate for Payer: Priority Health Narrow/Tiered Network	$222.77
Rate for Payer: Priority Health Narrow/Tiered Network	$222.77

CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I

Professional

Both

$196.00

Service Code	HCPCS 75756
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$244.35
Rate for Payer: Aetna Commercial	$184.66
Rate for Payer: Aetna Medicare	$98.00
Rate for Payer: BCN Commercial	$242.52
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$147.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$244.35
Rate for Payer: Priority Health Narrow/Tiered Network	$244.35

CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I

Professional

Both

$329.00

Service Code	HCPCS 75736
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$246.75
Rate for Payer: Aetna Commercial	$167.44
Rate for Payer: Aetna Medicare	$164.50
Rate for Payer: BCN Commercial	$215.63
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cash Price	$263.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$246.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$217.25
Rate for Payer: Priority Health Narrow/Tiered Network	$217.25

CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I

Professional

Both

$129.00

Service Code	HCPCS 75741
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$194.17
Rate for Payer: Aetna Commercial	$158.51
Rate for Payer: Aetna Medicare	$64.50
Rate for Payer: BCN Commercial	$192.72
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$194.17
Rate for Payer: Priority Health Narrow/Tiered Network	$194.17

CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I

Professional

Both

$449.00

Service Code	HCPCS 75705
Min. Negotiated Rate	$224.50
Max. Negotiated Rate	$386.34
Rate for Payer: Aetna Commercial	$287.69
Rate for Payer: Aetna Medicare	$224.50
Rate for Payer: BCN Commercial	$383.44
Rate for Payer: Cash Price	$359.20
Rate for Payer: Cash Price	$359.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$336.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$386.34
Rate for Payer: Priority Health Narrow/Tiered Network	$386.34

CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I

Professional

Both

$281.00

Service Code	HCPCS 75726
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$256.88
Rate for Payer: Aetna Commercial	$206.42
Rate for Payer: Aetna Medicare	$140.50
Rate for Payer: BCN Commercial	$254.97
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cash Price	$224.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$256.88
Rate for Payer: Priority Health Narrow/Tiered Network	$256.88

CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS

Professional

Both

$167.00

Service Code	HCPCS 75898
Min. Negotiated Rate	$83.50
Max. Negotiated Rate	$3,164.58
Rate for Payer: Aetna Commercial	$3,164.58
Rate for Payer: Aetna Medicare	$83.50
Rate for Payer: BCN Commercial	$134.96
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$125.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$202.70
Rate for Payer: Priority Health Narrow/Tiered Network	$202.70

CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I

Professional

Both

$311.00

Service Code	HCPCS 75774
Min. Negotiated Rate	$120.01
Max. Negotiated Rate	$233.25
Rate for Payer: Aetna Commercial	$120.01
Rate for Payer: Aetna Medicare	$155.50
Rate for Payer: BCN Commercial	$142.92
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$233.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$143.99
Rate for Payer: Priority Health Narrow/Tiered Network	$143.99

CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I

Professional

Both

$302.00

Service Code	HCPCS 75630
Min. Negotiated Rate	$151.00
Max. Negotiated Rate	$234.81
Rate for Payer: Aetna Commercial	$192.70
Rate for Payer: Aetna Commercial	$192.70
Rate for Payer: Aetna Medicare	$151.00
Rate for Payer: Aetna Medicare	$244.50
Rate for Payer: BCN Commercial	$233.06
Rate for Payer: BCN Commercial	$233.06
Rate for Payer: Cash Price	$391.20
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cash Price	$391.20
Rate for Payer: Cash Price	$241.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$226.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$366.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$234.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$234.81
Rate for Payer: Priority Health Narrow/Tiered Network	$234.81
Rate for Payer: Priority Health Narrow/Tiered Network	$234.81

CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I

Professional

Both

$117.00

Service Code	HCPCS 75625
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$188.65
Rate for Payer: Aetna Commercial	$155.85
Rate for Payer: Aetna Commercial	$155.85
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: Aetna Medicare	$59.00
Rate for Payer: BCN Commercial	$187.24
Rate for Payer: BCN Commercial	$187.24
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$93.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$188.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$188.65
Rate for Payer: Priority Health Narrow/Tiered Network	$188.65
Rate for Payer: Priority Health Narrow/Tiered Network	$188.65

CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I

Professional

Both

$273.00

Service Code	HCPCS 75605
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$204.75
Rate for Payer: Aetna Commercial	$145.70
Rate for Payer: Aetna Medicare	$136.50
Rate for Payer: BCN Commercial	$179.77
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$204.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$181.12
Rate for Payer: Priority Health Narrow/Tiered Network	$181.12

CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I

Professional

Both

$110.00

Service Code	HCPCS 75600
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$260.90
Rate for Payer: Aetna Commercial	$227.46
Rate for Payer: Aetna Medicare	$55.00
Rate for Payer: BCN Commercial	$258.95
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$82.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$260.90
Rate for Payer: Priority Health Narrow/Tiered Network	$260.90

CHG AQMBF PET REST AND PHARMACOLOGIC STRESS

Professional

Both

$62.00

Service Code	HCPCS 78434
Min. Negotiated Rate	$31.00
Max. Negotiated Rate	$308.07
Rate for Payer: Aetna Commercial	$239.63
Rate for Payer: Aetna Medicare	$31.00
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$308.07
Rate for Payer: Priority Health Narrow/Tiered Network	$308.07

CHG ASSAY OF LEAD

Professional

Both

$21.00

Service Code	HCPCS 83655
Min. Negotiated Rate	$9.08
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna Commercial	$11.50
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: BCN Commercial	$9.08
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$12.44
Rate for Payer: Priority Health Narrow/Tiered Network	$12.44

Know your out-of-pocket cost for care.

All Charges