Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHG ASSAY OF PHOSPHATASE ALKALINE

Professional

Both

$12.00

Service Code	HCPCS 84075
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: BCN Commercial	$1.08
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5.38
Rate for Payer: Priority Health Narrow/Tiered Network	$5.38

CHG ASSAY OF PROGESTERONE

Professional

Both

$97.00

Service Code	HCPCS 84144
Min. Negotiated Rate	$15.65
Max. Negotiated Rate	$72.75
Rate for Payer: Aetna Commercial	$19.82
Rate for Payer: Aetna Medicare	$48.50
Rate for Payer: BCN Commercial	$15.65
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cash Price	$77.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$21.52
Rate for Payer: Priority Health Narrow/Tiered Network	$21.52

CHG ASSAY OF PYRUVATE KINASE

Professional

Both

$98.00

Service Code	HCPCS 84220
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$73.50
Rate for Payer: Aetna Commercial	$8.97
Rate for Payer: Aetna Medicare	$49.00
Rate for Payer: BCBS Complete	$39.20
Rate for Payer: BCN Commercial	$7.08
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cash Price	$78.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$73.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$9.75
Rate for Payer: Priority Health Narrow/Tiered Network	$9.75

CHG ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE

Professional

Both

$82.00

Service Code	HCPCS 84588
Min. Negotiated Rate	$25.46
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna Commercial	$32.24
Rate for Payer: Aetna Medicare	$41.00
Rate for Payer: BCBS Complete	$32.80
Rate for Payer: BCN Commercial	$25.46
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$35.30
Rate for Payer: Priority Health Narrow/Tiered Network	$35.30

CHG BALLOON ANGIOPLASTY VISCERAL

Professional

Both

$165.00

Service Code	HCPCS 75966
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$123.75
Rate for Payer: Aetna Medicare	$82.50
Rate for Payer: BCBS Complete	$66.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$123.75

CHG BALLOON ANGIO VENOUS

Professional

Both

$409.00

Service Code	HCPCS 75978
Min. Negotiated Rate	$163.60
Max. Negotiated Rate	$306.75
Rate for Payer: Aetna Medicare	$204.50
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: BCBS Complete	$163.60
Rate for Payer: Cash Price	$327.20
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$306.75

CHG BASIC RADIATION DOSIMETRY CALCULATION

Professional

Both

$77.00

Service Code	HCPCS 77300
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$101.35
Rate for Payer: Aetna Commercial	$76.02
Rate for Payer: Aetna Commercial	$76.02
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: Aetna Medicare	$38.50
Rate for Payer: BCN Commercial	$100.60
Rate for Payer: BCN Commercial	$100.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$57.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$101.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$101.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$101.35
Rate for Payer: Priority Health Narrow/Tiered Network	$101.35
Rate for Payer: Priority Health Narrow/Tiered Network	$101.35

CHG BILIRUBIN TOTAL

Professional

Both

$24.00

Service Code	HCPCS 82247
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: Aetna Medicare	$12.00
Rate for Payer: BCN Commercial	$1.08
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5.38
Rate for Payer: Priority Health Narrow/Tiered Network	$5.38

CHG BILIRUBIN TOTAL TRANSCUTANEOUS

Professional

Both

$13.00

Service Code	HCPCS 88720
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCN Commercial	$3.77
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$8.04
Rate for Payer: Priority Health Narrow/Tiered Network	$8.04

CHG BLOOD COUNT HEMOGLOBIN

Professional

Both

$14.00

Service Code	HCPCS 85018
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCN Commercial	$2.37
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$10.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2.35
Rate for Payer: Priority Health Narrow/Tiered Network	$2.35

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

Professional

Both

$45.00

Service Code	HCPCS 82274
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna Commercial	$15.12
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCN Commercial	$15.92
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$16.48
Rate for Payer: Priority Health Narrow/Tiered Network	$16.48

CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC

Professional

Both

$10.00

Service Code	HCPCS 82272
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.02
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCN Commercial	$4.23
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4.38
Rate for Payer: Priority Health Narrow/Tiered Network	$4.38

CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER

Professional

Both

$14.00

Service Code	HCPCS 82270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$4.16
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCN Commercial	$4.38
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$10.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4.71
Rate for Payer: Priority Health Narrow/Tiered Network	$4.71

CHG BONE AGE STUDIES

Professional

Both

$37.00

Service Code	HCPCS 77072
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$38.64
Rate for Payer: Aetna Commercial	$29.76
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCN Commercial	$38.34
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$29.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$38.64
Rate for Payer: Priority Health Narrow/Tiered Network	$38.64

CHG BONE LENGTH STUDIES

Professional

Both

$138.00

Service Code	HCPCS 77073
Min. Negotiated Rate	$51.41
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$51.41
Rate for Payer: Aetna Commercial	$51.41
Rate for Payer: Aetna Medicare	$69.00
Rate for Payer: Aetna Medicare	$30.00
Rate for Payer: BCN Commercial	$67.72
Rate for Payer: BCN Commercial	$67.72
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$110.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$68.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$68.23
Rate for Payer: Priority Health Narrow/Tiered Network	$68.23
Rate for Payer: Priority Health Narrow/Tiered Network	$68.23

CHG BRACHYTHER DOSE PLAN COMPLX

Professional

Both

$318.00

Service Code	HCPCS 77328
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$238.50
Rate for Payer: Aetna Medicare	$159.00
Rate for Payer: Aetna Medicare	$271.00
Rate for Payer: BCBS Complete	$216.80
Rate for Payer: BCBS Complete	$127.20
Rate for Payer: Cash Price	$254.40
Rate for Payer: Cash Price	$433.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$238.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$406.50

CHG BRACHYTHER DOSE PLAN SIMPLE

Professional

Both

$190.00

Service Code	HCPCS 77326
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$142.50
Rate for Payer: Aetna Medicare	$95.00
Rate for Payer: Aetna Medicare	$143.50
Rate for Payer: BCBS Complete	$114.80
Rate for Payer: BCBS Complete	$76.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$229.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.25

CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL

Professional

Both

$662.00

Service Code	HCPCS 77318
Min. Negotiated Rate	$331.00
Max. Negotiated Rate	$698.40
Rate for Payer: Aetna Commercial	$494.97
Rate for Payer: Aetna Commercial	$494.97
Rate for Payer: Aetna Medicare	$331.00
Rate for Payer: Aetna Medicare	$365.00
Rate for Payer: BCN Commercial	$693.19
Rate for Payer: BCN Commercial	$693.19
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cash Price	$529.60
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cash Price	$529.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$496.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$547.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$698.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$698.40
Rate for Payer: Priority Health Narrow/Tiered Network	$698.40
Rate for Payer: Priority Health Narrow/Tiered Network	$698.40

CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS

Professional

Both

$263.00

Service Code	HCPCS 78472
Min. Negotiated Rate	$131.50
Max. Negotiated Rate	$310.56
Rate for Payer: Aetna Commercial	$259.45
Rate for Payer: Aetna Medicare	$131.50
Rate for Payer: BCN Commercial	$308.25
Rate for Payer: Cash Price	$210.40
Rate for Payer: Cash Price	$210.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$310.56
Rate for Payer: Priority Health Narrow/Tiered Network	$310.56

CHG CELL COUNT MISCELLANEOUS BODY FLUIDS

Professional

Both

$11.00

Service Code	HCPCS 89050
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna Commercial	$4.48
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCN Commercial	$3.54
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$7.52
Rate for Payer: Priority Health Narrow/Tiered Network	$7.52

CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY

Professional

Both

$678.00

Service Code	HCPCS 78630
Min. Negotiated Rate	$339.00
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna Commercial	$381.57
Rate for Payer: Aetna Medicare	$339.00
Rate for Payer: BCN Commercial	$450.17
Rate for Payer: Cash Price	$542.40
Rate for Payer: Cash Price	$542.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$508.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$453.56
Rate for Payer: Priority Health Narrow/Tiered Network	$453.56

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

Professional

Both

$142.00

Service Code	HCPCS 75984
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$141.99
Rate for Payer: Aetna Commercial	$119.58
Rate for Payer: Aetna Commercial	$119.58
Rate for Payer: Aetna Medicare	$71.00
Rate for Payer: Aetna Medicare	$82.50
Rate for Payer: BCN Commercial	$140.93
Rate for Payer: BCN Commercial	$140.93
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$113.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$106.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$123.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$141.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$141.99
Rate for Payer: Priority Health Narrow/Tiered Network	$141.99
Rate for Payer: Priority Health Narrow/Tiered Network	$141.99

CHG CHEST X-RAY 1 VW

Professional

Both

$30.00

Service Code	HCPCS 71010
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Medicare	$15.00
Rate for Payer: Aetna Medicare	$37.50
Rate for Payer: BCBS Complete	$30.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$56.25

CHG CHEST X-RAY 2 VW

Professional

Both

$40.00

Service Code	HCPCS 71020
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.75

CHG CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I

Professional

Both

$29.00

Service Code	HCPCS 74300
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$55.68
Rate for Payer: Aetna Commercial	$45.81
Rate for Payer: Aetna Medicare	$14.50
Rate for Payer: BCN Commercial	$19.43
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	$55.68
Rate for Payer: Priority Health Narrow/Tiered Network	$55.68

Know your out-of-pocket cost for care.

All Charges