Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHG CHOLESTEROL SERUM/WHOLE BLOOD TOTAL

Professional

Both

$14.00

Service Code	HCPCS 82465
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$4.13
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCN Commercial	$1.08
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	$4.38
Rate for Payer: Priority Health Narrow/Tiered Network	$4.38

CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-

Professional

Both

$115.00

Service Code	HCPCS 71271
Min. Negotiated Rate	$57.50
Max. Negotiated Rate	$210.22
Rate for Payer: Aetna Commercial	$178.84
Rate for Payer: Aetna Medicare	$57.50
Rate for Payer: BCN Commercial	$208.65
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$210.22
Rate for Payer: Priority Health Narrow/Tiered Network	$210.22

CHG CONTINUING MEDICAL PHYSICS CONSLTJ PR WK

Professional

Both

$159.00

Service Code	HCPCS 77336
Min. Negotiated Rate	$79.50
Max. Negotiated Rate	$137.48
Rate for Payer: Aetna Commercial	$90.57
Rate for Payer: Aetna Medicare	$79.50
Rate for Payer: BCN Commercial	$136.44
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$119.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$137.48
Rate for Payer: Priority Health Narrow/Tiered Network	$137.48

CHG CREATININE OTHER SOURCE

Professional

Both

$11.00

Service Code	HCPCS 82570
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCN Commercial	$3.89
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	$5.38
Rate for Payer: Priority Health Narrow/Tiered Network	$5.38

CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID

Professional

Both

$58.00

Service Code	HCPCS 89060
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$6.96
Rate for Payer: Aetna Medicare	$29.00
Rate for Payer: BCN Commercial	$31.54
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$43.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$38.13
Rate for Payer: Priority Health Narrow/Tiered Network	$38.13

CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP

Professional

Both

$315.00

Service Code	HCPCS 75635
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$627.66
Rate for Payer: Aetna Commercial	$351.85
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCN Commercial	$622.97
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$627.66
Rate for Payer: Priority Health Narrow/Tiered Network	$627.66

CHG CTA ABDOMEN W/CONTRAST&IMG POSTPROCESSING

Professional

Both

$193.00

Service Code	HCPCS 74175
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$467.12
Rate for Payer: Aetna Commercial	$316.72
Rate for Payer: Aetna Medicare	$96.50
Rate for Payer: BCN Commercial	$463.62
Rate for Payer: Cash Price	$154.40
Rate for Payer: Cash Price	$154.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$144.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$467.12
Rate for Payer: Priority Health Narrow/Tiered Network	$467.12

CHG CTA ABD&PLVS W/CNTRST & IMG POSTPROCESSING

Professional

Both

$232.00

Service Code	HCPCS 74174
Min. Negotiated Rate	$116.00
Max. Negotiated Rate	$580.50
Rate for Payer: Aetna Commercial	$493.17
Rate for Payer: Aetna Medicare	$116.00
Rate for Payer: BCN Commercial	$576.17
Rate for Payer: Cash Price	$185.60
Rate for Payer: Cash Price	$185.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$580.50
Rate for Payer: Priority Health Narrow/Tiered Network	$580.50

CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL

Professional

Both

$194.00

Service Code	HCPCS 74177
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$461.08
Rate for Payer: Aetna Commercial	$399.91
Rate for Payer: Aetna Medicare	$97.00
Rate for Payer: BCN Commercial	$457.65
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$145.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$461.08
Rate for Payer: Priority Health Narrow/Tiered Network	$461.08

CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL

Professional

Both

$185.00

Service Code	HCPCS 74176
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$280.47
Rate for Payer: Aetna Commercial	$239.29
Rate for Payer: Aetna Medicare	$92.50
Rate for Payer: BCN Commercial	$278.37
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cash Price	$148.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$280.47
Rate for Payer: Priority Health Narrow/Tiered Network	$280.47

CHG CT ABDOMEN W/CONTRAST MATERIAL

Professional

Both

$136.00

Service Code	HCPCS 74160
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$352.21
Rate for Payer: Aetna Commercial	$283.74
Rate for Payer: Aetna Commercial	$283.74
Rate for Payer: Aetna Medicare	$68.00
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCN Commercial	$349.59
Rate for Payer: BCN Commercial	$349.59
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cash Price	$108.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$101.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$352.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$352.21
Rate for Payer: Priority Health Narrow/Tiered Network	$352.21
Rate for Payer: Priority Health Narrow/Tiered Network	$352.21

CHG CT ABDOMEN W/O CONTRAST FLWD BY CONTRAST MATRL

Professional

Both

$148.00

Service Code	HCPCS 74170
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$395.86
Rate for Payer: Aetna Commercial	$291.58
Rate for Payer: Aetna Medicare	$74.00
Rate for Payer: BCN Commercial	$392.91
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$395.86
Rate for Payer: Priority Health Narrow/Tiered Network	$395.86

CHG CT ABDOMEN W/O CONTRAST MATERIAL

Professional

Both

$126.00

Service Code	HCPCS 74150
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$208.22
Rate for Payer: Aetna Commercial	$178.47
Rate for Payer: Aetna Medicare	$63.00
Rate for Payer: BCN Commercial	$206.66
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$94.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$208.22
Rate for Payer: Priority Health Narrow/Tiered Network	$208.22

CHG CT ABD&PLV W/O CNTRST 1/BTH FLWD CNTRST 1/BTH

Professional

Both

$212.00

Service Code	HCPCS 74178
Min. Negotiated Rate	$106.00
Max. Negotiated Rate	$516.29
Rate for Payer: Aetna Commercial	$448.29
Rate for Payer: Aetna Medicare	$106.00
Rate for Payer: BCN Commercial	$512.43
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$516.29
Rate for Payer: Priority Health Narrow/Tiered Network	$516.29

CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST

Professional

Both

$253.00

Service Code	HCPCS 75574
Min. Negotiated Rate	$126.50
Max. Negotiated Rate	$493.70
Rate for Payer: Aetna Commercial	$351.36
Rate for Payer: Aetna Medicare	$126.50
Rate for Payer: BCN Commercial	$490.01
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cash Price	$202.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$189.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$493.70
Rate for Payer: Priority Health Narrow/Tiered Network	$493.70

CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST

Professional

Both

$194.00

Service Code	HCPCS 71275
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$430.99
Rate for Payer: Aetna Commercial	$317.55
Rate for Payer: Aetna Medicare	$97.00
Rate for Payer: BCN Commercial	$427.76
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$145.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$430.99
Rate for Payer: Priority Health Narrow/Tiered Network	$430.99

CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST

Professional

Both

$186.00

Service Code	HCPCS 70496
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$422.46
Rate for Payer: Aetna Commercial	$313.24
Rate for Payer: Aetna Medicare	$93.00
Rate for Payer: BCN Commercial	$419.30
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$139.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$422.46
Rate for Payer: Priority Health Narrow/Tiered Network	$422.46

CHG CT ANGIOGRAPHY LOWER EXTREMITY

Professional

Both

$200.00

Service Code	HCPCS 73706
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$493.21
Rate for Payer: Aetna Commercial	$321.13
Rate for Payer: Aetna Medicare	$100.00
Rate for Payer: BCN Commercial	$489.52
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$493.21
Rate for Payer: Priority Health Narrow/Tiered Network	$493.21

CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST

Professional

Both

$186.00

Service Code	HCPCS 70498
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$421.95
Rate for Payer: Aetna Commercial	$313.24
Rate for Payer: Aetna Medicare	$93.00
Rate for Payer: BCN Commercial	$418.81
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$139.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$421.95
Rate for Payer: Priority Health Narrow/Tiered Network	$421.95

CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST

Professional

Both

$191.00

Service Code	HCPCS 72191
Min. Negotiated Rate	$95.50
Max. Negotiated Rate	$465.10
Rate for Payer: Aetna Commercial	$315.87
Rate for Payer: Aetna Medicare	$95.50
Rate for Payer: BCN Commercial	$461.63
Rate for Payer: Cash Price	$152.80
Rate for Payer: Cash Price	$152.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$143.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$465.10
Rate for Payer: Priority Health Narrow/Tiered Network	$465.10

CHG CT ANGIOGRAPHY UPPER EXTREMITY

Professional

Both

$191.00

Service Code	HCPCS 73206
Min. Negotiated Rate	$95.50
Max. Negotiated Rate	$454.07
Rate for Payer: Aetna Commercial	$315.93
Rate for Payer: Aetna Medicare	$95.50
Rate for Payer: BCN Commercial	$450.67
Rate for Payer: Cash Price	$152.80
Rate for Payer: Cash Price	$152.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$143.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$454.07
Rate for Payer: Priority Health Narrow/Tiered Network	$454.07

CHG CT CERVICAL SPINE W/CONTRAST MATERIAL

Professional

Both

$129.00

Service Code	HCPCS 72126
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$257.39
Rate for Payer: Aetna Commercial	$220.57
Rate for Payer: Aetna Medicare	$64.50
Rate for Payer: BCN Commercial	$255.46
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	$257.39
Rate for Payer: Priority Health Narrow/Tiered Network	$257.39

CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL

Professional

Both

$106.00

Service Code	HCPCS 72125
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$198.68
Rate for Payer: Aetna Commercial	$169.64
Rate for Payer: Aetna Medicare	$53.00
Rate for Payer: BCN Commercial	$197.20
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$79.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$198.68
Rate for Payer: Priority Health Narrow/Tiered Network	$198.68

CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL

Professional

Both

$135.00

Service Code	HCPCS 72127
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$300.03
Rate for Payer: Aetna Commercial	$258.31
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCN Commercial	$297.79
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$101.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$300.03
Rate for Payer: Priority Health Narrow/Tiered Network	$300.03

CHG CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING

Professional

Both

$242.00

Service Code	HCPCS 74263
Min. Negotiated Rate	$121.00
Max. Negotiated Rate	$1,085.75
Rate for Payer: Aetna Commercial	$905.57
Rate for Payer: Aetna Medicare	$121.00
Rate for Payer: BCN Commercial	$1,077.63
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$193.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$181.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,085.75
Rate for Payer: Priority Health Narrow/Tiered Network	$1,085.75

Know your out-of-pocket cost for care.

All Charges