Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST

Professional

Both

$266.00

Service Code	HCPCS 74262
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$704.93
Rate for Payer: Aetna Commercial	$358.62
Rate for Payer: Aetna Medicare	$133.00
Rate for Payer: BCN Commercial	$699.66
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cash Price	$212.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$199.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$704.93
Rate for Payer: Priority Health Narrow/Tiered Network	$704.93

CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST

Professional

Both

$254.00

Service Code	HCPCS 74261
Min. Negotiated Rate	$127.00
Max. Negotiated Rate	$627.16
Rate for Payer: Aetna Commercial	$272.64
Rate for Payer: Aetna Commercial	$272.64
Rate for Payer: Aetna Medicare	$127.00
Rate for Payer: Aetna Medicare	$473.00
Rate for Payer: BCN Commercial	$622.48
Rate for Payer: BCN Commercial	$622.48
Rate for Payer: Cash Price	$756.80
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cash Price	$756.80
Rate for Payer: Cash Price	$203.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$190.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$709.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$627.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$627.16
Rate for Payer: Priority Health Narrow/Tiered Network	$627.16
Rate for Payer: Priority Health Narrow/Tiered Network	$627.16

CHG CT GUIDANCE &MONITORING VISC TISS ABLATION

Professional

Both

$409.00

Service Code	HCPCS 77013
Min. Negotiated Rate	$204.50
Max. Negotiated Rate	$755.61
Rate for Payer: Aetna Commercial	$620.14
Rate for Payer: Aetna Medicare	$204.50
Rate for Payer: BCN Commercial	$269.92
Rate for Payer: Cash Price	$327.20
Rate for Payer: Cash Price	$327.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$306.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$755.61
Rate for Payer: Priority Health Narrow/Tiered Network	$755.61

CHG CT GUIDANCE NEEDLE PLACEMENT

Professional

Both

$225.00

Service Code	HCPCS 77012
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$189.65
Rate for Payer: Aetna Commercial	$181.02
Rate for Payer: Aetna Medicare	$112.50
Rate for Payer: BCN Commercial	$188.23
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$168.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$189.65
Rate for Payer: Priority Health Narrow/Tiered Network	$189.65

CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT

Professional

Both

$332.00

Service Code	HCPCS 77014
Min. Negotiated Rate	$132.80
Max. Negotiated Rate	$249.00
Rate for Payer: Aetna Commercial	$149.64
Rate for Payer: Aetna Commercial	$149.64
Rate for Payer: Aetna Medicare	$125.00
Rate for Payer: Aetna Medicare	$166.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: BCBS Complete	$132.80
Rate for Payer: BCN Commercial	$178.28
Rate for Payer: BCN Commercial	$178.28
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$265.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$249.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$187.50

CHG CT GUIDANCE STEREOTACTIC LOCALIZATION

Professional

Both

$480.00

Service Code	HCPCS 77011
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna Commercial	$283.63
Rate for Payer: Aetna Commercial	$283.63
Rate for Payer: Aetna Medicare	$69.00
Rate for Payer: Aetna Medicare	$240.00
Rate for Payer: BCN Commercial	$325.68
Rate for Payer: BCN Commercial	$325.68
Rate for Payer: Cash Price	$384.00
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$384.00
Rate for Payer: Cash Price	$110.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$360.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$328.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$328.14
Rate for Payer: Priority Health Narrow/Tiered Network	$328.14
Rate for Payer: Priority Health Narrow/Tiered Network	$328.14

CHG CT HEAD/BRAIN W/CONTRAST MATERIAL

Professional

Both

$121.00

Service Code	HCPCS 70460
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$226.79
Rate for Payer: Aetna Commercial	$193.57
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: BCN Commercial	$225.09
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$90.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$226.79
Rate for Payer: Priority Health Narrow/Tiered Network	$226.79

CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL

Professional

Both

$91.00

Service Code	HCPCS 70450
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$163.07
Rate for Payer: Aetna Commercial	$137.94
Rate for Payer: Aetna Medicare	$45.50
Rate for Payer: BCN Commercial	$161.85
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$163.07
Rate for Payer: Priority Health Narrow/Tiered Network	$163.07

CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL

Professional

Both

$136.00

Service Code	HCPCS 70470
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$264.91
Rate for Payer: Aetna Commercial	$227.23
Rate for Payer: Aetna Medicare	$68.00
Rate for Payer: BCN Commercial	$262.93
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cash Price	$108.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$264.91
Rate for Payer: Priority Health Narrow/Tiered Network	$264.91

CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH

Professional

Both

$184.00

Service Code	HCPCS 75572
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$348.19
Rate for Payer: Aetna Commercial	$311.94
Rate for Payer: Aetna Medicare	$92.00
Rate for Payer: BCN Commercial	$345.59
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$348.19
Rate for Payer: Priority Health Narrow/Tiered Network	$348.19

CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM

Professional

Both

$61.00

Service Code	HCPCS 75571
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$153.53
Rate for Payer: Aetna Commercial	$127.18
Rate for Payer: Aetna Medicare	$30.50
Rate for Payer: BCN Commercial	$152.39
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	$153.53
Rate for Payer: Priority Health Narrow/Tiered Network	$153.53

CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY

Professional

Both

$158.00

Service Code	HCPCS 76380
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$199.69
Rate for Payer: Aetna Commercial	$152.20
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCN Commercial	$198.19
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$199.69
Rate for Payer: Priority Health Narrow/Tiered Network	$199.69

CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL

Professional

Both

$123.00

Service Code	HCPCS 73701
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$254.38
Rate for Payer: Aetna Commercial	$217.91
Rate for Payer: Aetna Medicare	$61.50
Rate for Payer: BCN Commercial	$252.48
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$92.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$254.38
Rate for Payer: Priority Health Narrow/Tiered Network	$254.38

CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL

Professional

Both

$106.00

Service Code	HCPCS 73700
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$198.19
Rate for Payer: Aetna Commercial	$168.84
Rate for Payer: Aetna Medicare	$53.00
Rate for Payer: BCN Commercial	$196.71
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	$198.19
Rate for Payer: Priority Health Narrow/Tiered Network	$198.19

CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL

Professional

Both

$129.00

Service Code	HCPCS 73702
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$298.03
Rate for Payer: Aetna Commercial	$253.67
Rate for Payer: Aetna Medicare	$64.50
Rate for Payer: BCN Commercial	$295.80
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	$298.03
Rate for Payer: Priority Health Narrow/Tiered Network	$298.03

CHG CT LUMBAR SPINE W/CONTRAST MATERIAL

Professional

Both

$129.00

Service Code	HCPCS 72132
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$258.38
Rate for Payer: Aetna Commercial	$220.57
Rate for Payer: Aetna Medicare	$64.50
Rate for Payer: BCN Commercial	$256.46
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	$258.38
Rate for Payer: Priority Health Narrow/Tiered Network	$258.38

CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL

Professional

Both

$106.00

Service Code	HCPCS 72131
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$197.69
Rate for Payer: BCN Commercial	$196.20
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Aetna Commercial	$168.84
Rate for Payer: Aetna Medicare	$53.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$79.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$197.69
Rate for Payer: Priority Health Narrow/Tiered Network	$197.69

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

Professional

Both

$135.00

Service Code	HCPCS 72133
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$300.54
Rate for Payer: Aetna Commercial	$258.31
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCN Commercial	$298.29
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	$300.54
Rate for Payer: Priority Health Narrow/Tiered Network	$300.54

CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL

Professional

Both

$119.00

Service Code	HCPCS 70487
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$232.29
Rate for Payer: Aetna Commercial	$198.82
Rate for Payer: Aetna Medicare	$59.50
Rate for Payer: BCN Commercial	$230.56
Rate for Payer: Cash Price	$95.20
Rate for Payer: Cash Price	$95.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$89.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$232.29
Rate for Payer: Priority Health Narrow/Tiered Network	$232.29

CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL

Professional

Both

$91.00

Service Code	HCPCS 70486
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$195.67
Rate for Payer: Aetna Commercial	$166.20
Rate for Payer: Aetna Medicare	$45.50
Rate for Payer: BCN Commercial	$194.21
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$195.67
Rate for Payer: Priority Health Narrow/Tiered Network	$195.67

CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL

Professional

Both

$135.00

Service Code	HCPCS 70488
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$280.97
Rate for Payer: Aetna Commercial	$242.97
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCN Commercial	$278.87
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	$280.97
Rate for Payer: Priority Health Narrow/Tiered Network	$280.97

CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL

Professional

Both

$121.00

Service Code	HCPCS 70481
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$275.45
Rate for Payer: Aetna Commercial	$236.77
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: BCN Commercial	$273.39
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$90.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$275.45
Rate for Payer: Priority Health Narrow/Tiered Network	$275.45

CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL

Professional

Both

$137.00

Service Code	HCPCS 70480
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$242.84
Rate for Payer: Aetna Commercial	$206.27
Rate for Payer: Aetna Medicare	$68.50
Rate for Payer: BCN Commercial	$241.02
Rate for Payer: Cash Price	$109.60
Rate for Payer: Cash Price	$109.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$242.84
Rate for Payer: Priority Health Narrow/Tiered Network	$242.84

CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR

Professional

Both

$135.00

Service Code	HCPCS 70482
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$320.60
Rate for Payer: Aetna Commercial	$278.12
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCN Commercial	$318.21
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	$320.60
Rate for Payer: Priority Health Narrow/Tiered Network	$320.60

CHG CT PELVIS W/CONTRAST MATERIAL

Professional

Both

$123.00

Service Code	HCPCS 72193
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$346.19
Rate for Payer: Aetna Commercial	$277.26
Rate for Payer: Aetna Medicare	$61.50
Rate for Payer: BCN Commercial	$343.60
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$92.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$346.19
Rate for Payer: Priority Health Narrow/Tiered Network	$346.19

Know your out-of-pocket cost for care.

All Charges