Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY

Professional

Both

$256.00

Service Code	HCPCS 76820
Min. Negotiated Rate	$53.83
Max. Negotiated Rate	$192.00
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: Aetna Medicare	$128.00
Rate for Payer: BCN Commercial	$65.73
Rate for Payer: Cash Price	$204.80
Rate for Payer: Cash Price	$204.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$192.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$66.23
Rate for Payer: Priority Health Narrow/Tiered Network	$66.23

CHG DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES

Professional

Both

$40.00

Service Code	HCPCS 80300
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00

CHG DRUG SCREEN MULT CLASSES

Professional

Both

$32.00

Service Code	HCPCS 80100
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00

CHG DRUG SCREEN, QUAL,1+ DRUG CLASS,NON-CHROMOTOGRAPHIC,EACH

Professional

Both

$40.00

Service Code	HCPCS 80104
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00

CHG DRUG SCREEN SINGL CLASS

Professional

Both

$32.00

Service Code	HCPCS 80101
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00

CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE

Professional

Both

$40.00

Service Code	HCPCS 80305
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$11.97
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCN Commercial	$9.45
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$13.12
Rate for Payer: Priority Health Narrow/Tiered Network	$13.12

CHG DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE

Professional

Both

$84.00

Service Code	HCPCS 80307
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$64.56
Rate for Payer: Aetna Commercial	$59.03
Rate for Payer: Aetna Medicare	$42.00
Rate for Payer: BCN Commercial	$62.14
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$64.56
Rate for Payer: Priority Health Narrow/Tiered Network	$64.56

CHG DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS

Professional

Both

$28.00

Service Code	HCPCS 80306
Min. Negotiated Rate	$12.86
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: Aetna Medicare	$14.00
Rate for Payer: BCN Commercial	$12.86
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$17.82
Rate for Payer: Priority Health Narrow/Tiered Network	$17.82

CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL

Professional

Both

$166.00

Service Code	HCPCS 77081
Min. Negotiated Rate	$35.90
Max. Negotiated Rate	$124.50
Rate for Payer: Aetna Commercial	$35.90
Rate for Payer: Aetna Commercial	$35.90
Rate for Payer: Aetna Medicare	$83.00
Rate for Payer: Aetna Medicare	$14.00
Rate for Payer: BCN Commercial	$47.81
Rate for Payer: BCN Commercial	$47.81
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$132.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$124.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$48.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$48.16
Rate for Payer: Priority Health Narrow/Tiered Network	$48.16
Rate for Payer: Priority Health Narrow/Tiered Network	$48.16

CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL

Professional

Both

$176.00

Service Code	HCPCS 77080
Min. Negotiated Rate	$43.14
Max. Negotiated Rate	$132.00
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: Aetna Medicare	$88.00
Rate for Payer: Aetna Medicare	$123.00
Rate for Payer: BCN Commercial	$58.76
Rate for Payer: BCN Commercial	$58.76
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$59.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$59.21
Rate for Payer: Priority Health Narrow/Tiered Network	$59.21
Rate for Payer: Priority Health Narrow/Tiered Network	$59.21

CHG DX INTRAOPERATIVE THORACIC AORTA ULTRASOUND

Professional

Both

$66.00

Service Code	HCPCS 76984
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna Medicare	$33.00
Rate for Payer: BCBS Complete	$26.40
Rate for Payer: BCN Commercial	$46.32
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$46.66
Rate for Payer: Priority Health Narrow/Tiered Network	$46.66

CHG DX NTRAOP EPCAR CAR US CHD PLMT MNPJ&IMG ACQUISJ

Professional

Both

$218.00

Service Code	HCPCS 76988
Min. Negotiated Rate	$87.20
Max. Negotiated Rate	$163.50
Rate for Payer: Aetna Medicare	$109.00
Rate for Payer: BCBS Complete	$87.20
Rate for Payer: BCN Commercial	$89.65
Rate for Payer: Cash Price	$174.40
Rate for Payer: Cash Price	$174.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$163.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$90.31
Rate for Payer: Priority Health Narrow/Tiered Network	$90.31

CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING

Professional

Both

$330.00

Service Code	HCPCS 76506
Min. Negotiated Rate	$133.74
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$133.74
Rate for Payer: Aetna Medicare	$165.00
Rate for Payer: BCN Commercial	$163.34
Rate for Payer: Cash Price	$264.00
Rate for Payer: Cash Price	$264.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$247.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$164.57
Rate for Payer: Priority Health Narrow/Tiered Network	$164.57

CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING

Professional

Both

$286.00

Service Code	HCPCS 76825
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$384.83
Rate for Payer: Aetna Commercial	$314.31
Rate for Payer: Aetna Medicare	$143.00
Rate for Payer: BCN Commercial	$381.95
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$214.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$384.83
Rate for Payer: Priority Health Narrow/Tiered Network	$384.83

CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD

Professional

Both

$135.00

Service Code	HCPCS 76826
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna Commercial	$187.89
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCN Commercial	$229.57
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	$231.30
Rate for Payer: Priority Health Narrow/Tiered Network	$231.30

CHG ENDOVASC REPAIR AAA

Professional

Both

$527.00

Service Code	HCPCS 75952
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$395.25
Rate for Payer: Aetna Medicare	$263.50
Rate for Payer: BCBS Complete	$210.80
Rate for Payer: Cash Price	$421.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$395.25

CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I

Professional

Both

$611.00

Service Code	HCPCS 75957
Min. Negotiated Rate	$244.40
Max. Negotiated Rate	$458.25
Rate for Payer: Aetna Commercial	$345.53
Rate for Payer: Aetna Medicare	$305.50
Rate for Payer: BCBS Complete	$244.40
Rate for Payer: BCN Commercial	$417.81
Rate for Payer: Cash Price	$488.80
Rate for Payer: Cash Price	$488.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$458.25

CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I

Professional

Both

$714.00

Service Code	HCPCS 75956
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Commercial	$403.09
Rate for Payer: Aetna Medicare	$357.00
Rate for Payer: BCBS Complete	$285.60
Rate for Payer: BCN Commercial	$487.54
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cash Price	$571.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$535.50

CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING

Professional

Both

$345.00

Service Code	HCPCS 76818
Min. Negotiated Rate	$134.54
Max. Negotiated Rate	$258.75
Rate for Payer: Aetna Commercial	$134.54
Rate for Payer: Aetna Medicare	$172.50
Rate for Payer: BCN Commercial	$177.29
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cash Price	$276.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$258.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$178.61
Rate for Payer: Priority Health Narrow/Tiered Network	$178.61

CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING

Professional

Both

$237.00

Service Code	HCPCS 76819
Min. Negotiated Rate	$99.52
Max. Negotiated Rate	$177.75
Rate for Payer: Aetna Commercial	$99.52
Rate for Payer: Aetna Medicare	$118.50
Rate for Payer: BCN Commercial	$127.98
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cash Price	$189.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$177.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$128.94
Rate for Payer: Priority Health Narrow/Tiered Network	$128.94

CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON

Professional

Both

$309.00

Service Code	HCPCS 77003
Min. Negotiated Rate	$119.48
Max. Negotiated Rate	$231.75
Rate for Payer: Aetna Commercial	$119.48
Rate for Payer: Aetna Medicare	$154.50
Rate for Payer: BCN Commercial	$153.38
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$231.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$154.54
Rate for Payer: Priority Health Narrow/Tiered Network	$154.54

CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT

Professional

Both

$153.00

Service Code	HCPCS 77001
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$146.01
Rate for Payer: Aetna Commercial	$116.38
Rate for Payer: Aetna Commercial	$116.38
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: Aetna Medicare	$88.00
Rate for Payer: BCN Commercial	$144.92
Rate for Payer: BCN Commercial	$144.92
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$140.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$114.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$146.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$146.01
Rate for Payer: Priority Health Narrow/Tiered Network	$146.01
Rate for Payer: Priority Health Narrow/Tiered Network	$146.01

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Professional

Both

$117.00

Service Code	HCPCS 77002
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$171.09
Rate for Payer: Aetna Commercial	$132.23
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCN Commercial	$169.81
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$171.09
Rate for Payer: Priority Health Narrow/Tiered Network	$171.09

CHG FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME

Professional

Both

$69.00

Service Code	HCPCS 76001
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$51.75
Rate for Payer: Aetna Medicare	$34.50
Rate for Payer: BCBS Complete	$27.60
Rate for Payer: Cash Price	$55.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$51.75

CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME

Professional

Both

$57.00

Service Code	HCPCS 76000
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$64.73
Rate for Payer: Aetna Commercial	$48.94
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCN Commercial	$64.24
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$64.73
Rate for Payer: Priority Health Narrow/Tiered Network	$64.73

Know your out-of-pocket cost for care.

All Charges