Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHG GASTROESOPHAGEAL REFLUX STUDY

Professional

Both

$106.00

Service Code	HCPCS 78262
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$335.15
Rate for Payer: Aetna Commercial	$274.74
Rate for Payer: Aetna Medicare	$53.00
Rate for Payer: BCN Commercial	$332.65
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	$335.15
Rate for Payer: Priority Health Narrow/Tiered Network	$335.15

CHG GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE

Professional

Both

$12.00

Service Code	HCPCS 82962
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$3.12
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: BCN Commercial	$3.28
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	$3.36
Rate for Payer: Priority Health Narrow/Tiered Network	$3.36

CHG GLUCOSE BLOOD REAGENT STRIP

Professional

Both

$14.00

Service Code	HCPCS 82948
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$4.79
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCN Commercial	$3.78
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	$5.38
Rate for Payer: Priority Health Narrow/Tiered Network	$5.38

CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP

Professional

Both

$18.00

Service Code	HCPCS 82947
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$3.73
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCN Commercial	$1.71
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4.03
Rate for Payer: Priority Health Narrow/Tiered Network	$4.03

CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS

Professional

Both

$48.00

Service Code	HCPCS 82951
Min. Negotiated Rate	$9.65
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$12.23
Rate for Payer: Aetna Medicare	$24.00
Rate for Payer: BCN Commercial	$9.65
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$13.45
Rate for Payer: Priority Health Narrow/Tiered Network	$13.45

CHG GONADOTROPIN CHORIONIC QUALITATIVE

Professional

Both

$27.00

Service Code	HCPCS 84703
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$7.14
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: BCN Commercial	$5.64
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$7.73
Rate for Payer: Priority Health Narrow/Tiered Network	$7.73

CHG GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR

Professional

Both

$62.00

Service Code	HCPCS 77387
Min. Negotiated Rate	$31.00
Max. Negotiated Rate	$190.66
Rate for Payer: Aetna Commercial	$130.08
Rate for Payer: Aetna Medicare	$31.00
Rate for Payer: BCN Commercial	$105.75
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	$190.66
Rate for Payer: Priority Health Narrow/Tiered Network	$190.66

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL

Professional

Both

$659.00

Service Code	HCPCS 77770
Min. Negotiated Rate	$329.50
Max. Negotiated Rate	$526.31
Rate for Payer: Aetna Commercial	$393.99
Rate for Payer: Aetna Commercial	$393.99
Rate for Payer: Aetna Medicare	$329.50
Rate for Payer: Aetna Medicare	$106.50
Rate for Payer: BCN Commercial	$522.38
Rate for Payer: BCN Commercial	$522.38
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cash Price	$527.20
Rate for Payer: Cash Price	$527.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$494.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$526.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$526.31
Rate for Payer: Priority Health Narrow/Tiered Network	$526.31
Rate for Payer: Priority Health Narrow/Tiered Network	$526.31

CHG HEMOGLOBIN GLYCOSYLATED A1C

Professional

Both

$24.00

Service Code	HCPCS 83036
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$9.22
Rate for Payer: Aetna Medicare	$12.00
Rate for Payer: BCN Commercial	$14.71
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	$10.08
Rate for Payer: Priority Health Narrow/Tiered Network	$10.08

CHG HETEROPHILE ANTIBODIES SCREEN

Professional

Both

$15.00

Service Code	HCPCS 86308
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCN Commercial	$5.18
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5.38
Rate for Payer: Priority Health Narrow/Tiered Network	$5.38

CHG HYSTEROSALPINGOGRAPHY RS&I

Professional

Both

$158.00

Service Code	HCPCS 74740
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$135.97
Rate for Payer: Aetna Commercial	$110.60
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCN Commercial	$134.95
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	$135.97
Rate for Payer: Priority Health Narrow/Tiered Network	$135.97

CHG IAADIADOO INFLUENZA

Professional

Both

$31.00

Service Code	HCPCS 87804
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCN Commercial	$16.55
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$17.15
Rate for Payer: Priority Health Narrow/Tiered Network	$17.15

CHG IAADIADOO RESPIRATORY SYNCTIAL VIRUS

Professional

Both

$19.00

Service Code	HCPCS 87807
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna Commercial	$12.45
Rate for Payer: Aetna Medicare	$9.50
Rate for Payer: BCN Commercial	$13.10
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cash Price	$15.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$13.45
Rate for Payer: Priority Health Narrow/Tiered Network	$13.45

CHG IAADIADOO STREPTOCOCCUS GROUP A

Professional

Both

$30.00

Service Code	HCPCS 87880
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$15.70
Rate for Payer: Aetna Medicare	$15.00
Rate for Payer: BCN Commercial	$16.53
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$17.15
Rate for Payer: Priority Health Narrow/Tiered Network	$17.15

CHG IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS

Professional

Both

$42.00

Service Code	HCPCS 87426
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$45.23
Rate for Payer: Aetna Commercial	$45.23
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: BCN Commercial	$35.33
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$36.65
Rate for Payer: Priority Health Narrow/Tiered Network	$36.65

CHG IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS

Professional

Both

$45.00

Service Code	HCPCS 87265
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna Commercial	$11.38
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: BCN Commercial	$8.99
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	$12.44
Rate for Payer: Priority Health Narrow/Tiered Network	$12.44

CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ

Professional

Both

$79.00

Service Code	HCPCS 87491
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$59.25
Rate for Payer: Aetna Commercial	$33.34
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCN Commercial	$26.32
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$36.31
Rate for Payer: Priority Health Narrow/Tiered Network	$36.31

CHG IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ

Professional

Both

$85.00

Service Code	HCPCS 87800
Min. Negotiated Rate	$32.75
Max. Negotiated Rate	$63.75
Rate for Payer: Aetna Commercial	$41.49
Rate for Payer: Aetna Medicare	$42.50
Rate for Payer: BCBS Complete	$34.00
Rate for Payer: BCN Commercial	$32.75
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cash Price	$68.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$45.39
Rate for Payer: Priority Health Narrow/Tiered Network	$45.39

CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ

Professional

Both

$79.00

Service Code	HCPCS 87591
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$59.25
Rate for Payer: Aetna Commercial	$33.34
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCN Commercial	$26.32
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$36.31
Rate for Payer: Priority Health Narrow/Tiered Network	$36.31

CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ

Professional

Both

$152.00

Service Code	HCPCS 87635
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$51.31
Rate for Payer: Aetna Medicare	$76.00
Rate for Payer: BCN Commercial	$70.00
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cash Price	$121.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$114.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$53.46
Rate for Payer: Priority Health Narrow/Tiered Network	$53.46

CHG IA INFECTIOUS AGT ANTIBODY QUAL/SEMIQ 1STEP METH

Professional

Both

$48.00

Service Code	HCPCS 86318
Min. Negotiated Rate	$17.19
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$17.19
Rate for Payer: Aetna Medicare	$24.00
Rate for Payer: BCN Commercial	$18.09
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$18.82
Rate for Payer: Priority Health Narrow/Tiered Network	$18.82

CHG IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE

Professional

Both

$41.00

Service Code	HCPCS 86294
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$30.75
Rate for Payer: Aetna Commercial	$24.29
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCN Commercial	$19.18
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$26.56
Rate for Payer: Priority Health Narrow/Tiered Network	$26.56

CHG INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES

Professional

Both

$151.00

Service Code	HCPCS 87502
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$113.25
Rate for Payer: Aetna Commercial	$91.01
Rate for Payer: Aetna Medicare	$75.50
Rate for Payer: BCN Commercial	$71.85
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$120.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$113.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$99.53
Rate for Payer: Priority Health Narrow/Tiered Network	$99.53

CHG INTEN MOD RADIOTHER PLAN, SIN/MULT FIELD

Professional

Both

$968.00

Service Code	HCPCS 77418
Min. Negotiated Rate	$387.20
Max. Negotiated Rate	$726.00
Rate for Payer: Aetna Medicare	$484.00
Rate for Payer: BCBS Complete	$387.20
Rate for Payer: Cash Price	$774.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$726.00

CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX

Professional

Both

$548.00

Service Code	HCPCS 77778
Min. Negotiated Rate	$274.00
Max. Negotiated Rate	$1,407.85
Rate for Payer: Aetna Commercial	$1,018.17
Rate for Payer: Aetna Commercial	$1,018.17
Rate for Payer: Aetna Medicare	$880.00
Rate for Payer: Aetna Medicare	$274.00
Rate for Payer: BCN Commercial	$1,397.34
Rate for Payer: BCN Commercial	$1,397.34
Rate for Payer: Cash Price	$438.40
Rate for Payer: Cash Price	$1,408.00
Rate for Payer: Cash Price	$438.40
Rate for Payer: Cash Price	$1,408.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$411.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,320.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,407.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,407.85
Rate for Payer: Priority Health Narrow/Tiered Network	$1,407.85
Rate for Payer: Priority Health Narrow/Tiered Network	$1,407.85

Know your out-of-pocket cost for care.

All Charges