Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE

Professional

Both

$479.00

Service Code	HCPCS 77761
Min. Negotiated Rate	$239.50
Max. Negotiated Rate	$642.72
Rate for Payer: Aetna Commercial	$469.99
Rate for Payer: Aetna Medicare	$239.50
Rate for Payer: BCN Commercial	$637.91
Rate for Payer: Cash Price	$383.20
Rate for Payer: Cash Price	$383.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$359.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$642.72
Rate for Payer: Priority Health Narrow/Tiered Network	$642.72

CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I

Professional

Both

$94.00

Service Code	HCPCS 74360
Min. Negotiated Rate	$39.85
Max. Negotiated Rate	$167.07
Rate for Payer: Aetna Commercial	$128.38
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: BCN Commercial	$39.85
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cash Price	$75.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$167.07
Rate for Payer: Priority Health Narrow/Tiered Network	$167.07

CHG INTRAVASC ULTRASOUND,1ST VESSEL

Professional

Both

$231.00

Service Code	HCPCS 75945
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$173.25
Rate for Payer: Aetna Medicare	$115.50
Rate for Payer: Aetna Medicare	$44.00
Rate for Payer: BCBS Complete	$35.20
Rate for Payer: BCBS Complete	$92.40
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cash Price	$70.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$173.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.00

CHG INTRAVASC US, RAD SUPERISE/ INTERP, EA ADDN VESSEL

Professional

Both

$47.00

Service Code	HCPCS 75946
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$35.25
Rate for Payer: Aetna Medicare	$23.50
Rate for Payer: Aetna Medicare	$80.50
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: BCBS Complete	$64.40
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$37.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.75

CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I

Professional

Both

$216.00

Service Code	HCPCS 74340
Min. Negotiated Rate	$37.86
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$119.95
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCN Commercial	$37.86
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$162.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$152.52
Rate for Payer: Priority Health Narrow/Tiered Network	$152.52

CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS

Professional

Both

$63.00

Service Code	HCPCS 77077
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$69.74
Rate for Payer: Aetna Commercial	$53.57
Rate for Payer: Aetna Commercial	$53.57
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: Aetna Medicare	$71.00
Rate for Payer: BCN Commercial	$69.22
Rate for Payer: BCN Commercial	$69.22
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$106.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$69.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$69.74
Rate for Payer: Priority Health Narrow/Tiered Network	$69.74
Rate for Payer: Priority Health Narrow/Tiered Network	$69.74

CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX

Professional

Both

$365.00

Service Code	HCPCS 78708
Min. Negotiated Rate	$182.50
Max. Negotiated Rate	$273.75
Rate for Payer: Aetna Commercial	$202.77
Rate for Payer: Aetna Medicare	$182.50
Rate for Payer: BCN Commercial	$262.44
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cash Price	$292.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$273.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$264.42
Rate for Payer: Priority Health Narrow/Tiered Network	$264.42

CHG LIPID PANEL

Professional

Both

$46.00

Service Code	HCPCS 80061
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$12.72
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: BCN Commercial	$16.58
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$13.78
Rate for Payer: Priority Health Narrow/Tiered Network	$13.78

CHG MANUAL APPL STRESS PHYS/QHP JOINT RADIOGRAPHY

Professional

Both

$97.00

Service Code	HCPCS 77071
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$81.77
Rate for Payer: Aetna Commercial	$62.73
Rate for Payer: Aetna Commercial	$62.73
Rate for Payer: Aetna Medicare	$46.00
Rate for Payer: Aetna Medicare	$48.50
Rate for Payer: BCBS Complete	$39.14
Rate for Payer: BCBS Complete	$39.14
Rate for Payer: BCN Commercial	$81.17
Rate for Payer: BCN Commercial	$81.17
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$77.60
Rate for Payer: Mclaren Medicaid	$37.28
Rate for Payer: Mclaren Medicaid	$37.28
Rate for Payer: Meridian Medicaid	$39.14
Rate for Payer: Meridian Medicaid	$39.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$69.00
Rate for Payer: Priority Health Choice Medicaid	$37.28
Rate for Payer: Priority Health Choice Medicaid	$37.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$81.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$81.77
Rate for Payer: Priority Health Narrow/Tiered Network	$81.77
Rate for Payer: Priority Health Narrow/Tiered Network	$81.77
Rate for Payer: UHC Medicaid	$37.28
Rate for Payer: UHC Medicaid	$37.28
Rate for Payer: UHCCP Medicaid	$37.28
Rate for Payer: UHCCP Medicaid	$37.28

CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I

Professional

Both

$39.00

Service Code	HCPCS 75902
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$128.45
Rate for Payer: Aetna Commercial	$104.59
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCN Commercial	$127.49
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$128.45
Rate for Payer: Priority Health Narrow/Tiered Network	$128.45

CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I

Professional

Both

$349.00

Service Code	HCPCS 75901
Min. Negotiated Rate	$174.50
Max. Negotiated Rate	$334.16
Rate for Payer: Aetna Commercial	$267.87
Rate for Payer: Aetna Medicare	$174.50
Rate for Payer: BCN Commercial	$331.65
Rate for Payer: Cash Price	$279.20
Rate for Payer: Cash Price	$279.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$261.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$334.16
Rate for Payer: Priority Health Narrow/Tiered Network	$334.16

CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN

Professional

Both

$541.00

Service Code	HCPCS 77338
Min. Negotiated Rate	$270.50
Max. Negotiated Rate	$732.58
Rate for Payer: Aetna Commercial	$541.84
Rate for Payer: Aetna Commercial	$541.84
Rate for Payer: Aetna Commercial	$541.84
Rate for Payer: Aetna Medicare	$491.00
Rate for Payer: Aetna Medicare	$500.00
Rate for Payer: Aetna Medicare	$270.50
Rate for Payer: BCN Commercial	$732.58
Rate for Payer: BCN Commercial	$732.58
Rate for Payer: BCN Commercial	$732.58
Rate for Payer: Cash Price	$432.80
Rate for Payer: Cash Price	$800.00
Rate for Payer: Cash Price	$785.60
Rate for Payer: Cash Price	$800.00
Rate for Payer: Cash Price	$432.80
Rate for Payer: Cash Price	$785.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$736.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$750.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$405.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$715.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$715.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$715.96
Rate for Payer: Priority Health Narrow/Tiered Network	$715.96
Rate for Payer: Priority Health Narrow/Tiered Network	$715.96
Rate for Payer: Priority Health Narrow/Tiered Network	$715.96

CHG MRA ABDOMEN W/WO CONTRAST MATERIAL

Professional

Both

$190.00

Service Code	HCPCS 74185
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$555.56
Rate for Payer: Aetna Commercial	$555.56
Rate for Payer: Aetna Medicare	$95.00
Rate for Payer: BCN Commercial	$510.44
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$514.27
Rate for Payer: Priority Health Narrow/Tiered Network	$514.27

CHG MRA HEAD W/O CONTRST MATERIAL

Professional

Both

$707.00

Service Code	HCPCS 70544
Min. Negotiated Rate	$326.68
Max. Negotiated Rate	$530.25
Rate for Payer: Aetna Commercial	$349.94
Rate for Payer: Aetna Commercial	$349.94
Rate for Payer: Aetna Medicare	$353.50
Rate for Payer: Aetna Medicare	$123.00
Rate for Payer: BCN Commercial	$326.68
Rate for Payer: BCN Commercial	$326.68
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$565.60
Rate for Payer: Cash Price	$565.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$530.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$329.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$329.13
Rate for Payer: Priority Health Narrow/Tiered Network	$329.13
Rate for Payer: Priority Health Narrow/Tiered Network	$329.13

CHG MRA HEAD W/O & W/CONTRAST MATERIAL

Professional

Both

$147.00

Service Code	HCPCS 70546
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$533.21
Rate for Payer: Aetna Commercial	$533.21
Rate for Payer: Aetna Medicare	$73.50
Rate for Payer: BCN Commercial	$499.97
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$110.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$503.74
Rate for Payer: Priority Health Narrow/Tiered Network	$503.74

CHG MRA NECK W/O CONTRST MATERIAL

Professional

Both

$243.00

Service Code	HCPCS 70547
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$351.42
Rate for Payer: Aetna Commercial	$351.42
Rate for Payer: Aetna Medicare	$121.50
Rate for Payer: BCN Commercial	$327.67
Rate for Payer: Cash Price	$194.40
Rate for Payer: Cash Price	$194.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$182.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$330.14
Rate for Payer: Priority Health Narrow/Tiered Network	$330.14

CHG MRA NECK W/O &W/CONTRAST MATERIAL

Professional

Both

$289.00

Service Code	HCPCS 70549
Min. Negotiated Rate	$144.50
Max. Negotiated Rate	$560.98
Rate for Payer: Aetna Commercial	$560.98
Rate for Payer: Aetna Medicare	$144.50
Rate for Payer: BCN Commercial	$523.88
Rate for Payer: Cash Price	$231.20
Rate for Payer: Cash Price	$231.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$216.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$527.83
Rate for Payer: Priority Health Narrow/Tiered Network	$527.83

CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST

Professional

Both

$233.00

Service Code	HCPCS 74183
Min. Negotiated Rate	$116.50
Max. Negotiated Rate	$561.39
Rate for Payer: Aetna Commercial	$561.39
Rate for Payer: Aetna Medicare	$116.50
Rate for Payer: BCN Commercial	$511.92
Rate for Payer: Cash Price	$186.40
Rate for Payer: Cash Price	$186.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$515.78
Rate for Payer: Priority Health Narrow/Tiered Network	$515.78

CHG MRI ABDOMEN W/O CONTRAST MATERIAL

Professional

Both

$156.00

Service Code	HCPCS 74181
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$322.13
Rate for Payer: Aetna Commercial	$322.13
Rate for Payer: Aetna Medicare	$78.00
Rate for Payer: BCN Commercial	$296.30
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$298.53
Rate for Payer: Priority Health Narrow/Tiered Network	$298.53

CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL

Professional

Both

$135.00

Service Code	HCPCS 73721
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$329.02
Rate for Payer: Aetna Commercial	$329.02
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCN Commercial	$308.25
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	$310.56
Rate for Payer: Priority Health Narrow/Tiered Network	$310.56

CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL

Professional

Both

$216.00

Service Code	HCPCS 73723
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$646.38
Rate for Payer: Aetna Commercial	$646.38
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCN Commercial	$581.14
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$162.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$585.51
Rate for Payer: Priority Health Narrow/Tiered Network	$585.51

CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL

Professional

Both

$163.00

Service Code	HCPCS 73222
Min. Negotiated Rate	$81.50
Max. Negotiated Rate	$525.05
Rate for Payer: Aetna Commercial	$525.05
Rate for Payer: Aetna Medicare	$81.50
Rate for Payer: BCN Commercial	$470.59
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$122.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$474.13
Rate for Payer: Priority Health Narrow/Tiered Network	$474.13

CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL

Professional

Both

$135.00

Service Code	HCPCS 73221
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$330.01
Rate for Payer: Aetna Commercial	$330.01
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCN Commercial	$308.75
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	$311.08
Rate for Payer: Priority Health Narrow/Tiered Network	$311.08

CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL

Professional

Both

$216.00

Service Code	HCPCS 73223
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$648.35
Rate for Payer: Aetna Commercial	$648.35
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCN Commercial	$582.64
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$162.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$587.02
Rate for Payer: Priority Health Narrow/Tiered Network	$587.02

CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL

Professional

Both

$388.00

Service Code	HCPCS 70552
Min. Negotiated Rate	$194.00
Max. Negotiated Rate	$442.56
Rate for Payer: Aetna Commercial	$442.56
Rate for Payer: Aetna Medicare	$194.00
Rate for Payer: BCN Commercial	$410.33
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cash Price	$310.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$291.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$413.43
Rate for Payer: Priority Health Narrow/Tiered Network	$413.43

Know your out-of-pocket cost for care.

All Charges