Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS

Professional

Both

$129.00

Service Code	HCPCS 77331
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$98.84
Rate for Payer: Aetna Commercial	$75.48
Rate for Payer: Aetna Commercial	$75.48
Rate for Payer: Aetna Medicare	$64.50
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCN Commercial	$98.10
Rate for Payer: BCN Commercial	$98.10
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$103.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$98.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$98.84
Rate for Payer: Priority Health Narrow/Tiered Network	$98.84
Rate for Payer: Priority Health Narrow/Tiered Network	$98.84

CHG SPECIAL TREATMENT PROCEDURE

Professional

Both

$548.00

Service Code	HCPCS 77470
Min. Negotiated Rate	$155.09
Max. Negotiated Rate	$411.00
Rate for Payer: Aetna Commercial	$155.09
Rate for Payer: Aetna Commercial	$155.09
Rate for Payer: Aetna Medicare	$274.00
Rate for Payer: Aetna Medicare	$363.00
Rate for Payer: BCN Commercial	$219.11
Rate for Payer: BCN Commercial	$219.11
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$438.40
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$438.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$411.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$544.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$220.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$220.75
Rate for Payer: Priority Health Narrow/Tiered Network	$220.75
Rate for Payer: Priority Health Narrow/Tiered Network	$220.75

CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ

Professional

Both

$222.00

Service Code	HCPCS 77370
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$225.78
Rate for Payer: Aetna Commercial	$143.41
Rate for Payer: Aetna Medicare	$111.00
Rate for Payer: BCN Commercial	$224.09
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$166.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$225.78
Rate for Payer: Priority Health Narrow/Tiered Network	$225.78

CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY

Professional

Both

$290.00

Service Code	HCPCS 77321
Min. Negotiated Rate	$108.58
Max. Negotiated Rate	$217.50
Rate for Payer: Aetna Commercial	$108.58
Rate for Payer: Aetna Commercial	$108.58
Rate for Payer: Aetna Medicare	$145.00
Rate for Payer: Aetna Medicare	$104.50
Rate for Payer: BCN Commercial	$142.42
Rate for Payer: BCN Commercial	$142.42
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$156.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$217.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$143.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$143.49
Rate for Payer: Priority Health Narrow/Tiered Network	$143.49
Rate for Payer: Priority Health Narrow/Tiered Network	$143.49

CHG STEREOSCOPIC X-RAY GUIDANCE

Professional

Both

$179.00

Service Code	HCPCS 77421
Min. Negotiated Rate	$71.60
Max. Negotiated Rate	$134.25
Rate for Payer: Aetna Medicare	$89.50
Rate for Payer: Aetna Medicare	$106.00
Rate for Payer: BCBS Complete	$71.60
Rate for Payer: BCBS Complete	$84.80
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$169.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$134.25

CHG STEREOTACTIC BODY RADIATION MANAGEMENT

Professional

Both

$1,299.00

Service Code	HCPCS 77435
Min. Negotiated Rate	$408.96
Max. Negotiated Rate	$976.36
Rate for Payer: Aetna Commercial	$753.89
Rate for Payer: Aetna Medicare	$649.50
Rate for Payer: BCBS Complete	$429.41
Rate for Payer: BCN Commercial	$969.07
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Mclaren Medicaid	$408.96
Rate for Payer: Meridian Medicaid	$429.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$974.25
Rate for Payer: Priority Health Choice Medicaid	$408.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$976.36
Rate for Payer: Priority Health Narrow/Tiered Network	$976.36
Rate for Payer: UHC Medicaid	$408.96
Rate for Payer: UHCCP Medicaid	$408.96

CHG STEREOTACTIC BODY RADIATION TREATMENT DELIVERY

Professional

Both

$2,787.00

Service Code	HCPCS 77373
Min. Negotiated Rate	$1,281.89
Max. Negotiated Rate	$2,090.25
Rate for Payer: Aetna Commercial	$1,281.89
Rate for Payer: Aetna Medicare	$1,393.50
Rate for Payer: BCN Commercial	$1,461.57
Rate for Payer: Cash Price	$2,229.60
Rate for Payer: Cash Price	$2,229.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,090.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,472.58
Rate for Payer: Priority Health Narrow/Tiered Network	$1,472.58

CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION

Professional

Both

$898.00

Service Code	HCPCS 77432
Min. Negotiated Rate	$270.51
Max. Negotiated Rate	$673.50
Rate for Payer: Aetna Commercial	$499.97
Rate for Payer: Aetna Medicare	$449.00
Rate for Payer: BCBS Complete	$284.04
Rate for Payer: BCN Commercial	$641.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Mclaren Medicaid	$270.51
Rate for Payer: Meridian Medicaid	$284.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$673.50
Rate for Payer: Priority Health Choice Medicaid	$270.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$646.22
Rate for Payer: Priority Health Narrow/Tiered Network	$646.22
Rate for Payer: UHC Medicaid	$270.51
Rate for Payer: UHCCP Medicaid	$270.51

CHG SUPERVISION HANDLING LOADING RADIATION SOURCE

Professional

Both

$194.00

Service Code	HCPCS 77790
Min. Negotiated Rate	$17.19
Max. Negotiated Rate	$145.50
Rate for Payer: Aetna Commercial	$17.19
Rate for Payer: Aetna Commercial	$17.19
Rate for Payer: Aetna Medicare	$97.00
Rate for Payer: Aetna Medicare	$41.50
Rate for Payer: BCN Commercial	$28.39
Rate for Payer: BCN Commercial	$28.39
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$155.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$145.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$28.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$28.60
Rate for Payer: Priority Health Narrow/Tiered Network	$28.60
Rate for Payer: Priority Health Narrow/Tiered Network	$28.60

CHG TBS TECHNICAL CALCULATION ONLY

Professional

Both

$60.00

Service Code	HCPCS 77091
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$31.43
Rate for Payer: Aetna Medicare	$30.00
Rate for Payer: BCN Commercial	$40.83
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$41.14
Rate for Payer: Priority Health Narrow/Tiered Network	$41.14

CHG TELETHER ISODOSE PLAN COMPLX

Professional

Both

$149.00

Service Code	HCPCS 77315
Min. Negotiated Rate	$59.60
Max. Negotiated Rate	$111.75
Rate for Payer: Aetna Medicare	$74.50
Rate for Payer: Aetna Medicare	$141.00
Rate for Payer: BCBS Complete	$112.80
Rate for Payer: BCBS Complete	$59.60
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cash Price	$225.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$211.50

CHG TELETHER ISODOSE PLAN SIMPLE

Professional

Both

$100.00

Service Code	HCPCS 77305
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Medicare	$50.00
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$75.00

CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY

Professional

Both

$452.00

Service Code	HCPCS 77307
Min. Negotiated Rate	$226.00
Max. Negotiated Rate	$439.52
Rate for Payer: Aetna Commercial	$330.89
Rate for Payer: Aetna Commercial	$330.89
Rate for Payer: Aetna Medicare	$431.50
Rate for Payer: Aetna Medicare	$226.00
Rate for Payer: BCN Commercial	$436.23
Rate for Payer: BCN Commercial	$436.23
Rate for Payer: Cash Price	$690.40
Rate for Payer: Cash Price	$361.60
Rate for Payer: Cash Price	$361.60
Rate for Payer: Cash Price	$690.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$647.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$339.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$439.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$439.52
Rate for Payer: Priority Health Narrow/Tiered Network	$439.52
Rate for Payer: Priority Health Narrow/Tiered Network	$439.52

CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION

Professional

Both

$240.00

Service Code	HCPCS 77306
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$225.78
Rate for Payer: Aetna Commercial	$169.82
Rate for Payer: Aetna Commercial	$169.82
Rate for Payer: Aetna Medicare	$120.00
Rate for Payer: Aetna Medicare	$204.00
Rate for Payer: BCN Commercial	$224.09
Rate for Payer: BCN Commercial	$224.09
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$180.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$306.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$225.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$225.78
Rate for Payer: Priority Health Narrow/Tiered Network	$225.78
Rate for Payer: Priority Health Narrow/Tiered Network	$225.78

CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ

Professional

Both

$285.00

Service Code	HCPCS 74283
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$390.85
Rate for Payer: Aetna Commercial	$302.67
Rate for Payer: Aetna Medicare	$142.50
Rate for Payer: BCN Commercial	$387.93
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cash Price	$228.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$213.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$390.85
Rate for Payer: Priority Health Narrow/Tiered Network	$390.85

CHG THERAPEUTIC RADIOLOGY PORT IMAGE(S)

Professional

Both

$35.00

Service Code	HCPCS 77417
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$13.00
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: BCBS Complete	$0.45
Rate for Payer: BCN Commercial	$24.40
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Mclaren Medicaid	$0.43
Rate for Payer: Meridian Medicaid	$0.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25
Rate for Payer: Priority Health Choice Medicaid	$0.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$24.59
Rate for Payer: Priority Health Narrow/Tiered Network	$24.59
Rate for Payer: UHC Medicaid	$0.43
Rate for Payer: UHCCP Medicaid	$0.43

CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX

Professional

Both

$311.00

Service Code	HCPCS 77263
Min. Negotiated Rate	$107.35
Max. Negotiated Rate	$255.89
Rate for Payer: Aetna Commercial	$198.09
Rate for Payer: Aetna Medicare	$155.50
Rate for Payer: BCBS Complete	$112.72
Rate for Payer: BCN Commercial	$253.97
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Mclaren Medicaid	$107.35
Rate for Payer: Meridian Medicaid	$112.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$233.25
Rate for Payer: Priority Health Choice Medicaid	$107.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$255.89
Rate for Payer: Priority Health Narrow/Tiered Network	$255.89
Rate for Payer: UHC Medicaid	$107.35
Rate for Payer: UHCCP Medicaid	$107.35

CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE

Professional

Both

$208.00

Service Code	HCPCS 77262
Min. Negotiated Rate	$68.37
Max. Negotiated Rate	$164.57
Rate for Payer: Aetna Commercial	$127.25
Rate for Payer: Aetna Medicare	$104.00
Rate for Payer: BCBS Complete	$71.79
Rate for Payer: BCN Commercial	$163.34
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cash Price	$166.40
Rate for Payer: Mclaren Medicaid	$68.37
Rate for Payer: Meridian Medicaid	$71.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$156.00
Rate for Payer: Priority Health Choice Medicaid	$68.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$164.57
Rate for Payer: Priority Health Narrow/Tiered Network	$164.57
Rate for Payer: UHC Medicaid	$68.37
Rate for Payer: UHCCP Medicaid	$68.37

CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE

Professional

Both

$139.00

Service Code	HCPCS 77261
Min. Negotiated Rate	$44.52
Max. Negotiated Rate	$106.36
Rate for Payer: Aetna Commercial	$83.68
Rate for Payer: Aetna Medicare	$69.50
Rate for Payer: BCBS Complete	$46.75
Rate for Payer: BCN Commercial	$105.57
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Mclaren Medicaid	$44.52
Rate for Payer: Meridian Medicaid	$46.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.25
Rate for Payer: Priority Health Choice Medicaid	$44.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$106.36
Rate for Payer: Priority Health Narrow/Tiered Network	$106.36
Rate for Payer: UHC Medicaid	$44.52
Rate for Payer: UHCCP Medicaid	$44.52

CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX

Professional

Both

$827.00

Service Code	HCPCS 77290
Min. Negotiated Rate	$413.50
Max. Negotiated Rate	$663.29
Rate for Payer: Aetna Commercial	$554.16
Rate for Payer: Aetna Commercial	$554.16
Rate for Payer: Aetna Medicare	$413.50
Rate for Payer: Aetna Medicare	$496.50
Rate for Payer: BCN Commercial	$658.33
Rate for Payer: BCN Commercial	$658.33
Rate for Payer: Cash Price	$661.60
Rate for Payer: Cash Price	$661.60
Rate for Payer: Cash Price	$794.40
Rate for Payer: Cash Price	$794.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$620.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$744.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$663.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$663.29
Rate for Payer: Priority Health Narrow/Tiered Network	$663.29
Rate for Payer: Priority Health Narrow/Tiered Network	$663.29

CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED

Professional

Both

$117.00

Service Code	HCPCS 77285
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$669.31
Rate for Payer: Aetna Commercial	$528.58
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCN Commercial	$664.31
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	$669.31
Rate for Payer: Priority Health Narrow/Tiered Network	$669.31

CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE

Professional

Both

$530.00

Service Code	HCPCS 77280
Min. Negotiated Rate	$265.00
Max. Negotiated Rate	$403.40
Rate for Payer: Aetna Commercial	$319.36
Rate for Payer: Aetna Commercial	$319.36
Rate for Payer: Aetna Medicare	$265.00
Rate for Payer: Aetna Medicare	$228.50
Rate for Payer: BCN Commercial	$400.38
Rate for Payer: BCN Commercial	$400.38
Rate for Payer: Cash Price	$365.60
Rate for Payer: Cash Price	$365.60
Rate for Payer: Cash Price	$424.00
Rate for Payer: Cash Price	$424.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$342.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$397.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$403.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$403.40
Rate for Payer: Priority Health Narrow/Tiered Network	$403.40
Rate for Payer: Priority Health Narrow/Tiered Network	$403.40

CHG TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX

Professional

Both

$308.00

Service Code	HCPCS 88233
Min. Negotiated Rate	$105.55
Max. Negotiated Rate	$231.00
Rate for Payer: Aetna Commercial	$133.69
Rate for Payer: Aetna Medicare	$154.00
Rate for Payer: BCN Commercial	$105.55
Rate for Payer: Cash Price	$246.40
Rate for Payer: Cash Price	$246.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$231.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$218.26
Rate for Payer: Priority Health Narrow/Tiered Network	$218.26

CHG TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT

Professional

Both

$23.00

Service Code	HCPCS 87220
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$17.25
Rate for Payer: Aetna Commercial	$4.06
Rate for Payer: Aetna Medicare	$11.50
Rate for Payer: BCN Commercial	$3.20
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4.38
Rate for Payer: Priority Health Narrow/Tiered Network	$4.38

CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I

Professional

Both

$370.00

Service Code	HCPCS 75894
Min. Negotiated Rate	$106.58
Max. Negotiated Rate	$1,533.79
Rate for Payer: Aetna Commercial	$1,126.65
Rate for Payer: Aetna Medicare	$185.00
Rate for Payer: BCN Commercial	$106.58
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$277.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,533.79
Rate for Payer: Priority Health Narrow/Tiered Network	$1,533.79

Know your out-of-pocket cost for care.

All Charges