Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHG TRANSCATHETER INFUSION OTHER THAN THROMBOLYSIS

Professional

Both

$293.00

Service Code	HCPCS 75896
Min. Negotiated Rate	$117.20
Max. Negotiated Rate	$219.75
Rate for Payer: Aetna Medicare	$146.50
Rate for Payer: BCBS Complete	$117.20
Rate for Payer: Cash Price	$234.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$219.75

CHG TRANSFERASE ALANINE AMINO ALT SGPT

Professional

Both

$14.00

Service Code	HCPCS 84460
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$5.04
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCN Commercial	$1.08
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 TRANSFERASE ASPARTATE AMINO AST SGOT

Professional

Both

$14.00

Service Code	HCPCS 84450
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCN Commercial	$1.08
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 TX DEVICES DESIGN & CONSTRUCTION COMPLEX

Professional

Both

$188.00

Service Code	HCPCS 77334
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$220.17
Rate for Payer: Aetna Commercial	$144.42
Rate for Payer: Aetna Commercial	$144.42
Rate for Payer: Aetna Medicare	$94.00
Rate for Payer: Aetna Medicare	$150.00
Rate for Payer: BCN Commercial	$220.17
Rate for Payer: BCN Commercial	$220.17
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$150.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$225.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$190.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$190.66
Rate for Payer: Priority Health Narrow/Tiered Network	$190.66
Rate for Payer: Priority Health Narrow/Tiered Network	$190.66

CHG TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE

Professional

Both

$166.00

Service Code	HCPCS 77333
Min. Negotiated Rate	$76.63
Max. Negotiated Rate	$206.21
Rate for Payer: Aetna Commercial	$151.32
Rate for Payer: Aetna Commercial	$151.32
Rate for Payer: Aetna Medicare	$83.00
Rate for Payer: Aetna Medicare	$47.50
Rate for Payer: BCN Commercial	$76.63
Rate for Payer: BCN Commercial	$76.63
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$76.00
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	$71.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$206.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$206.21
Rate for Payer: Priority Health Narrow/Tiered Network	$206.21
Rate for Payer: Priority Health Narrow/Tiered Network	$206.21

CHG TX DEVICES DESIGN & CONSTRUCTION SIMPLE

Professional

Both

$102.00

Service Code	HCPCS 77332
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$119.55
Rate for Payer: Aetna Commercial	$48.30
Rate for Payer: Aetna Commercial	$48.30
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: BCN Commercial	$119.55
Rate for Payer: BCN Commercial	$119.55
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$81.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$76.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$61.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$61.72
Rate for Payer: Priority Health Narrow/Tiered Network	$61.72
Rate for Payer: Priority Health Narrow/Tiered Network	$61.72

CHG ULTRASONIC GUIDANCE INTRAOPERATIVE

Professional

Both

$304.00

Service Code	HCPCS 76998
Min. Negotiated Rate	$69.23
Max. Negotiated Rate	$228.00
Rate for Payer: Aetna Commercial	$74.11
Rate for Payer: Aetna Medicare	$152.00
Rate for Payer: BCN Commercial	$69.23
Rate for Payer: Cash Price	$243.20
Rate for Payer: Cash Price	$243.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$69.74
Rate for Payer: Priority Health Narrow/Tiered Network	$69.74

CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA

Professional

Both

$61.00

Service Code	HCPCS 76981
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$159.05
Rate for Payer: Aetna Commercial	$122.12
Rate for Payer: Aetna Medicare	$30.50
Rate for Payer: BCN Commercial	$157.86
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	$159.05
Rate for Payer: Priority Health Narrow/Tiered Network	$159.05

CHG ULTRASOUND SPINAL CANAL & CONTENTS

Professional

Both

$94.00

Service Code	HCPCS 76800
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$271.94
Rate for Payer: Aetna Commercial	$164.90
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: BCN Commercial	$269.91
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	$271.94
Rate for Payer: Priority Health Narrow/Tiered Network	$271.94

CHG UNLISTED FLUOROSCOPIC PROCEDURE

Professional

Both

$263.00

Service Code	HCPCS 76496
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$197.25
Rate for Payer: Aetna Commercial	$74.70
Rate for Payer: Aetna Medicare	$131.50
Rate for Payer: Cash Price	$210.40
Rate for Payer: Cash Price	$210.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.25

CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM

Professional

Both

$500.00

Service Code	HCPCS 78740
Min. Negotiated Rate	$249.86
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$249.86
Rate for Payer: Aetna Medicare	$250.00
Rate for Payer: BCN Commercial	$312.23
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$375.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$314.58
Rate for Payer: Priority Health Narrow/Tiered Network	$314.58

CHG URETHROCYSTOGRAPHY RETROGRADE RS&I

Professional

Both

$115.00

Service Code	HCPCS 74450
Min. Negotiated Rate	$22.92
Max. Negotiated Rate	$256.77
Rate for Payer: Aetna Commercial	$256.77
Rate for Payer: Aetna Medicare	$57.50
Rate for Payer: BCN Commercial	$22.92
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$100.34
Rate for Payer: Priority Health Narrow/Tiered Network	$100.34

CHG URETHROCYSTOGRAPHY VOIDING RS&I

Professional

Both

$34.00

Service Code	HCPCS 74455
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$152.52
Rate for Payer: Aetna Commercial	$119.16
Rate for Payer: Aetna Medicare	$17.00
Rate for Payer: BCN Commercial	$151.39
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$152.52
Rate for Payer: Priority Health Narrow/Tiered Network	$152.52

CHG URINALYSIS MICROSCOPIC ONLY

Professional

Both

$7.00

Service Code	HCPCS 81015
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCN Commercial	$3.05
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3.02
Rate for Payer: Priority Health Narrow/Tiered Network	$3.02

CHG URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS

Professional

Both

$14.00

Service Code	HCPCS 81005
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCN Commercial	$1.63
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	$2.35
Rate for Payer: Priority Health Narrow/Tiered Network	$2.35

CHG URINARY BLADDER RESIDUAL STUDY

Professional

Both

$245.00

Service Code	HCPCS 78730
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$183.75
Rate for Payer: Aetna Commercial	$86.80
Rate for Payer: Aetna Medicare	$122.50
Rate for Payer: BCN Commercial	$98.60
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cash Price	$196.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$99.35
Rate for Payer: Priority Health Narrow/Tiered Network	$99.35

CHG URINE ALBUMIN SEMIQUANTITATIVE

Professional

Both

$14.00

Service Code	HCPCS 82044
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$5.92
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCN Commercial	$4.67
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	$6.39
Rate for Payer: Priority Health Narrow/Tiered Network	$6.39

CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS

Professional

Both

$24.00

Service Code	HCPCS 81025
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$8.18
Rate for Payer: Aetna Medicare	$12.00
Rate for Payer: BCN Commercial	$8.61
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	$9.07
Rate for Payer: Priority Health Narrow/Tiered Network	$9.07

CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY

Professional

Both

$18.00

Service Code	HCPCS 81000
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$3.82
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCN Commercial	$4.02
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 URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY

Professional

Both

$32.00

Service Code	HCPCS 81001
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$3.01
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCN Commercial	$3.17
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3.36
Rate for Payer: Priority Health Narrow/Tiered Network	$3.36

CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY

Professional

Both

$14.00

Service Code	HCPCS 81003
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCN Commercial	$2.25
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	$2.35
Rate for Payer: Priority Health Narrow/Tiered Network	$2.35

CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP

Professional

Both

$12.00

Service Code	HCPCS 81002
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$3.31
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: BCN Commercial	$3.48
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	$3.70
Rate for Payer: Priority Health Narrow/Tiered Network	$3.70

CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY

Professional

Both

$219.00

Service Code	HCPCS 74400
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$199.19
Rate for Payer: Aetna Commercial	$153.73
Rate for Payer: Aetna Commercial	$153.73
Rate for Payer: Aetna Medicare	$109.50
Rate for Payer: Aetna Medicare	$72.00
Rate for Payer: BCN Commercial	$197.70
Rate for Payer: BCN Commercial	$197.70
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$175.20
Rate for Payer: Cash Price	$175.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$164.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$199.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$199.19
Rate for Payer: Priority Health Narrow/Tiered Network	$199.19
Rate for Payer: Priority Health Narrow/Tiered Network	$199.19

CHG UROGRAPHY RETROGRADE WITH/WO KUB

Professional

Both

$61.00

Service Code	HCPCS 74420
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$117.40
Rate for Payer: Aetna Commercial	$87.47
Rate for Payer: Aetna Medicare	$30.50
Rate for Payer: BCN Commercial	$116.53
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	$117.40
Rate for Payer: Priority Health Narrow/Tiered Network	$117.40

CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA

Professional

Both

$59.00

Service Code	HCPCS 76706
Min. Negotiated Rate	$29.50
Max. Negotiated Rate	$160.56
Rate for Payer: Aetna Commercial	$125.02
Rate for Payer: Aetna Medicare	$29.50
Rate for Payer: BCN Commercial	$159.35
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cash Price	$47.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$44.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$160.56
Rate for Payer: Priority Health Narrow/Tiered Network	$160.56

Know your out-of-pocket cost for care.

All Charges