Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION

Professional

Both

$219.00

Service Code	HCPCS 76700
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$173.60
Rate for Payer: Aetna Commercial	$139.34
Rate for Payer: Aetna Medicare	$109.50
Rate for Payer: BCN Commercial	$172.30
Rate for Payer: Cash Price	$175.20
Rate for Payer: Cash Price	$175.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$164.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$173.60
Rate for Payer: Priority Health Narrow/Tiered Network	$173.60

CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED

Professional

Both

$111.00

Service Code	HCPCS 76705
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$130.45
Rate for Payer: Aetna Commercial	$104.19
Rate for Payer: Aetna Commercial	$104.19
Rate for Payer: Aetna Medicare	$55.50
Rate for Payer: Aetna Medicare	$92.50
Rate for Payer: BCN Commercial	$129.48
Rate for Payer: BCN Commercial	$129.48
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cash Price	$88.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$83.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$130.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$130.45
Rate for Payer: Priority Health Narrow/Tiered Network	$130.45
Rate for Payer: Priority Health Narrow/Tiered Network	$130.45

CHG US, BREAST(S), REAL TIME

Professional

Both

$155.00

Service Code	HCPCS 76645
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$116.25
Rate for Payer: Aetna Medicare	$77.50
Rate for Payer: BCBS Complete	$62.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$116.25

CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION

Professional

Both

$59.00

Service Code	HCPCS 76604
Min. Negotiated Rate	$29.50
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna Commercial	$77.11
Rate for Payer: Aetna Medicare	$29.50
Rate for Payer: BCN Commercial	$86.65
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	$87.30
Rate for Payer: Priority Health Narrow/Tiered Network	$87.30

CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL

Professional

Both

$442.00

Service Code	HCPCS 76936
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$387.33
Rate for Payer: Aetna Commercial	$310.24
Rate for Payer: Aetna Medicare	$221.00
Rate for Payer: BCN Commercial	$384.44
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cash Price	$353.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$331.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$387.33
Rate for Payer: Priority Health Narrow/Tiered Network	$387.33

CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION

Professional

Both

$89.00

Service Code	HCPCS 76881
Min. Negotiated Rate	$44.50
Max. Negotiated Rate	$80.27
Rate for Payer: Aetna Commercial	$76.43
Rate for Payer: Aetna Commercial	$76.43
Rate for Payer: Aetna Medicare	$159.50
Rate for Payer: Aetna Medicare	$44.50
Rate for Payer: BCN Commercial	$79.68
Rate for Payer: BCN Commercial	$79.68
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$71.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$239.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$80.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$80.27
Rate for Payer: Priority Health Narrow/Tiered Network	$80.27
Rate for Payer: Priority Health Narrow/Tiered Network	$80.27

CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION

Professional

Both

$301.00

Service Code	HCPCS 76813
Min. Negotiated Rate	$140.72
Max. Negotiated Rate	$225.75
Rate for Payer: Aetna Commercial	$140.72
Rate for Payer: Aetna Medicare	$150.50
Rate for Payer: BCN Commercial	$169.31
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cash Price	$240.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$225.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$170.59
Rate for Payer: Priority Health Narrow/Tiered Network	$170.59

CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION

Professional

Both

$201.00

Service Code	HCPCS 76814
Min. Negotiated Rate	$91.18
Max. Negotiated Rate	$150.75
Rate for Payer: Aetna Commercial	$91.18
Rate for Payer: Aetna Medicare	$100.50
Rate for Payer: BCN Commercial	$109.55
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$110.38
Rate for Payer: Priority Health Narrow/Tiered Network	$110.38

CHG US GUIDANCE AMNIOCENTESIS IMG S&I

Professional

Both

$330.00

Service Code	HCPCS 76946
Min. Negotiated Rate	$37.71
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$37.71
Rate for Payer: Aetna Medicare	$165.00
Rate for Payer: BCN Commercial	$49.80
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	$50.18
Rate for Payer: Priority Health Narrow/Tiered Network	$50.18

CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION

Professional

Both

$275.00

Service Code	HCPCS 76965
Min. Negotiated Rate	$108.13
Max. Negotiated Rate	$206.25
Rate for Payer: Aetna Commercial	$108.13
Rate for Payer: Aetna Commercial	$108.13
Rate for Payer: Aetna Medicare	$137.50
Rate for Payer: Aetna Medicare	$195.00
Rate for Payer: BCN Commercial	$142.42
Rate for Payer: BCN Commercial	$142.42
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$206.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$292.50
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 US GUIDANCE NEEDLE PLACEMENT IMG S&I

Professional

Both

$116.00

Service Code	HCPCS 76942
Min. Negotiated Rate	$58.00
Max. Negotiated Rate	$88.80
Rate for Payer: Aetna Commercial	$67.10
Rate for Payer: Aetna Commercial	$67.10
Rate for Payer: Aetna Medicare	$58.00
Rate for Payer: Aetna Medicare	$240.00
Rate for Payer: BCN Commercial	$88.14
Rate for Payer: BCN Commercial	$88.14
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$384.00
Rate for Payer: Cash Price	$384.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$360.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$88.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$88.80
Rate for Payer: Priority Health Narrow/Tiered Network	$88.80
Rate for Payer: Priority Health Narrow/Tiered Network	$88.80

CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I

Professional

Both

$193.00

Service Code	HCPCS 76941
Min. Negotiated Rate	$94.13
Max. Negotiated Rate	$175.60
Rate for Payer: Aetna Commercial	$138.84
Rate for Payer: Aetna Medicare	$96.50
Rate for Payer: BCN Commercial	$94.13
Rate for Payer: Cash Price	$154.40
Rate for Payer: Cash Price	$154.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$144.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$175.60
Rate for Payer: Priority Health Narrow/Tiered Network	$175.60

CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG

Professional

Both

$69.00

Service Code	HCPCS 76882
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$96.84
Rate for Payer: Aetna Commercial	$64.85
Rate for Payer: Aetna Commercial	$64.85
Rate for Payer: Aetna Medicare	$34.50
Rate for Payer: Aetna Medicare	$46.00
Rate for Payer: BCN Commercial	$96.11
Rate for Payer: BCN Commercial	$96.11
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$55.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$51.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$69.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$96.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$96.84
Rate for Payer: Priority Health Narrow/Tiered Network	$96.84
Rate for Payer: Priority Health Narrow/Tiered Network	$96.84

CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U

Professional

Both

$232.00

Service Code	HCPCS 76857
Min. Negotiated Rate	$55.35
Max. Negotiated Rate	$174.00
Rate for Payer: Aetna Commercial	$55.35
Rate for Payer: Aetna Medicare	$116.00
Rate for Payer: BCN Commercial	$74.70
Rate for Payer: Cash Price	$185.60
Rate for Payer: Cash Price	$185.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$75.26
Rate for Payer: Priority Health Narrow/Tiered Network	$75.26

CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE

Professional

Both

$310.00

Service Code	HCPCS 76856
Min. Negotiated Rate	$125.54
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$125.54
Rate for Payer: Aetna Medicare	$155.00
Rate for Payer: BCN Commercial	$156.37
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$232.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$157.55
Rate for Payer: Priority Health Narrow/Tiered Network	$157.55

CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT

Professional

Both

$294.00

Service Code	HCPCS 76801
Min. Negotiated Rate	$139.63
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna Commercial	$139.63
Rate for Payer: Aetna Medicare	$147.00
Rate for Payer: BCN Commercial	$173.80
Rate for Payer: Cash Price	$235.20
Rate for Payer: Cash Price	$235.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$220.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$175.11
Rate for Payer: Priority Health Narrow/Tiered Network	$175.11

CHG US PREGNANT UTERUS LIMITED 1/> FETUSES

Professional

Both

$273.00

Service Code	HCPCS 76815
Min. Negotiated Rate	$96.78
Max. Negotiated Rate	$204.75
Rate for Payer: Aetna Commercial	$96.78
Rate for Payer: Aetna Medicare	$136.50
Rate for Payer: BCN Commercial	$120.51
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$204.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$121.42
Rate for Payer: Priority Health Narrow/Tiered Network	$121.42

CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION

Professional

Both

$147.00

Service Code	HCPCS 76802
Min. Negotiated Rate	$73.01
Max. Negotiated Rate	$110.25
Rate for Payer: Aetna Commercial	$73.01
Rate for Payer: Aetna Medicare	$73.50
Rate for Payer: BCN Commercial	$89.14
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	$89.81
Rate for Payer: Priority Health Narrow/Tiered Network	$89.81

CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO

Professional

Both

$436.00

Service Code	HCPCS 76810
Min. Negotiated Rate	$105.64
Max. Negotiated Rate	$327.00
Rate for Payer: Aetna Commercial	$105.64
Rate for Payer: Aetna Medicare	$218.00
Rate for Payer: BCN Commercial	$128.97
Rate for Payer: Cash Price	$348.80
Rate for Payer: Cash Price	$348.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$327.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$129.95
Rate for Payer: Priority Health Narrow/Tiered Network	$129.95

CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION

Professional

Both

$372.00

Service Code	HCPCS 76805
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna Commercial	$160.23
Rate for Payer: Aetna Medicare	$186.00
Rate for Payer: BCN Commercial	$200.19
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$297.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$279.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$201.69
Rate for Payer: Priority Health Narrow/Tiered Network	$201.69

CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT

Professional

Both

$356.00

Service Code	HCPCS 76812
Min. Negotiated Rate	$178.00
Max. Negotiated Rate	$284.47
Rate for Payer: Aetna Commercial	$228.84
Rate for Payer: Aetna Medicare	$178.00
Rate for Payer: BCN Commercial	$282.35
Rate for Payer: Cash Price	$284.80
Rate for Payer: Cash Price	$284.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$267.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$284.47
Rate for Payer: Priority Health Narrow/Tiered Network	$284.47

CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS

Professional

Both

$228.00

Service Code	HCPCS 76816
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$130.33
Rate for Payer: Aetna Medicare	$114.00
Rate for Payer: BCN Commercial	$161.85
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$171.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$163.07
Rate for Payer: Priority Health Narrow/Tiered Network	$163.07

CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG

Professional

Both

$294.00

Service Code	HCPCS 76817
Min. Negotiated Rate	$110.51
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna Commercial	$110.51
Rate for Payer: Aetna Medicare	$147.00
Rate for Payer: BCN Commercial	$136.95
Rate for Payer: Cash Price	$235.20
Rate for Payer: Cash Price	$235.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$220.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$137.97
Rate for Payer: Priority Health Narrow/Tiered Network	$137.97

CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION

Professional

Both

$389.00

Service Code	HCPCS 76811
Min. Negotiated Rate	$194.50
Max. Negotiated Rate	$291.75
Rate for Payer: Aetna Commercial	$203.73
Rate for Payer: Aetna Medicare	$194.50
Rate for Payer: BCN Commercial	$264.92
Rate for Payer: Cash Price	$311.20
Rate for Payer: Cash Price	$311.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$291.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$266.92
Rate for Payer: Priority Health Narrow/Tiered Network	$266.92

CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE

Professional

Both

$74.00

Service Code	HCPCS 76770
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$162.06
Rate for Payer: Aetna Commercial	$128.78
Rate for Payer: Aetna Medicare	$37.00
Rate for Payer: BCN Commercial	$160.85
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$162.06
Rate for Payer: Priority Health Narrow/Tiered Network	$162.06

Know your out-of-pocket cost for care.

All Charges