Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD

Professional

Both

$80.00

Service Code	HCPCS 93985
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$367.51
Rate for Payer: Aetna Commercial	$282.30
Rate for Payer: Aetna Medicare	$40.00
Rate for Payer: BCN Commercial	$367.51
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$338.93
Rate for Payer: Priority Health Narrow/Tiered Network	$338.93

PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD

Professional

Both

$49.00

Service Code	HCPCS 93986
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$215.63
Rate for Payer: Aetna Commercial	$137.95
Rate for Payer: Aetna Medicare	$24.50
Rate for Payer: BCN Commercial	$215.63
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$198.85
Rate for Payer: Priority Health Narrow/Tiered Network	$198.85

PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY

Professional

Both

$457.00

Service Code	HCPCS 93880
Min. Negotiated Rate	$211.27
Max. Negotiated Rate	$342.75
Rate for Payer: Aetna Commercial	$211.27
Rate for Payer: Aetna Medicare	$228.50
Rate for Payer: BCN Commercial	$279.86
Rate for Payer: Cash Price	$365.60
Rate for Payer: Cash Price	$365.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$342.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$258.10
Rate for Payer: Priority Health Narrow/Tiered Network	$258.10

PR DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY

Professional

Both

$328.00

Service Code	HCPCS 93882
Min. Negotiated Rate	$137.60
Max. Negotiated Rate	$246.00
Rate for Payer: Aetna Commercial	$137.60
Rate for Payer: Aetna Medicare	$164.00
Rate for Payer: BCN Commercial	$183.26
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cash Price	$262.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$246.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$169.01
Rate for Payer: Priority Health Narrow/Tiered Network	$169.01

PR DUPLEX SCAN HEMODIALYSIS ACCESS

Professional

Both

$357.00

Service Code	HCPCS 93990
Min. Negotiated Rate	$138.39
Max. Negotiated Rate	$267.75
Rate for Payer: Aetna Commercial	$138.39
Rate for Payer: Aetna Commercial	$138.39
Rate for Payer: Aetna Medicare	$178.50
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCN Commercial	$216.13
Rate for Payer: BCN Commercial	$216.13
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$285.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$267.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$199.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$199.31
Rate for Payer: Priority Health Narrow/Tiered Network	$199.31
Rate for Payer: Priority Health Narrow/Tiered Network	$199.31

PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE

Professional

Both

$410.00

Service Code	HCPCS 93978
Min. Negotiated Rate	$199.98
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$199.98
Rate for Payer: Aetna Commercial	$199.98
Rate for Payer: Aetna Medicare	$205.00
Rate for Payer: Aetna Medicare	$41.50
Rate for Payer: BCN Commercial	$267.91
Rate for Payer: BCN Commercial	$267.91
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$328.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$307.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$247.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$247.07
Rate for Payer: Priority Health Narrow/Tiered Network	$247.07
Rate for Payer: Priority Health Narrow/Tiered Network	$247.07

PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD

Professional

Both

$283.00

Service Code	HCPCS 93979
Min. Negotiated Rate	$129.02
Max. Negotiated Rate	$212.25
Rate for Payer: Aetna Commercial	$129.02
Rate for Payer: Aetna Commercial	$129.02
Rate for Payer: Aetna Medicare	$141.50
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: BCN Commercial	$173.80
Rate for Payer: BCN Commercial	$173.80
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$226.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$212.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$40.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$160.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$160.28
Rate for Payer: Priority Health Narrow/Tiered Network	$160.28
Rate for Payer: Priority Health Narrow/Tiered Network	$160.28

PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM

Professional

Both

$266.00

Service Code	HCPCS 93975
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$388.92
Rate for Payer: Aetna Commercial	$294.18
Rate for Payer: Aetna Commercial	$294.18
Rate for Payer: Aetna Medicare	$133.00
Rate for Payer: Aetna Medicare	$319.00
Rate for Payer: BCN Commercial	$388.92
Rate for Payer: BCN Commercial	$388.92
Rate for Payer: Cash Price	$510.40
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cash Price	$510.40
Rate for Payer: Cash Price	$212.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$199.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$478.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$358.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$358.68
Rate for Payer: Priority Health Narrow/Tiered Network	$358.68
Rate for Payer: Priority Health Narrow/Tiered Network	$358.68

PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT

Professional

Both

$186.00

Service Code	HCPCS 93976
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$235.55
Rate for Payer: Aetna Commercial	$154.25
Rate for Payer: Aetna Commercial	$154.25
Rate for Payer: Aetna Medicare	$93.00
Rate for Payer: Aetna Medicare	$331.00
Rate for Payer: BCN Commercial	$235.55
Rate for Payer: BCN Commercial	$235.55
Rate for Payer: Cash Price	$529.60
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$529.60
Rate for Payer: Cash Price	$148.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$139.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$496.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$217.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$217.22
Rate for Payer: Priority Health Narrow/Tiered Network	$217.22
Rate for Payer: Priority Health Narrow/Tiered Network	$217.22

PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY

Professional

Both

$105.00

Service Code	HCPCS 93925
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$352.57
Rate for Payer: Aetna Commercial	$268.26
Rate for Payer: Aetna Commercial	$268.26
Rate for Payer: Aetna Medicare	$52.50
Rate for Payer: Aetna Medicare	$220.50
Rate for Payer: BCN Commercial	$352.57
Rate for Payer: BCN Commercial	$352.57
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$330.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$325.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$325.14
Rate for Payer: Priority Health Narrow/Tiered Network	$325.14
Rate for Payer: Priority Health Narrow/Tiered Network	$325.14

PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY

Professional

Both

$344.00

Service Code	HCPCS 93926
Min. Negotiated Rate	$137.57
Max. Negotiated Rate	$258.00
Rate for Payer: Aetna Commercial	$137.57
Rate for Payer: Aetna Commercial	$137.57
Rate for Payer: Aetna Medicare	$172.00
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: BCN Commercial	$211.65
Rate for Payer: BCN Commercial	$211.65
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$275.20
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$275.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$258.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$195.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$195.18
Rate for Payer: Priority Health Narrow/Tiered Network	$195.18
Rate for Payer: Priority Health Narrow/Tiered Network	$195.18

PR DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY

Professional

Both

$418.00

Service Code	HCPCS 93930
Min. Negotiated Rate	$209.00
Max. Negotiated Rate	$313.50
Rate for Payer: Aetna Commercial	$218.52
Rate for Payer: Aetna Commercial	$218.52
Rate for Payer: Aetna Medicare	$209.00
Rate for Payer: Aetna Medicare	$33.00
Rate for Payer: BCN Commercial	$293.81
Rate for Payer: BCN Commercial	$293.81
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$334.40
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$334.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$313.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$270.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$270.95
Rate for Payer: Priority Health Narrow/Tiered Network	$270.95
Rate for Payer: Priority Health Narrow/Tiered Network	$270.95

PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY

Professional

Both

$280.00

Service Code	HCPCS 93931
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$136.50
Rate for Payer: Aetna Commercial	$136.50
Rate for Payer: Aetna Medicare	$140.00
Rate for Payer: Aetna Medicare	$17.00
Rate for Payer: BCN Commercial	$182.26
Rate for Payer: BCN Commercial	$182.26
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$224.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$168.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$168.09
Rate for Payer: Priority Health Narrow/Tiered Network	$168.09
Rate for Payer: Priority Health Narrow/Tiered Network	$168.09

PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY

Professional

Both

$121.00

Service Code	HCPCS 93970
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$275.39
Rate for Payer: Aetna Commercial	$206.98
Rate for Payer: Aetna Commercial	$206.98
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: Aetna Medicare	$217.50
Rate for Payer: BCN Commercial	$275.39
Rate for Payer: BCN Commercial	$275.39
Rate for Payer: Cash Price	$348.00
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$348.00
Rate for Payer: Cash Price	$96.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$90.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$326.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$253.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$253.97
Rate for Payer: Priority Health Narrow/Tiered Network	$253.97
Rate for Payer: Priority Health Narrow/Tiered Network	$253.97

PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Professional

Both

$287.00

Service Code	HCPCS 93971
Min. Negotiated Rate	$130.22
Max. Negotiated Rate	$215.25
Rate for Payer: Aetna Commercial	$130.22
Rate for Payer: Aetna Commercial	$130.22
Rate for Payer: Aetna Medicare	$143.50
Rate for Payer: Aetna Medicare	$38.00
Rate for Payer: BCN Commercial	$176.28
Rate for Payer: BCN Commercial	$176.28
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$229.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$57.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$162.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$162.58
Rate for Payer: Priority Health Narrow/Tiered Network	$162.58
Rate for Payer: Priority Health Narrow/Tiered Network	$162.58

PR DURAL GRAFT SPINAL

Professional

Both

$5,245.00

Service Code	HCPCS 63710
Min. Negotiated Rate	$666.90
Max. Negotiated Rate	$3,933.75
Rate for Payer: Aetna Commercial	$1,398.53
Rate for Payer: Aetna Medicare	$2,622.50
Rate for Payer: BCBS Complete	$700.25
Rate for Payer: BCN Commercial	$1,815.72
Rate for Payer: Cash Price	$4,196.00
Rate for Payer: Cash Price	$4,196.00
Rate for Payer: Mclaren Medicaid	$666.90
Rate for Payer: Meridian Medicaid	$700.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,933.75
Rate for Payer: Priority Health Choice Medicaid	$666.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,919.69
Rate for Payer: Priority Health Narrow/Tiered Network	$1,919.69
Rate for Payer: UHC Medicaid	$666.90
Rate for Payer: UHCCP Medicaid	$666.90

PR DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR 1ST 60

Professional

Both

$171.00

Service Code	HCPCS 92622
Min. Negotiated Rate	$34.29
Max. Negotiated Rate	$128.25
Rate for Payer: Aetna Commercial	$69.85
Rate for Payer: Aetna Medicare	$85.50
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCN Commercial	$98.60
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Mclaren Medicaid	$34.29
Rate for Payer: Meridian Medicaid	$36.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$128.25
Rate for Payer: Priority Health Choice Medicaid	$34.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$90.94
Rate for Payer: Priority Health Narrow/Tiered Network	$90.94
Rate for Payer: UHC Medicaid	$34.29
Rate for Payer: UHCCP Medicaid	$34.29

PR DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR EA ADL

Professional

Both

$44.00

Service Code	HCPCS 92623
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$18.55
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCBS Complete	$9.40
Rate for Payer: BCN Commercial	$25.90
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Mclaren Medicaid	$8.95
Rate for Payer: Meridian Medicaid	$9.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.00
Rate for Payer: Priority Health Choice Medicaid	$8.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$23.88
Rate for Payer: Priority Health Narrow/Tiered Network	$23.88
Rate for Payer: UHC Medicaid	$8.95
Rate for Payer: UHCCP Medicaid	$8.95

PR DYSPORT

Professional

Both

$12.00

Hospital Revenue Code	990
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.00

PR EAR MOLD/INSERT

Professional

Both

$132.00

Service Code	HCPCS V5264
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$57.45
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00

PR EAR PIERCING

Professional

Both

$73.00

Service Code	HCPCS 69090
Min. Negotiated Rate	$29.20
Max. Negotiated Rate	$54.75
Rate for Payer: Aetna Commercial	$35.41
Rate for Payer: Aetna Medicare	$36.50
Rate for Payer: BCBS Complete	$29.20
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cash Price	$58.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$45.27
Rate for Payer: Priority Health Narrow/Tiered Network	$45.27

PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY

Professional

Both

$24.00

Service Code	HCPCS 93010
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$11.04
Rate for Payer: Aetna Medicare	$12.00
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCN Commercial	$9.42
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Mclaren Medicaid	$5.33
Rate for Payer: Meridian Medicaid	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.00
Rate for Payer: Priority Health Choice Medicaid	$5.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$11.35
Rate for Payer: Priority Health Narrow/Tiered Network	$11.35
Rate for Payer: UHC Medicaid	$5.33
Rate for Payer: UHCCP Medicaid	$5.33

PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R

Professional

Both

$44.00

Service Code	HCPCS 93005
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$8.19
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCN Commercial	$7.46
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$9.00
Rate for Payer: Priority Health Narrow/Tiered Network	$9.00

PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R

Professional

Both

$81.00

Service Code	HCPCS 93000
Min. Negotiated Rate	$16.89
Max. Negotiated Rate	$60.75
Rate for Payer: Aetna Commercial	$19.23
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: BCN Commercial	$16.89
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$20.35
Rate for Payer: Priority Health Narrow/Tiered Network	$20.35

PR ECHO GUIDANCE RADIOTHERAPY

Professional

Both

$394.00

Service Code	HCPCS G6001
Min. Negotiated Rate	$157.60
Max. Negotiated Rate	$295.50
Rate for Payer: Aetna Commercial	$173.52
Rate for Payer: Aetna Medicare	$197.00
Rate for Payer: BCBS Complete	$157.60
Rate for Payer: BCN Commercial	$264.43
Rate for Payer: Cash Price	$315.20
Rate for Payer: Cash Price	$315.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$295.50

Know your out-of-pocket cost for care.

All Charges