Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC CATH ATHRECT ROTATIONAL LVL 5

Facility

$5,705.55

Service Code	HCPCS C1724
Hospital Charge Code	27200025
Hospital Revenue Code	272
Min. Negotiated Rate	$2,282.22
Max. Negotiated Rate	$5,134.99
Rate for Payer: Aetna Commercial	$4,849.72
Rate for Payer: Aetna Medicare	$2,852.78
Rate for Payer: Aetna New Business (MI Preferred)	$3,708.61
Rate for Payer: BCBS Complete	$2,282.22
Rate for Payer: Cash Price	$4,564.44
Rate for Payer: Cofinity Commercial	$3,993.89
Rate for Payer: Cofinity Commercial	$4,906.77
Rate for Payer: Cofinity Medicare Advantage	$3,993.89
Rate for Payer: Encore Health Key Benefits Commercial	$4,564.44
Rate for Payer: Healthscope Commercial	$5,134.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,849.72
Rate for Payer: PHP Commercial	$4,849.72
Rate for Payer: Priority Health Cigna Priority Health	$3,708.61
Rate for Payer: Priority Health SBD	$3,594.50

HC CATH ATHRECT ROTATIONAL LVL 5

Facility

$5,705.55

Service Code	HCPCS C1724
Hospital Charge Code	27200025
Hospital Revenue Code	272
Min. Negotiated Rate	$3,594.50
Max. Negotiated Rate	$5,134.99
Rate for Payer: Aetna Commercial	$4,849.72
Rate for Payer: Aetna New Business (MI Preferred)	$3,708.61
Rate for Payer: Cash Price	$4,564.44
Rate for Payer: Cofinity Commercial	$3,993.89
Rate for Payer: Cofinity Commercial	$4,906.77
Rate for Payer: Cofinity Medicare Advantage	$3,993.89
Rate for Payer: Encore Health Key Benefits Commercial	$4,564.44
Rate for Payer: Healthscope Commercial	$5,134.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,849.72
Rate for Payer: PHP Commercial	$4,849.72
Rate for Payer: Priority Health Cigna Priority Health	$3,708.61
Rate for Payer: Priority Health SBD	$3,594.50

HC CATHETER BALLOON DILATATION NON VASCULAR

Facility

$3,501.78

Service Code	HCPCS C1726
Hospital Charge Code	27200384
Hospital Revenue Code	272
Min. Negotiated Rate	$1,400.71
Max. Negotiated Rate	$3,151.60
Rate for Payer: Aetna Commercial	$2,976.51
Rate for Payer: Aetna Medicare	$1,750.89
Rate for Payer: Aetna New Business (MI Preferred)	$2,276.16
Rate for Payer: BCBS Complete	$1,400.71
Rate for Payer: Cash Price	$2,801.42
Rate for Payer: Cofinity Commercial	$2,451.25
Rate for Payer: Cofinity Commercial	$3,011.53
Rate for Payer: Cofinity Medicare Advantage	$2,451.25
Rate for Payer: Encore Health Key Benefits Commercial	$2,801.42
Rate for Payer: Healthscope Commercial	$3,151.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,976.51
Rate for Payer: PHP Commercial	$2,976.51
Rate for Payer: Priority Health Cigna Priority Health	$2,276.16
Rate for Payer: Priority Health SBD	$2,206.12

HC CATHETER BALLOON DILATATION NON VASCULAR

Facility

$3,501.78

Service Code	HCPCS C1726
Hospital Charge Code	27200384
Hospital Revenue Code	272
Min. Negotiated Rate	$2,206.12
Max. Negotiated Rate	$3,151.60
Rate for Payer: Aetna Commercial	$2,976.51
Rate for Payer: Aetna New Business (MI Preferred)	$2,276.16
Rate for Payer: Cash Price	$2,801.42
Rate for Payer: Cofinity Commercial	$2,451.25
Rate for Payer: Cofinity Commercial	$3,011.53
Rate for Payer: Cofinity Medicare Advantage	$2,451.25
Rate for Payer: Encore Health Key Benefits Commercial	$2,801.42
Rate for Payer: Healthscope Commercial	$3,151.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,976.51
Rate for Payer: PHP Commercial	$2,976.51
Rate for Payer: Priority Health Cigna Priority Health	$2,276.16
Rate for Payer: Priority Health SBD	$2,206.12

HC CATHETER BALLOON DILAT NON VASC LVL 1

Facility

$148.17

Service Code	HCPCS C1726
Hospital Charge Code	27200353
Hospital Revenue Code	272
Min. Negotiated Rate	$93.35
Max. Negotiated Rate	$133.35
Rate for Payer: Aetna Commercial	$125.94
Rate for Payer: Aetna New Business (MI Preferred)	$96.31
Rate for Payer: Cash Price	$118.54
Rate for Payer: Cofinity Commercial	$103.72
Rate for Payer: Cofinity Commercial	$127.43
Rate for Payer: Cofinity Medicare Advantage	$103.72
Rate for Payer: Encore Health Key Benefits Commercial	$118.54
Rate for Payer: Healthscope Commercial	$133.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.94
Rate for Payer: PHP Commercial	$125.94
Rate for Payer: Priority Health Cigna Priority Health	$96.31
Rate for Payer: Priority Health SBD	$93.35

HC CATHETER BALLOON DILAT NON VASC LVL 1

Facility

$148.17

Service Code	HCPCS C1726
Hospital Charge Code	27200353
Hospital Revenue Code	272
Min. Negotiated Rate	$59.27
Max. Negotiated Rate	$133.35
Rate for Payer: Aetna Commercial	$125.94
Rate for Payer: Aetna Medicare	$74.08
Rate for Payer: Aetna New Business (MI Preferred)	$96.31
Rate for Payer: BCBS Complete	$59.27
Rate for Payer: Cash Price	$118.54
Rate for Payer: Cofinity Commercial	$103.72
Rate for Payer: Cofinity Commercial	$127.43
Rate for Payer: Cofinity Medicare Advantage	$103.72
Rate for Payer: Encore Health Key Benefits Commercial	$118.54
Rate for Payer: Healthscope Commercial	$133.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.94
Rate for Payer: PHP Commercial	$125.94
Rate for Payer: Priority Health Cigna Priority Health	$96.31
Rate for Payer: Priority Health SBD	$93.35

HC CATHETER BALLOON DILAT NON VASC LVL 7

Facility

$792.81

Service Code	HCPCS C1726
Hospital Charge Code	27200295
Hospital Revenue Code	272
Min. Negotiated Rate	$317.12
Max. Negotiated Rate	$713.53
Rate for Payer: Aetna Commercial	$673.89
Rate for Payer: Aetna Medicare	$396.40
Rate for Payer: Aetna New Business (MI Preferred)	$515.33
Rate for Payer: BCBS Complete	$317.12
Rate for Payer: Cash Price	$634.25
Rate for Payer: Cofinity Commercial	$554.97
Rate for Payer: Cofinity Commercial	$681.82
Rate for Payer: Cofinity Medicare Advantage	$554.97
Rate for Payer: Encore Health Key Benefits Commercial	$634.25
Rate for Payer: Healthscope Commercial	$713.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$673.89
Rate for Payer: PHP Commercial	$673.89
Rate for Payer: Priority Health Cigna Priority Health	$515.33
Rate for Payer: Priority Health SBD	$499.47

HC CATHETER BALLOON DILAT NON VASC LVL 7

Facility

$792.81

Service Code	HCPCS C1726
Hospital Charge Code	27200295
Hospital Revenue Code	272
Min. Negotiated Rate	$499.47
Max. Negotiated Rate	$713.53
Rate for Payer: Aetna Commercial	$673.89
Rate for Payer: Aetna New Business (MI Preferred)	$515.33
Rate for Payer: Cash Price	$634.25
Rate for Payer: Cofinity Commercial	$554.97
Rate for Payer: Cofinity Commercial	$681.82
Rate for Payer: Cofinity Medicare Advantage	$554.97
Rate for Payer: Encore Health Key Benefits Commercial	$634.25
Rate for Payer: Healthscope Commercial	$713.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$673.89
Rate for Payer: PHP Commercial	$673.89
Rate for Payer: Priority Health Cigna Priority Health	$515.33
Rate for Payer: Priority Health SBD	$499.47

HC CATHETER INTRADISCAL

Facility

$1,532.09

Service Code	CPT C1754
Hospital Charge Code	27200357
Hospital Revenue Code	272
Min. Negotiated Rate	$965.22
Max. Negotiated Rate	$1,378.88
Rate for Payer: Aetna Commercial	$1,302.28
Rate for Payer: Aetna New Business (MI Preferred)	$995.86
Rate for Payer: Cash Price	$1,225.67
Rate for Payer: Cofinity Commercial	$1,072.46
Rate for Payer: Cofinity Commercial	$1,317.60
Rate for Payer: Cofinity Medicare Advantage	$1,072.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,225.67
Rate for Payer: Healthscope Commercial	$1,378.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,302.28
Rate for Payer: PHP Commercial	$1,302.28
Rate for Payer: Priority Health Cigna Priority Health	$995.86
Rate for Payer: Priority Health SBD	$965.22

HC CATHETER INTRADISCAL

Facility

$1,532.09

Service Code	CPT C1754
Hospital Charge Code	27200357
Hospital Revenue Code	272
Min. Negotiated Rate	$612.84
Max. Negotiated Rate	$1,378.88
Rate for Payer: Aetna Commercial	$1,302.28
Rate for Payer: Aetna Medicare	$766.04
Rate for Payer: Aetna New Business (MI Preferred)	$995.86
Rate for Payer: BCBS Complete	$612.84
Rate for Payer: Cash Price	$1,225.67
Rate for Payer: Cofinity Commercial	$1,072.46
Rate for Payer: Cofinity Commercial	$1,317.60
Rate for Payer: Cofinity Medicare Advantage	$1,072.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,225.67
Rate for Payer: Healthscope Commercial	$1,378.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,302.28
Rate for Payer: PHP Commercial	$1,302.28
Rate for Payer: Priority Health Cigna Priority Health	$995.86
Rate for Payer: Priority Health SBD	$965.22

HC CATHETERIZATION FOR COLLECTION OF SPECIMEN

Facility

$30.17

Service Code	CPT P9612
Hospital Charge Code	30000114
Hospital Revenue Code	300
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$27.15
Rate for Payer: Aetna Commercial	$25.64
Rate for Payer: Aetna Medicare	$9.45
Rate for Payer: Aetna New Business (MI Preferred)	$19.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$11.36
Rate for Payer: Amish Plain Church Group Commercial	$11.36
Rate for Payer: BCBS Complete	$5.12
Rate for Payer: BCBS MAPPO	$9.09
Rate for Payer: BCN Medicare Advantage	$9.09
Rate for Payer: Cash Price	$24.14
Rate for Payer: Cash Price	$24.14
Rate for Payer: Cofinity Commercial	$25.95
Rate for Payer: Cofinity Commercial	$21.12
Rate for Payer: Cofinity Medicare Advantage	$21.12
Rate for Payer: Encore Health Key Benefits Commercial	$24.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$9.09
Rate for Payer: Healthscope Commercial	$27.15
Rate for Payer: Mclaren Medicaid	$4.87
Rate for Payer: Mclaren Medicare	$9.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9.54
Rate for Payer: Meridian Medicaid	$5.12
Rate for Payer: MI Amish Medical Board Commercial	$10.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.64
Rate for Payer: PACE Medicare	$8.64
Rate for Payer: PACE SWMI	$9.09
Rate for Payer: PHP Commercial	$25.64
Rate for Payer: PHP Medicare Advantage	$9.09
Rate for Payer: Priority Health Choice Medicaid	$4.87
Rate for Payer: Priority Health Cigna Priority Health	$19.61
Rate for Payer: Priority Health Medicare	$9.09
Rate for Payer: Priority Health SBD	$19.01
Rate for Payer: Railroad Medicare Medicare	$9.09
Rate for Payer: UHC All Payor (Choice/PPO)	$25.59
Rate for Payer: UHC Dual Complete DSNP	$9.09
Rate for Payer: UHC Medicare Advantage	$9.09
Rate for Payer: UHCCP Medicaid	$5.12
Rate for Payer: VA VA	$9.09

HC CATHETERIZATION FOR COLLECTION OF SPECIMEN

Facility

$30.17

Service Code	CPT P9612
Hospital Charge Code	30000114
Hospital Revenue Code	300
Min. Negotiated Rate	$19.01
Max. Negotiated Rate	$27.15
Rate for Payer: Aetna Commercial	$25.64
Rate for Payer: Aetna New Business (MI Preferred)	$19.61
Rate for Payer: Cash Price	$24.14
Rate for Payer: Cofinity Commercial	$21.12
Rate for Payer: Cofinity Commercial	$25.95
Rate for Payer: Cofinity Medicare Advantage	$21.12
Rate for Payer: Encore Health Key Benefits Commercial	$24.14
Rate for Payer: Healthscope Commercial	$27.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.64
Rate for Payer: PHP Commercial	$25.64
Rate for Payer: Priority Health Cigna Priority Health	$19.61
Rate for Payer: Priority Health SBD	$19.01

HC CATHETER NOS LVL 1

Facility

$67.32

Service Code	HCPCS C1889
Hospital Charge Code	27800126
Hospital Revenue Code	278
Min. Negotiated Rate	$42.41
Max. Negotiated Rate	$60.59
Rate for Payer: Aetna Commercial	$57.22
Rate for Payer: Aetna New Business (MI Preferred)	$43.76
Rate for Payer: Cash Price	$53.86
Rate for Payer: Cofinity Commercial	$47.12
Rate for Payer: Cofinity Commercial	$57.90
Rate for Payer: Cofinity Medicare Advantage	$47.12
Rate for Payer: Encore Health Key Benefits Commercial	$53.86
Rate for Payer: Healthscope Commercial	$60.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.22
Rate for Payer: PHP Commercial	$57.22
Rate for Payer: Priority Health Cigna Priority Health	$43.76
Rate for Payer: Priority Health SBD	$42.41

HC CATHETER NOS LVL 1

Facility

$67.32

Service Code	HCPCS C1889
Hospital Charge Code	27800126
Hospital Revenue Code	278
Min. Negotiated Rate	$26.93
Max. Negotiated Rate	$60.59
Rate for Payer: Aetna Commercial	$57.22
Rate for Payer: Aetna Medicare	$33.66
Rate for Payer: Aetna New Business (MI Preferred)	$43.76
Rate for Payer: BCBS Complete	$26.93
Rate for Payer: Cash Price	$53.86
Rate for Payer: Cofinity Commercial	$47.12
Rate for Payer: Cofinity Commercial	$57.90
Rate for Payer: Cofinity Medicare Advantage	$47.12
Rate for Payer: Encore Health Key Benefits Commercial	$53.86
Rate for Payer: Healthscope Commercial	$60.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.22
Rate for Payer: PHP Commercial	$57.22
Rate for Payer: Priority Health Cigna Priority Health	$43.76
Rate for Payer: Priority Health SBD	$42.41

HC CATHETER NOS LVL 2

Facility

$357.00

Service Code	HCPCS C1889
Hospital Charge Code	27800127
Hospital Revenue Code	278
Min. Negotiated Rate	$224.91
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna Commercial	$303.45
Rate for Payer: Aetna New Business (MI Preferred)	$232.05
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cofinity Commercial	$249.90
Rate for Payer: Cofinity Commercial	$307.02
Rate for Payer: Cofinity Medicare Advantage	$249.90
Rate for Payer: Encore Health Key Benefits Commercial	$285.60
Rate for Payer: Healthscope Commercial	$321.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$303.45
Rate for Payer: PHP Commercial	$303.45
Rate for Payer: Priority Health Cigna Priority Health	$232.05
Rate for Payer: Priority Health SBD	$224.91

HC CATHETER NOS LVL 2

Facility

$357.00

Service Code	HCPCS C1889
Hospital Charge Code	27800127
Hospital Revenue Code	278
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna Commercial	$303.45
Rate for Payer: Aetna Medicare	$178.50
Rate for Payer: Aetna New Business (MI Preferred)	$232.05
Rate for Payer: BCBS Complete	$142.80
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cofinity Commercial	$249.90
Rate for Payer: Cofinity Commercial	$307.02
Rate for Payer: Cofinity Medicare Advantage	$249.90
Rate for Payer: Encore Health Key Benefits Commercial	$285.60
Rate for Payer: Healthscope Commercial	$321.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$303.45
Rate for Payer: PHP Commercial	$303.45
Rate for Payer: Priority Health Cigna Priority Health	$232.05
Rate for Payer: Priority Health SBD	$224.91

HC CATHETER PRESSURE GENERATING ONE WAY INTERMED OCCLUSIVE

Facility

$11,857.50

Service Code	CPT C1982
Hospital Charge Code	27800147
Hospital Revenue Code	278
Min. Negotiated Rate	$4,173.84
Max. Negotiated Rate	$10,671.75
Rate for Payer: Aetna Commercial	$10,078.88
Rate for Payer: Aetna Medicare	$5,928.75
Rate for Payer: Aetna New Business (MI Preferred)	$7,707.38
Rate for Payer: BCBS Complete	$4,743.00
Rate for Payer: Cash Price	$9,486.00
Rate for Payer: Cofinity Commercial	$10,197.45
Rate for Payer: Cofinity Commercial	$8,300.25
Rate for Payer: Cofinity Medicare Advantage	$8,300.25
Rate for Payer: Encore Health Key Benefits Commercial	$9,486.00
Rate for Payer: Healthscope Commercial	$10,671.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,078.88
Rate for Payer: PHP Commercial	$10,078.88
Rate for Payer: Priority Health Cigna Priority Health	$7,707.38
Rate for Payer: Priority Health SBD	$7,470.23
Rate for Payer: UHC All Payor (Choice/PPO)	$4,173.84

HC CATHETER PRESSURE GENERATING ONE WAY INTERMED OCCLUSIVE

Facility

$11,857.50

Service Code	CPT C1982
Hospital Charge Code	27800147
Hospital Revenue Code	278
Min. Negotiated Rate	$7,470.23
Max. Negotiated Rate	$10,671.75
Rate for Payer: Aetna Commercial	$10,078.88
Rate for Payer: Aetna New Business (MI Preferred)	$7,707.38
Rate for Payer: Cash Price	$9,486.00
Rate for Payer: Cofinity Commercial	$10,197.45
Rate for Payer: Cofinity Commercial	$8,300.25
Rate for Payer: Cofinity Medicare Advantage	$8,300.25
Rate for Payer: Encore Health Key Benefits Commercial	$9,486.00
Rate for Payer: Healthscope Commercial	$10,671.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,078.88
Rate for Payer: PHP Commercial	$10,078.88
Rate for Payer: Priority Health Cigna Priority Health	$7,707.38
Rate for Payer: Priority Health SBD	$7,470.23

HC CATHETER SINGLE

Facility

$190.56

Service Code	HCPCS C1881
Hospital Charge Code	27200018
Hospital Revenue Code	272
Min. Negotiated Rate	$120.05
Max. Negotiated Rate	$171.50
Rate for Payer: Aetna Commercial	$161.98
Rate for Payer: Aetna New Business (MI Preferred)	$123.86
Rate for Payer: Cash Price	$152.45
Rate for Payer: Cofinity Commercial	$133.39
Rate for Payer: Cofinity Commercial	$163.88
Rate for Payer: Cofinity Medicare Advantage	$133.39
Rate for Payer: Encore Health Key Benefits Commercial	$152.45
Rate for Payer: Healthscope Commercial	$171.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.98
Rate for Payer: PHP Commercial	$161.98
Rate for Payer: Priority Health Cigna Priority Health	$123.86
Rate for Payer: Priority Health SBD	$120.05

HC CATHETER SINGLE

Facility

$190.56

Service Code	HCPCS C1881
Hospital Charge Code	27200018
Hospital Revenue Code	272
Min. Negotiated Rate	$76.22
Max. Negotiated Rate	$171.50
Rate for Payer: Aetna Commercial	$161.98
Rate for Payer: Aetna Medicare	$95.28
Rate for Payer: Aetna New Business (MI Preferred)	$123.86
Rate for Payer: BCBS Complete	$76.22
Rate for Payer: Cash Price	$152.45
Rate for Payer: Cofinity Commercial	$133.39
Rate for Payer: Cofinity Commercial	$163.88
Rate for Payer: Cofinity Medicare Advantage	$133.39
Rate for Payer: Encore Health Key Benefits Commercial	$152.45
Rate for Payer: Healthscope Commercial	$171.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.98
Rate for Payer: PHP Commercial	$161.98
Rate for Payer: Priority Health Cigna Priority Health	$123.86
Rate for Payer: Priority Health SBD	$120.05

HC CATHETER TLA DRUG COATED NON LASER

Facility

$1,638.63

Service Code	HCPCS C2623
Hospital Charge Code	27200302
Hospital Revenue Code	272
Min. Negotiated Rate	$655.45
Max. Negotiated Rate	$1,474.77
Rate for Payer: Aetna Commercial	$1,392.84
Rate for Payer: Aetna Medicare	$819.32
Rate for Payer: Aetna New Business (MI Preferred)	$1,065.11
Rate for Payer: BCBS Complete	$655.45
Rate for Payer: Cash Price	$1,310.90
Rate for Payer: Cofinity Commercial	$1,147.04
Rate for Payer: Cofinity Commercial	$1,409.22
Rate for Payer: Cofinity Medicare Advantage	$1,147.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,310.90
Rate for Payer: Healthscope Commercial	$1,474.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,392.84
Rate for Payer: PHP Commercial	$1,392.84
Rate for Payer: Priority Health Cigna Priority Health	$1,065.11
Rate for Payer: Priority Health SBD	$1,032.34

HC CATHETER TLA DRUG COATED NON LASER

Facility

$1,638.63

Service Code	HCPCS C2623
Hospital Charge Code	27200302
Hospital Revenue Code	272
Min. Negotiated Rate	$1,032.34
Max. Negotiated Rate	$1,474.77
Rate for Payer: Aetna Commercial	$1,392.84
Rate for Payer: Aetna New Business (MI Preferred)	$1,065.11
Rate for Payer: Cash Price	$1,310.90
Rate for Payer: Cofinity Commercial	$1,147.04
Rate for Payer: Cofinity Commercial	$1,409.22
Rate for Payer: Cofinity Medicare Advantage	$1,147.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,310.90
Rate for Payer: Healthscope Commercial	$1,474.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,392.84
Rate for Payer: PHP Commercial	$1,392.84
Rate for Payer: Priority Health Cigna Priority Health	$1,065.11
Rate for Payer: Priority Health SBD	$1,032.34

HC CATHETER TRANSLUM ATHERECT DIRECTIONAL

Facility

$7,696.07

Service Code	HCPCS C1714
Hospital Charge Code	27200294
Hospital Revenue Code	272
Min. Negotiated Rate	$3,078.43
Max. Negotiated Rate	$6,926.46
Rate for Payer: Aetna Commercial	$6,541.66
Rate for Payer: Aetna Medicare	$3,848.03
Rate for Payer: Aetna New Business (MI Preferred)	$5,002.45
Rate for Payer: BCBS Complete	$3,078.43
Rate for Payer: Cash Price	$6,156.86
Rate for Payer: Cofinity Commercial	$5,387.25
Rate for Payer: Cofinity Commercial	$6,618.62
Rate for Payer: Cofinity Medicare Advantage	$5,387.25
Rate for Payer: Encore Health Key Benefits Commercial	$6,156.86
Rate for Payer: Healthscope Commercial	$6,926.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,541.66
Rate for Payer: PHP Commercial	$6,541.66
Rate for Payer: Priority Health Cigna Priority Health	$5,002.45
Rate for Payer: Priority Health SBD	$4,848.52

HC CATHETER TRANSLUM ATHERECT DIRECTIONAL

Facility

$7,696.07

Service Code	HCPCS C1714
Hospital Charge Code	27200294
Hospital Revenue Code	272
Min. Negotiated Rate	$4,848.52
Max. Negotiated Rate	$6,926.46
Rate for Payer: Aetna Commercial	$6,541.66
Rate for Payer: Aetna New Business (MI Preferred)	$5,002.45
Rate for Payer: Cash Price	$6,156.86
Rate for Payer: Cofinity Commercial	$5,387.25
Rate for Payer: Cofinity Commercial	$6,618.62
Rate for Payer: Cofinity Medicare Advantage	$5,387.25
Rate for Payer: Encore Health Key Benefits Commercial	$6,156.86
Rate for Payer: Healthscope Commercial	$6,926.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,541.66
Rate for Payer: PHP Commercial	$6,541.66
Rate for Payer: Priority Health Cigna Priority Health	$5,002.45
Rate for Payer: Priority Health SBD	$4,848.52

HC CATHETER TRANSLUM INTRAVAS LITHOTRIPSY CORONARY

Facility

$9,710.40

Service Code	CPT C1761
Hospital Charge Code	27200350
Hospital Revenue Code	278
Min. Negotiated Rate	$3,418.06
Max. Negotiated Rate	$8,739.36
Rate for Payer: Aetna Commercial	$8,253.84
Rate for Payer: Aetna Medicare	$4,855.20
Rate for Payer: Aetna New Business (MI Preferred)	$6,311.76
Rate for Payer: BCBS Complete	$3,884.16
Rate for Payer: Cash Price	$7,768.32
Rate for Payer: Cofinity Commercial	$6,797.28
Rate for Payer: Cofinity Commercial	$8,350.94
Rate for Payer: Cofinity Medicare Advantage	$6,797.28
Rate for Payer: Encore Health Key Benefits Commercial	$7,768.32
Rate for Payer: Healthscope Commercial	$8,739.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8,253.84
Rate for Payer: PHP Commercial	$8,253.84
Rate for Payer: Priority Health Cigna Priority Health	$6,311.76
Rate for Payer: Priority Health SBD	$6,117.55
Rate for Payer: UHC All Payor (Choice/PPO)	$3,418.06

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