Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC STENT NONCOATED W SYS LVL 7

Facility

$2,444.40

Service Code	HCPCS c1876
Hospital Charge Code	27800099
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.97
Max. Negotiated Rate	$2,199.96
Rate for Payer: Aetna Commercial	$2,077.74
Rate for Payer: Aetna New Business (MI Preferred)	$1,588.86
Rate for Payer: Cash Price	$1,955.52
Rate for Payer: Cofinity Commercial	$1,711.08
Rate for Payer: Cofinity Commercial	$2,102.18
Rate for Payer: Healthscope Commercial	$2,199.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,077.74
Rate for Payer: PHP Commercial	$2,077.74
Rate for Payer: Priority Health Cigna Priority Health	$1,711.08
Rate for Payer: Priority Health SBD	$1,539.97

HC STENT NONCOATED W SYS LVL 8

Facility

$3,546.90

Service Code	HCPCS C1876
Hospital Charge Code	27800100
Hospital Revenue Code	278
Min. Negotiated Rate	$2,234.55
Max. Negotiated Rate	$3,192.21
Rate for Payer: Aetna Commercial	$3,014.86
Rate for Payer: Aetna New Business (MI Preferred)	$2,305.48
Rate for Payer: Cash Price	$2,837.52
Rate for Payer: Cofinity Commercial	$2,482.83
Rate for Payer: Cofinity Commercial	$3,050.33
Rate for Payer: Healthscope Commercial	$3,192.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,014.86
Rate for Payer: PHP Commercial	$3,014.86
Rate for Payer: Priority Health Cigna Priority Health	$2,482.83
Rate for Payer: Priority Health SBD	$2,234.55

HC STENT NONCOATED W SYS LVL 8

Facility

$3,546.90

Service Code	HCPCS C1876
Hospital Charge Code	27800100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,418.76
Max. Negotiated Rate	$3,192.21
Rate for Payer: Aetna Commercial	$3,014.86
Rate for Payer: Aetna New Business (MI Preferred)	$2,305.48
Rate for Payer: BCBS Complete	$1,418.76
Rate for Payer: Cash Price	$2,837.52
Rate for Payer: Cofinity Commercial	$2,482.83
Rate for Payer: Cofinity Commercial	$3,050.33
Rate for Payer: Healthscope Commercial	$3,192.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,014.86
Rate for Payer: PHP Commercial	$3,014.86
Rate for Payer: Priority Health Cigna Priority Health	$2,482.83
Rate for Payer: Priority Health SBD	$2,234.55

HC STENT NON CORONARY LVL 2

Facility

$239.40

Service Code	HCPCS C2625
Hospital Charge Code	27800101
Hospital Revenue Code	278
Min. Negotiated Rate	$95.76
Max. Negotiated Rate	$215.46
Rate for Payer: Aetna Commercial	$203.49
Rate for Payer: Aetna New Business (MI Preferred)	$155.61
Rate for Payer: BCBS Complete	$95.76
Rate for Payer: Cash Price	$191.52
Rate for Payer: Cofinity Commercial	$167.58
Rate for Payer: Cofinity Commercial	$205.88
Rate for Payer: Healthscope Commercial	$215.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$203.49
Rate for Payer: PHP Commercial	$203.49
Rate for Payer: Priority Health Cigna Priority Health	$167.58
Rate for Payer: Priority Health SBD	$150.82

HC STENT NON CORONARY LVL 2

Facility

$239.40

Service Code	HCPCS C2625
Hospital Charge Code	27800101
Hospital Revenue Code	278
Min. Negotiated Rate	$150.82
Max. Negotiated Rate	$215.46
Rate for Payer: Aetna Commercial	$203.49
Rate for Payer: Aetna New Business (MI Preferred)	$155.61
Rate for Payer: Cash Price	$191.52
Rate for Payer: Cofinity Commercial	$167.58
Rate for Payer: Cofinity Commercial	$205.88
Rate for Payer: Healthscope Commercial	$215.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$203.49
Rate for Payer: PHP Commercial	$203.49
Rate for Payer: Priority Health Cigna Priority Health	$167.58
Rate for Payer: Priority Health SBD	$150.82

HC STENT NON CORONARY LVL 3

Facility

$491.40

Service Code	HCPCS c2625
Hospital Charge Code	27800102
Hospital Revenue Code	278
Min. Negotiated Rate	$309.58
Max. Negotiated Rate	$442.26
Rate for Payer: Aetna Commercial	$417.69
Rate for Payer: Aetna New Business (MI Preferred)	$319.41
Rate for Payer: Cash Price	$393.12
Rate for Payer: Cofinity Commercial	$343.98
Rate for Payer: Cofinity Commercial	$422.60
Rate for Payer: Healthscope Commercial	$442.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$417.69
Rate for Payer: PHP Commercial	$417.69
Rate for Payer: Priority Health Cigna Priority Health	$343.98
Rate for Payer: Priority Health SBD	$309.58

HC STENT NON CORONARY LVL 3

Facility

$491.40

Service Code	HCPCS c2625
Hospital Charge Code	27800102
Hospital Revenue Code	278
Min. Negotiated Rate	$196.56
Max. Negotiated Rate	$442.26
Rate for Payer: Aetna Commercial	$417.69
Rate for Payer: Aetna New Business (MI Preferred)	$319.41
Rate for Payer: BCBS Complete	$196.56
Rate for Payer: Cash Price	$393.12
Rate for Payer: Cofinity Commercial	$343.98
Rate for Payer: Cofinity Commercial	$422.60
Rate for Payer: Healthscope Commercial	$442.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$417.69
Rate for Payer: PHP Commercial	$417.69
Rate for Payer: Priority Health Cigna Priority Health	$343.98
Rate for Payer: Priority Health SBD	$309.58

HC STENT NON CORONARY LVL 4

Facility

$822.28

Service Code	HCPCS C2625
Hospital Charge Code	27200103
Hospital Revenue Code	272
Min. Negotiated Rate	$328.91
Max. Negotiated Rate	$740.05
Rate for Payer: Aetna Commercial	$698.94
Rate for Payer: Aetna New Business (MI Preferred)	$534.48
Rate for Payer: BCBS Complete	$328.91
Rate for Payer: Cash Price	$657.82
Rate for Payer: Cofinity Commercial	$575.60
Rate for Payer: Cofinity Commercial	$707.16
Rate for Payer: Healthscope Commercial	$740.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$698.94
Rate for Payer: PHP Commercial	$698.94
Rate for Payer: Priority Health Cigna Priority Health	$575.60
Rate for Payer: Priority Health SBD	$518.04

HC STENT NON CORONARY LVL 4

Facility

$822.28

Service Code	HCPCS C2625
Hospital Charge Code	27200103
Hospital Revenue Code	272
Min. Negotiated Rate	$518.04
Max. Negotiated Rate	$740.05
Rate for Payer: Aetna Commercial	$698.94
Rate for Payer: Aetna New Business (MI Preferred)	$534.48
Rate for Payer: Cash Price	$657.82
Rate for Payer: Cofinity Commercial	$575.60
Rate for Payer: Cofinity Commercial	$707.16
Rate for Payer: Healthscope Commercial	$740.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$698.94
Rate for Payer: PHP Commercial	$698.94
Rate for Payer: Priority Health Cigna Priority Health	$575.60
Rate for Payer: Priority Health SBD	$518.04

HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL

Facility

$10,408.41

Service Code	CPT 37237
Hospital Charge Code	36100425
Hospital Revenue Code	361
Min. Negotiated Rate	$201.38
Max. Negotiated Rate	$9,367.57
Rate for Payer: Aetna Commercial	$8,847.15
Rate for Payer: Aetna New Business (MI Preferred)	$6,765.47
Rate for Payer: BCBS Complete	$4,163.36
Rate for Payer: BCBS Trust/PPO	$4,815.82
Rate for Payer: Cash Price	$8,326.73
Rate for Payer: Cash Price	$8,326.73
Rate for Payer: Cofinity Commercial	$8,951.23
Rate for Payer: Cofinity Commercial	$7,285.89
Rate for Payer: Healthscope Commercial	$9,367.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,847.15
Rate for Payer: PHP Commercial	$8,847.15
Rate for Payer: Priority Health Cigna Priority Health	$7,285.89
Rate for Payer: Priority Health SBD	$6,557.30
Rate for Payer: UHC All Payor (Choice/PPO)	$221.52
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Exchange	$201.38

HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL

Facility

$10,408.41

Service Code	CPT 37237
Hospital Charge Code	36100425
Hospital Revenue Code	361
Min. Negotiated Rate	$6,557.30
Max. Negotiated Rate	$9,367.57
Rate for Payer: Aetna Commercial	$8,847.15
Rate for Payer: Aetna New Business (MI Preferred)	$6,765.47
Rate for Payer: Cash Price	$8,326.73
Rate for Payer: Cofinity Commercial	$7,285.89
Rate for Payer: Cofinity Commercial	$8,951.23
Rate for Payer: Healthscope Commercial	$9,367.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,847.15
Rate for Payer: PHP Commercial	$8,847.15
Rate for Payer: Priority Health Cigna Priority Health	$7,285.89
Rate for Payer: Priority Health SBD	$6,557.30

HC STENT PLACE OTHER THAN LOWER EXTREM CERV CAROTID INTRACRAN

Facility

$16,081.87

Service Code	CPT 37236
Hospital Charge Code	36100424
Hospital Revenue Code	361
Min. Negotiated Rate	$10,131.58
Max. Negotiated Rate	$14,473.68
Rate for Payer: Aetna Commercial	$13,669.59
Rate for Payer: Aetna New Business (MI Preferred)	$10,453.22
Rate for Payer: Cash Price	$12,865.50
Rate for Payer: Cofinity Commercial	$11,257.31
Rate for Payer: Cofinity Commercial	$13,830.41
Rate for Payer: Healthscope Commercial	$14,473.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13,669.59
Rate for Payer: PHP Commercial	$13,669.59
Rate for Payer: Priority Health Cigna Priority Health	$11,257.31
Rate for Payer: Priority Health SBD	$10,131.58

HC STENT PLACE OTHER THAN LOWER EXTREM CERV CAROTID INTRACRAN

Facility

$16,081.87

Service Code	CPT 37236
Hospital Charge Code	36100424
Hospital Revenue Code	361
Min. Negotiated Rate	$420.44
Max. Negotiated Rate	$31,275.01
Rate for Payer: Aetna Commercial	$13,669.59
Rate for Payer: Aetna Medicare	$10,180.30
Rate for Payer: Aetna New Business (MI Preferred)	$10,453.22
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,235.94
Rate for Payer: Amish Plain Church Group Commercial	$12,235.94
Rate for Payer: BCBS Complete	$5,622.66
Rate for Payer: BCBS MAPPO	$9,788.75
Rate for Payer: BCBS Trust/PPO	$6,543.60
Rate for Payer: BCN Medicare Advantage	$9,788.75
Rate for Payer: Cash Price	$12,865.50
Rate for Payer: Cash Price	$12,865.50
Rate for Payer: Cofinity Commercial	$13,830.41
Rate for Payer: Cofinity Commercial	$11,257.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,788.75
Rate for Payer: Healthscope Commercial	$14,473.68
Rate for Payer: Mclaren Medicaid	$5,354.45
Rate for Payer: Mclaren Medicare	$9,788.75
Rate for Payer: Meridian Medicaid	$5,622.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,278.19
Rate for Payer: MI Amish Medical Board Commercial	$11,257.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13,669.59
Rate for Payer: PACE Medicare	$9,299.31
Rate for Payer: PACE SWMI	$9,788.75
Rate for Payer: PHP Commercial	$13,669.59
Rate for Payer: PHP Medicare Advantage	$9,788.75
Rate for Payer: Priority Health Choice Medicaid	$5,354.45
Rate for Payer: Priority Health Cigna Priority Health	$11,257.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31,275.01
Rate for Payer: Priority Health Medicare	$9,788.75
Rate for Payer: Priority Health Narrow Network	$25,020.01
Rate for Payer: Priority Health SBD	$10,131.58
Rate for Payer: Railroad Medicare Medicare	$9,788.75
Rate for Payer: UHC All Payor (Choice/PPO)	$462.48
Rate for Payer: UHC Core	$8,819.00
Rate for Payer: UHC Dual Complete DSNP	$9,788.75
Rate for Payer: UHC Exchange	$420.44
Rate for Payer: UHC Medicare Advantage	$10,082.41
Rate for Payer: VA VA	$9,788.75

HC STENT PLACE VENOUS

Facility

$18,379.26

Service Code	CPT 37238
Hospital Charge Code	36100426
Hospital Revenue Code	361
Min. Negotiated Rate	$11,578.93
Max. Negotiated Rate	$16,541.33
Rate for Payer: Aetna Commercial	$15,622.37
Rate for Payer: Aetna New Business (MI Preferred)	$11,946.52
Rate for Payer: Cash Price	$14,703.41
Rate for Payer: Cofinity Commercial	$12,865.48
Rate for Payer: Cofinity Commercial	$15,806.16
Rate for Payer: Healthscope Commercial	$16,541.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15,622.37
Rate for Payer: PHP Commercial	$15,622.37
Rate for Payer: Priority Health Cigna Priority Health	$12,865.48
Rate for Payer: Priority Health SBD	$11,578.93

HC STENT PLACE VENOUS

Facility

$18,379.26

Service Code	CPT 37238
Hospital Charge Code	36100426
Hospital Revenue Code	361
Min. Negotiated Rate	$292.73
Max. Negotiated Rate	$31,275.01
Rate for Payer: Aetna Commercial	$15,622.37
Rate for Payer: Aetna Medicare	$10,180.30
Rate for Payer: Aetna New Business (MI Preferred)	$11,946.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,235.94
Rate for Payer: Amish Plain Church Group Commercial	$12,235.94
Rate for Payer: BCBS Complete	$5,622.66
Rate for Payer: BCBS MAPPO	$9,788.75
Rate for Payer: BCBS Trust/PPO	$8,503.67
Rate for Payer: BCN Medicare Advantage	$9,788.75
Rate for Payer: Cash Price	$14,703.41
Rate for Payer: Cash Price	$14,703.41
Rate for Payer: Cofinity Commercial	$15,806.16
Rate for Payer: Cofinity Commercial	$12,865.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,788.75
Rate for Payer: Healthscope Commercial	$16,541.33
Rate for Payer: Mclaren Medicaid	$5,354.45
Rate for Payer: Mclaren Medicare	$9,788.75
Rate for Payer: Meridian Medicaid	$5,622.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,278.19
Rate for Payer: MI Amish Medical Board Commercial	$11,257.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15,622.37
Rate for Payer: PACE Medicare	$9,299.31
Rate for Payer: PACE SWMI	$9,788.75
Rate for Payer: PHP Commercial	$15,622.37
Rate for Payer: PHP Medicare Advantage	$9,788.75
Rate for Payer: Priority Health Choice Medicaid	$5,354.45
Rate for Payer: Priority Health Cigna Priority Health	$12,865.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31,275.01
Rate for Payer: Priority Health Medicare	$9,788.75
Rate for Payer: Priority Health Narrow Network	$25,020.01
Rate for Payer: Priority Health SBD	$11,578.93
Rate for Payer: Railroad Medicare Medicare	$9,788.75
Rate for Payer: UHC All Payor (Choice/PPO)	$322.00
Rate for Payer: UHC Core	$8,819.00
Rate for Payer: UHC Dual Complete DSNP	$9,788.75
Rate for Payer: UHC Exchange	$292.73
Rate for Payer: UHC Medicare Advantage	$10,082.41
Rate for Payer: VA VA	$9,788.75

HC STENT PLACE VENOUS EA ADDL VEIN

Facility

$10,408.41

Service Code	CPT 37239
Hospital Charge Code	36100427
Hospital Revenue Code	361
Min. Negotiated Rate	$6,557.30
Max. Negotiated Rate	$9,367.57
Rate for Payer: Aetna Commercial	$8,847.15
Rate for Payer: Aetna New Business (MI Preferred)	$6,765.47
Rate for Payer: Cash Price	$8,326.73
Rate for Payer: Cofinity Commercial	$7,285.89
Rate for Payer: Cofinity Commercial	$8,951.23
Rate for Payer: Healthscope Commercial	$9,367.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,847.15
Rate for Payer: PHP Commercial	$8,847.15
Rate for Payer: Priority Health Cigna Priority Health	$7,285.89
Rate for Payer: Priority Health SBD	$6,557.30

HC STENT PLACE VENOUS EA ADDL VEIN

Facility

$10,408.41

Service Code	CPT 37239
Hospital Charge Code	36100427
Hospital Revenue Code	361
Min. Negotiated Rate	$143.42
Max. Negotiated Rate	$9,367.57
Rate for Payer: Aetna Commercial	$8,847.15
Rate for Payer: Aetna New Business (MI Preferred)	$6,765.47
Rate for Payer: BCBS Complete	$4,163.36
Rate for Payer: BCBS Trust/PPO	$3,993.35
Rate for Payer: Cash Price	$8,326.73
Rate for Payer: Cash Price	$8,326.73
Rate for Payer: Cofinity Commercial	$7,285.89
Rate for Payer: Cofinity Commercial	$8,951.23
Rate for Payer: Healthscope Commercial	$9,367.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,847.15
Rate for Payer: PHP Commercial	$8,847.15
Rate for Payer: Priority Health Cigna Priority Health	$7,285.89
Rate for Payer: Priority Health SBD	$6,557.30
Rate for Payer: UHC All Payor (Choice/PPO)	$157.76
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Exchange	$143.42

HC STENT TRASCATH VEIN EACH ADDL

Facility

$6,720.90

Service Code	CPT 37239
Hospital Charge Code	36100441
Hospital Revenue Code	361
Min. Negotiated Rate	$4,234.17
Max. Negotiated Rate	$6,048.81
Rate for Payer: Aetna Commercial	$5,712.76
Rate for Payer: Aetna New Business (MI Preferred)	$4,368.58
Rate for Payer: Cash Price	$5,376.72
Rate for Payer: Cofinity Commercial	$4,704.63
Rate for Payer: Cofinity Commercial	$5,779.97
Rate for Payer: Healthscope Commercial	$6,048.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,712.76
Rate for Payer: PHP Commercial	$5,712.76
Rate for Payer: Priority Health Cigna Priority Health	$4,704.63
Rate for Payer: Priority Health SBD	$4,234.17

HC STENT TRASCATH VEIN EACH ADDL

Facility

$6,720.90

Service Code	CPT 37239
Hospital Charge Code	36100441
Hospital Revenue Code	361
Min. Negotiated Rate	$143.42
Max. Negotiated Rate	$7,632.00
Rate for Payer: Aetna Commercial	$5,712.76
Rate for Payer: Aetna New Business (MI Preferred)	$4,368.58
Rate for Payer: BCBS Complete	$2,688.36
Rate for Payer: BCBS Trust/PPO	$3,993.35
Rate for Payer: Cash Price	$5,376.72
Rate for Payer: Cash Price	$5,376.72
Rate for Payer: Cofinity Commercial	$4,704.63
Rate for Payer: Cofinity Commercial	$5,779.97
Rate for Payer: Healthscope Commercial	$6,048.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,712.76
Rate for Payer: PHP Commercial	$5,712.76
Rate for Payer: Priority Health Cigna Priority Health	$4,704.63
Rate for Payer: Priority Health SBD	$4,234.17
Rate for Payer: UHC All Payor (Choice/PPO)	$157.76
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Exchange	$143.42

HC STENT VESSEL/BRANCH

Facility

$24,183.90

Service Code	CPT 92928
Hospital Charge Code	48100073
Hospital Revenue Code	481
Min. Negotiated Rate	$562.87
Max. Negotiated Rate	$31,275.01
Rate for Payer: Aetna Commercial	$20,556.32
Rate for Payer: Aetna Medicare	$10,180.30
Rate for Payer: Aetna New Business (MI Preferred)	$15,719.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,235.94
Rate for Payer: Amish Plain Church Group Commercial	$12,235.94
Rate for Payer: BCBS Complete	$5,622.66
Rate for Payer: BCBS MAPPO	$9,788.75
Rate for Payer: BCBS Trust/PPO	$9,383.43
Rate for Payer: BCN Medicare Advantage	$9,788.75
Rate for Payer: Cash Price	$19,347.12
Rate for Payer: Cash Price	$19,347.12
Rate for Payer: Cofinity Commercial	$20,798.15
Rate for Payer: Cofinity Commercial	$16,928.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,788.75
Rate for Payer: Healthscope Commercial	$21,765.51
Rate for Payer: Mclaren Medicaid	$5,354.45
Rate for Payer: Mclaren Medicare	$9,788.75
Rate for Payer: Meridian Medicaid	$5,622.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,278.19
Rate for Payer: MI Amish Medical Board Commercial	$11,257.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20,556.32
Rate for Payer: PACE Medicare	$9,299.31
Rate for Payer: PACE SWMI	$9,788.75
Rate for Payer: PHP Commercial	$20,556.32
Rate for Payer: PHP Medicare Advantage	$9,788.75
Rate for Payer: Priority Health Choice Medicaid	$5,354.45
Rate for Payer: Priority Health Cigna Priority Health	$16,928.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31,275.01
Rate for Payer: Priority Health Medicare	$9,788.75
Rate for Payer: Priority Health Narrow Network	$25,020.01
Rate for Payer: Priority Health SBD	$15,235.86
Rate for Payer: Railroad Medicare Medicare	$9,788.75
Rate for Payer: UHC All Payor (Choice/PPO)	$619.16
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$9,788.75
Rate for Payer: UHC Exchange	$562.87
Rate for Payer: UHC Medicare Advantage	$10,082.41
Rate for Payer: VA VA	$9,788.75

HC STENT VESSEL/BRANCH

Facility

$24,183.90

Service Code	CPT 92928
Hospital Charge Code	48100073
Hospital Revenue Code	481
Min. Negotiated Rate	$15,235.86
Max. Negotiated Rate	$21,765.51
Rate for Payer: Aetna Commercial	$20,556.32
Rate for Payer: Aetna New Business (MI Preferred)	$15,719.54
Rate for Payer: Cash Price	$19,347.12
Rate for Payer: Cofinity Commercial	$16,928.73
Rate for Payer: Cofinity Commercial	$20,798.15
Rate for Payer: Healthscope Commercial	$21,765.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20,556.32
Rate for Payer: PHP Commercial	$20,556.32
Rate for Payer: Priority Health Cigna Priority Health	$16,928.73
Rate for Payer: Priority Health SBD	$15,235.86

HC STIZ MARKER

Facility

$84.00

Service Code	CPT A9698
Hospital Charge Code	25500004
Hospital Revenue Code	255
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna Commercial	$71.40
Rate for Payer: Aetna New Business (MI Preferred)	$54.60
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cofinity Commercial	$58.80
Rate for Payer: Cofinity Commercial	$72.24
Rate for Payer: Healthscope Commercial	$75.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.40
Rate for Payer: PHP Commercial	$71.40
Rate for Payer: Priority Health Cigna Priority Health	$58.80
Rate for Payer: Priority Health SBD	$52.92

HC STIZ MARKER

Facility

$84.00

Service Code	CPT A9698
Hospital Charge Code	25500004
Hospital Revenue Code	255
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna Commercial	$71.40
Rate for Payer: Aetna New Business (MI Preferred)	$54.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cofinity Commercial	$58.80
Rate for Payer: Cofinity Commercial	$72.24
Rate for Payer: Healthscope Commercial	$75.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.40
Rate for Payer: PHP Commercial	$71.40
Rate for Payer: Priority Health Cigna Priority Health	$58.80
Rate for Payer: Priority Health SBD	$52.92

HC ST JUDE CRT ICD

Facility

$27,540.00

Service Code	HCPCS C1882
Hospital Charge Code	27500009
Hospital Revenue Code	275
Min. Negotiated Rate	$17,350.20
Max. Negotiated Rate	$24,786.00
Rate for Payer: Aetna Commercial	$23,409.00
Rate for Payer: Aetna New Business (MI Preferred)	$17,901.00
Rate for Payer: Cash Price	$22,032.00
Rate for Payer: Cofinity Commercial	$19,278.00
Rate for Payer: Cofinity Commercial	$23,684.40
Rate for Payer: Healthscope Commercial	$24,786.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23,409.00
Rate for Payer: PHP Commercial	$23,409.00
Rate for Payer: Priority Health Cigna Priority Health	$19,278.00
Rate for Payer: Priority Health SBD	$17,350.20

HC ST JUDE CRT ICD

Facility

$27,540.00

Service Code	HCPCS C1882
Hospital Charge Code	27500009
Hospital Revenue Code	275
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$24,786.00
Rate for Payer: Aetna Commercial	$23,409.00
Rate for Payer: Aetna New Business (MI Preferred)	$17,901.00
Rate for Payer: BCBS Complete	$11,016.00
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$22,032.00
Rate for Payer: Cash Price	$22,032.00
Rate for Payer: Cofinity Commercial	$19,278.00
Rate for Payer: Cofinity Commercial	$23,684.40
Rate for Payer: Healthscope Commercial	$24,786.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23,409.00
Rate for Payer: PHP Commercial	$23,409.00
Rate for Payer: Priority Health Cigna Priority Health	$19,278.00
Rate for Payer: Priority Health SBD	$17,350.20

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