Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC STENT COATED W DELIVERY SYSTEM

Facility

$12,112.82

Service Code	HCPCS C1874
Hospital Charge Code	27800111
Hospital Revenue Code	278
Min. Negotiated Rate	$7,631.08
Max. Negotiated Rate	$10,901.54
Rate for Payer: Aetna Commercial	$10,295.90
Rate for Payer: Aetna New Business (MI Preferred)	$7,873.33
Rate for Payer: Cash Price	$9,690.26
Rate for Payer: Cofinity Advantage	$8,478.97
Rate for Payer: Cofinity Commercial	$10,417.03
Rate for Payer: Encore Health Key Benefits Commercial	$9,690.26
Rate for Payer: Healthscope Commercial	$10,901.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,295.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$9,084.61
Rate for Payer: PHP Commercial	$10,295.90
Rate for Payer: Priority Health SBD	$7,631.08

HC STENT COATED W DELIVERY SYSTEM LVL 12

Facility

$5,572.41

Service Code	HCPCS C1874
Hospital Charge Code	27800096
Hospital Revenue Code	278
Min. Negotiated Rate	$2,189.96
Max. Negotiated Rate	$5,015.17
Rate for Payer: Aetna Commercial	$4,736.55
Rate for Payer: Aetna Medicare	$2,786.20
Rate for Payer: Aetna New Business (MI Preferred)	$3,622.07
Rate for Payer: BCBS Complete	$2,228.96
Rate for Payer: Cash Price	$4,457.93
Rate for Payer: Cofinity Advantage	$3,900.69
Rate for Payer: Cofinity Commercial	$4,792.27
Rate for Payer: Encore Health Key Benefits Commercial	$4,457.93
Rate for Payer: Healthscope Commercial	$5,015.17
Rate for Payer: MI Amish Medical Board Commercial	$4,457.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,736.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,179.31
Rate for Payer: PHP Commercial	$4,736.55
Rate for Payer: Priority Health SBD	$3,510.62
Rate for Payer: UHC All Payor (Choice/PPO)	$3,622.07
Rate for Payer: UHC Core	$2,903.23
Rate for Payer: UHC Exchange	$2,189.96

HC STENT COATED W DELIVERY SYSTEM LVL 12

Facility

$5,572.41

Service Code	HCPCS C1874
Hospital Charge Code	27800096
Hospital Revenue Code	278
Min. Negotiated Rate	$3,510.62
Max. Negotiated Rate	$5,015.17
Rate for Payer: Aetna Commercial	$4,736.55
Rate for Payer: Aetna New Business (MI Preferred)	$3,622.07
Rate for Payer: Cash Price	$4,457.93
Rate for Payer: Cofinity Advantage	$3,900.69
Rate for Payer: Cofinity Commercial	$4,792.27
Rate for Payer: Encore Health Key Benefits Commercial	$4,457.93
Rate for Payer: Healthscope Commercial	$5,015.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,736.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,179.31
Rate for Payer: PHP Commercial	$4,736.55
Rate for Payer: Priority Health SBD	$3,510.62

HC STENT COATED W DELIVERY SYSTEM LVL 13

Facility

$6,476.98

Service Code	HCPCS C1874
Hospital Charge Code	27800016
Hospital Revenue Code	278
Min. Negotiated Rate	$4,080.50
Max. Negotiated Rate	$5,829.28
Rate for Payer: Aetna Commercial	$5,505.43
Rate for Payer: Aetna New Business (MI Preferred)	$4,210.04
Rate for Payer: Cash Price	$5,181.58
Rate for Payer: Cofinity Advantage	$4,533.89
Rate for Payer: Cofinity Commercial	$5,570.20
Rate for Payer: Encore Health Key Benefits Commercial	$5,181.58
Rate for Payer: Healthscope Commercial	$5,829.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,505.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,857.73
Rate for Payer: PHP Commercial	$5,505.43
Rate for Payer: Priority Health SBD	$4,080.50

HC STENT COATED W DELIVERY SYSTEM LVL 13

Facility

$6,476.98

Service Code	HCPCS C1874
Hospital Charge Code	27800016
Hospital Revenue Code	278
Min. Negotiated Rate	$2,545.45
Max. Negotiated Rate	$5,829.28
Rate for Payer: Aetna Commercial	$5,505.43
Rate for Payer: Aetna Medicare	$3,238.49
Rate for Payer: Aetna New Business (MI Preferred)	$4,210.04
Rate for Payer: BCBS Complete	$2,590.79
Rate for Payer: Cash Price	$5,181.58
Rate for Payer: Cofinity Advantage	$4,533.89
Rate for Payer: Cofinity Commercial	$5,570.20
Rate for Payer: Encore Health Key Benefits Commercial	$5,181.58
Rate for Payer: Healthscope Commercial	$5,829.28
Rate for Payer: MI Amish Medical Board Commercial	$5,181.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,505.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,857.73
Rate for Payer: PHP Commercial	$5,505.43
Rate for Payer: Priority Health SBD	$4,080.50
Rate for Payer: UHC All Payor (Choice/PPO)	$4,210.04
Rate for Payer: UHC Core	$3,374.51
Rate for Payer: UHC Exchange	$2,545.45

HC STENT COATED W DELIVERY SYSTEM LVL 14

Facility

$8,774.84

Service Code	HCPCS C1874
Hospital Charge Code	27800060
Hospital Revenue Code	278
Min. Negotiated Rate	$3,448.51
Max. Negotiated Rate	$7,897.36
Rate for Payer: Aetna Commercial	$7,458.61
Rate for Payer: Aetna Medicare	$4,387.42
Rate for Payer: Aetna New Business (MI Preferred)	$5,703.65
Rate for Payer: BCBS Complete	$3,509.94
Rate for Payer: Cash Price	$7,019.87
Rate for Payer: Cofinity Advantage	$6,142.39
Rate for Payer: Cofinity Commercial	$7,546.36
Rate for Payer: Encore Health Key Benefits Commercial	$7,019.87
Rate for Payer: Healthscope Commercial	$7,897.36
Rate for Payer: MI Amish Medical Board Commercial	$7,019.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7,458.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,581.13
Rate for Payer: PHP Commercial	$7,458.61
Rate for Payer: Priority Health SBD	$5,528.15
Rate for Payer: UHC All Payor (Choice/PPO)	$5,703.65
Rate for Payer: UHC Core	$4,571.69
Rate for Payer: UHC Exchange	$3,448.51

HC STENT COATED W DELIVERY SYSTEM LVL 14

Facility

$8,774.84

Service Code	HCPCS C1874
Hospital Charge Code	27800060
Hospital Revenue Code	278
Min. Negotiated Rate	$5,528.15
Max. Negotiated Rate	$7,897.36
Rate for Payer: Aetna Commercial	$7,458.61
Rate for Payer: Aetna New Business (MI Preferred)	$5,703.65
Rate for Payer: Cash Price	$7,019.87
Rate for Payer: Cofinity Advantage	$6,142.39
Rate for Payer: Cofinity Commercial	$7,546.36
Rate for Payer: Encore Health Key Benefits Commercial	$7,019.87
Rate for Payer: Healthscope Commercial	$7,897.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7,458.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,581.13
Rate for Payer: PHP Commercial	$7,458.61
Rate for Payer: Priority Health SBD	$5,528.15

HC STENT NON COATED NON CVD NO DELIV SYS

Facility

$2,879.55

Service Code	HCPCS C1877
Hospital Charge Code	27800083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,131.66
Max. Negotiated Rate	$2,591.59
Rate for Payer: Aetna Commercial	$2,447.62
Rate for Payer: Aetna Medicare	$1,439.78
Rate for Payer: Aetna New Business (MI Preferred)	$1,871.71
Rate for Payer: BCBS Complete	$1,151.82
Rate for Payer: Cash Price	$2,303.64
Rate for Payer: Cofinity Advantage	$2,015.68
Rate for Payer: Cofinity Commercial	$2,476.41
Rate for Payer: Encore Health Key Benefits Commercial	$2,303.64
Rate for Payer: Healthscope Commercial	$2,591.59
Rate for Payer: MI Amish Medical Board Commercial	$2,303.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,447.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,159.66
Rate for Payer: PHP Commercial	$2,447.62
Rate for Payer: Priority Health SBD	$1,814.12
Rate for Payer: UHC All Payor (Choice/PPO)	$1,871.71
Rate for Payer: UHC Core	$1,500.25
Rate for Payer: UHC Exchange	$1,131.66

HC STENT NON COATED NON CVD NO DELIV SYS

Facility

$2,879.55

Service Code	HCPCS C1877
Hospital Charge Code	27800083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,814.12
Max. Negotiated Rate	$2,591.59
Rate for Payer: Aetna Commercial	$2,447.62
Rate for Payer: Aetna New Business (MI Preferred)	$1,871.71
Rate for Payer: Cash Price	$2,303.64
Rate for Payer: Cofinity Advantage	$2,015.68
Rate for Payer: Cofinity Commercial	$2,476.41
Rate for Payer: Encore Health Key Benefits Commercial	$2,303.64
Rate for Payer: Healthscope Commercial	$2,591.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,447.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,159.66
Rate for Payer: PHP Commercial	$2,447.62
Rate for Payer: Priority Health SBD	$1,814.12

HC STENT NONCOATED W SYS LVL 112

Facility

$11,245.50

Service Code	HCPCS C1876
Hospital Charge Code	27200303
Hospital Revenue Code	278
Min. Negotiated Rate	$4,419.48
Max. Negotiated Rate	$10,120.95
Rate for Payer: Aetna Commercial	$9,558.67
Rate for Payer: Aetna Medicare	$5,622.75
Rate for Payer: Aetna New Business (MI Preferred)	$7,309.57
Rate for Payer: BCBS Complete	$4,498.20
Rate for Payer: Cash Price	$8,996.40
Rate for Payer: Cofinity Advantage	$7,871.85
Rate for Payer: Cofinity Commercial	$9,671.13
Rate for Payer: Encore Health Key Benefits Commercial	$8,996.40
Rate for Payer: Healthscope Commercial	$10,120.95
Rate for Payer: MI Amish Medical Board Commercial	$8,996.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,558.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$8,434.12
Rate for Payer: PHP Commercial	$9,558.67
Rate for Payer: Priority Health SBD	$7,084.66
Rate for Payer: UHC All Payor (Choice/PPO)	$7,309.57
Rate for Payer: UHC Core	$5,858.91
Rate for Payer: UHC Exchange	$4,419.48

HC STENT NONCOATED W SYS LVL 112

Facility

$11,245.50

Service Code	HCPCS C1876
Hospital Charge Code	27200303
Hospital Revenue Code	278
Min. Negotiated Rate	$7,084.66
Max. Negotiated Rate	$10,120.95
Rate for Payer: Aetna Commercial	$9,558.67
Rate for Payer: Aetna New Business (MI Preferred)	$7,309.57
Rate for Payer: Cash Price	$8,996.40
Rate for Payer: Cofinity Advantage	$7,871.85
Rate for Payer: Cofinity Commercial	$9,671.13
Rate for Payer: Encore Health Key Benefits Commercial	$8,996.40
Rate for Payer: Healthscope Commercial	$10,120.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,558.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$8,434.12
Rate for Payer: PHP Commercial	$9,558.67
Rate for Payer: Priority Health SBD	$7,084.66

HC STENT NON COATED W SYS LVL 14

Facility

$1,420.65

Service Code	HCPCS C1876
Hospital Charge Code	27800156
Hospital Revenue Code	278
Min. Negotiated Rate	$558.32
Max. Negotiated Rate	$1,278.59
Rate for Payer: Aetna Commercial	$1,207.55
Rate for Payer: Aetna Medicare	$710.33
Rate for Payer: Aetna New Business (MI Preferred)	$923.42
Rate for Payer: BCBS Complete	$568.26
Rate for Payer: Cash Price	$1,136.52
Rate for Payer: Cofinity Advantage	$994.46
Rate for Payer: Cofinity Commercial	$1,221.76
Rate for Payer: Encore Health Key Benefits Commercial	$1,136.52
Rate for Payer: Healthscope Commercial	$1,278.59
Rate for Payer: MI Amish Medical Board Commercial	$1,136.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,207.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,065.49
Rate for Payer: PHP Commercial	$1,207.55
Rate for Payer: Priority Health SBD	$895.01
Rate for Payer: UHC All Payor (Choice/PPO)	$923.42
Rate for Payer: UHC Core	$740.16
Rate for Payer: UHC Exchange	$558.32

HC STENT NON COATED W SYS LVL 14

Facility

$1,420.65

Service Code	HCPCS C1876
Hospital Charge Code	27800156
Hospital Revenue Code	278
Min. Negotiated Rate	$895.01
Max. Negotiated Rate	$1,278.59
Rate for Payer: Aetna Commercial	$1,207.55
Rate for Payer: Aetna New Business (MI Preferred)	$923.42
Rate for Payer: Cash Price	$1,136.52
Rate for Payer: Cofinity Advantage	$994.46
Rate for Payer: Cofinity Commercial	$1,221.76
Rate for Payer: Encore Health Key Benefits Commercial	$1,136.52
Rate for Payer: Healthscope Commercial	$1,278.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,207.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,065.49
Rate for Payer: PHP Commercial	$1,207.55
Rate for Payer: Priority Health SBD	$895.01

HC STENT NON COATED W SYS LVL 18

Facility

$1,860.48

Service Code	HCPCS C1876
Hospital Charge Code	27800157
Hospital Revenue Code	278
Min. Negotiated Rate	$1,172.10
Max. Negotiated Rate	$1,674.43
Rate for Payer: Aetna Commercial	$1,581.41
Rate for Payer: Aetna New Business (MI Preferred)	$1,209.31
Rate for Payer: Cash Price	$1,488.38
Rate for Payer: Cofinity Advantage	$1,302.34
Rate for Payer: Cofinity Commercial	$1,600.01
Rate for Payer: Encore Health Key Benefits Commercial	$1,488.38
Rate for Payer: Healthscope Commercial	$1,674.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,581.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,395.36
Rate for Payer: PHP Commercial	$1,581.41
Rate for Payer: Priority Health SBD	$1,172.10

HC STENT NON COATED W SYS LVL 18

Facility

$1,860.48

Service Code	HCPCS C1876
Hospital Charge Code	27800157
Hospital Revenue Code	278
Min. Negotiated Rate	$731.17
Max. Negotiated Rate	$1,674.43
Rate for Payer: Aetna Commercial	$1,581.41
Rate for Payer: Aetna Medicare	$930.24
Rate for Payer: Aetna New Business (MI Preferred)	$1,209.31
Rate for Payer: BCBS Complete	$744.19
Rate for Payer: Cash Price	$1,488.38
Rate for Payer: Cofinity Advantage	$1,302.34
Rate for Payer: Cofinity Commercial	$1,600.01
Rate for Payer: Encore Health Key Benefits Commercial	$1,488.38
Rate for Payer: Healthscope Commercial	$1,674.43
Rate for Payer: MI Amish Medical Board Commercial	$1,488.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,581.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,395.36
Rate for Payer: PHP Commercial	$1,581.41
Rate for Payer: Priority Health SBD	$1,172.10
Rate for Payer: UHC All Payor (Choice/PPO)	$1,209.31
Rate for Payer: UHC Core	$969.31
Rate for Payer: UHC Exchange	$731.17

HC STENT NONCOATED W SYS LVL 196

Facility

$19,625.00

Service Code	HCPCS C1876
Hospital Charge Code	27800145
Hospital Revenue Code	278
Min. Negotiated Rate	$7,712.62
Max. Negotiated Rate	$17,662.50
Rate for Payer: Aetna Commercial	$16,681.25
Rate for Payer: Aetna Medicare	$9,812.50
Rate for Payer: Aetna New Business (MI Preferred)	$12,756.25
Rate for Payer: BCBS Complete	$7,850.00
Rate for Payer: Cash Price	$15,700.00
Rate for Payer: Cofinity Advantage	$13,737.50
Rate for Payer: Cofinity Commercial	$16,877.50
Rate for Payer: Encore Health Key Benefits Commercial	$15,700.00
Rate for Payer: Healthscope Commercial	$17,662.50
Rate for Payer: MI Amish Medical Board Commercial	$15,700.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16,681.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$14,718.75
Rate for Payer: PHP Commercial	$16,681.25
Rate for Payer: Priority Health SBD	$12,363.75
Rate for Payer: UHC All Payor (Choice/PPO)	$12,756.25
Rate for Payer: UHC Core	$10,224.62
Rate for Payer: UHC Exchange	$7,712.62

HC STENT NONCOATED W SYS LVL 196

Facility

$19,625.00

Service Code	HCPCS C1876
Hospital Charge Code	27800145
Hospital Revenue Code	278
Min. Negotiated Rate	$12,363.75
Max. Negotiated Rate	$17,662.50
Rate for Payer: Aetna Commercial	$16,681.25
Rate for Payer: Aetna New Business (MI Preferred)	$12,756.25
Rate for Payer: Cash Price	$15,700.00
Rate for Payer: Cofinity Advantage	$13,737.50
Rate for Payer: Cofinity Commercial	$16,877.50
Rate for Payer: Encore Health Key Benefits Commercial	$15,700.00
Rate for Payer: Healthscope Commercial	$17,662.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16,681.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$14,718.75
Rate for Payer: PHP Commercial	$16,681.25
Rate for Payer: Priority Health SBD	$12,363.75

HC STENT NON COATED W SYS LVL 20

Facility

$2,051.57

Service Code	HCPCS C1876
Hospital Charge Code	27800098
Hospital Revenue Code	278
Min. Negotiated Rate	$806.27
Max. Negotiated Rate	$1,846.41
Rate for Payer: Aetna Commercial	$1,743.83
Rate for Payer: Aetna Medicare	$1,025.79
Rate for Payer: Aetna New Business (MI Preferred)	$1,333.52
Rate for Payer: BCBS Complete	$820.63
Rate for Payer: Cash Price	$1,641.26
Rate for Payer: Cofinity Advantage	$1,436.10
Rate for Payer: Cofinity Commercial	$1,764.35
Rate for Payer: Encore Health Key Benefits Commercial	$1,641.26
Rate for Payer: Healthscope Commercial	$1,846.41
Rate for Payer: MI Amish Medical Board Commercial	$1,641.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,743.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,538.68
Rate for Payer: PHP Commercial	$1,743.83
Rate for Payer: Priority Health SBD	$1,292.49
Rate for Payer: UHC All Payor (Choice/PPO)	$1,333.52
Rate for Payer: UHC Core	$1,068.87
Rate for Payer: UHC Exchange	$806.27

HC STENT NON COATED W SYS LVL 20

Facility

$2,051.57

Service Code	HCPCS C1876
Hospital Charge Code	27800098
Hospital Revenue Code	278
Min. Negotiated Rate	$1,292.49
Max. Negotiated Rate	$1,846.41
Rate for Payer: Aetna Commercial	$1,743.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,333.52
Rate for Payer: Cash Price	$1,641.26
Rate for Payer: Cofinity Advantage	$1,436.10
Rate for Payer: Cofinity Commercial	$1,764.35
Rate for Payer: Encore Health Key Benefits Commercial	$1,641.26
Rate for Payer: Healthscope Commercial	$1,846.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,743.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,538.68
Rate for Payer: PHP Commercial	$1,743.83
Rate for Payer: Priority Health SBD	$1,292.49

HC STENT NON COATED W SYS LVL 24

Facility

$2,493.29

Service Code	HCPCS C1876
Hospital Charge Code	27800099
Hospital Revenue Code	278
Min. Negotiated Rate	$979.86
Max. Negotiated Rate	$2,243.96
Rate for Payer: Aetna Commercial	$2,119.30
Rate for Payer: Aetna Medicare	$1,246.64
Rate for Payer: Aetna New Business (MI Preferred)	$1,620.64
Rate for Payer: BCBS Complete	$997.32
Rate for Payer: Cash Price	$1,994.63
Rate for Payer: Cofinity Advantage	$1,745.30
Rate for Payer: Cofinity Commercial	$2,144.23
Rate for Payer: Encore Health Key Benefits Commercial	$1,994.63
Rate for Payer: Healthscope Commercial	$2,243.96
Rate for Payer: MI Amish Medical Board Commercial	$1,994.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,119.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,869.97
Rate for Payer: PHP Commercial	$2,119.30
Rate for Payer: Priority Health SBD	$1,570.77
Rate for Payer: UHC All Payor (Choice/PPO)	$1,620.64
Rate for Payer: UHC Core	$1,299.00
Rate for Payer: UHC Exchange	$979.86

HC STENT NON COATED W SYS LVL 24

Facility

$2,493.29

Service Code	HCPCS C1876
Hospital Charge Code	27800099
Hospital Revenue Code	278
Min. Negotiated Rate	$1,570.77
Max. Negotiated Rate	$2,243.96
Rate for Payer: Aetna Commercial	$2,119.30
Rate for Payer: Aetna New Business (MI Preferred)	$1,620.64
Rate for Payer: Cash Price	$1,994.63
Rate for Payer: Cofinity Advantage	$1,745.30
Rate for Payer: Cofinity Commercial	$2,144.23
Rate for Payer: Encore Health Key Benefits Commercial	$1,994.63
Rate for Payer: Healthscope Commercial	$2,243.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,119.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,869.97
Rate for Payer: PHP Commercial	$2,119.30
Rate for Payer: Priority Health SBD	$1,570.77

HC STENT NONCOATED W SYS LVL 26

Facility

$2,679.06

Service Code	HCPCS C1876
Hospital Charge Code	27800004
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.81
Max. Negotiated Rate	$2,411.15
Rate for Payer: Aetna Commercial	$2,277.20
Rate for Payer: Aetna New Business (MI Preferred)	$1,741.39
Rate for Payer: Cash Price	$2,143.25
Rate for Payer: Cofinity Advantage	$1,875.34
Rate for Payer: Cofinity Commercial	$2,303.99
Rate for Payer: Encore Health Key Benefits Commercial	$2,143.25
Rate for Payer: Healthscope Commercial	$2,411.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,277.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,009.30
Rate for Payer: PHP Commercial	$2,277.20
Rate for Payer: Priority Health SBD	$1,687.81

HC STENT NONCOATED W SYS LVL 26

Facility

$2,679.06

Service Code	HCPCS C1876
Hospital Charge Code	27800004
Hospital Revenue Code	278
Min. Negotiated Rate	$1,052.87
Max. Negotiated Rate	$2,411.15
Rate for Payer: Aetna Commercial	$2,277.20
Rate for Payer: Aetna Medicare	$1,339.53
Rate for Payer: Aetna New Business (MI Preferred)	$1,741.39
Rate for Payer: BCBS Complete	$1,071.62
Rate for Payer: Cash Price	$2,143.25
Rate for Payer: Cofinity Advantage	$1,875.34
Rate for Payer: Cofinity Commercial	$2,303.99
Rate for Payer: Encore Health Key Benefits Commercial	$2,143.25
Rate for Payer: Healthscope Commercial	$2,411.15
Rate for Payer: MI Amish Medical Board Commercial	$2,143.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,277.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,009.30
Rate for Payer: PHP Commercial	$2,277.20
Rate for Payer: Priority Health SBD	$1,687.81
Rate for Payer: UHC All Payor (Choice/PPO)	$1,741.39
Rate for Payer: UHC Core	$1,395.79
Rate for Payer: UHC Exchange	$1,052.87

HC STENT NON COATED W SYS LVL 29

Facility

$2,989.24

Service Code	HCPCS C1876
Hospital Charge Code	27800012
Hospital Revenue Code	278
Min. Negotiated Rate	$1,883.22
Max. Negotiated Rate	$2,690.32
Rate for Payer: Aetna Commercial	$2,540.85
Rate for Payer: Aetna New Business (MI Preferred)	$1,943.01
Rate for Payer: Cash Price	$2,391.39
Rate for Payer: Cofinity Advantage	$2,092.47
Rate for Payer: Cofinity Commercial	$2,570.75
Rate for Payer: Encore Health Key Benefits Commercial	$2,391.39
Rate for Payer: Healthscope Commercial	$2,690.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,540.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,241.93
Rate for Payer: PHP Commercial	$2,540.85
Rate for Payer: Priority Health SBD	$1,883.22

HC STENT NON COATED W SYS LVL 29

Facility

$2,989.24

Service Code	HCPCS C1876
Hospital Charge Code	27800012
Hospital Revenue Code	278
Min. Negotiated Rate	$1,174.77
Max. Negotiated Rate	$2,690.32
Rate for Payer: Aetna Commercial	$2,540.85
Rate for Payer: Aetna Medicare	$1,494.62
Rate for Payer: Aetna New Business (MI Preferred)	$1,943.01
Rate for Payer: BCBS Complete	$1,195.70
Rate for Payer: Cash Price	$2,391.39
Rate for Payer: Cofinity Advantage	$2,092.47
Rate for Payer: Cofinity Commercial	$2,570.75
Rate for Payer: Encore Health Key Benefits Commercial	$2,391.39
Rate for Payer: Healthscope Commercial	$2,690.32
Rate for Payer: MI Amish Medical Board Commercial	$2,391.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,540.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,241.93
Rate for Payer: PHP Commercial	$2,540.85
Rate for Payer: Priority Health SBD	$1,883.22
Rate for Payer: UHC All Payor (Choice/PPO)	$1,943.01
Rate for Payer: UHC Core	$1,557.39
Rate for Payer: UHC Exchange	$1,174.77

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