Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC STENT

Facility

$953.16

Service Code	HCPCS C2617
Hospital Charge Code	27800030
Hospital Revenue Code	278
Min. Negotiated Rate	$600.49
Max. Negotiated Rate	$857.84
Rate for Payer: Aetna Commercial	$810.19
Rate for Payer: Aetna New Business (MI Preferred)	$619.55
Rate for Payer: Cash Price	$762.53
Rate for Payer: Cofinity Commercial	$667.21
Rate for Payer: Cofinity Commercial	$819.72
Rate for Payer: Cofinity Medicare Advantage	$667.21
Rate for Payer: Encore Health Key Benefits Commercial	$762.53
Rate for Payer: Healthscope Commercial	$857.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$810.19
Rate for Payer: PHP Commercial	$810.19
Rate for Payer: Priority Health Cigna Priority Health	$619.55
Rate for Payer: Priority Health SBD	$600.49

HC STENT

Facility

$953.16

Service Code	HCPCS C2617
Hospital Charge Code	27800030
Hospital Revenue Code	278
Min. Negotiated Rate	$381.26
Max. Negotiated Rate	$857.84
Rate for Payer: Aetna Commercial	$810.19
Rate for Payer: Aetna Medicare	$476.58
Rate for Payer: Aetna New Business (MI Preferred)	$619.55
Rate for Payer: BCBS Complete	$381.26
Rate for Payer: Cash Price	$762.53
Rate for Payer: Cofinity Commercial	$667.21
Rate for Payer: Cofinity Commercial	$819.72
Rate for Payer: Cofinity Medicare Advantage	$667.21
Rate for Payer: Encore Health Key Benefits Commercial	$762.53
Rate for Payer: Healthscope Commercial	$857.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$810.19
Rate for Payer: PHP Commercial	$810.19
Rate for Payer: Priority Health Cigna Priority Health	$619.55
Rate for Payer: Priority Health SBD	$600.49

HC STENT ADD.BRANCH

Facility

$17,010.57

Service Code	CPT 92929
Hospital Charge Code	48100074
Hospital Revenue Code	481
Min. Negotiated Rate	$6,804.23
Max. Negotiated Rate	$15,309.51
Rate for Payer: Aetna Commercial	$14,458.98
Rate for Payer: Aetna Medicare	$8,505.28
Rate for Payer: Aetna New Business (MI Preferred)	$11,056.87
Rate for Payer: BCBS Complete	$6,804.23
Rate for Payer: Cash Price	$13,608.46
Rate for Payer: Cofinity Commercial	$11,907.40
Rate for Payer: Cofinity Commercial	$14,629.09
Rate for Payer: Cofinity Medicare Advantage	$11,907.40
Rate for Payer: Encore Health Key Benefits Commercial	$13,608.46
Rate for Payer: Healthscope Commercial	$15,309.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14,458.98
Rate for Payer: PHP Commercial	$14,458.98
Rate for Payer: Priority Health Cigna Priority Health	$11,056.87
Rate for Payer: Priority Health SBD	$10,716.66

HC STENT ADD.BRANCH

Facility

$17,010.57

Service Code	CPT 92929
Hospital Charge Code	48100074
Hospital Revenue Code	481
Min. Negotiated Rate	$10,716.66
Max. Negotiated Rate	$15,309.51
Rate for Payer: Aetna Commercial	$14,458.98
Rate for Payer: Aetna New Business (MI Preferred)	$11,056.87
Rate for Payer: Cash Price	$13,608.46
Rate for Payer: Cofinity Commercial	$11,907.40
Rate for Payer: Cofinity Commercial	$14,629.09
Rate for Payer: Cofinity Medicare Advantage	$11,907.40
Rate for Payer: Encore Health Key Benefits Commercial	$13,608.46
Rate for Payer: Healthscope Commercial	$15,309.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14,458.98
Rate for Payer: PHP Commercial	$14,458.98
Rate for Payer: Priority Health Cigna Priority Health	$11,056.87
Rate for Payer: Priority Health SBD	$10,716.66

HC STENT COATED W DELIVERY SYSTEM

Facility

$11,875.31

Service Code	HCPCS C1874
Hospital Charge Code	27800111
Hospital Revenue Code	278
Min. Negotiated Rate	$4,750.12
Max. Negotiated Rate	$10,687.78
Rate for Payer: Aetna Commercial	$10,094.01
Rate for Payer: Aetna Medicare	$5,937.65
Rate for Payer: Aetna New Business (MI Preferred)	$7,718.95
Rate for Payer: BCBS Complete	$4,750.12
Rate for Payer: Cash Price	$9,500.25
Rate for Payer: Cofinity Commercial	$10,212.77
Rate for Payer: Cofinity Commercial	$8,312.72
Rate for Payer: Cofinity Medicare Advantage	$8,312.72
Rate for Payer: Encore Health Key Benefits Commercial	$9,500.25
Rate for Payer: Healthscope Commercial	$10,687.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,094.01
Rate for Payer: PHP Commercial	$10,094.01
Rate for Payer: Priority Health Cigna Priority Health	$7,718.95
Rate for Payer: Priority Health SBD	$7,481.45

HC STENT COATED W DELIVERY SYSTEM

Facility

$11,875.31

Service Code	HCPCS C1874
Hospital Charge Code	27800111
Hospital Revenue Code	278
Min. Negotiated Rate	$7,481.45
Max. Negotiated Rate	$10,687.78
Rate for Payer: Aetna Commercial	$10,094.01
Rate for Payer: Aetna New Business (MI Preferred)	$7,718.95
Rate for Payer: Cash Price	$9,500.25
Rate for Payer: Cofinity Commercial	$10,212.77
Rate for Payer: Cofinity Commercial	$8,312.72
Rate for Payer: Cofinity Medicare Advantage	$8,312.72
Rate for Payer: Encore Health Key Benefits Commercial	$9,500.25
Rate for Payer: Healthscope Commercial	$10,687.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,094.01
Rate for Payer: PHP Commercial	$10,094.01
Rate for Payer: Priority Health Cigna Priority Health	$7,718.95
Rate for Payer: Priority Health SBD	$7,481.45

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	$2,228.96
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 Commercial	$3,900.69
Rate for Payer: Cofinity Commercial	$4,792.27
Rate for Payer: Cofinity Medicare Advantage	$3,900.69
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: PHP Commercial	$4,736.55
Rate for Payer: Priority Health Cigna Priority Health	$3,622.07
Rate for Payer: Priority Health SBD	$3,510.62

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 Commercial	$3,900.69
Rate for Payer: Cofinity Commercial	$4,792.27
Rate for Payer: Cofinity Medicare Advantage	$3,900.69
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: PHP Commercial	$4,736.55
Rate for Payer: Priority Health Cigna Priority Health	$3,622.07
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 Commercial	$4,533.89
Rate for Payer: Cofinity Commercial	$5,570.20
Rate for Payer: Cofinity Medicare Advantage	$4,533.89
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: PHP Commercial	$5,505.43
Rate for Payer: Priority Health Cigna Priority Health	$4,210.04
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	$2,590.79
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 Commercial	$4,533.89
Rate for Payer: Cofinity Commercial	$5,570.20
Rate for Payer: Cofinity Medicare Advantage	$4,533.89
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: PHP Commercial	$5,505.43
Rate for Payer: Priority Health Cigna Priority Health	$4,210.04
Rate for Payer: Priority Health SBD	$4,080.50

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 Commercial	$6,142.39
Rate for Payer: Cofinity Commercial	$7,546.36
Rate for Payer: Cofinity Medicare Advantage	$6,142.39
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: PHP Commercial	$7,458.61
Rate for Payer: Priority Health Cigna Priority Health	$5,703.65
Rate for Payer: Priority Health SBD	$5,528.15

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	$3,509.94
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 Commercial	$6,142.39
Rate for Payer: Cofinity Commercial	$7,546.36
Rate for Payer: Cofinity Medicare Advantage	$6,142.39
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: PHP Commercial	$7,458.61
Rate for Payer: Priority Health Cigna Priority Health	$5,703.65
Rate for Payer: Priority Health SBD	$5,528.15

HC STENT NON COATED NON CVD NO DELIV SYS

Facility

$2,823.09

Service Code	HCPCS C1877
Hospital Charge Code	27800083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.24
Max. Negotiated Rate	$2,540.78
Rate for Payer: Aetna Commercial	$2,399.63
Rate for Payer: Aetna Medicare	$1,411.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,835.01
Rate for Payer: BCBS Complete	$1,129.24
Rate for Payer: Cash Price	$2,258.47
Rate for Payer: Cofinity Commercial	$1,976.16
Rate for Payer: Cofinity Commercial	$2,427.86
Rate for Payer: Cofinity Medicare Advantage	$1,976.16
Rate for Payer: Encore Health Key Benefits Commercial	$2,258.47
Rate for Payer: Healthscope Commercial	$2,540.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,399.63
Rate for Payer: PHP Commercial	$2,399.63
Rate for Payer: Priority Health Cigna Priority Health	$1,835.01
Rate for Payer: Priority Health SBD	$1,778.55

HC STENT NON COATED NON CVD NO DELIV SYS

Facility

$2,823.09

Service Code	HCPCS C1877
Hospital Charge Code	27800083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,778.55
Max. Negotiated Rate	$2,540.78
Rate for Payer: Aetna Commercial	$2,399.63
Rate for Payer: Aetna New Business (MI Preferred)	$1,835.01
Rate for Payer: Cash Price	$2,258.47
Rate for Payer: Cofinity Commercial	$1,976.16
Rate for Payer: Cofinity Commercial	$2,427.86
Rate for Payer: Cofinity Medicare Advantage	$1,976.16
Rate for Payer: Encore Health Key Benefits Commercial	$2,258.47
Rate for Payer: Healthscope Commercial	$2,540.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,399.63
Rate for Payer: PHP Commercial	$2,399.63
Rate for Payer: Priority Health Cigna Priority Health	$1,835.01
Rate for Payer: Priority Health SBD	$1,778.55

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	$4,498.20
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 Commercial	$7,871.85
Rate for Payer: Cofinity Commercial	$9,671.13
Rate for Payer: Cofinity Medicare Advantage	$7,871.85
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: PHP Commercial	$9,558.67
Rate for Payer: Priority Health Cigna Priority Health	$7,309.57
Rate for Payer: Priority Health SBD	$7,084.66

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 Commercial	$7,871.85
Rate for Payer: Cofinity Commercial	$9,671.13
Rate for Payer: Cofinity Medicare Advantage	$7,871.85
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: PHP Commercial	$9,558.67
Rate for Payer: Priority Health Cigna Priority Health	$7,309.57
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	$568.26
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 Commercial	$1,221.76
Rate for Payer: Cofinity Commercial	$994.46
Rate for Payer: Cofinity Medicare Advantage	$994.46
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: PHP Commercial	$1,207.55
Rate for Payer: Priority Health Cigna Priority Health	$923.42
Rate for Payer: Priority Health SBD	$895.01

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 Commercial	$1,221.76
Rate for Payer: Cofinity Commercial	$994.46
Rate for Payer: Cofinity Medicare Advantage	$994.46
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: PHP Commercial	$1,207.55
Rate for Payer: Priority Health Cigna Priority Health	$923.42
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	$744.19
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 Commercial	$1,302.34
Rate for Payer: Cofinity Commercial	$1,600.01
Rate for Payer: Cofinity Medicare Advantage	$1,302.34
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: PHP Commercial	$1,581.41
Rate for Payer: Priority Health Cigna Priority Health	$1,209.31
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	$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 Commercial	$1,302.34
Rate for Payer: Cofinity Commercial	$1,600.01
Rate for Payer: Cofinity Medicare Advantage	$1,302.34
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: PHP Commercial	$1,581.41
Rate for Payer: Priority Health Cigna Priority Health	$1,209.31
Rate for Payer: Priority Health SBD	$1,172.10

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	$7,850.00
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 Commercial	$13,737.50
Rate for Payer: Cofinity Commercial	$16,877.50
Rate for Payer: Cofinity Medicare Advantage	$13,737.50
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: PHP Commercial	$16,681.25
Rate for Payer: Priority Health Cigna Priority Health	$12,756.25
Rate for Payer: Priority Health SBD	$12,363.75

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 Commercial	$13,737.50
Rate for Payer: Cofinity Commercial	$16,877.50
Rate for Payer: Cofinity Medicare Advantage	$13,737.50
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: PHP Commercial	$16,681.25
Rate for Payer: Priority Health Cigna Priority Health	$12,756.25
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	$820.63
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 Commercial	$1,436.10
Rate for Payer: Cofinity Commercial	$1,764.35
Rate for Payer: Cofinity Medicare Advantage	$1,436.10
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: PHP Commercial	$1,743.83
Rate for Payer: Priority Health Cigna Priority Health	$1,333.52
Rate for Payer: Priority Health SBD	$1,292.49

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 Commercial	$1,436.10
Rate for Payer: Cofinity Commercial	$1,764.35
Rate for Payer: Cofinity Medicare Advantage	$1,436.10
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: PHP Commercial	$1,743.83
Rate for Payer: Priority Health Cigna Priority Health	$1,333.52
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	$997.32
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 Commercial	$1,745.30
Rate for Payer: Cofinity Commercial	$2,144.23
Rate for Payer: Cofinity Medicare Advantage	$1,745.30
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: PHP Commercial	$2,119.30
Rate for Payer: Priority Health Cigna Priority Health	$1,620.64
Rate for Payer: Priority Health SBD	$1,570.77

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