Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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 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

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 Commercial	$1,875.34
Rate for Payer: Cofinity Commercial	$2,303.99
Rate for Payer: Cofinity Medicare Advantage	$1,875.34
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: PHP Commercial	$2,277.20
Rate for Payer: Priority Health Cigna Priority Health	$1,741.39
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	$1,071.62
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 Commercial	$1,875.34
Rate for Payer: Cofinity Commercial	$2,303.99
Rate for Payer: Cofinity Medicare Advantage	$1,875.34
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: PHP Commercial	$2,277.20
Rate for Payer: Priority Health Cigna Priority Health	$1,741.39
Rate for Payer: Priority Health SBD	$1,687.81

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 Commercial	$2,092.47
Rate for Payer: Cofinity Commercial	$2,570.75
Rate for Payer: Cofinity Medicare Advantage	$2,092.47
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: PHP Commercial	$2,540.85
Rate for Payer: Priority Health Cigna Priority Health	$1,943.01
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	$1,195.70
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 Commercial	$2,092.47
Rate for Payer: Cofinity Commercial	$2,570.75
Rate for Payer: Cofinity Medicare Advantage	$2,092.47
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: PHP Commercial	$2,540.85
Rate for Payer: Priority Health Cigna Priority Health	$1,943.01
Rate for Payer: Priority Health SBD	$1,883.22

HC STENT NON COATED W SYS LVL 35

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 Medicare	$1,773.45
Rate for Payer: Aetna New Business (MI Preferred)	$2,305.49
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: Cofinity Medicare Advantage	$2,482.83
Rate for Payer: Encore Health Key Benefits Commercial	$2,837.52
Rate for Payer: Healthscope Commercial	$3,192.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,014.86
Rate for Payer: PHP Commercial	$3,014.86
Rate for Payer: Priority Health Cigna Priority Health	$2,305.49
Rate for Payer: Priority Health SBD	$2,234.55

HC STENT NON COATED W SYS LVL 35

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)	$2,305.49
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: Cofinity Medicare Advantage	$2,482.83
Rate for Payer: Encore Health Key Benefits Commercial	$2,837.52
Rate for Payer: Healthscope Commercial	$3,192.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,014.86
Rate for Payer: PHP Commercial	$3,014.86
Rate for Payer: Priority Health Cigna Priority Health	$2,305.49
Rate for Payer: Priority Health SBD	$2,234.55

HC STENT NONCOATED W SYS LVL 37

Facility

$3,739.66

Service Code	HCPCS C1876
Hospital Charge Code	27800006
Hospital Revenue Code	278
Min. Negotiated Rate	$1,495.86
Max. Negotiated Rate	$3,365.69
Rate for Payer: Aetna Commercial	$3,178.71
Rate for Payer: Aetna Medicare	$1,869.83
Rate for Payer: Aetna New Business (MI Preferred)	$2,430.78
Rate for Payer: BCBS Complete	$1,495.86
Rate for Payer: Cash Price	$2,991.73
Rate for Payer: Cofinity Commercial	$2,617.76
Rate for Payer: Cofinity Commercial	$3,216.11
Rate for Payer: Cofinity Medicare Advantage	$2,617.76
Rate for Payer: Encore Health Key Benefits Commercial	$2,991.73
Rate for Payer: Healthscope Commercial	$3,365.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,178.71
Rate for Payer: PHP Commercial	$3,178.71
Rate for Payer: Priority Health Cigna Priority Health	$2,430.78
Rate for Payer: Priority Health SBD	$2,355.99

HC STENT NONCOATED W SYS LVL 37

Facility

$3,739.66

Service Code	HCPCS C1876
Hospital Charge Code	27800006
Hospital Revenue Code	278
Min. Negotiated Rate	$2,355.99
Max. Negotiated Rate	$3,365.69
Rate for Payer: Aetna Commercial	$3,178.71
Rate for Payer: Aetna New Business (MI Preferred)	$2,430.78
Rate for Payer: Cash Price	$2,991.73
Rate for Payer: Cofinity Commercial	$2,617.76
Rate for Payer: Cofinity Commercial	$3,216.11
Rate for Payer: Cofinity Medicare Advantage	$2,617.76
Rate for Payer: Encore Health Key Benefits Commercial	$2,991.73
Rate for Payer: Healthscope Commercial	$3,365.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,178.71
Rate for Payer: PHP Commercial	$3,178.71
Rate for Payer: Priority Health Cigna Priority Health	$2,430.78
Rate for Payer: Priority Health SBD	$2,355.99

HC STENT NON COATED W SYS LVL 44

Facility

$4,451.00

Service Code	HCPCS C1876
Hospital Charge Code	27800007
Hospital Revenue Code	278
Min. Negotiated Rate	$2,804.13
Max. Negotiated Rate	$4,005.90
Rate for Payer: Aetna Commercial	$3,783.35
Rate for Payer: Aetna New Business (MI Preferred)	$2,893.15
Rate for Payer: Cash Price	$3,560.80
Rate for Payer: Cofinity Commercial	$3,115.70
Rate for Payer: Cofinity Commercial	$3,827.86
Rate for Payer: Cofinity Medicare Advantage	$3,115.70
Rate for Payer: Encore Health Key Benefits Commercial	$3,560.80
Rate for Payer: Healthscope Commercial	$4,005.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,783.35
Rate for Payer: PHP Commercial	$3,783.35
Rate for Payer: Priority Health Cigna Priority Health	$2,893.15
Rate for Payer: Priority Health SBD	$2,804.13

HC STENT NON COATED W SYS LVL 44

Facility

$4,451.00

Service Code	HCPCS C1876
Hospital Charge Code	27800007
Hospital Revenue Code	278
Min. Negotiated Rate	$1,780.40
Max. Negotiated Rate	$4,005.90
Rate for Payer: Aetna Commercial	$3,783.35
Rate for Payer: Aetna Medicare	$2,225.50
Rate for Payer: Aetna New Business (MI Preferred)	$2,893.15
Rate for Payer: BCBS Complete	$1,780.40
Rate for Payer: Cash Price	$3,560.80
Rate for Payer: Cofinity Commercial	$3,115.70
Rate for Payer: Cofinity Commercial	$3,827.86
Rate for Payer: Cofinity Medicare Advantage	$3,115.70
Rate for Payer: Encore Health Key Benefits Commercial	$3,560.80
Rate for Payer: Healthscope Commercial	$4,005.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,783.35
Rate for Payer: PHP Commercial	$3,783.35
Rate for Payer: Priority Health Cigna Priority Health	$2,893.15
Rate for Payer: Priority Health SBD	$2,804.13

HC STENT NON COATED W SYS LVL 49

Facility

$4,962.00

Service Code	HCPCS C1876
Hospital Charge Code	27800031
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.80
Max. Negotiated Rate	$4,465.80
Rate for Payer: Aetna Commercial	$4,217.70
Rate for Payer: Aetna Medicare	$2,481.00
Rate for Payer: Aetna New Business (MI Preferred)	$3,225.30
Rate for Payer: BCBS Complete	$1,984.80
Rate for Payer: Cash Price	$3,969.60
Rate for Payer: Cofinity Commercial	$3,473.40
Rate for Payer: Cofinity Commercial	$4,267.32
Rate for Payer: Cofinity Medicare Advantage	$3,473.40
Rate for Payer: Encore Health Key Benefits Commercial	$3,969.60
Rate for Payer: Healthscope Commercial	$4,465.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,217.70
Rate for Payer: PHP Commercial	$4,217.70
Rate for Payer: Priority Health Cigna Priority Health	$3,225.30
Rate for Payer: Priority Health SBD	$3,126.06

HC STENT NON COATED W SYS LVL 49

Facility

$4,962.00

Service Code	HCPCS C1876
Hospital Charge Code	27800031
Hospital Revenue Code	278
Min. Negotiated Rate	$3,126.06
Max. Negotiated Rate	$4,465.80
Rate for Payer: Aetna Commercial	$4,217.70
Rate for Payer: Aetna New Business (MI Preferred)	$3,225.30
Rate for Payer: Cash Price	$3,969.60
Rate for Payer: Cofinity Commercial	$3,473.40
Rate for Payer: Cofinity Commercial	$4,267.32
Rate for Payer: Cofinity Medicare Advantage	$3,473.40
Rate for Payer: Encore Health Key Benefits Commercial	$3,969.60
Rate for Payer: Healthscope Commercial	$4,465.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,217.70
Rate for Payer: PHP Commercial	$4,217.70
Rate for Payer: Priority Health Cigna Priority Health	$3,225.30
Rate for Payer: Priority Health SBD	$3,126.06

HC STENT NON COATED W SYS LVL 5

Facility

$1,449.06

Service Code	HCPCS C1876
Hospital Charge Code	27800097
Hospital Revenue Code	278
Min. Negotiated Rate	$912.91
Max. Negotiated Rate	$1,304.15
Rate for Payer: Aetna Commercial	$1,231.70
Rate for Payer: Aetna New Business (MI Preferred)	$941.89
Rate for Payer: Cash Price	$1,159.25
Rate for Payer: Cofinity Commercial	$1,014.34
Rate for Payer: Cofinity Commercial	$1,246.19
Rate for Payer: Cofinity Medicare Advantage	$1,014.34
Rate for Payer: Encore Health Key Benefits Commercial	$1,159.25
Rate for Payer: Healthscope Commercial	$1,304.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,231.70
Rate for Payer: PHP Commercial	$1,231.70
Rate for Payer: Priority Health Cigna Priority Health	$941.89
Rate for Payer: Priority Health SBD	$912.91

HC STENT NON COATED W SYS LVL 5

Facility

$1,449.06

Service Code	HCPCS C1876
Hospital Charge Code	27800097
Hospital Revenue Code	278
Min. Negotiated Rate	$579.62
Max. Negotiated Rate	$1,304.15
Rate for Payer: Aetna Commercial	$1,231.70
Rate for Payer: Aetna Medicare	$724.53
Rate for Payer: Aetna New Business (MI Preferred)	$941.89
Rate for Payer: BCBS Complete	$579.62
Rate for Payer: Cash Price	$1,159.25
Rate for Payer: Cofinity Commercial	$1,014.34
Rate for Payer: Cofinity Commercial	$1,246.19
Rate for Payer: Cofinity Medicare Advantage	$1,014.34
Rate for Payer: Encore Health Key Benefits Commercial	$1,159.25
Rate for Payer: Healthscope Commercial	$1,304.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,231.70
Rate for Payer: PHP Commercial	$1,231.70
Rate for Payer: Priority Health Cigna Priority Health	$941.89
Rate for Payer: Priority Health SBD	$912.91

HC STENT NON COATED W SYS LVL 53

Facility

$5,488.15

Service Code	HCPCS C1876
Hospital Charge Code	27800038
Hospital Revenue Code	278
Min. Negotiated Rate	$2,195.26
Max. Negotiated Rate	$4,939.34
Rate for Payer: Aetna Commercial	$4,664.93
Rate for Payer: Aetna Medicare	$2,744.07
Rate for Payer: Aetna New Business (MI Preferred)	$3,567.30
Rate for Payer: BCBS Complete	$2,195.26
Rate for Payer: Cash Price	$4,390.52
Rate for Payer: Cofinity Commercial	$3,841.70
Rate for Payer: Cofinity Commercial	$4,719.81
Rate for Payer: Cofinity Medicare Advantage	$3,841.70
Rate for Payer: Encore Health Key Benefits Commercial	$4,390.52
Rate for Payer: Healthscope Commercial	$4,939.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,664.93
Rate for Payer: PHP Commercial	$4,664.93
Rate for Payer: Priority Health Cigna Priority Health	$3,567.30
Rate for Payer: Priority Health SBD	$3,457.53

HC STENT NON COATED W SYS LVL 53

Facility

$5,488.15

Service Code	HCPCS C1876
Hospital Charge Code	27800038
Hospital Revenue Code	278
Min. Negotiated Rate	$3,457.53
Max. Negotiated Rate	$4,939.34
Rate for Payer: Aetna Commercial	$4,664.93
Rate for Payer: Aetna New Business (MI Preferred)	$3,567.30
Rate for Payer: Cash Price	$4,390.52
Rate for Payer: Cofinity Commercial	$3,841.70
Rate for Payer: Cofinity Commercial	$4,719.81
Rate for Payer: Cofinity Medicare Advantage	$3,841.70
Rate for Payer: Encore Health Key Benefits Commercial	$4,390.52
Rate for Payer: Healthscope Commercial	$4,939.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,664.93
Rate for Payer: PHP Commercial	$4,664.93
Rate for Payer: Priority Health Cigna Priority Health	$3,567.30
Rate for Payer: Priority Health SBD	$3,457.53

HC STENT NON COATED W SYS LVL 57

Facility

$5,782.90

Service Code	HCPCS C1876
Hospital Charge Code	27800043
Hospital Revenue Code	278
Min. Negotiated Rate	$2,313.16
Max. Negotiated Rate	$5,204.61
Rate for Payer: Aetna Commercial	$4,915.47
Rate for Payer: Aetna Medicare	$2,891.45
Rate for Payer: Aetna New Business (MI Preferred)	$3,758.89
Rate for Payer: BCBS Complete	$2,313.16
Rate for Payer: Cash Price	$4,626.32
Rate for Payer: Cofinity Commercial	$4,048.03
Rate for Payer: Cofinity Commercial	$4,973.29
Rate for Payer: Cofinity Medicare Advantage	$4,048.03
Rate for Payer: Encore Health Key Benefits Commercial	$4,626.32
Rate for Payer: Healthscope Commercial	$5,204.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,915.47
Rate for Payer: PHP Commercial	$4,915.47
Rate for Payer: Priority Health Cigna Priority Health	$3,758.89
Rate for Payer: Priority Health SBD	$3,643.23

HC STENT NON COATED W SYS LVL 57

Facility

$5,782.90

Service Code	HCPCS C1876
Hospital Charge Code	27800043
Hospital Revenue Code	278
Min. Negotiated Rate	$3,643.23
Max. Negotiated Rate	$5,204.61
Rate for Payer: Aetna Commercial	$4,915.47
Rate for Payer: Aetna New Business (MI Preferred)	$3,758.89
Rate for Payer: Cash Price	$4,626.32
Rate for Payer: Cofinity Commercial	$4,048.03
Rate for Payer: Cofinity Commercial	$4,973.29
Rate for Payer: Cofinity Medicare Advantage	$4,048.03
Rate for Payer: Encore Health Key Benefits Commercial	$4,626.32
Rate for Payer: Healthscope Commercial	$5,204.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,915.47
Rate for Payer: PHP Commercial	$4,915.47
Rate for Payer: Priority Health Cigna Priority Health	$3,758.89
Rate for Payer: Priority Health SBD	$3,643.23

HC STENT NON COATED W SYS LVL 59

Facility

$5,979.44

Service Code	HCPCS C1876
Hospital Charge Code	27800035
Hospital Revenue Code	278
Min. Negotiated Rate	$3,767.05
Max. Negotiated Rate	$5,381.50
Rate for Payer: Aetna Commercial	$5,082.52
Rate for Payer: Aetna New Business (MI Preferred)	$3,886.64
Rate for Payer: Cash Price	$4,783.55
Rate for Payer: Cofinity Commercial	$4,185.61
Rate for Payer: Cofinity Commercial	$5,142.32
Rate for Payer: Cofinity Medicare Advantage	$4,185.61
Rate for Payer: Encore Health Key Benefits Commercial	$4,783.55
Rate for Payer: Healthscope Commercial	$5,381.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,082.52
Rate for Payer: PHP Commercial	$5,082.52
Rate for Payer: Priority Health Cigna Priority Health	$3,886.64
Rate for Payer: Priority Health SBD	$3,767.05

HC STENT NON COATED W SYS LVL 59

Facility

$5,979.44

Service Code	HCPCS C1876
Hospital Charge Code	27800035
Hospital Revenue Code	278
Min. Negotiated Rate	$2,391.78
Max. Negotiated Rate	$5,381.50
Rate for Payer: Aetna Commercial	$5,082.52
Rate for Payer: Aetna Medicare	$2,989.72
Rate for Payer: Aetna New Business (MI Preferred)	$3,886.64
Rate for Payer: BCBS Complete	$2,391.78
Rate for Payer: Cash Price	$4,783.55
Rate for Payer: Cofinity Commercial	$4,185.61
Rate for Payer: Cofinity Commercial	$5,142.32
Rate for Payer: Cofinity Medicare Advantage	$4,185.61
Rate for Payer: Encore Health Key Benefits Commercial	$4,783.55
Rate for Payer: Healthscope Commercial	$5,381.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,082.52
Rate for Payer: PHP Commercial	$5,082.52
Rate for Payer: Priority Health Cigna Priority Health	$3,886.64
Rate for Payer: Priority Health SBD	$3,767.05

HC STENT NON COATED W SYS LVL 67

Facility

$6,779.33

Service Code	HCPCS C1876
Hospital Charge Code	27800036
Hospital Revenue Code	278
Min. Negotiated Rate	$4,270.98
Max. Negotiated Rate	$6,101.40
Rate for Payer: Aetna Commercial	$5,762.43
Rate for Payer: Aetna New Business (MI Preferred)	$4,406.56
Rate for Payer: Cash Price	$5,423.46
Rate for Payer: Cofinity Commercial	$4,745.53
Rate for Payer: Cofinity Commercial	$5,830.22
Rate for Payer: Cofinity Medicare Advantage	$4,745.53
Rate for Payer: Encore Health Key Benefits Commercial	$5,423.46
Rate for Payer: Healthscope Commercial	$6,101.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,762.43
Rate for Payer: PHP Commercial	$5,762.43
Rate for Payer: Priority Health Cigna Priority Health	$4,406.56
Rate for Payer: Priority Health SBD	$4,270.98

HC STENT NON COATED W SYS LVL 67

Facility

$6,779.33

Service Code	HCPCS C1876
Hospital Charge Code	27800036
Hospital Revenue Code	278
Min. Negotiated Rate	$2,711.73
Max. Negotiated Rate	$6,101.40
Rate for Payer: Aetna Commercial	$5,762.43
Rate for Payer: Aetna Medicare	$3,389.66
Rate for Payer: Aetna New Business (MI Preferred)	$4,406.56
Rate for Payer: BCBS Complete	$2,711.73
Rate for Payer: Cash Price	$5,423.46
Rate for Payer: Cofinity Commercial	$4,745.53
Rate for Payer: Cofinity Commercial	$5,830.22
Rate for Payer: Cofinity Medicare Advantage	$4,745.53
Rate for Payer: Encore Health Key Benefits Commercial	$5,423.46
Rate for Payer: Healthscope Commercial	$6,101.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,762.43
Rate for Payer: PHP Commercial	$5,762.43
Rate for Payer: Priority Health Cigna Priority Health	$4,406.56
Rate for Payer: Priority Health SBD	$4,270.98

HC STENT NON CORONARY LVL 2

Facility

$244.19

Service Code	HCPCS C2625
Hospital Charge Code	27800101
Hospital Revenue Code	278
Min. Negotiated Rate	$153.84
Max. Negotiated Rate	$219.77
Rate for Payer: Aetna Commercial	$207.56
Rate for Payer: Aetna New Business (MI Preferred)	$158.72
Rate for Payer: Cash Price	$195.35
Rate for Payer: Cofinity Commercial	$170.93
Rate for Payer: Cofinity Commercial	$210.00
Rate for Payer: Cofinity Medicare Advantage	$170.93
Rate for Payer: Encore Health Key Benefits Commercial	$195.35
Rate for Payer: Healthscope Commercial	$219.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.56
Rate for Payer: PHP Commercial	$207.56
Rate for Payer: Priority Health Cigna Priority Health	$158.72
Rate for Payer: Priority Health SBD	$153.84

HC STENT NON CORONARY LVL 2

Facility

$244.19

Service Code	HCPCS C2625
Hospital Charge Code	27800101
Hospital Revenue Code	278
Min. Negotiated Rate	$97.68
Max. Negotiated Rate	$219.77
Rate for Payer: Aetna Commercial	$207.56
Rate for Payer: Aetna Medicare	$122.09
Rate for Payer: Aetna New Business (MI Preferred)	$158.72
Rate for Payer: BCBS Complete	$97.68
Rate for Payer: Cash Price	$195.35
Rate for Payer: Cofinity Commercial	$170.93
Rate for Payer: Cofinity Commercial	$210.00
Rate for Payer: Cofinity Medicare Advantage	$170.93
Rate for Payer: Encore Health Key Benefits Commercial	$195.35
Rate for Payer: Healthscope Commercial	$219.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.56
Rate for Payer: PHP Commercial	$207.56
Rate for Payer: Priority Health Cigna Priority Health	$158.72
Rate for Payer: Priority Health SBD	$153.84

Know your out-of-pocket cost for care.

All Charges