Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC STENT COATED W DELIVERY SYSTEM LVL 14

Facility

$8,602.78

Service Code	HCPCS C1874
Hospital Charge Code	27800060
Hospital Revenue Code	278
Min. Negotiated Rate	$6,021.95
Max. Negotiated Rate	$8,602.78
Rate for Payer: Aetna Commercial	$7,742.50
Rate for Payer: ASR ASR	$8,344.70
Rate for Payer: BCBS Trust/PPO	$6,669.74
Rate for Payer: BCN Commercial	$6,669.74
Rate for Payer: Cash Price	$6,882.22
Rate for Payer: Cofinity Commercial	$8,086.61
Rate for Payer: Encore Health Key Benefits Commercial	$6,882.22
Rate for Payer: Healthscope Commercial	$8,602.78
Rate for Payer: Healthscope Whirlpool	$8,344.70
Rate for Payer: Mclaren Commercial	$7,742.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,312.36
Rate for Payer: Priority Health Cigna Priority Health	$6,021.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7,570.45

HC STENT COATED W DELIVERY SYSTEM LVL 14

Facility

$8,602.78

Service Code	HCPCS C1874
Hospital Charge Code	27800060
Hospital Revenue Code	278
Min. Negotiated Rate	$3,441.11
Max. Negotiated Rate	$8,602.78
Rate for Payer: Aetna Commercial	$7,742.50
Rate for Payer: ASR ASR	$8,344.70
Rate for Payer: BCBS Complete	$3,441.11
Rate for Payer: BCBS Trust/PPO	$6,669.74
Rate for Payer: BCN Commercial	$6,669.74
Rate for Payer: Cash Price	$6,882.22
Rate for Payer: Cofinity Commercial	$8,086.61
Rate for Payer: Encore Health Key Benefits Commercial	$6,882.22
Rate for Payer: Healthscope Commercial	$8,602.78
Rate for Payer: Healthscope Whirlpool	$8,344.70
Rate for Payer: Mclaren Commercial	$7,742.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,312.36
Rate for Payer: Priority Health Cigna Priority Health	$6,021.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,828.53
Rate for Payer: Priority Health Narrow Network	$6,107.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7,570.45

HC STENT NON COATED NON CVD NO DELIV SYS

Facility

$2,767.74

Service Code	HCPCS C1877
Hospital Charge Code	27800083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,937.42
Max. Negotiated Rate	$2,767.74
Rate for Payer: Aetna Commercial	$2,490.97
Rate for Payer: ASR ASR	$2,684.71
Rate for Payer: BCBS Trust/PPO	$2,145.83
Rate for Payer: BCN Commercial	$2,145.83
Rate for Payer: Cash Price	$2,214.19
Rate for Payer: Cofinity Commercial	$2,601.68
Rate for Payer: Encore Health Key Benefits Commercial	$2,214.19
Rate for Payer: Healthscope Commercial	$2,767.74
Rate for Payer: Healthscope Whirlpool	$2,684.71
Rate for Payer: Mclaren Commercial	$2,490.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,352.58
Rate for Payer: Priority Health Cigna Priority Health	$1,937.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,435.61

HC STENT NON COATED NON CVD NO DELIV SYS

Facility

$2,767.74

Service Code	HCPCS C1877
Hospital Charge Code	27800083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,107.10
Max. Negotiated Rate	$2,767.74
Rate for Payer: Aetna Commercial	$2,490.97
Rate for Payer: ASR ASR	$2,684.71
Rate for Payer: BCBS Complete	$1,107.10
Rate for Payer: BCBS Trust/PPO	$2,145.83
Rate for Payer: BCN Commercial	$2,145.83
Rate for Payer: Cash Price	$2,214.19
Rate for Payer: Cofinity Commercial	$2,601.68
Rate for Payer: Encore Health Key Benefits Commercial	$2,214.19
Rate for Payer: Healthscope Commercial	$2,767.74
Rate for Payer: Healthscope Whirlpool	$2,684.71
Rate for Payer: Mclaren Commercial	$2,490.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,352.58
Rate for Payer: Priority Health Cigna Priority Health	$1,937.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,518.64
Rate for Payer: Priority Health Narrow Network	$1,965.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,435.61

HC STENT NON-COATED W/DELIVERY SYS

Facility

$4,962.00

Service Code	HCPCS C1876
Hospital Charge Code	27800031
Hospital Revenue Code	278
Min. Negotiated Rate	$3,473.40
Max. Negotiated Rate	$4,962.00
Rate for Payer: Aetna Commercial	$4,465.80
Rate for Payer: ASR ASR	$4,813.14
Rate for Payer: BCBS Trust/PPO	$3,847.04
Rate for Payer: BCN Commercial	$3,847.04
Rate for Payer: Cash Price	$3,969.60
Rate for Payer: Cofinity Commercial	$4,664.28
Rate for Payer: Encore Health Key Benefits Commercial	$3,969.60
Rate for Payer: Healthscope Commercial	$4,962.00
Rate for Payer: Healthscope Whirlpool	$4,813.14
Rate for Payer: Mclaren Commercial	$4,465.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,217.70
Rate for Payer: Priority Health Cigna Priority Health	$3,473.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4,366.56

HC STENT NON-COATED W/DELIVERY SYS

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	$4,962.00
Rate for Payer: Aetna Commercial	$4,465.80
Rate for Payer: ASR ASR	$4,813.14
Rate for Payer: BCBS Complete	$1,984.80
Rate for Payer: BCBS Trust/PPO	$3,847.04
Rate for Payer: BCN Commercial	$3,847.04
Rate for Payer: Cash Price	$3,969.60
Rate for Payer: Cofinity Commercial	$4,664.28
Rate for Payer: Encore Health Key Benefits Commercial	$3,969.60
Rate for Payer: Healthscope Commercial	$4,962.00
Rate for Payer: Healthscope Whirlpool	$4,813.14
Rate for Payer: Mclaren Commercial	$4,465.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,217.70
Rate for Payer: Priority Health Cigna Priority Health	$3,473.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,515.42
Rate for Payer: Priority Health Narrow Network	$3,523.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4,366.56

HC STENT NONCOATED W SYS LVL 19

Facility

$19,625.00

Service Code	CPT C1876
Hospital Charge Code	27800145
Hospital Revenue Code	278
Min. Negotiated Rate	$7,850.00
Max. Negotiated Rate	$19,625.00
Rate for Payer: Aetna Commercial	$17,662.50
Rate for Payer: ASR ASR	$19,036.25
Rate for Payer: BCBS Complete	$7,850.00
Rate for Payer: BCBS Trust/PPO	$15,215.26
Rate for Payer: BCN Commercial	$15,215.26
Rate for Payer: Cash Price	$15,700.00
Rate for Payer: Cofinity Commercial	$18,447.50
Rate for Payer: Encore Health Key Benefits Commercial	$15,700.00
Rate for Payer: Healthscope Commercial	$19,625.00
Rate for Payer: Healthscope Whirlpool	$19,036.25
Rate for Payer: Mclaren Commercial	$17,662.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16,681.25
Rate for Payer: Priority Health Cigna Priority Health	$13,737.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,858.75
Rate for Payer: Priority Health Narrow Network	$13,933.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$17,270.00

HC STENT NONCOATED W SYS LVL 19

Facility

$19,625.00

Service Code	CPT C1876
Hospital Charge Code	27800145
Hospital Revenue Code	278
Min. Negotiated Rate	$13,737.50
Max. Negotiated Rate	$19,625.00
Rate for Payer: Aetna Commercial	$17,662.50
Rate for Payer: ASR ASR	$19,036.25
Rate for Payer: BCBS Trust/PPO	$15,215.26
Rate for Payer: BCN Commercial	$15,215.26
Rate for Payer: Cash Price	$15,700.00
Rate for Payer: Cofinity Commercial	$18,447.50
Rate for Payer: Encore Health Key Benefits Commercial	$15,700.00
Rate for Payer: Healthscope Commercial	$19,625.00
Rate for Payer: Healthscope Whirlpool	$19,036.25
Rate for Payer: Mclaren Commercial	$17,662.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16,681.25
Rate for Payer: Priority Health Cigna Priority Health	$13,737.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$17,270.00

HC STENT NON COATED W SYS LVL 5

Facility

$1,420.65

Service Code	HCPCS C1876
Hospital Charge Code	27800097
Hospital Revenue Code	278
Min. Negotiated Rate	$568.26
Max. Negotiated Rate	$1,420.65
Rate for Payer: Aetna Commercial	$1,278.58
Rate for Payer: ASR ASR	$1,378.03
Rate for Payer: BCBS Complete	$568.26
Rate for Payer: BCBS Trust/PPO	$1,101.43
Rate for Payer: BCN Commercial	$1,101.43
Rate for Payer: Cash Price	$1,136.52
Rate for Payer: Cofinity Commercial	$1,335.41
Rate for Payer: Encore Health Key Benefits Commercial	$1,136.52
Rate for Payer: Healthscope Commercial	$1,420.65
Rate for Payer: Healthscope Whirlpool	$1,378.03
Rate for Payer: Mclaren Commercial	$1,278.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,207.55
Rate for Payer: Priority Health Cigna Priority Health	$994.46
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,292.79
Rate for Payer: Priority Health Narrow Network	$1,008.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,250.17

HC STENT NON COATED W SYS LVL 5

Facility

$1,420.65

Service Code	HCPCS C1876
Hospital Charge Code	27800097
Hospital Revenue Code	278
Min. Negotiated Rate	$994.46
Max. Negotiated Rate	$1,420.65
Rate for Payer: Aetna Commercial	$1,278.58
Rate for Payer: ASR ASR	$1,378.03
Rate for Payer: BCBS Trust/PPO	$1,101.43
Rate for Payer: BCN Commercial	$1,101.43
Rate for Payer: Cash Price	$1,136.52
Rate for Payer: Cofinity Commercial	$1,335.41
Rate for Payer: Encore Health Key Benefits Commercial	$1,136.52
Rate for Payer: Healthscope Commercial	$1,420.65
Rate for Payer: Healthscope Whirlpool	$1,378.03
Rate for Payer: Mclaren Commercial	$1,278.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,207.55
Rate for Payer: Priority Health Cigna Priority Health	$994.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,250.17

HC STENT NONCOATED W SYS LVL 6

Facility

$2,011.34

Service Code	HCPCS C1876
Hospital Charge Code	27800098
Hospital Revenue Code	278
Min. Negotiated Rate	$804.54
Max. Negotiated Rate	$2,011.34
Rate for Payer: Aetna Commercial	$1,810.21
Rate for Payer: ASR ASR	$1,951.00
Rate for Payer: BCBS Complete	$804.54
Rate for Payer: BCBS Trust/PPO	$1,559.39
Rate for Payer: BCN Commercial	$1,559.39
Rate for Payer: Cash Price	$1,609.07
Rate for Payer: Cofinity Commercial	$1,890.66
Rate for Payer: Encore Health Key Benefits Commercial	$1,609.07
Rate for Payer: Healthscope Commercial	$2,011.34
Rate for Payer: Healthscope Whirlpool	$1,951.00
Rate for Payer: Mclaren Commercial	$1,810.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,709.64
Rate for Payer: Priority Health Cigna Priority Health	$1,407.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,830.32
Rate for Payer: Priority Health Narrow Network	$1,428.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,769.98

HC STENT NONCOATED W SYS LVL 6

Facility

$2,011.34

Service Code	HCPCS C1876
Hospital Charge Code	27800098
Hospital Revenue Code	278
Min. Negotiated Rate	$1,407.94
Max. Negotiated Rate	$2,011.34
Rate for Payer: Aetna Commercial	$1,810.21
Rate for Payer: ASR ASR	$1,951.00
Rate for Payer: BCBS Trust/PPO	$1,559.39
Rate for Payer: BCN Commercial	$1,559.39
Rate for Payer: Cash Price	$1,609.07
Rate for Payer: Cofinity Commercial	$1,890.66
Rate for Payer: Encore Health Key Benefits Commercial	$1,609.07
Rate for Payer: Healthscope Commercial	$2,011.34
Rate for Payer: Healthscope Whirlpool	$1,951.00
Rate for Payer: Mclaren Commercial	$1,810.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,709.64
Rate for Payer: Priority Health Cigna Priority Health	$1,407.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,769.98

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	$1,711.08
Max. Negotiated Rate	$2,444.40
Rate for Payer: Aetna Commercial	$2,199.96
Rate for Payer: ASR ASR	$2,371.07
Rate for Payer: BCBS Trust/PPO	$1,895.14
Rate for Payer: BCN Commercial	$1,895.14
Rate for Payer: Cash Price	$1,955.52
Rate for Payer: Cofinity Commercial	$2,297.74
Rate for Payer: Encore Health Key Benefits Commercial	$1,955.52
Rate for Payer: Healthscope Commercial	$2,444.40
Rate for Payer: Healthscope Whirlpool	$2,371.07
Rate for Payer: Mclaren Commercial	$2,199.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,077.74
Rate for Payer: Priority Health Cigna Priority Health	$1,711.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,151.07

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	$977.76
Max. Negotiated Rate	$2,444.40
Rate for Payer: Aetna Commercial	$2,199.96
Rate for Payer: ASR ASR	$2,371.07
Rate for Payer: BCBS Complete	$977.76
Rate for Payer: BCBS Trust/PPO	$1,895.14
Rate for Payer: BCN Commercial	$1,895.14
Rate for Payer: Cash Price	$1,955.52
Rate for Payer: Cofinity Commercial	$2,297.74
Rate for Payer: Encore Health Key Benefits Commercial	$1,955.52
Rate for Payer: Healthscope Commercial	$2,444.40
Rate for Payer: Healthscope Whirlpool	$2,371.07
Rate for Payer: Mclaren Commercial	$2,199.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,077.74
Rate for Payer: Priority Health Cigna Priority Health	$1,711.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,224.40
Rate for Payer: Priority Health Narrow Network	$1,735.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,151.07

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	$2,482.83
Max. Negotiated Rate	$3,546.90
Rate for Payer: Aetna Commercial	$3,192.21
Rate for Payer: ASR ASR	$3,440.49
Rate for Payer: BCBS Trust/PPO	$2,749.91
Rate for Payer: BCN Commercial	$2,749.91
Rate for Payer: Cash Price	$2,837.52
Rate for Payer: Cofinity Commercial	$3,334.09
Rate for Payer: Encore Health Key Benefits Commercial	$2,837.52
Rate for Payer: Healthscope Commercial	$3,546.90
Rate for Payer: Healthscope Whirlpool	$3,440.49
Rate for Payer: Mclaren Commercial	$3,192.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,014.86
Rate for Payer: Priority Health Cigna Priority Health	$2,482.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,121.27

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	$3,546.90
Rate for Payer: Aetna Commercial	$3,192.21
Rate for Payer: ASR ASR	$3,440.49
Rate for Payer: BCBS Complete	$1,418.76
Rate for Payer: BCBS Trust/PPO	$2,749.91
Rate for Payer: BCN Commercial	$2,749.91
Rate for Payer: Cash Price	$2,837.52
Rate for Payer: Cofinity Commercial	$3,334.09
Rate for Payer: Encore Health Key Benefits Commercial	$2,837.52
Rate for Payer: Healthscope Commercial	$3,546.90
Rate for Payer: Healthscope Whirlpool	$3,440.49
Rate for Payer: Mclaren Commercial	$3,192.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,014.86
Rate for Payer: Priority Health Cigna Priority Health	$2,482.83
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,227.68
Rate for Payer: Priority Health Narrow Network	$2,518.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,121.27

HC STENT NON CORONARY LVL 2

Facility

$239.40

Service Code	HCPCS C2625
Hospital Charge Code	27800101
Hospital Revenue Code	278
Min. Negotiated Rate	$167.58
Max. Negotiated Rate	$239.40
Rate for Payer: Aetna Commercial	$215.46
Rate for Payer: ASR ASR	$232.22
Rate for Payer: BCBS Trust/PPO	$185.61
Rate for Payer: BCN Commercial	$185.61
Rate for Payer: Cash Price	$191.52
Rate for Payer: Cofinity Commercial	$225.04
Rate for Payer: Encore Health Key Benefits Commercial	$191.52
Rate for Payer: Healthscope Commercial	$239.40
Rate for Payer: Healthscope Whirlpool	$232.22
Rate for Payer: Mclaren Commercial	$215.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$203.49
Rate for Payer: Priority Health Cigna Priority Health	$167.58
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$210.67

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	$239.40
Rate for Payer: Aetna Commercial	$215.46
Rate for Payer: ASR ASR	$232.22
Rate for Payer: BCBS Complete	$95.76
Rate for Payer: BCBS Trust/PPO	$185.61
Rate for Payer: BCN Commercial	$185.61
Rate for Payer: Cash Price	$191.52
Rate for Payer: Cofinity Commercial	$225.04
Rate for Payer: Encore Health Key Benefits Commercial	$191.52
Rate for Payer: Healthscope Commercial	$239.40
Rate for Payer: Healthscope Whirlpool	$232.22
Rate for Payer: Mclaren Commercial	$215.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$203.49
Rate for Payer: Priority Health Cigna Priority Health	$167.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$217.85
Rate for Payer: Priority Health Narrow Network	$169.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$210.67

HC STENT NON CORONARY LVL 3

Facility

$491.40

Service Code	HCPCS c2625
Hospital Charge Code	27800102
Hospital Revenue Code	278
Min. Negotiated Rate	$343.98
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna Commercial	$442.26
Rate for Payer: ASR ASR	$476.66
Rate for Payer: BCBS Trust/PPO	$380.98
Rate for Payer: BCN Commercial	$380.98
Rate for Payer: Cash Price	$393.12
Rate for Payer: Cofinity Commercial	$461.92
Rate for Payer: Encore Health Key Benefits Commercial	$393.12
Rate for Payer: Healthscope Commercial	$491.40
Rate for Payer: Healthscope Whirlpool	$476.66
Rate for Payer: Mclaren Commercial	$442.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$417.69
Rate for Payer: Priority Health Cigna Priority Health	$343.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$432.43

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	$491.40
Rate for Payer: Aetna Commercial	$442.26
Rate for Payer: ASR ASR	$476.66
Rate for Payer: BCBS Complete	$196.56
Rate for Payer: BCBS Trust/PPO	$380.98
Rate for Payer: BCN Commercial	$380.98
Rate for Payer: Cash Price	$393.12
Rate for Payer: Cofinity Commercial	$461.92
Rate for Payer: Encore Health Key Benefits Commercial	$393.12
Rate for Payer: Healthscope Commercial	$491.40
Rate for Payer: Healthscope Whirlpool	$476.66
Rate for Payer: Mclaren Commercial	$442.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$417.69
Rate for Payer: Priority Health Cigna Priority Health	$343.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$447.17
Rate for Payer: Priority Health Narrow Network	$348.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$432.43

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	$822.28
Rate for Payer: Aetna Commercial	$740.05
Rate for Payer: ASR ASR	$797.61
Rate for Payer: BCBS Complete	$328.91
Rate for Payer: BCBS Trust/PPO	$637.51
Rate for Payer: BCN Commercial	$637.51
Rate for Payer: Cash Price	$657.82
Rate for Payer: Cofinity Commercial	$772.94
Rate for Payer: Encore Health Key Benefits Commercial	$657.82
Rate for Payer: Healthscope Commercial	$822.28
Rate for Payer: Healthscope Whirlpool	$797.61
Rate for Payer: Mclaren Commercial	$740.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$698.94
Rate for Payer: Priority Health Cigna Priority Health	$575.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$748.27
Rate for Payer: Priority Health Narrow Network	$583.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$723.61

HC STENT NON CORONARY LVL 4

Facility

$822.28

Service Code	HCPCS C2625
Hospital Charge Code	27200103
Hospital Revenue Code	272
Min. Negotiated Rate	$575.60
Max. Negotiated Rate	$822.28
Rate for Payer: Aetna Commercial	$740.05
Rate for Payer: ASR ASR	$797.61
Rate for Payer: BCBS Trust/PPO	$637.51
Rate for Payer: BCN Commercial	$637.51
Rate for Payer: Cash Price	$657.82
Rate for Payer: Cofinity Commercial	$772.94
Rate for Payer: Encore Health Key Benefits Commercial	$657.82
Rate for Payer: Healthscope Commercial	$822.28
Rate for Payer: Healthscope Whirlpool	$797.61
Rate for Payer: Mclaren Commercial	$740.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$698.94
Rate for Payer: Priority Health Cigna Priority Health	$575.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$723.61

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	$3,775.31
Max. Negotiated Rate	$10,408.41
Rate for Payer: Aetna Commercial	$9,367.57
Rate for Payer: ASR ASR	$10,096.16
Rate for Payer: BCBS Complete	$4,163.36
Rate for Payer: BCBS Trust/PPO	$8,069.64
Rate for Payer: BCN Commercial	$8,069.64
Rate for Payer: Cash Price	$8,326.73
Rate for Payer: Cash Price	$8,326.73
Rate for Payer: Cofinity Commercial	$9,783.91
Rate for Payer: Encore Health Key Benefits Commercial	$8,326.73
Rate for Payer: Healthscope Commercial	$10,408.41
Rate for Payer: Healthscope Whirlpool	$10,096.16
Rate for Payer: Mclaren Commercial	$9,367.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,847.15
Rate for Payer: Priority Health Cigna Priority Health	$7,285.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,719.14
Rate for Payer: Priority Health Narrow Network	$3,775.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$9,159.40

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	$7,285.89
Max. Negotiated Rate	$10,408.41
Rate for Payer: Aetna Commercial	$9,367.57
Rate for Payer: ASR ASR	$10,096.16
Rate for Payer: BCBS Trust/PPO	$8,069.64
Rate for Payer: BCN Commercial	$8,069.64
Rate for Payer: Cash Price	$8,326.73
Rate for Payer: Cofinity Commercial	$9,783.91
Rate for Payer: Encore Health Key Benefits Commercial	$8,326.73
Rate for Payer: Healthscope Commercial	$10,408.41
Rate for Payer: Healthscope Whirlpool	$10,096.16
Rate for Payer: Mclaren Commercial	$9,367.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8,847.15
Rate for Payer: Priority Health Cigna Priority Health	$7,285.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$9,159.40

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	$11,257.31
Max. Negotiated Rate	$16,081.87
Rate for Payer: Aetna Commercial	$14,473.68
Rate for Payer: ASR ASR	$15,599.41
Rate for Payer: BCBS Trust/PPO	$12,468.27
Rate for Payer: BCN Commercial	$12,468.27
Rate for Payer: Cash Price	$12,865.50
Rate for Payer: Cofinity Commercial	$15,116.96
Rate for Payer: Encore Health Key Benefits Commercial	$12,865.50
Rate for Payer: Healthscope Commercial	$16,081.87
Rate for Payer: Healthscope Whirlpool	$15,599.41
Rate for Payer: Mclaren Commercial	$14,473.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13,669.59
Rate for Payer: Priority Health Cigna Priority Health	$11,257.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14,152.05

Know your out-of-pocket cost for care.

All Charges