|
DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE MINI BLADE
|
Facility
|
OP
|
$5,757.00
|
|
| Hospital Charge Code |
24127793
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$863.55 |
| Max. Negotiated Rate |
$5,181.30 |
| Rate for Payer: Aetna of AZ Commercial |
$5,181.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,611.96
|
| Rate for Payer: Allwell Medicare |
$863.55
|
| Rate for Payer: Amerigroup Medicare |
$863.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,150.24
|
| Rate for Payer: AZCH Complete Medicare |
$863.55
|
| Rate for Payer: Banner UC Health Medicare |
$863.55
|
| Rate for Payer: Bisbee Police All Plans |
$1,496.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,914.76
|
| Rate for Payer: Cash Price |
$4,605.60
|
| Rate for Payer: Cigna of AZ Commercial |
$4,029.90
|
| Rate for Payer: Copperpoint Commercial |
$1,424.86
|
| Rate for Payer: Health Net of AZ Commercial |
$3,454.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,611.96
|
| Rate for Payer: Humana of AZ Medicare |
$863.55
|
| Rate for Payer: Self Pay Self Pay |
$4,605.60
|
| Rate for Payer: TriWest Medicare |
$863.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,356.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,036.26
|
|
|
DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE MINI BLADE
|
Facility
|
IP
|
$5,757.00
|
|
| Hospital Charge Code |
24127793
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,496.82 |
| Max. Negotiated Rate |
$5,181.30 |
| Rate for Payer: Aetna of AZ Commercial |
$5,181.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,496.82
|
| Rate for Payer: Cash Price |
$4,605.60
|
| Rate for Payer: Self Pay Self Pay |
$4,605.60
|
|
|
DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE SHORT
|
Facility
|
IP
|
$5,757.00
|
|
| Hospital Charge Code |
24129271
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,496.82 |
| Max. Negotiated Rate |
$5,181.30 |
| Rate for Payer: Aetna of AZ Commercial |
$5,181.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,496.82
|
| Rate for Payer: Cash Price |
$4,605.60
|
| Rate for Payer: Self Pay Self Pay |
$4,605.60
|
|
|
DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE SHORT
|
Facility
|
OP
|
$5,757.00
|
|
| Hospital Charge Code |
24129271
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$863.55 |
| Max. Negotiated Rate |
$5,181.30 |
| Rate for Payer: Aetna of AZ Commercial |
$5,181.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,611.96
|
| Rate for Payer: Allwell Medicare |
$863.55
|
| Rate for Payer: Amerigroup Medicare |
$863.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,150.24
|
| Rate for Payer: AZCH Complete Medicare |
$863.55
|
| Rate for Payer: Banner UC Health Medicare |
$863.55
|
| Rate for Payer: Bisbee Police All Plans |
$1,496.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,914.76
|
| Rate for Payer: Cash Price |
$4,605.60
|
| Rate for Payer: Cigna of AZ Commercial |
$4,029.90
|
| Rate for Payer: Copperpoint Commercial |
$1,424.86
|
| Rate for Payer: Health Net of AZ Commercial |
$3,454.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,611.96
|
| Rate for Payer: Humana of AZ Medicare |
$863.55
|
| Rate for Payer: Self Pay Self Pay |
$4,605.60
|
| Rate for Payer: TriWest Medicare |
$863.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,356.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,036.26
|
|
|
DIGIFUSE IMPLANT 2.5MM 0 DEGREE ANGLE
|
Facility
|
IP
|
$5,757.00
|
|
| Hospital Charge Code |
24129272
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,496.82 |
| Max. Negotiated Rate |
$5,181.30 |
| Rate for Payer: Aetna of AZ Commercial |
$5,181.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,496.82
|
| Rate for Payer: Cash Price |
$4,605.60
|
| Rate for Payer: Self Pay Self Pay |
$4,605.60
|
|
|
DIGIFUSE IMPLANT 2.5MM 0 DEGREE ANGLE
|
Facility
|
OP
|
$5,757.00
|
|
| Hospital Charge Code |
24129272
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$863.55 |
| Max. Negotiated Rate |
$5,181.30 |
| Rate for Payer: Aetna of AZ Commercial |
$5,181.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,611.96
|
| Rate for Payer: Allwell Medicare |
$863.55
|
| Rate for Payer: Amerigroup Medicare |
$863.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,150.24
|
| Rate for Payer: AZCH Complete Medicare |
$863.55
|
| Rate for Payer: Banner UC Health Medicare |
$863.55
|
| Rate for Payer: Bisbee Police All Plans |
$1,496.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,914.76
|
| Rate for Payer: Cash Price |
$4,605.60
|
| Rate for Payer: Cigna of AZ Commercial |
$4,029.90
|
| Rate for Payer: Copperpoint Commercial |
$1,424.86
|
| Rate for Payer: Health Net of AZ Commercial |
$3,454.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,611.96
|
| Rate for Payer: Humana of AZ Medicare |
$863.55
|
| Rate for Payer: Self Pay Self Pay |
$4,605.60
|
| Rate for Payer: TriWest Medicare |
$863.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,356.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,036.26
|
|
|
DIGITAL SCREW SZ 2MM X 32MM
|
Facility
|
OP
|
$1,308.00
|
|
| Hospital Charge Code |
27341820
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$1,177.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,177.20
|
| Rate for Payer: Aetna of AZ Medicare |
$366.24
|
| Rate for Payer: Allwell Medicare |
$196.20
|
| Rate for Payer: Amerigroup Medicare |
$196.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$488.54
|
| Rate for Payer: AZCH Complete Medicare |
$196.20
|
| Rate for Payer: Banner UC Health Medicare |
$196.20
|
| Rate for Payer: Bisbee Police All Plans |
$340.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$889.44
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna of AZ Commercial |
$915.60
|
| Rate for Payer: Copperpoint Commercial |
$323.73
|
| Rate for Payer: Health Net of AZ Commercial |
$784.80
|
| Rate for Payer: Health Net of AZ Medicare |
$366.24
|
| Rate for Payer: Humana of AZ Medicare |
$196.20
|
| Rate for Payer: Self Pay Self Pay |
$1,046.40
|
| Rate for Payer: TriWest Medicare |
$196.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$762.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$235.44
|
|
|
DIGITAL SCREW SZ 2MM X 32MM
|
Facility
|
IP
|
$1,308.00
|
|
| Hospital Charge Code |
27341820
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$340.08 |
| Max. Negotiated Rate |
$1,177.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,177.20
|
| Rate for Payer: Bisbee Police All Plans |
$340.08
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Self Pay Self Pay |
$1,046.40
|
|
|
DIGITAL SCREW SZ 2MM X 40MM
|
Facility
|
IP
|
$2,180.00
|
|
| Hospital Charge Code |
27595622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$566.80 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,962.00
|
| Rate for Payer: Bisbee Police All Plans |
$566.80
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Self Pay Self Pay |
$1,744.00
|
|
|
DIGITAL SCREW SZ 2MM X 40MM
|
Facility
|
OP
|
$2,180.00
|
|
| Hospital Charge Code |
27595622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,962.00
|
| Rate for Payer: Aetna of AZ Medicare |
$610.40
|
| Rate for Payer: Allwell Medicare |
$327.00
|
| Rate for Payer: Amerigroup Medicare |
$327.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$814.23
|
| Rate for Payer: AZCH Complete Medicare |
$327.00
|
| Rate for Payer: Banner UC Health Medicare |
$327.00
|
| Rate for Payer: Bisbee Police All Plans |
$566.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,526.00
|
| Rate for Payer: Copperpoint Commercial |
$539.55
|
| Rate for Payer: Health Net of AZ Commercial |
$1,308.00
|
| Rate for Payer: Health Net of AZ Medicare |
$610.40
|
| Rate for Payer: Humana of AZ Medicare |
$327.00
|
| Rate for Payer: Self Pay Self Pay |
$1,744.00
|
| Rate for Payer: TriWest Medicare |
$327.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,270.94
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$392.40
|
|
|
DIGITAL SCREW SZ 2MM X 44MM
|
Facility
|
OP
|
$2,180.00
|
|
| Hospital Charge Code |
27595623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,962.00
|
| Rate for Payer: Aetna of AZ Medicare |
$610.40
|
| Rate for Payer: Allwell Medicare |
$327.00
|
| Rate for Payer: Amerigroup Medicare |
$327.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$814.23
|
| Rate for Payer: AZCH Complete Medicare |
$327.00
|
| Rate for Payer: Banner UC Health Medicare |
$327.00
|
| Rate for Payer: Bisbee Police All Plans |
$566.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,526.00
|
| Rate for Payer: Copperpoint Commercial |
$539.55
|
| Rate for Payer: Health Net of AZ Commercial |
$1,308.00
|
| Rate for Payer: Health Net of AZ Medicare |
$610.40
|
| Rate for Payer: Humana of AZ Medicare |
$327.00
|
| Rate for Payer: Self Pay Self Pay |
$1,744.00
|
| Rate for Payer: TriWest Medicare |
$327.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,270.94
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$392.40
|
|
|
DIGITAL SCREW SZ 2MM X 44MM
|
Facility
|
IP
|
$2,180.00
|
|
| Hospital Charge Code |
27595623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$566.80 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,962.00
|
| Rate for Payer: Bisbee Police All Plans |
$566.80
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Self Pay Self Pay |
$1,744.00
|
|
|
DIGITAL SCREW SZ 2MM X 46MM
|
Facility
|
OP
|
$1,308.00
|
|
| Hospital Charge Code |
27341823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$1,177.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,177.20
|
| Rate for Payer: Aetna of AZ Medicare |
$366.24
|
| Rate for Payer: Allwell Medicare |
$196.20
|
| Rate for Payer: Amerigroup Medicare |
$196.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$488.54
|
| Rate for Payer: AZCH Complete Medicare |
$196.20
|
| Rate for Payer: Banner UC Health Medicare |
$196.20
|
| Rate for Payer: Bisbee Police All Plans |
$340.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$889.44
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna of AZ Commercial |
$915.60
|
| Rate for Payer: Copperpoint Commercial |
$323.73
|
| Rate for Payer: Health Net of AZ Commercial |
$784.80
|
| Rate for Payer: Health Net of AZ Medicare |
$366.24
|
| Rate for Payer: Humana of AZ Medicare |
$196.20
|
| Rate for Payer: Self Pay Self Pay |
$1,046.40
|
| Rate for Payer: TriWest Medicare |
$196.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$762.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$235.44
|
|
|
DIGITAL SCREW SZ 2MM X 46MM
|
Facility
|
IP
|
$1,308.00
|
|
| Hospital Charge Code |
27341823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$340.08 |
| Max. Negotiated Rate |
$1,177.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,177.20
|
| Rate for Payer: Bisbee Police All Plans |
$340.08
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Self Pay Self Pay |
$1,046.40
|
|
|
DIGITAL SCREW SZ 2MM X 48MM
|
Facility
|
OP
|
$1,308.00
|
|
| Hospital Charge Code |
27341816
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$1,177.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,177.20
|
| Rate for Payer: Aetna of AZ Medicare |
$366.24
|
| Rate for Payer: Allwell Medicare |
$196.20
|
| Rate for Payer: Amerigroup Medicare |
$196.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$488.54
|
| Rate for Payer: AZCH Complete Medicare |
$196.20
|
| Rate for Payer: Banner UC Health Medicare |
$196.20
|
| Rate for Payer: Bisbee Police All Plans |
$340.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$889.44
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna of AZ Commercial |
$915.60
|
| Rate for Payer: Copperpoint Commercial |
$323.73
|
| Rate for Payer: Health Net of AZ Commercial |
$784.80
|
| Rate for Payer: Health Net of AZ Medicare |
$366.24
|
| Rate for Payer: Humana of AZ Medicare |
$196.20
|
| Rate for Payer: Self Pay Self Pay |
$1,046.40
|
| Rate for Payer: TriWest Medicare |
$196.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$762.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$235.44
|
|
|
DIGITAL SCREW SZ 2MM X 48MM
|
Facility
|
IP
|
$1,308.00
|
|
| Hospital Charge Code |
27341816
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$340.08 |
| Max. Negotiated Rate |
$1,177.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,177.20
|
| Rate for Payer: Bisbee Police All Plans |
$340.08
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Self Pay Self Pay |
$1,046.40
|
|
|
digoxin 125 mcg (0.125 mg) Tab [CQCH]
|
Facility
|
IP
|
$1.23
|
|
|
Service Code
|
NDC 904592161
|
| Hospital Charge Code |
105918974
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of AZ Commercial |
$1.11
|
| Rate for Payer: Bisbee Police All Plans |
$0.32
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Self Pay Self Pay |
$0.98
|
|
|
digoxin 125 mcg (0.125 mg) Tab [CQCH]
|
Facility
|
OP
|
$1.23
|
|
|
Service Code
|
NDC 904592161
|
| Hospital Charge Code |
105918974
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of AZ Commercial |
$1.11
|
| Rate for Payer: Aetna of AZ Medicare |
$0.34
|
| Rate for Payer: Allwell Medicare |
$0.18
|
| Rate for Payer: Amerigroup Medicare |
$0.18
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.46
|
| Rate for Payer: AZCH Complete Medicare |
$0.18
|
| Rate for Payer: Banner UC Health Medicare |
$0.18
|
| Rate for Payer: Bisbee Police All Plans |
$0.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna of AZ Commercial |
$0.80
|
| Rate for Payer: Copperpoint Commercial |
$0.30
|
| Rate for Payer: Health Net of AZ Commercial |
$0.74
|
| Rate for Payer: Health Net of AZ Medicare |
$0.34
|
| Rate for Payer: Humana of AZ Medicare |
$0.18
|
| Rate for Payer: Self Pay Self Pay |
$0.98
|
| Rate for Payer: TriWest Medicare |
$0.18
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.22
|
|
|
digoxin 500 mcg (0.25 mg/mL) Inj Sol [CQCH]
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
105918899
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$15.44 |
| Rate for Payer: Aetna of AZ Commercial |
$1.39
|
| Rate for Payer: Aetna of AZ Medicare |
$0.43
|
| Rate for Payer: AHCCCS Medicaid |
$15.44
|
| Rate for Payer: Allwell Medicaid |
$15.44
|
| Rate for Payer: Allwell Medicare |
$0.23
|
| Rate for Payer: Amerigroup Medicare |
$0.23
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.58
|
| Rate for Payer: AZCH Complete Medicaid |
$15.44
|
| Rate for Payer: AZCH Complete Medicare |
$0.23
|
| Rate for Payer: Banner UC Health Medicaid |
$15.44
|
| Rate for Payer: Banner UC Health Medicare |
$0.23
|
| Rate for Payer: Bisbee Police All Plans |
$0.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cigna of AZ Commercial |
$1.00
|
| Rate for Payer: Copperpoint Commercial |
$0.38
|
| Rate for Payer: Health Net of AZ Commercial |
$0.92
|
| Rate for Payer: Health Net of AZ Medicare |
$0.43
|
| Rate for Payer: Humana of AZ Medicare |
$0.23
|
| Rate for Payer: Mercy Care Medicaid |
$15.44
|
| Rate for Payer: Self Pay Self Pay |
$1.23
|
| Rate for Payer: TriWest Medicare |
$0.23
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.28
|
|
|
digoxin 500 mcg (0.25 mg/mL) Inj Sol [CQCH]
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
105918899
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of AZ Commercial |
$1.39
|
| Rate for Payer: Bisbee Police All Plans |
$0.40
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Self Pay Self Pay |
$1.23
|
|
|
Digoxin Level
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
633719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Aetna of AZ Commercial |
$174.60
|
| Rate for Payer: Bisbee Police All Plans |
$50.44
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Self Pay Self Pay |
$155.20
|
|
|
Digoxin Level
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
633719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Aetna of AZ Commercial |
$174.60
|
| Rate for Payer: Aetna of AZ Medicare |
$54.32
|
| Rate for Payer: AHCCCS Medicaid |
$13.28
|
| Rate for Payer: Allwell Medicaid |
$13.28
|
| Rate for Payer: Allwell Medicare |
$29.10
|
| Rate for Payer: Amerigroup Medicare |
$29.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$72.46
|
| Rate for Payer: AZCH Complete Medicaid |
$13.28
|
| Rate for Payer: AZCH Complete Medicare |
$29.10
|
| Rate for Payer: Banner UC Health Medicaid |
$13.28
|
| Rate for Payer: Banner UC Health Medicare |
$29.10
|
| Rate for Payer: Bisbee Police All Plans |
$50.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cigna of AZ Commercial |
$126.10
|
| Rate for Payer: Copperpoint Commercial |
$48.02
|
| Rate for Payer: Health Net of AZ Commercial |
$116.40
|
| Rate for Payer: Health Net of AZ Medicare |
$54.32
|
| Rate for Payer: Humana of AZ Medicare |
$29.10
|
| Rate for Payer: Mercy Care Medicaid |
$13.28
|
| Rate for Payer: Self Pay Self Pay |
$155.20
|
| Rate for Payer: TriWest Medicare |
$29.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$113.10
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$34.92
|
|
|
Dihydrotestosterone LC
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
6781102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of AZ Commercial |
$270.90
|
| Rate for Payer: Bisbee Police All Plans |
$78.26
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Self Pay Self Pay |
$240.80
|
|
|
Dihydrotestosterone LC
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
6781102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Aetna of AZ Commercial |
$270.90
|
| Rate for Payer: Aetna of AZ Medicare |
$84.28
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$45.15
|
| Rate for Payer: Amerigroup Medicare |
$45.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$112.42
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$45.15
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$45.15
|
| Rate for Payer: Bisbee Police All Plans |
$78.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$204.68
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cigna of AZ Commercial |
$195.65
|
| Rate for Payer: Copperpoint Commercial |
$74.50
|
| Rate for Payer: Health Net of AZ Commercial |
$180.60
|
| Rate for Payer: Health Net of AZ Medicare |
$84.28
|
| Rate for Payer: Humana of AZ Medicare |
$45.15
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$240.80
|
| Rate for Payer: TriWest Medicare |
$45.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$175.48
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$54.18
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$4,712.71
|
|
|
Service Code
|
APR-DRG 5171
|
| Hospital Charge Code |
APRDRG5173
|
| Min. Negotiated Rate |
$4,712.71 |
| Max. Negotiated Rate |
$4,712.71 |
| Rate for Payer: AHCCCS Medicaid |
$4,712.71
|
| Rate for Payer: Allwell Medicaid |
$4,712.71
|
| Rate for Payer: AZCH Complete Medicaid |
$4,712.71
|
| Rate for Payer: Banner UC Health Medicaid |
$4,712.71
|
| Rate for Payer: Mercy Care Medicaid |
$4,712.71
|
|
