DRAPE INCISE IOBAN 13X13-IN (36CM)
|
Facility
|
OP
|
$68.00
|
|
Hospital Charge Code |
22354969
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$10.20 |
Max. Negotiated Rate |
$61.20 |
Rate for Payer: Aetna of AZ Commercial |
$61.20
|
Rate for Payer: Aetna of AZ Medicare |
$19.04
|
Rate for Payer: Allwell Medicare |
$10.20
|
Rate for Payer: Amerigroup Medicare |
$10.20
|
Rate for Payer: APIPA Medicare/Medicaid |
$25.40
|
Rate for Payer: AZCH Complete Medicare |
$10.20
|
Rate for Payer: Banner UC Health Medicare |
$10.20
|
Rate for Payer: Bisbee Police All Plans |
$17.68
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$46.24
|
Rate for Payer: Cash Price |
$54.40
|
Rate for Payer: Cigna of AZ Commercial |
$47.60
|
Rate for Payer: Copperpoint Commercial |
$16.83
|
Rate for Payer: Health Net of AZ Commercial |
$40.80
|
Rate for Payer: Health Net of AZ Medicare |
$19.04
|
Rate for Payer: Humana of AZ Medicare |
$10.20
|
Rate for Payer: Self Pay Self Pay |
$54.40
|
Rate for Payer: TriWest Medicare |
$10.20
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$39.64
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.24
|
|
DRAPE LAPAROSCOPY PACK
|
Facility
|
OP
|
$395.00
|
|
Hospital Charge Code |
22354239
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$59.25 |
Max. Negotiated Rate |
$355.50 |
Rate for Payer: Aetna of AZ Commercial |
$355.50
|
Rate for Payer: Aetna of AZ Medicare |
$110.60
|
Rate for Payer: Allwell Medicare |
$59.25
|
Rate for Payer: Amerigroup Medicare |
$59.25
|
Rate for Payer: APIPA Medicare/Medicaid |
$147.53
|
Rate for Payer: AZCH Complete Medicare |
$59.25
|
Rate for Payer: Banner UC Health Medicare |
$59.25
|
Rate for Payer: Bisbee Police All Plans |
$102.70
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$268.60
|
Rate for Payer: Cash Price |
$316.00
|
Rate for Payer: Cigna of AZ Commercial |
$276.50
|
Rate for Payer: Copperpoint Commercial |
$97.76
|
Rate for Payer: Health Net of AZ Commercial |
$237.00
|
Rate for Payer: Health Net of AZ Medicare |
$110.60
|
Rate for Payer: Humana of AZ Medicare |
$59.25
|
Rate for Payer: Self Pay Self Pay |
$316.00
|
Rate for Payer: TriWest Medicare |
$59.25
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$230.28
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$71.10
|
|
DRAPE LAPAROSCOPY PACK
|
Facility
|
IP
|
$395.00
|
|
Hospital Charge Code |
22354239
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$102.70 |
Max. Negotiated Rate |
$355.50 |
Rate for Payer: Aetna of AZ Commercial |
$355.50
|
Rate for Payer: Bisbee Police All Plans |
$102.70
|
Rate for Payer: Cash Price |
$316.00
|
Rate for Payer: Self Pay Self Pay |
$316.00
|
|
DRAPE LAPAROTOMY
|
Facility
|
OP
|
$37.00
|
|
Hospital Charge Code |
22355293
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$5.55 |
Max. Negotiated Rate |
$33.30 |
Rate for Payer: Aetna of AZ Commercial |
$33.30
|
Rate for Payer: Aetna of AZ Medicare |
$10.36
|
Rate for Payer: Allwell Medicare |
$5.55
|
Rate for Payer: Amerigroup Medicare |
$5.55
|
Rate for Payer: APIPA Medicare/Medicaid |
$13.82
|
Rate for Payer: AZCH Complete Medicare |
$5.55
|
Rate for Payer: Banner UC Health Medicare |
$5.55
|
Rate for Payer: Bisbee Police All Plans |
$9.62
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$25.16
|
Rate for Payer: Cash Price |
$29.60
|
Rate for Payer: Cigna of AZ Commercial |
$25.90
|
Rate for Payer: Copperpoint Commercial |
$9.16
|
Rate for Payer: Health Net of AZ Commercial |
$22.20
|
Rate for Payer: Health Net of AZ Medicare |
$10.36
|
Rate for Payer: Humana of AZ Medicare |
$5.55
|
Rate for Payer: Self Pay Self Pay |
$29.60
|
Rate for Payer: TriWest Medicare |
$5.55
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$21.57
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.66
|
|
DRAPE LAPAROTOMY
|
Facility
|
IP
|
$37.00
|
|
Hospital Charge Code |
22355293
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$9.62 |
Max. Negotiated Rate |
$33.30 |
Rate for Payer: Aetna of AZ Commercial |
$33.30
|
Rate for Payer: Bisbee Police All Plans |
$9.62
|
Rate for Payer: Cash Price |
$29.60
|
Rate for Payer: Self Pay Self Pay |
$29.60
|
|
DRAPE PELVIC
|
Facility
|
IP
|
$97.00
|
|
Hospital Charge Code |
22926417
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$25.22 |
Max. Negotiated Rate |
$87.30 |
Rate for Payer: Aetna of AZ Commercial |
$87.30
|
Rate for Payer: Bisbee Police All Plans |
$25.22
|
Rate for Payer: Cash Price |
$77.60
|
Rate for Payer: Self Pay Self Pay |
$77.60
|
|
DRAPE PELVIC
|
Facility
|
OP
|
$97.00
|
|
Hospital Charge Code |
22926417
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$14.55 |
Max. Negotiated Rate |
$87.30 |
Rate for Payer: Aetna of AZ Commercial |
$87.30
|
Rate for Payer: Aetna of AZ Medicare |
$27.16
|
Rate for Payer: Allwell Medicare |
$14.55
|
Rate for Payer: Amerigroup Medicare |
$14.55
|
Rate for Payer: APIPA Medicare/Medicaid |
$36.23
|
Rate for Payer: AZCH Complete Medicare |
$14.55
|
Rate for Payer: Banner UC Health Medicare |
$14.55
|
Rate for Payer: Bisbee Police All Plans |
$25.22
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$65.96
|
Rate for Payer: Cash Price |
$77.60
|
Rate for Payer: Cigna of AZ Commercial |
$67.90
|
Rate for Payer: Copperpoint Commercial |
$24.01
|
Rate for Payer: Health Net of AZ Commercial |
$58.20
|
Rate for Payer: Health Net of AZ Medicare |
$27.16
|
Rate for Payer: Humana of AZ Medicare |
$14.55
|
Rate for Payer: Self Pay Self Pay |
$77.60
|
Rate for Payer: TriWest Medicare |
$14.55
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$56.55
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$17.46
|
|
DRAPE UNDER BUTTOCK W/FLUID COLLECTION
|
Facility
|
OP
|
$23.00
|
|
Hospital Charge Code |
22355540
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$3.45 |
Max. Negotiated Rate |
$20.70 |
Rate for Payer: Aetna of AZ Commercial |
$20.70
|
Rate for Payer: Aetna of AZ Medicare |
$6.44
|
Rate for Payer: Allwell Medicare |
$3.45
|
Rate for Payer: Amerigroup Medicare |
$3.45
|
Rate for Payer: APIPA Medicare/Medicaid |
$8.59
|
Rate for Payer: AZCH Complete Medicare |
$3.45
|
Rate for Payer: Banner UC Health Medicare |
$3.45
|
Rate for Payer: Bisbee Police All Plans |
$5.98
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$15.64
|
Rate for Payer: Cash Price |
$18.40
|
Rate for Payer: Cigna of AZ Commercial |
$16.10
|
Rate for Payer: Copperpoint Commercial |
$5.69
|
Rate for Payer: Health Net of AZ Commercial |
$13.80
|
Rate for Payer: Health Net of AZ Medicare |
$6.44
|
Rate for Payer: Humana of AZ Medicare |
$3.45
|
Rate for Payer: Self Pay Self Pay |
$18.40
|
Rate for Payer: TriWest Medicare |
$3.45
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$13.41
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.14
|
|
DRAPE UNDER BUTTOCK W/FLUID COLLECTION
|
Facility
|
IP
|
$23.00
|
|
Hospital Charge Code |
22355540
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$5.98 |
Max. Negotiated Rate |
$20.70 |
Rate for Payer: Aetna of AZ Commercial |
$20.70
|
Rate for Payer: Bisbee Police All Plans |
$5.98
|
Rate for Payer: Cash Price |
$18.40
|
Rate for Payer: Self Pay Self Pay |
$18.40
|
|
DRESSING COLLAGEN PURACOL PLUS AG 4X4
|
Facility
|
OP
|
$109.00
|
|
Hospital Charge Code |
27571812
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$16.35 |
Max. Negotiated Rate |
$98.10 |
Rate for Payer: Aetna of AZ Commercial |
$98.10
|
Rate for Payer: Aetna of AZ Medicare |
$30.52
|
Rate for Payer: Allwell Medicare |
$16.35
|
Rate for Payer: Amerigroup Medicare |
$16.35
|
Rate for Payer: APIPA Medicare/Medicaid |
$40.71
|
Rate for Payer: AZCH Complete Medicare |
$16.35
|
Rate for Payer: Banner UC Health Medicare |
$16.35
|
Rate for Payer: Bisbee Police All Plans |
$28.34
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$74.12
|
Rate for Payer: Cash Price |
$87.20
|
Rate for Payer: Cigna of AZ Commercial |
$76.30
|
Rate for Payer: Copperpoint Commercial |
$26.98
|
Rate for Payer: Health Net of AZ Commercial |
$65.40
|
Rate for Payer: Health Net of AZ Medicare |
$30.52
|
Rate for Payer: Humana of AZ Medicare |
$16.35
|
Rate for Payer: Self Pay Self Pay |
$87.20
|
Rate for Payer: TriWest Medicare |
$16.35
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$63.55
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.62
|
|
DRESSING COLLAGEN PURACOL PLUS AG 4X4
|
Facility
|
IP
|
$109.00
|
|
Hospital Charge Code |
27571812
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$28.34 |
Max. Negotiated Rate |
$98.10 |
Rate for Payer: Aetna of AZ Commercial |
$98.10
|
Rate for Payer: Bisbee Police All Plans |
$28.34
|
Rate for Payer: Cash Price |
$87.20
|
Rate for Payer: Self Pay Self Pay |
$87.20
|
|
DRESSING COLLAGEN PURACOL PLUS AG 4X4
|
Facility
|
OP
|
$109.00
|
|
Hospital Charge Code |
23359342
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$16.35 |
Max. Negotiated Rate |
$98.10 |
Rate for Payer: Aetna of AZ Commercial |
$98.10
|
Rate for Payer: Aetna of AZ Medicare |
$30.52
|
Rate for Payer: Allwell Medicare |
$16.35
|
Rate for Payer: Amerigroup Medicare |
$16.35
|
Rate for Payer: APIPA Medicare/Medicaid |
$40.71
|
Rate for Payer: AZCH Complete Medicare |
$16.35
|
Rate for Payer: Banner UC Health Medicare |
$16.35
|
Rate for Payer: Bisbee Police All Plans |
$28.34
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$74.12
|
Rate for Payer: Cash Price |
$87.20
|
Rate for Payer: Cigna of AZ Commercial |
$76.30
|
Rate for Payer: Copperpoint Commercial |
$26.98
|
Rate for Payer: Health Net of AZ Commercial |
$65.40
|
Rate for Payer: Health Net of AZ Medicare |
$30.52
|
Rate for Payer: Humana of AZ Medicare |
$16.35
|
Rate for Payer: Self Pay Self Pay |
$87.20
|
Rate for Payer: TriWest Medicare |
$16.35
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$63.55
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.62
|
|
DRESSING COLLAGEN PURACOL PLUS AG 4X4
|
Facility
|
IP
|
$109.00
|
|
Hospital Charge Code |
23359342
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$28.34 |
Max. Negotiated Rate |
$98.10 |
Rate for Payer: Aetna of AZ Commercial |
$98.10
|
Rate for Payer: Bisbee Police All Plans |
$28.34
|
Rate for Payer: Cash Price |
$87.20
|
Rate for Payer: Self Pay Self Pay |
$87.20
|
|
DRESSING MEPITEL SILICONE 3X4
|
Facility
|
OP
|
$29.00
|
|
Hospital Charge Code |
27569974
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.35 |
Max. Negotiated Rate |
$26.10 |
Rate for Payer: Aetna of AZ Commercial |
$26.10
|
Rate for Payer: Aetna of AZ Medicare |
$8.12
|
Rate for Payer: Allwell Medicare |
$4.35
|
Rate for Payer: Amerigroup Medicare |
$4.35
|
Rate for Payer: APIPA Medicare/Medicaid |
$10.83
|
Rate for Payer: AZCH Complete Medicare |
$4.35
|
Rate for Payer: Banner UC Health Medicare |
$4.35
|
Rate for Payer: Bisbee Police All Plans |
$7.54
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$19.72
|
Rate for Payer: Cash Price |
$23.20
|
Rate for Payer: Cigna of AZ Commercial |
$20.30
|
Rate for Payer: Copperpoint Commercial |
$7.18
|
Rate for Payer: Health Net of AZ Commercial |
$17.40
|
Rate for Payer: Health Net of AZ Medicare |
$8.12
|
Rate for Payer: Humana of AZ Medicare |
$4.35
|
Rate for Payer: Self Pay Self Pay |
$23.20
|
Rate for Payer: TriWest Medicare |
$4.35
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$16.91
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.22
|
|
DRESSING MEPITEL SILICONE 3X4
|
Facility
|
OP
|
$29.00
|
|
Hospital Charge Code |
23770583
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.35 |
Max. Negotiated Rate |
$26.10 |
Rate for Payer: Aetna of AZ Commercial |
$26.10
|
Rate for Payer: Aetna of AZ Medicare |
$8.12
|
Rate for Payer: Allwell Medicare |
$4.35
|
Rate for Payer: Amerigroup Medicare |
$4.35
|
Rate for Payer: APIPA Medicare/Medicaid |
$10.83
|
Rate for Payer: AZCH Complete Medicare |
$4.35
|
Rate for Payer: Banner UC Health Medicare |
$4.35
|
Rate for Payer: Bisbee Police All Plans |
$7.54
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$19.72
|
Rate for Payer: Cash Price |
$23.20
|
Rate for Payer: Cigna of AZ Commercial |
$20.30
|
Rate for Payer: Copperpoint Commercial |
$7.18
|
Rate for Payer: Health Net of AZ Commercial |
$17.40
|
Rate for Payer: Health Net of AZ Medicare |
$8.12
|
Rate for Payer: Humana of AZ Medicare |
$4.35
|
Rate for Payer: Self Pay Self Pay |
$23.20
|
Rate for Payer: TriWest Medicare |
$4.35
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$16.91
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.22
|
|
DRESSING MEPITEL SILICONE 3X4
|
Facility
|
IP
|
$29.00
|
|
Hospital Charge Code |
23770583
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$7.54 |
Max. Negotiated Rate |
$26.10 |
Rate for Payer: Aetna of AZ Commercial |
$26.10
|
Rate for Payer: Bisbee Police All Plans |
$7.54
|
Rate for Payer: Cash Price |
$23.20
|
Rate for Payer: Self Pay Self Pay |
$23.20
|
|
DRESSING MEPITEL SILICONE 3X4
|
Facility
|
IP
|
$29.00
|
|
Hospital Charge Code |
27569974
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$7.54 |
Max. Negotiated Rate |
$26.10 |
Rate for Payer: Aetna of AZ Commercial |
$26.10
|
Rate for Payer: Bisbee Police All Plans |
$7.54
|
Rate for Payer: Cash Price |
$23.20
|
Rate for Payer: Self Pay Self Pay |
$23.20
|
|
DRESSING STRATASORB COMP 4X10
|
Facility
|
OP
|
$10.00
|
|
Hospital Charge Code |
27449661
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1.50 |
Max. Negotiated Rate |
$9.00 |
Rate for Payer: Aetna of AZ Commercial |
$9.00
|
Rate for Payer: Aetna of AZ Medicare |
$2.80
|
Rate for Payer: Allwell Medicare |
$1.50
|
Rate for Payer: Amerigroup Medicare |
$1.50
|
Rate for Payer: APIPA Medicare/Medicaid |
$3.74
|
Rate for Payer: AZCH Complete Medicare |
$1.50
|
Rate for Payer: Banner UC Health Medicare |
$1.50
|
Rate for Payer: Bisbee Police All Plans |
$2.60
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6.80
|
Rate for Payer: Cash Price |
$8.00
|
Rate for Payer: Cigna of AZ Commercial |
$7.00
|
Rate for Payer: Copperpoint Commercial |
$2.48
|
Rate for Payer: Health Net of AZ Commercial |
$6.00
|
Rate for Payer: Health Net of AZ Medicare |
$2.80
|
Rate for Payer: Humana of AZ Medicare |
$1.50
|
Rate for Payer: Self Pay Self Pay |
$8.00
|
Rate for Payer: TriWest Medicare |
$1.50
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.83
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.80
|
|
DRESSING STRATASORB COMP 4X10
|
Facility
|
IP
|
$10.00
|
|
Hospital Charge Code |
27449661
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.60 |
Max. Negotiated Rate |
$9.00 |
Rate for Payer: Aetna of AZ Commercial |
$9.00
|
Rate for Payer: Bisbee Police All Plans |
$2.60
|
Rate for Payer: Cash Price |
$8.00
|
Rate for Payer: Self Pay Self Pay |
$8.00
|
|
DRILL AO D 2.0MM
|
Facility
|
IP
|
$1,510.00
|
|
Hospital Charge Code |
24415637
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$392.60 |
Max. Negotiated Rate |
$1,359.00 |
Rate for Payer: Aetna of AZ Commercial |
$1,359.00
|
Rate for Payer: Bisbee Police All Plans |
$392.60
|
Rate for Payer: Cash Price |
$1,208.00
|
Rate for Payer: Self Pay Self Pay |
$1,208.00
|
|
DRILL AO D 2.0MM
|
Facility
|
OP
|
$1,510.00
|
|
Hospital Charge Code |
24415637
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$226.50 |
Max. Negotiated Rate |
$1,359.00 |
Rate for Payer: Aetna of AZ Commercial |
$1,359.00
|
Rate for Payer: Aetna of AZ Medicare |
$422.80
|
Rate for Payer: Allwell Medicare |
$226.50
|
Rate for Payer: Amerigroup Medicare |
$226.50
|
Rate for Payer: APIPA Medicare/Medicaid |
$563.98
|
Rate for Payer: AZCH Complete Medicare |
$226.50
|
Rate for Payer: Banner UC Health Medicare |
$226.50
|
Rate for Payer: Bisbee Police All Plans |
$392.60
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,026.80
|
Rate for Payer: Cash Price |
$1,208.00
|
Rate for Payer: Cigna of AZ Commercial |
$1,057.00
|
Rate for Payer: Copperpoint Commercial |
$373.72
|
Rate for Payer: Health Net of AZ Commercial |
$906.00
|
Rate for Payer: Health Net of AZ Medicare |
$422.80
|
Rate for Payer: Humana of AZ Medicare |
$226.50
|
Rate for Payer: Self Pay Self Pay |
$1,208.00
|
Rate for Payer: TriWest Medicare |
$226.50
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$880.33
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$271.80
|
|
DRSG ACTICOAT 7 4X5 IN.
|
Facility
|
IP
|
$116.00
|
|
Hospital Charge Code |
22354838
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$30.16 |
Max. Negotiated Rate |
$104.40 |
Rate for Payer: Aetna of AZ Commercial |
$104.40
|
Rate for Payer: Bisbee Police All Plans |
$30.16
|
Rate for Payer: Cash Price |
$92.80
|
Rate for Payer: Self Pay Self Pay |
$92.80
|
|
DRSG ACTICOAT 7 4X5 IN.
|
Facility
|
OP
|
$116.00
|
|
Hospital Charge Code |
22354838
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$17.40 |
Max. Negotiated Rate |
$104.40 |
Rate for Payer: Aetna of AZ Commercial |
$104.40
|
Rate for Payer: Aetna of AZ Medicare |
$32.48
|
Rate for Payer: Allwell Medicare |
$17.40
|
Rate for Payer: Amerigroup Medicare |
$17.40
|
Rate for Payer: APIPA Medicare/Medicaid |
$43.33
|
Rate for Payer: AZCH Complete Medicare |
$17.40
|
Rate for Payer: Banner UC Health Medicare |
$17.40
|
Rate for Payer: Bisbee Police All Plans |
$30.16
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$78.88
|
Rate for Payer: Cash Price |
$92.80
|
Rate for Payer: Cigna of AZ Commercial |
$81.20
|
Rate for Payer: Copperpoint Commercial |
$28.71
|
Rate for Payer: Health Net of AZ Commercial |
$69.60
|
Rate for Payer: Health Net of AZ Medicare |
$32.48
|
Rate for Payer: Humana of AZ Medicare |
$17.40
|
Rate for Payer: Self Pay Self Pay |
$92.80
|
Rate for Payer: TriWest Medicare |
$17.40
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$67.63
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$20.88
|
|
DRSG ALGINATE AQUACEL 4X4.7
|
Facility
|
IP
|
$53.00
|
|
Hospital Charge Code |
22354975
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$13.78 |
Max. Negotiated Rate |
$47.70 |
Rate for Payer: Aetna of AZ Commercial |
$47.70
|
Rate for Payer: Bisbee Police All Plans |
$13.78
|
Rate for Payer: Cash Price |
$42.40
|
Rate for Payer: Self Pay Self Pay |
$42.40
|
|
DRSG ALGINATE AQUACEL 4X4.7
|
Facility
|
OP
|
$53.00
|
|
Hospital Charge Code |
22354975
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$7.95 |
Max. Negotiated Rate |
$47.70 |
Rate for Payer: Aetna of AZ Commercial |
$47.70
|
Rate for Payer: Aetna of AZ Medicare |
$14.84
|
Rate for Payer: Allwell Medicare |
$7.95
|
Rate for Payer: Amerigroup Medicare |
$7.95
|
Rate for Payer: APIPA Medicare/Medicaid |
$19.80
|
Rate for Payer: AZCH Complete Medicare |
$7.95
|
Rate for Payer: Banner UC Health Medicare |
$7.95
|
Rate for Payer: Bisbee Police All Plans |
$13.78
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$36.04
|
Rate for Payer: Cash Price |
$42.40
|
Rate for Payer: Cigna of AZ Commercial |
$37.10
|
Rate for Payer: Copperpoint Commercial |
$13.12
|
Rate for Payer: Health Net of AZ Commercial |
$31.80
|
Rate for Payer: Health Net of AZ Medicare |
$14.84
|
Rate for Payer: Humana of AZ Medicare |
$7.95
|
Rate for Payer: Self Pay Self Pay |
$42.40
|
Rate for Payer: TriWest Medicare |
$7.95
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$30.90
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$9.54
|
|