DRSG BIO PATCH ANTIMICROBIAL
|
Facility
|
IP
|
$29.00
|
|
Hospital Charge Code |
22354413
|
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
|
|
DRSG BIO PATCH ANTIMICROBIAL
|
Facility
|
OP
|
$29.00
|
|
Hospital Charge Code |
22354413
|
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
|
|
DRSG COBAN 2 IN
|
Facility
|
OP
|
$8.00
|
|
Hospital Charge Code |
22354290
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1.20 |
Max. Negotiated Rate |
$7.20 |
Rate for Payer: Aetna of AZ Commercial |
$7.20
|
Rate for Payer: Aetna of AZ Medicare |
$2.24
|
Rate for Payer: Allwell Medicare |
$1.20
|
Rate for Payer: Amerigroup Medicare |
$1.20
|
Rate for Payer: APIPA Medicare/Medicaid |
$2.99
|
Rate for Payer: AZCH Complete Medicare |
$1.20
|
Rate for Payer: Banner UC Health Medicare |
$1.20
|
Rate for Payer: Bisbee Police All Plans |
$2.08
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5.44
|
Rate for Payer: Cash Price |
$6.40
|
Rate for Payer: Cigna of AZ Commercial |
$5.60
|
Rate for Payer: Copperpoint Commercial |
$1.98
|
Rate for Payer: Health Net of AZ Commercial |
$4.80
|
Rate for Payer: Health Net of AZ Medicare |
$2.24
|
Rate for Payer: Humana of AZ Medicare |
$1.20
|
Rate for Payer: Self Pay Self Pay |
$6.40
|
Rate for Payer: TriWest Medicare |
$1.20
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$4.66
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.44
|
|
DRSG COBAN 2 IN
|
Facility
|
OP
|
$8.00
|
|
Hospital Charge Code |
27571813
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1.20 |
Max. Negotiated Rate |
$7.20 |
Rate for Payer: Aetna of AZ Commercial |
$7.20
|
Rate for Payer: Aetna of AZ Medicare |
$2.24
|
Rate for Payer: Allwell Medicare |
$1.20
|
Rate for Payer: Amerigroup Medicare |
$1.20
|
Rate for Payer: APIPA Medicare/Medicaid |
$2.99
|
Rate for Payer: AZCH Complete Medicare |
$1.20
|
Rate for Payer: Banner UC Health Medicare |
$1.20
|
Rate for Payer: Bisbee Police All Plans |
$2.08
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5.44
|
Rate for Payer: Cash Price |
$6.40
|
Rate for Payer: Cigna of AZ Commercial |
$5.60
|
Rate for Payer: Copperpoint Commercial |
$1.98
|
Rate for Payer: Health Net of AZ Commercial |
$4.80
|
Rate for Payer: Health Net of AZ Medicare |
$2.24
|
Rate for Payer: Humana of AZ Medicare |
$1.20
|
Rate for Payer: Self Pay Self Pay |
$6.40
|
Rate for Payer: TriWest Medicare |
$1.20
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$4.66
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.44
|
|
DRSG COBAN 2 IN
|
Facility
|
IP
|
$8.00
|
|
Hospital Charge Code |
22354290
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.08 |
Max. Negotiated Rate |
$7.20 |
Rate for Payer: Aetna of AZ Commercial |
$7.20
|
Rate for Payer: Bisbee Police All Plans |
$2.08
|
Rate for Payer: Cash Price |
$6.40
|
Rate for Payer: Self Pay Self Pay |
$6.40
|
|
DRSG COBAN 2 IN
|
Facility
|
IP
|
$8.00
|
|
Hospital Charge Code |
27571813
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.08 |
Max. Negotiated Rate |
$7.20 |
Rate for Payer: Aetna of AZ Commercial |
$7.20
|
Rate for Payer: Bisbee Police All Plans |
$2.08
|
Rate for Payer: Cash Price |
$6.40
|
Rate for Payer: Self Pay Self Pay |
$6.40
|
|
DRSG COBAN 6 IN
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
CPT A4460
|
Hospital Charge Code |
22355146
|
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
|
|
DRSG COBAN 6 IN
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
CPT A4460
|
Hospital Charge Code |
22355146
|
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
|
|
DRSG DUODERM X THIN
|
Facility
|
OP
|
$30.00
|
|
Hospital Charge Code |
27567552
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.50 |
Max. Negotiated Rate |
$27.00 |
Rate for Payer: Aetna of AZ Commercial |
$27.00
|
Rate for Payer: Aetna of AZ Medicare |
$8.40
|
Rate for Payer: Allwell Medicare |
$4.50
|
Rate for Payer: Amerigroup Medicare |
$4.50
|
Rate for Payer: APIPA Medicare/Medicaid |
$11.20
|
Rate for Payer: AZCH Complete Medicare |
$4.50
|
Rate for Payer: Banner UC Health Medicare |
$4.50
|
Rate for Payer: Bisbee Police All Plans |
$7.80
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$20.40
|
Rate for Payer: Cash Price |
$24.00
|
Rate for Payer: Cigna of AZ Commercial |
$21.00
|
Rate for Payer: Copperpoint Commercial |
$7.42
|
Rate for Payer: Health Net of AZ Commercial |
$18.00
|
Rate for Payer: Health Net of AZ Medicare |
$8.40
|
Rate for Payer: Humana of AZ Medicare |
$4.50
|
Rate for Payer: Self Pay Self Pay |
$24.00
|
Rate for Payer: TriWest Medicare |
$4.50
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$17.49
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.40
|
|
DRSG DUODERM X THIN
|
Facility
|
OP
|
$30.00
|
|
Hospital Charge Code |
22354979
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.50 |
Max. Negotiated Rate |
$27.00 |
Rate for Payer: Aetna of AZ Commercial |
$27.00
|
Rate for Payer: Aetna of AZ Medicare |
$8.40
|
Rate for Payer: Allwell Medicare |
$4.50
|
Rate for Payer: Amerigroup Medicare |
$4.50
|
Rate for Payer: APIPA Medicare/Medicaid |
$11.20
|
Rate for Payer: AZCH Complete Medicare |
$4.50
|
Rate for Payer: Banner UC Health Medicare |
$4.50
|
Rate for Payer: Bisbee Police All Plans |
$7.80
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$20.40
|
Rate for Payer: Cash Price |
$24.00
|
Rate for Payer: Cigna of AZ Commercial |
$21.00
|
Rate for Payer: Copperpoint Commercial |
$7.42
|
Rate for Payer: Health Net of AZ Commercial |
$18.00
|
Rate for Payer: Health Net of AZ Medicare |
$8.40
|
Rate for Payer: Humana of AZ Medicare |
$4.50
|
Rate for Payer: Self Pay Self Pay |
$24.00
|
Rate for Payer: TriWest Medicare |
$4.50
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$17.49
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.40
|
|
DRSG DUODERM X THIN
|
Facility
|
IP
|
$30.00
|
|
Hospital Charge Code |
22354979
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$7.80 |
Max. Negotiated Rate |
$27.00 |
Rate for Payer: Aetna of AZ Commercial |
$27.00
|
Rate for Payer: Bisbee Police All Plans |
$7.80
|
Rate for Payer: Cash Price |
$24.00
|
Rate for Payer: Self Pay Self Pay |
$24.00
|
|
DRSG DUODERM X THIN
|
Facility
|
IP
|
$30.00
|
|
Hospital Charge Code |
27567552
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$7.80 |
Max. Negotiated Rate |
$27.00 |
Rate for Payer: Aetna of AZ Commercial |
$27.00
|
Rate for Payer: Bisbee Police All Plans |
$7.80
|
Rate for Payer: Cash Price |
$24.00
|
Rate for Payer: Self Pay Self Pay |
$24.00
|
|
DRSG MEPILEX AG 4X4
|
Facility
|
OP
|
$47.00
|
|
Hospital Charge Code |
27569979
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$7.05 |
Max. Negotiated Rate |
$42.30 |
Rate for Payer: Aetna of AZ Commercial |
$42.30
|
Rate for Payer: Aetna of AZ Medicare |
$13.16
|
Rate for Payer: Allwell Medicare |
$7.05
|
Rate for Payer: Amerigroup Medicare |
$7.05
|
Rate for Payer: APIPA Medicare/Medicaid |
$17.55
|
Rate for Payer: AZCH Complete Medicare |
$7.05
|
Rate for Payer: Banner UC Health Medicare |
$7.05
|
Rate for Payer: Bisbee Police All Plans |
$12.22
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$31.96
|
Rate for Payer: Cash Price |
$37.60
|
Rate for Payer: Cigna of AZ Commercial |
$32.90
|
Rate for Payer: Copperpoint Commercial |
$11.63
|
Rate for Payer: Health Net of AZ Commercial |
$28.20
|
Rate for Payer: Health Net of AZ Medicare |
$13.16
|
Rate for Payer: Humana of AZ Medicare |
$7.05
|
Rate for Payer: Self Pay Self Pay |
$37.60
|
Rate for Payer: TriWest Medicare |
$7.05
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$27.40
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.46
|
|
DRSG MEPILEX AG 4X4
|
Facility
|
OP
|
$47.00
|
|
Hospital Charge Code |
22355695
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$7.05 |
Max. Negotiated Rate |
$42.30 |
Rate for Payer: Aetna of AZ Commercial |
$42.30
|
Rate for Payer: Aetna of AZ Medicare |
$13.16
|
Rate for Payer: Allwell Medicare |
$7.05
|
Rate for Payer: Amerigroup Medicare |
$7.05
|
Rate for Payer: APIPA Medicare/Medicaid |
$17.55
|
Rate for Payer: AZCH Complete Medicare |
$7.05
|
Rate for Payer: Banner UC Health Medicare |
$7.05
|
Rate for Payer: Bisbee Police All Plans |
$12.22
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$31.96
|
Rate for Payer: Cash Price |
$37.60
|
Rate for Payer: Cigna of AZ Commercial |
$32.90
|
Rate for Payer: Copperpoint Commercial |
$11.63
|
Rate for Payer: Health Net of AZ Commercial |
$28.20
|
Rate for Payer: Health Net of AZ Medicare |
$13.16
|
Rate for Payer: Humana of AZ Medicare |
$7.05
|
Rate for Payer: Self Pay Self Pay |
$37.60
|
Rate for Payer: TriWest Medicare |
$7.05
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$27.40
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.46
|
|
DRSG MEPILEX AG 4X4
|
Facility
|
IP
|
$47.00
|
|
Hospital Charge Code |
22355695
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$12.22 |
Max. Negotiated Rate |
$42.30 |
Rate for Payer: Aetna of AZ Commercial |
$42.30
|
Rate for Payer: Bisbee Police All Plans |
$12.22
|
Rate for Payer: Cash Price |
$37.60
|
Rate for Payer: Self Pay Self Pay |
$37.60
|
|
DRSG MEPILEX AG 4X4
|
Facility
|
IP
|
$47.00
|
|
Hospital Charge Code |
27569979
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$12.22 |
Max. Negotiated Rate |
$42.30 |
Rate for Payer: Aetna of AZ Commercial |
$42.30
|
Rate for Payer: Bisbee Police All Plans |
$12.22
|
Rate for Payer: Cash Price |
$37.60
|
Rate for Payer: Self Pay Self Pay |
$37.60
|
|
DRSG MEPILEX BORDER 15X15 (6X6)
|
Facility
|
IP
|
$32.00
|
|
Hospital Charge Code |
22354829
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$8.32 |
Max. Negotiated Rate |
$28.80 |
Rate for Payer: Aetna of AZ Commercial |
$28.80
|
Rate for Payer: Bisbee Police All Plans |
$8.32
|
Rate for Payer: Cash Price |
$25.60
|
Rate for Payer: Self Pay Self Pay |
$25.60
|
|
DRSG MEPILEX BORDER 15X15 (6X6)
|
Facility
|
OP
|
$32.00
|
|
Hospital Charge Code |
22354829
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$4.80 |
Max. Negotiated Rate |
$28.80 |
Rate for Payer: Aetna of AZ Commercial |
$28.80
|
Rate for Payer: Aetna of AZ Medicare |
$8.96
|
Rate for Payer: Allwell Medicare |
$4.80
|
Rate for Payer: Amerigroup Medicare |
$4.80
|
Rate for Payer: APIPA Medicare/Medicaid |
$11.95
|
Rate for Payer: AZCH Complete Medicare |
$4.80
|
Rate for Payer: Banner UC Health Medicare |
$4.80
|
Rate for Payer: Bisbee Police All Plans |
$8.32
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$21.76
|
Rate for Payer: Cash Price |
$25.60
|
Rate for Payer: Cigna of AZ Commercial |
$22.40
|
Rate for Payer: Copperpoint Commercial |
$7.92
|
Rate for Payer: Health Net of AZ Commercial |
$19.20
|
Rate for Payer: Health Net of AZ Medicare |
$8.96
|
Rate for Payer: Humana of AZ Medicare |
$4.80
|
Rate for Payer: Self Pay Self Pay |
$25.60
|
Rate for Payer: TriWest Medicare |
$4.80
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$18.66
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.76
|
|
DRSG MEPILEX BORDER 3X3
|
Facility
|
OP
|
$16.00
|
|
Hospital Charge Code |
22354828
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.40 |
Max. Negotiated Rate |
$14.40 |
Rate for Payer: Aetna of AZ Commercial |
$14.40
|
Rate for Payer: Aetna of AZ Medicare |
$4.48
|
Rate for Payer: Allwell Medicare |
$2.40
|
Rate for Payer: Amerigroup Medicare |
$2.40
|
Rate for Payer: APIPA Medicare/Medicaid |
$5.98
|
Rate for Payer: AZCH Complete Medicare |
$2.40
|
Rate for Payer: Banner UC Health Medicare |
$2.40
|
Rate for Payer: Bisbee Police All Plans |
$4.16
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$10.88
|
Rate for Payer: Cash Price |
$12.80
|
Rate for Payer: Cigna of AZ Commercial |
$11.20
|
Rate for Payer: Copperpoint Commercial |
$3.96
|
Rate for Payer: Health Net of AZ Commercial |
$9.60
|
Rate for Payer: Health Net of AZ Medicare |
$4.48
|
Rate for Payer: Humana of AZ Medicare |
$2.40
|
Rate for Payer: Self Pay Self Pay |
$12.80
|
Rate for Payer: TriWest Medicare |
$2.40
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$9.33
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.88
|
|
DRSG MEPILEX BORDER 3X3
|
Facility
|
IP
|
$16.00
|
|
Hospital Charge Code |
22354828
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.16 |
Max. Negotiated Rate |
$14.40 |
Rate for Payer: Aetna of AZ Commercial |
$14.40
|
Rate for Payer: Bisbee Police All Plans |
$4.16
|
Rate for Payer: Cash Price |
$12.80
|
Rate for Payer: Self Pay Self Pay |
$12.80
|
|
DRSG MEPILEX BORDER 4X4
|
Facility
|
IP
|
$19.00
|
|
Hospital Charge Code |
27569980
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.94 |
Max. Negotiated Rate |
$17.10 |
Rate for Payer: Aetna of AZ Commercial |
$17.10
|
Rate for Payer: Bisbee Police All Plans |
$4.94
|
Rate for Payer: Cash Price |
$15.20
|
Rate for Payer: Self Pay Self Pay |
$15.20
|
|
DRSG MEPILEX BORDER 4X4
|
Facility
|
OP
|
$19.00
|
|
Hospital Charge Code |
27569980
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.85 |
Max. Negotiated Rate |
$17.10 |
Rate for Payer: Aetna of AZ Commercial |
$17.10
|
Rate for Payer: Aetna of AZ Medicare |
$5.32
|
Rate for Payer: Allwell Medicare |
$2.85
|
Rate for Payer: Amerigroup Medicare |
$2.85
|
Rate for Payer: APIPA Medicare/Medicaid |
$7.10
|
Rate for Payer: AZCH Complete Medicare |
$2.85
|
Rate for Payer: Banner UC Health Medicare |
$2.85
|
Rate for Payer: Bisbee Police All Plans |
$4.94
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$12.92
|
Rate for Payer: Cash Price |
$15.20
|
Rate for Payer: Cigna of AZ Commercial |
$13.30
|
Rate for Payer: Copperpoint Commercial |
$4.70
|
Rate for Payer: Health Net of AZ Commercial |
$11.40
|
Rate for Payer: Health Net of AZ Medicare |
$5.32
|
Rate for Payer: Humana of AZ Medicare |
$2.85
|
Rate for Payer: Self Pay Self Pay |
$15.20
|
Rate for Payer: TriWest Medicare |
$2.85
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$11.08
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.42
|
|
DRSG MEPILEX BORDER 4X4
|
Facility
|
IP
|
$19.00
|
|
Hospital Charge Code |
22354832
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.94 |
Max. Negotiated Rate |
$17.10 |
Rate for Payer: Aetna of AZ Commercial |
$17.10
|
Rate for Payer: Bisbee Police All Plans |
$4.94
|
Rate for Payer: Cash Price |
$15.20
|
Rate for Payer: Self Pay Self Pay |
$15.20
|
|
DRSG MEPILEX BORDER 4X4
|
Facility
|
OP
|
$19.00
|
|
Hospital Charge Code |
22354832
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.85 |
Max. Negotiated Rate |
$17.10 |
Rate for Payer: Aetna of AZ Commercial |
$17.10
|
Rate for Payer: Aetna of AZ Medicare |
$5.32
|
Rate for Payer: Allwell Medicare |
$2.85
|
Rate for Payer: Amerigroup Medicare |
$2.85
|
Rate for Payer: APIPA Medicare/Medicaid |
$7.10
|
Rate for Payer: AZCH Complete Medicare |
$2.85
|
Rate for Payer: Banner UC Health Medicare |
$2.85
|
Rate for Payer: Bisbee Police All Plans |
$4.94
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$12.92
|
Rate for Payer: Cash Price |
$15.20
|
Rate for Payer: Cigna of AZ Commercial |
$13.30
|
Rate for Payer: Copperpoint Commercial |
$4.70
|
Rate for Payer: Health Net of AZ Commercial |
$11.40
|
Rate for Payer: Health Net of AZ Medicare |
$5.32
|
Rate for Payer: Humana of AZ Medicare |
$2.85
|
Rate for Payer: Self Pay Self Pay |
$15.20
|
Rate for Payer: TriWest Medicare |
$2.85
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$11.08
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.42
|
|
DRSG MEPILEX BORDER 6X6
|
Facility
|
OP
|
$32.00
|
|
Hospital Charge Code |
27571814
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$4.80 |
Max. Negotiated Rate |
$28.80 |
Rate for Payer: Aetna of AZ Commercial |
$28.80
|
Rate for Payer: Aetna of AZ Medicare |
$8.96
|
Rate for Payer: Allwell Medicare |
$4.80
|
Rate for Payer: Amerigroup Medicare |
$4.80
|
Rate for Payer: APIPA Medicare/Medicaid |
$11.95
|
Rate for Payer: AZCH Complete Medicare |
$4.80
|
Rate for Payer: Banner UC Health Medicare |
$4.80
|
Rate for Payer: Bisbee Police All Plans |
$8.32
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$21.76
|
Rate for Payer: Cash Price |
$25.60
|
Rate for Payer: Cigna of AZ Commercial |
$22.40
|
Rate for Payer: Copperpoint Commercial |
$7.92
|
Rate for Payer: Health Net of AZ Commercial |
$19.20
|
Rate for Payer: Health Net of AZ Medicare |
$8.96
|
Rate for Payer: Humana of AZ Medicare |
$4.80
|
Rate for Payer: Self Pay Self Pay |
$25.60
|
Rate for Payer: TriWest Medicare |
$4.80
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$18.66
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.76
|
|