|
ELECTRODE BLADE 6-IN DISP BOVIE EXT TIP
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
22355558
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna of AZ Commercial |
$24.30
|
| Rate for Payer: Bisbee Police All Plans |
$7.02
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Self Pay Self Pay |
$21.60
|
|
|
ELECTRODE BLUE AMBU ECG
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT A4556
|
| Hospital Charge Code |
22354143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$21.88 |
| Rate for Payer: Aetna of AZ Commercial |
$12.60
|
| Rate for Payer: Aetna of AZ Medicare |
$3.92
|
| Rate for Payer: AHCCCS Medicaid |
$21.88
|
| Rate for Payer: Allwell Medicaid |
$21.88
|
| Rate for Payer: Allwell Medicare |
$2.10
|
| Rate for Payer: Amerigroup Medicare |
$2.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$5.23
|
| Rate for Payer: AZCH Complete Medicaid |
$21.88
|
| Rate for Payer: AZCH Complete Medicare |
$2.10
|
| Rate for Payer: Banner UC Health Medicaid |
$21.88
|
| Rate for Payer: Banner UC Health Medicare |
$2.10
|
| Rate for Payer: Bisbee Police All Plans |
$3.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$9.52
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cigna of AZ Commercial |
$9.80
|
| Rate for Payer: Copperpoint Commercial |
$3.46
|
| Rate for Payer: Health Net of AZ Commercial |
$8.40
|
| Rate for Payer: Health Net of AZ Medicare |
$3.92
|
| Rate for Payer: Humana of AZ Medicare |
$2.10
|
| Rate for Payer: Mercy Care Medicaid |
$21.88
|
| Rate for Payer: Self Pay Self Pay |
$11.20
|
| Rate for Payer: TriWest Medicare |
$2.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$8.16
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.52
|
|
|
ELECTRODE BLUE AMBU ECG
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT A4556
|
| Hospital Charge Code |
22354143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of AZ Commercial |
$12.60
|
| Rate for Payer: Bisbee Police All Plans |
$3.64
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Self Pay Self Pay |
$11.20
|
|
|
ELECTRODE CUTTING LOOP 24-28F OLYMPUS
|
Facility
|
IP
|
$129.00
|
|
| Hospital Charge Code |
22354138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of AZ Commercial |
$116.10
|
| Rate for Payer: Bisbee Police All Plans |
$33.54
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Self Pay Self Pay |
$103.20
|
|
|
ELECTRODE CUTTING LOOP 24-28F OLYMPUS
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
22354138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of AZ Commercial |
$116.10
|
| Rate for Payer: Aetna of AZ Medicare |
$36.12
|
| Rate for Payer: Allwell Medicare |
$19.35
|
| Rate for Payer: Amerigroup Medicare |
$19.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$48.18
|
| Rate for Payer: AZCH Complete Medicare |
$19.35
|
| Rate for Payer: Banner UC Health Medicare |
$19.35
|
| Rate for Payer: Bisbee Police All Plans |
$33.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$87.72
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna of AZ Commercial |
$90.30
|
| Rate for Payer: Copperpoint Commercial |
$31.93
|
| Rate for Payer: Health Net of AZ Commercial |
$77.40
|
| Rate for Payer: Health Net of AZ Medicare |
$36.12
|
| Rate for Payer: Humana of AZ Medicare |
$19.35
|
| Rate for Payer: Self Pay Self Pay |
$103.20
|
| Rate for Payer: TriWest Medicare |
$19.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$75.21
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$23.22
|
|
|
ELECTRODE CUTTING LOOP 24F
|
Facility
|
OP
|
$116.00
|
|
| Hospital Charge Code |
22354140
|
|
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
|
|
|
ELECTRODE CUTTING LOOP 24F
|
Facility
|
IP
|
$116.00
|
|
| Hospital Charge Code |
22354140
|
|
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
|
|
|
ELECTRODE CUTTING LOOP 24F 12 OLYMPUS
|
Facility
|
IP
|
$3,246.00
|
|
| Hospital Charge Code |
22354280
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$843.96 |
| Max. Negotiated Rate |
$2,921.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,921.40
|
| Rate for Payer: Bisbee Police All Plans |
$843.96
|
| Rate for Payer: Cash Price |
$2,596.80
|
| Rate for Payer: Self Pay Self Pay |
$2,596.80
|
|
|
ELECTRODE CUTTING LOOP 24F 12 OLYMPUS
|
Facility
|
OP
|
$3,246.00
|
|
| Hospital Charge Code |
22354280
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$486.90 |
| Max. Negotiated Rate |
$2,921.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,921.40
|
| Rate for Payer: Aetna of AZ Medicare |
$908.88
|
| Rate for Payer: Allwell Medicare |
$486.90
|
| Rate for Payer: Amerigroup Medicare |
$486.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,212.38
|
| Rate for Payer: AZCH Complete Medicare |
$486.90
|
| Rate for Payer: Banner UC Health Medicare |
$486.90
|
| Rate for Payer: Bisbee Police All Plans |
$843.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,207.28
|
| Rate for Payer: Cash Price |
$2,596.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,272.20
|
| Rate for Payer: Copperpoint Commercial |
$803.38
|
| Rate for Payer: Health Net of AZ Commercial |
$1,947.60
|
| Rate for Payer: Health Net of AZ Medicare |
$908.88
|
| Rate for Payer: Humana of AZ Medicare |
$486.90
|
| Rate for Payer: Self Pay Self Pay |
$2,596.80
|
| Rate for Payer: TriWest Medicare |
$486.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,892.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$584.28
|
|
|
ELECTRODE CUTTING LOOP 30 DEGREE OLYMP
|
Facility
|
IP
|
$1,115.00
|
|
| Hospital Charge Code |
22354327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.90 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,003.50
|
| Rate for Payer: Bisbee Police All Plans |
$289.90
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Self Pay Self Pay |
$892.00
|
|
|
ELECTRODE CUTTING LOOP 30 DEGREE OLYMP
|
Facility
|
OP
|
$1,115.00
|
|
| Hospital Charge Code |
22354327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.25 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,003.50
|
| Rate for Payer: Aetna of AZ Medicare |
$312.20
|
| Rate for Payer: Allwell Medicare |
$167.25
|
| Rate for Payer: Amerigroup Medicare |
$167.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$416.45
|
| Rate for Payer: AZCH Complete Medicare |
$167.25
|
| Rate for Payer: Banner UC Health Medicare |
$167.25
|
| Rate for Payer: Bisbee Police All Plans |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$758.20
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cigna of AZ Commercial |
$780.50
|
| Rate for Payer: Copperpoint Commercial |
$275.96
|
| Rate for Payer: Health Net of AZ Commercial |
$669.00
|
| Rate for Payer: Health Net of AZ Medicare |
$312.20
|
| Rate for Payer: Humana of AZ Medicare |
$167.25
|
| Rate for Payer: Self Pay Self Pay |
$892.00
|
| Rate for Payer: TriWest Medicare |
$167.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$650.04
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$200.70
|
|
|
ELECTRODE NEEDLE TIP DISP 2-IN BOVIE
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
22355518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna of AZ Commercial |
$9.90
|
| Rate for Payer: Aetna of AZ Medicare |
$3.08
|
| Rate for Payer: Allwell Medicare |
$1.65
|
| Rate for Payer: Amerigroup Medicare |
$1.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4.11
|
| Rate for Payer: AZCH Complete Medicare |
$1.65
|
| Rate for Payer: Banner UC Health Medicare |
$1.65
|
| Rate for Payer: Bisbee Police All Plans |
$2.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$7.48
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cigna of AZ Commercial |
$7.70
|
| Rate for Payer: Copperpoint Commercial |
$2.72
|
| Rate for Payer: Health Net of AZ Commercial |
$6.60
|
| Rate for Payer: Health Net of AZ Medicare |
$3.08
|
| Rate for Payer: Humana of AZ Medicare |
$1.65
|
| Rate for Payer: Self Pay Self Pay |
$8.80
|
| Rate for Payer: TriWest Medicare |
$1.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$6.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.98
|
|
|
ELECTRODE NEEDLE TIP DISP 2-IN BOVIE
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
22355518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna of AZ Commercial |
$9.90
|
| Rate for Payer: Bisbee Police All Plans |
$2.86
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Self Pay Self Pay |
$8.80
|
|
|
Electro lube
|
Facility
|
OP
|
$214.00
|
|
| Hospital Charge Code |
22926413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna of AZ Commercial |
$192.60
|
| Rate for Payer: Aetna of AZ Medicare |
$59.92
|
| Rate for Payer: Allwell Medicare |
$32.10
|
| Rate for Payer: Amerigroup Medicare |
$32.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$79.93
|
| Rate for Payer: AZCH Complete Medicare |
$32.10
|
| Rate for Payer: Banner UC Health Medicare |
$32.10
|
| Rate for Payer: Bisbee Police All Plans |
$55.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$145.52
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cigna of AZ Commercial |
$149.80
|
| Rate for Payer: Copperpoint Commercial |
$52.96
|
| Rate for Payer: Health Net of AZ Commercial |
$128.40
|
| Rate for Payer: Health Net of AZ Medicare |
$59.92
|
| Rate for Payer: Humana of AZ Medicare |
$32.10
|
| Rate for Payer: Self Pay Self Pay |
$171.20
|
| Rate for Payer: TriWest Medicare |
$32.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$124.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.52
|
|
|
Electro lube
|
Facility
|
IP
|
$214.00
|
|
| Hospital Charge Code |
22926413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna of AZ Commercial |
$192.60
|
| Rate for Payer: Bisbee Police All Plans |
$55.64
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Self Pay Self Pay |
$171.20
|
|
|
Electrolyte Panel Standard
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
22141054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna of AZ Commercial |
$90.90
|
| Rate for Payer: Bisbee Police All Plans |
$26.26
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Self Pay Self Pay |
$80.80
|
|
|
Electrolyte Panel Standard
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
22141054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna of AZ Commercial |
$90.90
|
| Rate for Payer: Aetna of AZ Medicare |
$28.28
|
| Rate for Payer: AHCCCS Medicaid |
$7.01
|
| Rate for Payer: Allwell Medicaid |
$7.01
|
| Rate for Payer: Allwell Medicare |
$15.15
|
| Rate for Payer: Amerigroup Medicare |
$15.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$37.72
|
| Rate for Payer: AZCH Complete Medicaid |
$7.01
|
| Rate for Payer: AZCH Complete Medicare |
$15.15
|
| Rate for Payer: Banner UC Health Medicaid |
$7.01
|
| Rate for Payer: Banner UC Health Medicare |
$15.15
|
| Rate for Payer: Bisbee Police All Plans |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$68.68
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cigna of AZ Commercial |
$65.65
|
| Rate for Payer: Copperpoint Commercial |
$25.00
|
| Rate for Payer: Health Net of AZ Commercial |
$60.60
|
| Rate for Payer: Health Net of AZ Medicare |
$28.28
|
| Rate for Payer: Humana of AZ Medicare |
$15.15
|
| Rate for Payer: Mercy Care Medicaid |
$7.01
|
| Rate for Payer: Self Pay Self Pay |
$80.80
|
| Rate for Payer: TriWest Medicare |
$15.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$58.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.18
|
|
|
Electromyography (patch)
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
27267787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna of AZ Commercial |
$321.30
|
| Rate for Payer: Bisbee Police All Plans |
$92.82
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Self Pay Self Pay |
$285.60
|
|
|
Electromyography (patch)
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
27267787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$321.30
|
| Rate for Payer: Aetna of AZ Medicare |
$99.96
|
| Rate for Payer: AHCCCS Medicaid |
$202.34
|
| Rate for Payer: Allwell Medicaid |
$202.34
|
| Rate for Payer: Allwell Medicare |
$53.55
|
| Rate for Payer: Amerigroup Medicare |
$53.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$133.34
|
| Rate for Payer: AZCH Complete Medicaid |
$202.34
|
| Rate for Payer: AZCH Complete Medicare |
$53.55
|
| Rate for Payer: Banner UC Health Medicaid |
$202.34
|
| Rate for Payer: Banner UC Health Medicare |
$53.55
|
| Rate for Payer: Bisbee Police All Plans |
$92.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$242.76
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna of AZ Commercial |
$178.50
|
| Rate for Payer: Copperpoint Commercial |
$88.36
|
| Rate for Payer: Health Net of AZ Commercial |
$214.20
|
| Rate for Payer: Health Net of AZ Medicare |
$99.96
|
| Rate for Payer: Humana of AZ Medicare |
$53.55
|
| Rate for Payer: Mercy Care Medicaid |
$202.34
|
| Rate for Payer: Self Pay Self Pay |
$285.60
|
| Rate for Payer: TriWest Medicare |
$53.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$64.26
|
|
|
ELECTRO PEN CORD BOVIE
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
22355516
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of AZ Commercial |
$18.90
|
| Rate for Payer: Bisbee Police All Plans |
$5.46
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Self Pay Self Pay |
$16.80
|
|
|
ELECTRO PEN CORD BOVIE
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
22355516
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of AZ Commercial |
$18.90
|
| Rate for Payer: Aetna of AZ Medicare |
$5.88
|
| Rate for Payer: Allwell Medicare |
$3.15
|
| Rate for Payer: Amerigroup Medicare |
$3.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$7.84
|
| Rate for Payer: AZCH Complete Medicare |
$3.15
|
| Rate for Payer: Banner UC Health Medicare |
$3.15
|
| Rate for Payer: Bisbee Police All Plans |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna of AZ Commercial |
$14.70
|
| Rate for Payer: Copperpoint Commercial |
$5.20
|
| Rate for Payer: Health Net of AZ Commercial |
$12.60
|
| Rate for Payer: Health Net of AZ Medicare |
$5.88
|
| Rate for Payer: Humana of AZ Medicare |
$3.15
|
| Rate for Payer: Self Pay Self Pay |
$16.80
|
| Rate for Payer: TriWest Medicare |
$3.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$12.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.78
|
|
|
ELEVATORS LOCKE WITH NARROW 5MMX15MM BLADE
|
Facility
|
OP
|
$741.00
|
|
| Hospital Charge Code |
23751874
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$111.15 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna of AZ Commercial |
$666.90
|
| Rate for Payer: Aetna of AZ Medicare |
$207.48
|
| Rate for Payer: Allwell Medicare |
$111.15
|
| Rate for Payer: Amerigroup Medicare |
$111.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$276.76
|
| Rate for Payer: AZCH Complete Medicare |
$111.15
|
| Rate for Payer: Banner UC Health Medicare |
$111.15
|
| Rate for Payer: Bisbee Police All Plans |
$192.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$503.88
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cigna of AZ Commercial |
$518.70
|
| Rate for Payer: Copperpoint Commercial |
$183.40
|
| Rate for Payer: Health Net of AZ Commercial |
$444.60
|
| Rate for Payer: Health Net of AZ Medicare |
$207.48
|
| Rate for Payer: Humana of AZ Medicare |
$111.15
|
| Rate for Payer: Self Pay Self Pay |
$592.80
|
| Rate for Payer: TriWest Medicare |
$111.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$432.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$133.38
|
|
|
ELEVATORS LOCKE WITH NARROW 5MMX15MM BLADE
|
Facility
|
IP
|
$741.00
|
|
| Hospital Charge Code |
23751874
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$192.66 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna of AZ Commercial |
$666.90
|
| Rate for Payer: Bisbee Police All Plans |
$192.66
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Self Pay Self Pay |
$592.80
|
|
|
emtricitabine-tenofovir 200 mg-300 mg Tab [CQCH]
|
Facility
|
IP
|
$48.62
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
105920292
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$43.76 |
| Rate for Payer: Aetna of AZ Commercial |
$43.76
|
| Rate for Payer: Bisbee Police All Plans |
$12.64
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Self Pay Self Pay |
$38.90
|
|
|
emtricitabine-tenofovir 200 mg-300 mg Tab [CQCH]
|
Facility
|
OP
|
$48.62
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
105920292
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$43.76 |
| Rate for Payer: Aetna of AZ Commercial |
$43.76
|
| Rate for Payer: Aetna of AZ Medicare |
$13.61
|
| Rate for Payer: Allwell Medicare |
$7.29
|
| Rate for Payer: Amerigroup Medicare |
$7.29
|
| Rate for Payer: APIPA Medicare/Medicaid |
$18.16
|
| Rate for Payer: AZCH Complete Medicare |
$7.29
|
| Rate for Payer: Banner UC Health Medicare |
$7.29
|
| Rate for Payer: Bisbee Police All Plans |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$33.06
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cigna of AZ Commercial |
$31.60
|
| Rate for Payer: Copperpoint Commercial |
$12.03
|
| Rate for Payer: Health Net of AZ Commercial |
$29.17
|
| Rate for Payer: Health Net of AZ Medicare |
$13.61
|
| Rate for Payer: Humana of AZ Medicare |
$7.29
|
| Rate for Payer: Self Pay Self Pay |
$38.90
|
| Rate for Payer: TriWest Medicare |
$7.29
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$28.35
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.75
|
|
