|
.ENA+DNA/DS+Sjorgen's LC
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
1285801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of AZ Commercial |
$201.60
|
| Rate for Payer: Bisbee Police All Plans |
$58.24
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Self Pay Self Pay |
$179.20
|
|
|
.ENA+DNA/DS+Sjorgen's LC
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
1285801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of AZ Commercial |
$201.60
|
| Rate for Payer: Aetna of AZ Medicare |
$62.72
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicare |
$33.60
|
| Rate for Payer: Amerigroup Medicare |
$33.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$83.66
|
| Rate for Payer: AZCH Complete Medicaid |
$17.93
|
| Rate for Payer: AZCH Complete Medicare |
$33.60
|
| Rate for Payer: Banner UC Health Medicaid |
$17.93
|
| Rate for Payer: Banner UC Health Medicare |
$33.60
|
| Rate for Payer: Bisbee Police All Plans |
$58.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$152.32
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cigna of AZ Commercial |
$145.60
|
| Rate for Payer: Copperpoint Commercial |
$55.44
|
| Rate for Payer: Health Net of AZ Commercial |
$134.40
|
| Rate for Payer: Health Net of AZ Medicare |
$62.72
|
| Rate for Payer: Humana of AZ Medicare |
$33.60
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: Self Pay Self Pay |
$179.20
|
| Rate for Payer: TriWest Medicare |
$33.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$130.59
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.32
|
|
|
enalaprilat 1.25 mg inj Sol [CQCH]
|
Facility
|
IP
|
$3.68
|
|
|
Service Code
|
NDC 143978710
|
| Hospital Charge Code |
108072662
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna of AZ Commercial |
$3.31
|
| Rate for Payer: Bisbee Police All Plans |
$0.96
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Self Pay Self Pay |
$2.94
|
|
|
enalaprilat 1.25 mg inj Sol [CQCH]
|
Facility
|
OP
|
$3.68
|
|
|
Service Code
|
NDC 143978710
|
| Hospital Charge Code |
108072662
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna of AZ Commercial |
$3.31
|
| Rate for Payer: Aetna of AZ Medicare |
$1.03
|
| Rate for Payer: Allwell Medicare |
$0.55
|
| Rate for Payer: Amerigroup Medicare |
$0.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.37
|
| Rate for Payer: AZCH Complete Medicare |
$0.55
|
| Rate for Payer: Banner UC Health Medicare |
$0.55
|
| Rate for Payer: Bisbee Police All Plans |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna of AZ Commercial |
$2.39
|
| Rate for Payer: Copperpoint Commercial |
$0.91
|
| Rate for Payer: Health Net of AZ Commercial |
$2.21
|
| Rate for Payer: Health Net of AZ Medicare |
$1.03
|
| Rate for Payer: Humana of AZ Medicare |
$0.55
|
| Rate for Payer: Self Pay Self Pay |
$2.94
|
| Rate for Payer: TriWest Medicare |
$0.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.66
|
|
|
Endocervical Curettage (alone)
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
27281903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$520.20
|
| Rate for Payer: Aetna of AZ Medicare |
$161.84
|
| Rate for Payer: AHCCCS Medicaid |
$918.44
|
| Rate for Payer: Allwell Medicaid |
$918.44
|
| Rate for Payer: Allwell Medicare |
$86.70
|
| Rate for Payer: Amerigroup Medicare |
$86.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$215.88
|
| Rate for Payer: AZCH Complete Medicaid |
$918.44
|
| Rate for Payer: AZCH Complete Medicare |
$86.70
|
| Rate for Payer: Banner UC Health Medicaid |
$918.44
|
| Rate for Payer: Banner UC Health Medicare |
$86.70
|
| Rate for Payer: Bisbee Police All Plans |
$150.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$393.04
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cigna of AZ Commercial |
$289.00
|
| Rate for Payer: Copperpoint Commercial |
$143.06
|
| Rate for Payer: Health Net of AZ Commercial |
$346.80
|
| Rate for Payer: Health Net of AZ Medicare |
$161.84
|
| Rate for Payer: Humana of AZ Medicare |
$86.70
|
| Rate for Payer: Mercy Care Medicaid |
$918.44
|
| Rate for Payer: Self Pay Self Pay |
$462.40
|
| Rate for Payer: TriWest Medicare |
$86.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$104.04
|
|
|
Endocervical Curettage (alone)
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
27281903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$150.28 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Aetna of AZ Commercial |
$520.20
|
| Rate for Payer: Bisbee Police All Plans |
$150.28
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Self Pay Self Pay |
$462.40
|
|
|
ENDO CLIP
|
Facility
|
IP
|
$290.00
|
|
| Hospital Charge Code |
22354200
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of AZ Commercial |
$261.00
|
| Rate for Payer: Bisbee Police All Plans |
$75.40
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Self Pay Self Pay |
$232.00
|
|
|
ENDO CLIP
|
Facility
|
OP
|
$290.00
|
|
| Hospital Charge Code |
22354200
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of AZ Commercial |
$261.00
|
| Rate for Payer: Aetna of AZ Medicare |
$81.20
|
| Rate for Payer: Allwell Medicare |
$43.50
|
| Rate for Payer: Amerigroup Medicare |
$43.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$108.32
|
| Rate for Payer: AZCH Complete Medicare |
$43.50
|
| Rate for Payer: Banner UC Health Medicare |
$43.50
|
| Rate for Payer: Bisbee Police All Plans |
$75.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$197.20
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cigna of AZ Commercial |
$203.00
|
| Rate for Payer: Copperpoint Commercial |
$71.78
|
| Rate for Payer: Health Net of AZ Commercial |
$174.00
|
| Rate for Payer: Health Net of AZ Medicare |
$81.20
|
| Rate for Payer: Humana of AZ Medicare |
$43.50
|
| Rate for Payer: Self Pay Self Pay |
$232.00
|
| Rate for Payer: TriWest Medicare |
$43.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$169.07
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$52.20
|
|
|
ENDOCLOT SIS
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
27537158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna of AZ Commercial |
$472.50
|
| Rate for Payer: Bisbee Police All Plans |
$136.50
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Self Pay Self Pay |
$420.00
|
|
|
ENDOCLOT SIS
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
27537158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna of AZ Commercial |
$472.50
|
| Rate for Payer: Aetna of AZ Medicare |
$147.00
|
| Rate for Payer: Allwell Medicare |
$78.75
|
| Rate for Payer: Amerigroup Medicare |
$78.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$196.09
|
| Rate for Payer: AZCH Complete Medicare |
$78.75
|
| Rate for Payer: Banner UC Health Medicare |
$78.75
|
| Rate for Payer: Bisbee Police All Plans |
$136.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$357.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna of AZ Commercial |
$367.50
|
| Rate for Payer: Copperpoint Commercial |
$129.94
|
| Rate for Payer: Health Net of AZ Commercial |
$315.00
|
| Rate for Payer: Health Net of AZ Medicare |
$147.00
|
| Rate for Payer: Humana of AZ Medicare |
$78.75
|
| Rate for Payer: Self Pay Self Pay |
$420.00
|
| Rate for Payer: TriWest Medicare |
$78.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$306.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$94.50
|
|
|
ENDO KITS (INFECTION PREVENTION)
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
23531708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of AZ Commercial |
$36.00
|
| Rate for Payer: Bisbee Police All Plans |
$10.40
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Self Pay Self Pay |
$32.00
|
|
|
ENDO KITS (INFECTION PREVENTION)
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
23531708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of AZ Commercial |
$36.00
|
| Rate for Payer: Aetna of AZ Medicare |
$11.20
|
| Rate for Payer: Allwell Medicare |
$6.00
|
| Rate for Payer: Amerigroup Medicare |
$6.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$14.94
|
| Rate for Payer: AZCH Complete Medicare |
$6.00
|
| Rate for Payer: Banner UC Health Medicare |
$6.00
|
| Rate for Payer: Bisbee Police All Plans |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna of AZ Commercial |
$28.00
|
| Rate for Payer: Copperpoint Commercial |
$9.90
|
| Rate for Payer: Health Net of AZ Commercial |
$24.00
|
| Rate for Payer: Health Net of AZ Medicare |
$11.20
|
| Rate for Payer: Humana of AZ Medicare |
$6.00
|
| Rate for Payer: Self Pay Self Pay |
$32.00
|
| Rate for Payer: TriWest Medicare |
$6.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$23.32
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.20
|
|
|
Endometrial Ablation hysteroscopic
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
27291806
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,147.50
|
| Rate for Payer: Bisbee Police All Plans |
$331.50
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Self Pay Self Pay |
$1,020.00
|
|
|
Endometrial Ablation hysteroscopic
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
27291806
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$6,393.84 |
| Rate for Payer: Aetna of AZ Commercial |
$1,147.50
|
| Rate for Payer: Aetna of AZ Medicare |
$357.00
|
| Rate for Payer: AHCCCS Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicare |
$191.25
|
| Rate for Payer: Amerigroup Medicare |
$191.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$476.21
|
| Rate for Payer: AZCH Complete Medicaid |
$6,393.84
|
| Rate for Payer: AZCH Complete Medicare |
$191.25
|
| Rate for Payer: Banner UC Health Medicaid |
$6,393.84
|
| Rate for Payer: Banner UC Health Medicare |
$191.25
|
| Rate for Payer: Bisbee Police All Plans |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$867.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna of AZ Commercial |
$637.50
|
| Rate for Payer: Copperpoint Commercial |
$315.56
|
| Rate for Payer: Health Net of AZ Commercial |
$765.00
|
| Rate for Payer: Health Net of AZ Medicare |
$357.00
|
| Rate for Payer: Humana of AZ Medicare |
$191.25
|
| Rate for Payer: Mercy Care Medicaid |
$6,393.84
|
| Rate for Payer: Self Pay Self Pay |
$1,020.00
|
| Rate for Payer: TriWest Medicare |
$191.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$229.50
|
|
|
Endometrial Ablation Thermal
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
27291807
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$326.30 |
| Max. Negotiated Rate |
$1,129.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,129.50
|
| Rate for Payer: Bisbee Police All Plans |
$326.30
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Self Pay Self Pay |
$1,004.00
|
|
|
Endometrial Ablation Thermal
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
27291807
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$6,393.84 |
| Rate for Payer: Aetna of AZ Commercial |
$1,129.50
|
| Rate for Payer: Aetna of AZ Medicare |
$351.40
|
| Rate for Payer: AHCCCS Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicare |
$188.25
|
| Rate for Payer: Amerigroup Medicare |
$188.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$468.74
|
| Rate for Payer: AZCH Complete Medicaid |
$6,393.84
|
| Rate for Payer: AZCH Complete Medicare |
$188.25
|
| Rate for Payer: Banner UC Health Medicaid |
$6,393.84
|
| Rate for Payer: Banner UC Health Medicare |
$188.25
|
| Rate for Payer: Bisbee Police All Plans |
$326.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$853.40
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cigna of AZ Commercial |
$627.50
|
| Rate for Payer: Copperpoint Commercial |
$310.61
|
| Rate for Payer: Health Net of AZ Commercial |
$753.00
|
| Rate for Payer: Health Net of AZ Medicare |
$351.40
|
| Rate for Payer: Humana of AZ Medicare |
$188.25
|
| Rate for Payer: Mercy Care Medicaid |
$6,393.84
|
| Rate for Payer: Self Pay Self Pay |
$1,004.00
|
| Rate for Payer: TriWest Medicare |
$188.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$225.90
|
|
|
ENDOMYSIAL AB
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
22481473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$694.80 |
| Rate for Payer: Aetna of AZ Commercial |
$694.80
|
| Rate for Payer: Bisbee Police All Plans |
$200.72
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Self Pay Self Pay |
$617.60
|
|
|
ENDOMYSIAL AB
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
22481473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$694.80 |
| Rate for Payer: Aetna of AZ Commercial |
$694.80
|
| Rate for Payer: Aetna of AZ Medicare |
$216.16
|
| Rate for Payer: AHCCCS Medicaid |
$12.05
|
| Rate for Payer: Allwell Medicaid |
$12.05
|
| Rate for Payer: Allwell Medicare |
$115.80
|
| Rate for Payer: Amerigroup Medicare |
$115.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$288.34
|
| Rate for Payer: AZCH Complete Medicaid |
$12.05
|
| Rate for Payer: AZCH Complete Medicare |
$115.80
|
| Rate for Payer: Banner UC Health Medicaid |
$12.05
|
| Rate for Payer: Banner UC Health Medicare |
$115.80
|
| Rate for Payer: Bisbee Police All Plans |
$200.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$524.96
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cigna of AZ Commercial |
$501.80
|
| Rate for Payer: Copperpoint Commercial |
$191.07
|
| Rate for Payer: Health Net of AZ Commercial |
$463.20
|
| Rate for Payer: Health Net of AZ Medicare |
$216.16
|
| Rate for Payer: Humana of AZ Medicare |
$115.80
|
| Rate for Payer: Mercy Care Medicaid |
$12.05
|
| Rate for Payer: Self Pay Self Pay |
$617.60
|
| Rate for Payer: TriWest Medicare |
$115.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$450.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$138.96
|
|
|
Endomysial Antibody IgA LC
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2087582
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$694.80 |
| Rate for Payer: Aetna of AZ Commercial |
$694.80
|
| Rate for Payer: Bisbee Police All Plans |
$200.72
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Self Pay Self Pay |
$617.60
|
|
|
Endomysial Antibody IgA LC
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2087582
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$694.80 |
| Rate for Payer: Aetna of AZ Commercial |
$694.80
|
| Rate for Payer: Aetna of AZ Medicare |
$216.16
|
| Rate for Payer: AHCCCS Medicaid |
$12.05
|
| Rate for Payer: Allwell Medicaid |
$12.05
|
| Rate for Payer: Allwell Medicare |
$115.80
|
| Rate for Payer: Amerigroup Medicare |
$115.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$288.34
|
| Rate for Payer: AZCH Complete Medicaid |
$12.05
|
| Rate for Payer: AZCH Complete Medicare |
$115.80
|
| Rate for Payer: Banner UC Health Medicaid |
$12.05
|
| Rate for Payer: Banner UC Health Medicare |
$115.80
|
| Rate for Payer: Bisbee Police All Plans |
$200.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$524.96
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cigna of AZ Commercial |
$501.80
|
| Rate for Payer: Copperpoint Commercial |
$191.07
|
| Rate for Payer: Health Net of AZ Commercial |
$463.20
|
| Rate for Payer: Health Net of AZ Medicare |
$216.16
|
| Rate for Payer: Humana of AZ Medicare |
$115.80
|
| Rate for Payer: Mercy Care Medicaid |
$12.05
|
| Rate for Payer: Self Pay Self Pay |
$617.60
|
| Rate for Payer: TriWest Medicare |
$115.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$450.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$138.96
|
|
|
ENDOPATH ETS45 3.5MM 45MM RELOADS
|
Facility
|
OP
|
$888.00
|
|
| Hospital Charge Code |
23227839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$799.20 |
| Rate for Payer: Aetna of AZ Commercial |
$799.20
|
| Rate for Payer: Aetna of AZ Medicare |
$248.64
|
| Rate for Payer: Allwell Medicare |
$133.20
|
| Rate for Payer: Amerigroup Medicare |
$133.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$331.67
|
| Rate for Payer: AZCH Complete Medicare |
$133.20
|
| Rate for Payer: Banner UC Health Medicare |
$133.20
|
| Rate for Payer: Bisbee Police All Plans |
$230.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$603.84
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna of AZ Commercial |
$621.60
|
| Rate for Payer: Copperpoint Commercial |
$219.78
|
| Rate for Payer: Health Net of AZ Commercial |
$532.80
|
| Rate for Payer: Health Net of AZ Medicare |
$248.64
|
| Rate for Payer: Humana of AZ Medicare |
$133.20
|
| Rate for Payer: Self Pay Self Pay |
$710.40
|
| Rate for Payer: TriWest Medicare |
$133.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$517.70
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$159.84
|
|
|
ENDOPATH ETS45 3.5MM 45MM RELOADS
|
Facility
|
IP
|
$888.00
|
|
| Hospital Charge Code |
23227839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.88 |
| Max. Negotiated Rate |
$799.20 |
| Rate for Payer: Aetna of AZ Commercial |
$799.20
|
| Rate for Payer: Bisbee Police All Plans |
$230.88
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Self Pay Self Pay |
$710.40
|
|
|
ENDOPATH SCISSORS CURVED 5MM W/ MON CAUT
|
Facility
|
OP
|
$1,403.00
|
|
| Hospital Charge Code |
22354144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$210.45 |
| Max. Negotiated Rate |
$1,262.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,262.70
|
| Rate for Payer: Aetna of AZ Medicare |
$392.84
|
| Rate for Payer: Allwell Medicare |
$210.45
|
| Rate for Payer: Amerigroup Medicare |
$210.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$524.02
|
| Rate for Payer: AZCH Complete Medicare |
$210.45
|
| Rate for Payer: Banner UC Health Medicare |
$210.45
|
| Rate for Payer: Bisbee Police All Plans |
$364.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$954.04
|
| Rate for Payer: Cash Price |
$1,122.40
|
| Rate for Payer: Cigna of AZ Commercial |
$982.10
|
| Rate for Payer: Copperpoint Commercial |
$347.24
|
| Rate for Payer: Health Net of AZ Commercial |
$841.80
|
| Rate for Payer: Health Net of AZ Medicare |
$392.84
|
| Rate for Payer: Humana of AZ Medicare |
$210.45
|
| Rate for Payer: Self Pay Self Pay |
$1,122.40
|
| Rate for Payer: TriWest Medicare |
$210.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$817.95
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$252.54
|
|
|
ENDOPATH SCISSORS CURVED 5MM W/ MON CAUT
|
Facility
|
IP
|
$1,403.00
|
|
| Hospital Charge Code |
22354144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$364.78 |
| Max. Negotiated Rate |
$1,262.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,262.70
|
| Rate for Payer: Bisbee Police All Plans |
$364.78
|
| Rate for Payer: Cash Price |
$1,122.40
|
| Rate for Payer: Self Pay Self Pay |
$1,122.40
|
|
|
ENDOPOUCH RETRIEVER
|
Facility
|
OP
|
$896.00
|
|
| Hospital Charge Code |
22560772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna of AZ Commercial |
$806.40
|
| Rate for Payer: Aetna of AZ Medicare |
$250.88
|
| Rate for Payer: Allwell Medicare |
$134.40
|
| Rate for Payer: Amerigroup Medicare |
$134.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$334.66
|
| Rate for Payer: AZCH Complete Medicare |
$134.40
|
| Rate for Payer: Banner UC Health Medicare |
$134.40
|
| Rate for Payer: Bisbee Police All Plans |
$232.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$609.28
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Cigna of AZ Commercial |
$627.20
|
| Rate for Payer: Copperpoint Commercial |
$221.76
|
| Rate for Payer: Health Net of AZ Commercial |
$537.60
|
| Rate for Payer: Health Net of AZ Medicare |
$250.88
|
| Rate for Payer: Humana of AZ Medicare |
$134.40
|
| Rate for Payer: Self Pay Self Pay |
$716.80
|
| Rate for Payer: TriWest Medicare |
$134.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$522.37
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$161.28
|
|
