|
.GTT-1 Hr
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1160798
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna of AZ Commercial |
$246.60
|
| Rate for Payer: Aetna of AZ Medicare |
$76.72
|
| Rate for Payer: AHCCCS Medicaid |
$3.92
|
| Rate for Payer: Allwell Medicaid |
$3.92
|
| Rate for Payer: Allwell Medicare |
$41.10
|
| Rate for Payer: Amerigroup Medicare |
$41.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$102.34
|
| Rate for Payer: AZCH Complete Medicaid |
$3.92
|
| Rate for Payer: AZCH Complete Medicare |
$41.10
|
| Rate for Payer: Banner UC Health Medicaid |
$3.92
|
| Rate for Payer: Banner UC Health Medicare |
$41.10
|
| Rate for Payer: Bisbee Police All Plans |
$71.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$186.32
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cigna of AZ Commercial |
$178.10
|
| Rate for Payer: Copperpoint Commercial |
$67.82
|
| Rate for Payer: Health Net of AZ Commercial |
$164.40
|
| Rate for Payer: Health Net of AZ Medicare |
$76.72
|
| Rate for Payer: Humana of AZ Medicare |
$41.10
|
| Rate for Payer: Mercy Care Medicaid |
$3.92
|
| Rate for Payer: Self Pay Self Pay |
$219.20
|
| Rate for Payer: TriWest Medicare |
$41.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$159.74
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$49.32
|
|
|
.GTT-1 Hr
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1160798
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna of AZ Commercial |
$246.60
|
| Rate for Payer: Bisbee Police All Plans |
$71.24
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Self Pay Self Pay |
$219.20
|
|
|
.GTT-2 Hr
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
1160799
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of AZ Commercial |
$255.60
|
| Rate for Payer: Bisbee Police All Plans |
$73.84
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Self Pay Self Pay |
$227.20
|
|
|
.GTT-2 Hr
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
1160799
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of AZ Commercial |
$255.60
|
| Rate for Payer: Aetna of AZ Medicare |
$79.52
|
| Rate for Payer: AHCCCS Medicaid |
$12.87
|
| Rate for Payer: Allwell Medicaid |
$12.87
|
| Rate for Payer: Allwell Medicare |
$42.60
|
| Rate for Payer: Amerigroup Medicare |
$42.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$106.07
|
| Rate for Payer: AZCH Complete Medicaid |
$12.87
|
| Rate for Payer: AZCH Complete Medicare |
$42.60
|
| Rate for Payer: Banner UC Health Medicaid |
$12.87
|
| Rate for Payer: Banner UC Health Medicare |
$42.60
|
| Rate for Payer: Bisbee Police All Plans |
$73.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$193.12
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cigna of AZ Commercial |
$184.60
|
| Rate for Payer: Copperpoint Commercial |
$70.29
|
| Rate for Payer: Health Net of AZ Commercial |
$170.40
|
| Rate for Payer: Health Net of AZ Medicare |
$79.52
|
| Rate for Payer: Humana of AZ Medicare |
$42.60
|
| Rate for Payer: Mercy Care Medicaid |
$12.87
|
| Rate for Payer: Self Pay Self Pay |
$227.20
|
| Rate for Payer: TriWest Medicare |
$42.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$165.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$51.12
|
|
|
.GTT 2Hr Post Prandial
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
1165876
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of AZ Commercial |
$74.70
|
| Rate for Payer: Aetna of AZ Medicare |
$23.24
|
| Rate for Payer: AHCCCS Medicaid |
$4.75
|
| Rate for Payer: Allwell Medicaid |
$4.75
|
| Rate for Payer: Allwell Medicare |
$12.45
|
| Rate for Payer: Amerigroup Medicare |
$12.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$31.00
|
| Rate for Payer: AZCH Complete Medicaid |
$4.75
|
| Rate for Payer: AZCH Complete Medicare |
$12.45
|
| Rate for Payer: Banner UC Health Medicaid |
$4.75
|
| Rate for Payer: Banner UC Health Medicare |
$12.45
|
| Rate for Payer: Bisbee Police All Plans |
$21.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$56.44
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cigna of AZ Commercial |
$53.95
|
| Rate for Payer: Copperpoint Commercial |
$20.54
|
| Rate for Payer: Health Net of AZ Commercial |
$49.80
|
| Rate for Payer: Health Net of AZ Medicare |
$23.24
|
| Rate for Payer: Humana of AZ Medicare |
$12.45
|
| Rate for Payer: Mercy Care Medicaid |
$4.75
|
| Rate for Payer: Self Pay Self Pay |
$66.40
|
| Rate for Payer: TriWest Medicare |
$12.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$48.39
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.94
|
|
|
.GTT 2Hr Post Prandial
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
1165876
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of AZ Commercial |
$74.70
|
| Rate for Payer: Bisbee Police All Plans |
$21.58
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Self Pay Self Pay |
$66.40
|
|
|
GTT 3-Hour
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
10349371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of AZ Commercial |
$255.60
|
| Rate for Payer: Aetna of AZ Medicare |
$79.52
|
| Rate for Payer: AHCCCS Medicaid |
$12.87
|
| Rate for Payer: Allwell Medicaid |
$12.87
|
| Rate for Payer: Allwell Medicare |
$42.60
|
| Rate for Payer: Amerigroup Medicare |
$42.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$106.07
|
| Rate for Payer: AZCH Complete Medicaid |
$12.87
|
| Rate for Payer: AZCH Complete Medicare |
$42.60
|
| Rate for Payer: Banner UC Health Medicaid |
$12.87
|
| Rate for Payer: Banner UC Health Medicare |
$42.60
|
| Rate for Payer: Bisbee Police All Plans |
$73.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$193.12
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cigna of AZ Commercial |
$184.60
|
| Rate for Payer: Copperpoint Commercial |
$70.29
|
| Rate for Payer: Health Net of AZ Commercial |
$170.40
|
| Rate for Payer: Health Net of AZ Medicare |
$79.52
|
| Rate for Payer: Humana of AZ Medicare |
$42.60
|
| Rate for Payer: Mercy Care Medicaid |
$12.87
|
| Rate for Payer: Self Pay Self Pay |
$227.20
|
| Rate for Payer: TriWest Medicare |
$42.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$165.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$51.12
|
|
|
GTT 3-Hour
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
10349371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of AZ Commercial |
$255.60
|
| Rate for Payer: Bisbee Police All Plans |
$73.84
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Self Pay Self Pay |
$227.20
|
|
|
GTT Each Add
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
22525225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Aetna of AZ Medicare |
$9.24
|
| Rate for Payer: AHCCCS Medicaid |
$3.92
|
| Rate for Payer: Allwell Medicaid |
$3.92
|
| Rate for Payer: Allwell Medicare |
$4.95
|
| Rate for Payer: Amerigroup Medicare |
$4.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$12.33
|
| Rate for Payer: AZCH Complete Medicaid |
$3.92
|
| Rate for Payer: AZCH Complete Medicare |
$4.95
|
| Rate for Payer: Banner UC Health Medicaid |
$3.92
|
| Rate for Payer: Banner UC Health Medicare |
$4.95
|
| Rate for Payer: Bisbee Police All Plans |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$22.44
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of AZ Commercial |
$21.45
|
| Rate for Payer: Copperpoint Commercial |
$8.17
|
| Rate for Payer: Health Net of AZ Commercial |
$19.80
|
| Rate for Payer: Health Net of AZ Medicare |
$9.24
|
| Rate for Payer: Humana of AZ Medicare |
$4.95
|
| Rate for Payer: Mercy Care Medicaid |
$3.92
|
| Rate for Payer: Self Pay Self Pay |
$26.40
|
| Rate for Payer: TriWest Medicare |
$4.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$19.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.94
|
|
|
GTT Each Add
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
22525225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Bisbee Police All Plans |
$8.58
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Self Pay Self Pay |
$26.40
|
|
|
GTT OB 3 Hour
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
22283156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of AZ Commercial |
$268.20
|
| Rate for Payer: Aetna of AZ Medicare |
$83.44
|
| Rate for Payer: AHCCCS Medicaid |
$12.87
|
| Rate for Payer: Allwell Medicaid |
$12.87
|
| Rate for Payer: Allwell Medicare |
$44.70
|
| Rate for Payer: Amerigroup Medicare |
$44.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$111.30
|
| Rate for Payer: AZCH Complete Medicaid |
$12.87
|
| Rate for Payer: AZCH Complete Medicare |
$44.70
|
| Rate for Payer: Banner UC Health Medicaid |
$12.87
|
| Rate for Payer: Banner UC Health Medicare |
$44.70
|
| Rate for Payer: Bisbee Police All Plans |
$77.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$202.64
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cigna of AZ Commercial |
$193.70
|
| Rate for Payer: Copperpoint Commercial |
$73.76
|
| Rate for Payer: Health Net of AZ Commercial |
$178.80
|
| Rate for Payer: Health Net of AZ Medicare |
$83.44
|
| Rate for Payer: Humana of AZ Medicare |
$44.70
|
| Rate for Payer: Mercy Care Medicaid |
$12.87
|
| Rate for Payer: Self Pay Self Pay |
$238.40
|
| Rate for Payer: TriWest Medicare |
$44.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$173.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$53.64
|
|
|
GTT OB 3 Hour
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
22283156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.48 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of AZ Commercial |
$268.20
|
| Rate for Payer: Bisbee Police All Plans |
$77.48
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Self Pay Self Pay |
$238.40
|
|
|
guaiFENesin 100 mg/5 mL UD Oral Liq [CQCH]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 121174405
|
| Hospital Charge Code |
105925028
|
|
Hospital Revenue Code
|
251
|
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of AZ Commercial |
$0.03
|
| Rate for Payer: Aetna of AZ Medicare |
$0.01
|
| Rate for Payer: Allwell Medicare |
$0.00
|
| Rate for Payer: Amerigroup Medicare |
$0.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.01
|
| Rate for Payer: AZCH Complete Medicare |
$0.00
|
| Rate for Payer: Banner UC Health Medicare |
$0.00
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of AZ Commercial |
$0.02
|
| Rate for Payer: Copperpoint Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Medicare |
$0.01
|
| Rate for Payer: Humana of AZ Medicare |
$0.00
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
| Rate for Payer: TriWest Medicare |
$0.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
guaiFENesin 100 mg/5 mL UD Oral Liq [CQCH]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 121174405
|
| Hospital Charge Code |
105925028
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of AZ Commercial |
$0.03
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
|
|
guaiFENesin 600 mg ER Tablet [CQCH]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 63824000834
|
| Hospital Charge Code |
105924961
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of AZ Commercial |
$0.30
|
| Rate for Payer: Bisbee Police All Plans |
$0.09
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Self Pay Self Pay |
$0.26
|
|
|
guaiFENesin 600 mg ER Tablet [CQCH]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 63824000834
|
| Hospital Charge Code |
105924961
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of AZ Commercial |
$0.30
|
| Rate for Payer: Aetna of AZ Medicare |
$0.09
|
| Rate for Payer: Allwell Medicare |
$0.05
|
| Rate for Payer: Amerigroup Medicare |
$0.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.12
|
| Rate for Payer: AZCH Complete Medicare |
$0.05
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of AZ Commercial |
$0.21
|
| Rate for Payer: Copperpoint Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Commercial |
$0.20
|
| Rate for Payer: Health Net of AZ Medicare |
$0.09
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.26
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.06
|
|
|
guaiFENesin-dextromethorphan 100 mg-10 mg/5 mL UD Oral Liq [CQCH]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 121063805
|
| Hospital Charge Code |
105918158
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of AZ Commercial |
$0.12
|
| Rate for Payer: Aetna of AZ Medicare |
$0.04
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.05
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of AZ Commercial |
$0.08
|
| Rate for Payer: Copperpoint Commercial |
$0.03
|
| Rate for Payer: Health Net of AZ Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Medicare |
$0.04
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.10
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
|
guaiFENesin-dextromethorphan 100 mg-10 mg/5 mL UD Oral Liq [CQCH]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 121063805
|
| Hospital Charge Code |
105918158
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of AZ Commercial |
$0.12
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Self Pay Self Pay |
$0.10
|
|
|
GUIDEWIRE HI WIRE NITINOL CORE
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
22354824
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of AZ Commercial |
$137.70
|
| Rate for Payer: Bisbee Police All Plans |
$39.78
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Self Pay Self Pay |
$122.40
|
|
|
GUIDEWIRE HI WIRE NITINOL CORE
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
22354824
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of AZ Commercial |
$137.70
|
| Rate for Payer: Aetna of AZ Medicare |
$42.84
|
| Rate for Payer: Allwell Medicare |
$22.95
|
| Rate for Payer: Amerigroup Medicare |
$22.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$57.15
|
| Rate for Payer: AZCH Complete Medicare |
$22.95
|
| Rate for Payer: Banner UC Health Medicare |
$22.95
|
| Rate for Payer: Bisbee Police All Plans |
$39.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$104.04
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna of AZ Commercial |
$107.10
|
| Rate for Payer: Copperpoint Commercial |
$37.87
|
| Rate for Payer: Health Net of AZ Commercial |
$91.80
|
| Rate for Payer: Health Net of AZ Medicare |
$42.84
|
| Rate for Payer: Humana of AZ Medicare |
$22.95
|
| Rate for Payer: Self Pay Self Pay |
$122.40
|
| Rate for Payer: TriWest Medicare |
$22.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$89.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$27.54
|
|
|
GUIDE WIRE SMOOTH .82 X 90MM DOUBLE POINT
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
24127799
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna of AZ Commercial |
$80.10
|
| Rate for Payer: Bisbee Police All Plans |
$23.14
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Self Pay Self Pay |
$71.20
|
|
|
GUIDE WIRE SMOOTH .82 X 90MM DOUBLE POINT
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
24127799
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna of AZ Commercial |
$80.10
|
| Rate for Payer: Aetna of AZ Medicare |
$24.92
|
| Rate for Payer: Allwell Medicare |
$13.35
|
| Rate for Payer: Amerigroup Medicare |
$13.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$33.24
|
| Rate for Payer: AZCH Complete Medicare |
$13.35
|
| Rate for Payer: Banner UC Health Medicare |
$13.35
|
| Rate for Payer: Bisbee Police All Plans |
$23.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$60.52
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cigna of AZ Commercial |
$62.30
|
| Rate for Payer: Copperpoint Commercial |
$22.03
|
| Rate for Payer: Health Net of AZ Commercial |
$53.40
|
| Rate for Payer: Health Net of AZ Medicare |
$24.92
|
| Rate for Payer: Humana of AZ Medicare |
$13.35
|
| Rate for Payer: Self Pay Self Pay |
$71.20
|
| Rate for Payer: TriWest Medicare |
$13.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$51.89
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$16.02
|
|
|
GYRUS ACMI SOF CURL URETERAL STENT 6.X24
|
Facility
|
IP
|
$720.00
|
|
| Hospital Charge Code |
22354135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of AZ Commercial |
$648.00
|
| Rate for Payer: Bisbee Police All Plans |
$187.20
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Self Pay Self Pay |
$576.00
|
|
|
GYRUS ACMI SOF CURL URETERAL STENT 6.X24
|
Facility
|
OP
|
$720.00
|
|
| Hospital Charge Code |
22354135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of AZ Commercial |
$648.00
|
| Rate for Payer: Aetna of AZ Medicare |
$201.60
|
| Rate for Payer: Allwell Medicare |
$108.00
|
| Rate for Payer: Amerigroup Medicare |
$108.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$268.92
|
| Rate for Payer: AZCH Complete Medicare |
$108.00
|
| Rate for Payer: Banner UC Health Medicare |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$489.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna of AZ Commercial |
$504.00
|
| Rate for Payer: Copperpoint Commercial |
$178.20
|
| Rate for Payer: Health Net of AZ Commercial |
$432.00
|
| Rate for Payer: Health Net of AZ Medicare |
$201.60
|
| Rate for Payer: Humana of AZ Medicare |
$108.00
|
| Rate for Payer: Self Pay Self Pay |
$576.00
|
| Rate for Payer: TriWest Medicare |
$108.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$419.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$129.60
|
|
|
GYRUS ACMI SOF CURL URETERAL STENT 6.X26
|
Facility
|
IP
|
$720.00
|
|
| Hospital Charge Code |
22354136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of AZ Commercial |
$648.00
|
| Rate for Payer: Bisbee Police All Plans |
$187.20
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Self Pay Self Pay |
$576.00
|
|
