|
GYRUS ACMI SOF CURL URETERAL STENT 6.X26
|
Facility
|
OP
|
$720.00
|
|
| Hospital Charge Code |
22354136
|
|
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 SUR CATCH NT BASKET 2.2FR
|
Facility
|
IP
|
$823.00
|
|
| Hospital Charge Code |
22354137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$213.98 |
| Max. Negotiated Rate |
$740.70 |
| Rate for Payer: Aetna of AZ Commercial |
$740.70
|
| Rate for Payer: Bisbee Police All Plans |
$213.98
|
| Rate for Payer: Cash Price |
$658.40
|
| Rate for Payer: Self Pay Self Pay |
$658.40
|
|
|
GYRUS ACMI SUR CATCH NT BASKET 2.2FR
|
Facility
|
OP
|
$823.00
|
|
| Hospital Charge Code |
22354137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$740.70 |
| Rate for Payer: Aetna of AZ Commercial |
$740.70
|
| Rate for Payer: Aetna of AZ Medicare |
$230.44
|
| Rate for Payer: Allwell Medicare |
$123.45
|
| Rate for Payer: Amerigroup Medicare |
$123.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$307.39
|
| Rate for Payer: AZCH Complete Medicare |
$123.45
|
| Rate for Payer: Banner UC Health Medicare |
$123.45
|
| Rate for Payer: Bisbee Police All Plans |
$213.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$559.64
|
| Rate for Payer: Cash Price |
$658.40
|
| Rate for Payer: Cigna of AZ Commercial |
$576.10
|
| Rate for Payer: Copperpoint Commercial |
$203.69
|
| Rate for Payer: Health Net of AZ Commercial |
$493.80
|
| Rate for Payer: Health Net of AZ Medicare |
$230.44
|
| Rate for Payer: Humana of AZ Medicare |
$123.45
|
| Rate for Payer: Self Pay Self Pay |
$658.40
|
| Rate for Payer: TriWest Medicare |
$123.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$479.81
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$148.14
|
|
|
GYRUS CUTTING FORCEPS 10MM
|
Facility
|
OP
|
$2,409.00
|
|
| Hospital Charge Code |
22354831
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$361.35 |
| Max. Negotiated Rate |
$2,168.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,168.10
|
| Rate for Payer: Aetna of AZ Medicare |
$674.52
|
| Rate for Payer: Allwell Medicare |
$361.35
|
| Rate for Payer: Amerigroup Medicare |
$361.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$899.76
|
| Rate for Payer: AZCH Complete Medicare |
$361.35
|
| Rate for Payer: Banner UC Health Medicare |
$361.35
|
| Rate for Payer: Bisbee Police All Plans |
$626.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,638.12
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,686.30
|
| Rate for Payer: Copperpoint Commercial |
$596.23
|
| Rate for Payer: Health Net of AZ Commercial |
$1,445.40
|
| Rate for Payer: Health Net of AZ Medicare |
$674.52
|
| Rate for Payer: Humana of AZ Medicare |
$361.35
|
| Rate for Payer: Self Pay Self Pay |
$1,927.20
|
| Rate for Payer: TriWest Medicare |
$361.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,404.45
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$433.62
|
|
|
GYRUS CUTTING FORCEPS 10MM
|
Facility
|
IP
|
$2,409.00
|
|
| Hospital Charge Code |
22354831
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$626.34 |
| Max. Negotiated Rate |
$2,168.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,168.10
|
| Rate for Payer: Bisbee Police All Plans |
$626.34
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Self Pay Self Pay |
$1,927.20
|
|
|
GYRUS CUTTING FORCEPS 5MM
|
Facility
|
OP
|
$1,665.00
|
|
| Hospital Charge Code |
22354830
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$249.75 |
| Max. Negotiated Rate |
$1,498.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,498.50
|
| Rate for Payer: Aetna of AZ Medicare |
$466.20
|
| Rate for Payer: Allwell Medicare |
$249.75
|
| Rate for Payer: Amerigroup Medicare |
$249.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$621.88
|
| Rate for Payer: AZCH Complete Medicare |
$249.75
|
| Rate for Payer: Banner UC Health Medicare |
$249.75
|
| Rate for Payer: Bisbee Police All Plans |
$432.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,132.20
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,165.50
|
| Rate for Payer: Copperpoint Commercial |
$412.09
|
| Rate for Payer: Health Net of AZ Commercial |
$999.00
|
| Rate for Payer: Health Net of AZ Medicare |
$466.20
|
| Rate for Payer: Humana of AZ Medicare |
$249.75
|
| Rate for Payer: Self Pay Self Pay |
$1,332.00
|
| Rate for Payer: TriWest Medicare |
$249.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$970.70
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$299.70
|
|
|
GYRUS CUTTING FORCEPS 5MM
|
Facility
|
IP
|
$1,665.00
|
|
| Hospital Charge Code |
22354830
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$432.90 |
| Max. Negotiated Rate |
$1,498.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,498.50
|
| Rate for Payer: Bisbee Police All Plans |
$432.90
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Self Pay Self Pay |
$1,332.00
|
|
|
GYRUS LAP SPATULA
|
Facility
|
IP
|
$981.00
|
|
| Hospital Charge Code |
22354817
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$255.06 |
| Max. Negotiated Rate |
$882.90 |
| Rate for Payer: Aetna of AZ Commercial |
$882.90
|
| Rate for Payer: Bisbee Police All Plans |
$255.06
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Self Pay Self Pay |
$784.80
|
|
|
GYRUS LAP SPATULA
|
Facility
|
OP
|
$981.00
|
|
| Hospital Charge Code |
22354817
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$882.90 |
| Rate for Payer: Aetna of AZ Commercial |
$882.90
|
| Rate for Payer: Aetna of AZ Medicare |
$274.68
|
| Rate for Payer: Allwell Medicare |
$147.15
|
| Rate for Payer: Amerigroup Medicare |
$147.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$366.40
|
| Rate for Payer: AZCH Complete Medicare |
$147.15
|
| Rate for Payer: Banner UC Health Medicare |
$147.15
|
| Rate for Payer: Bisbee Police All Plans |
$255.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$667.08
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna of AZ Commercial |
$686.70
|
| Rate for Payer: Copperpoint Commercial |
$242.80
|
| Rate for Payer: Health Net of AZ Commercial |
$588.60
|
| Rate for Payer: Health Net of AZ Medicare |
$274.68
|
| Rate for Payer: Humana of AZ Medicare |
$147.15
|
| Rate for Payer: Self Pay Self Pay |
$784.80
|
| Rate for Payer: TriWest Medicare |
$147.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$571.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$176.58
|
|
|
GYRUS SUPERLOOP
|
Facility
|
OP
|
$1,686.00
|
|
| Hospital Charge Code |
22354814
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$252.90 |
| Max. Negotiated Rate |
$1,517.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,517.40
|
| Rate for Payer: Aetna of AZ Medicare |
$472.08
|
| Rate for Payer: Allwell Medicare |
$252.90
|
| Rate for Payer: Amerigroup Medicare |
$252.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$629.72
|
| Rate for Payer: AZCH Complete Medicare |
$252.90
|
| Rate for Payer: Banner UC Health Medicare |
$252.90
|
| Rate for Payer: Bisbee Police All Plans |
$438.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,146.48
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,180.20
|
| Rate for Payer: Copperpoint Commercial |
$417.28
|
| Rate for Payer: Health Net of AZ Commercial |
$1,011.60
|
| Rate for Payer: Health Net of AZ Medicare |
$472.08
|
| Rate for Payer: Humana of AZ Medicare |
$252.90
|
| Rate for Payer: Self Pay Self Pay |
$1,348.80
|
| Rate for Payer: TriWest Medicare |
$252.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$982.94
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$303.48
|
|
|
GYRUS SUPERLOOP
|
Facility
|
IP
|
$1,686.00
|
|
| Hospital Charge Code |
22354814
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$438.36 |
| Max. Negotiated Rate |
$1,517.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,517.40
|
| Rate for Payer: Bisbee Police All Plans |
$438.36
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Self Pay Self Pay |
$1,348.80
|
|
|
GYRUS SUPERSECT
|
Facility
|
OP
|
$1,681.00
|
|
| Hospital Charge Code |
22354816
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$252.15 |
| Max. Negotiated Rate |
$1,512.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,512.90
|
| Rate for Payer: Aetna of AZ Medicare |
$470.68
|
| Rate for Payer: Allwell Medicare |
$252.15
|
| Rate for Payer: Amerigroup Medicare |
$252.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$627.85
|
| Rate for Payer: AZCH Complete Medicare |
$252.15
|
| Rate for Payer: Banner UC Health Medicare |
$252.15
|
| Rate for Payer: Bisbee Police All Plans |
$437.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,143.08
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,176.70
|
| Rate for Payer: Copperpoint Commercial |
$416.05
|
| Rate for Payer: Health Net of AZ Commercial |
$1,008.60
|
| Rate for Payer: Health Net of AZ Medicare |
$470.68
|
| Rate for Payer: Humana of AZ Medicare |
$252.15
|
| Rate for Payer: Self Pay Self Pay |
$1,344.80
|
| Rate for Payer: TriWest Medicare |
$252.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$980.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$302.58
|
|
|
GYRUS SUPERSECT
|
Facility
|
IP
|
$1,681.00
|
|
| Hospital Charge Code |
22354816
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$437.06 |
| Max. Negotiated Rate |
$1,512.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,512.90
|
| Rate for Payer: Bisbee Police All Plans |
$437.06
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Self Pay Self Pay |
$1,344.80
|
|
|
HALLU LOCK C PLACE SIZE 2 RIGHT
|
Facility
|
OP
|
$8,175.00
|
|
| Hospital Charge Code |
27595621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,226.25 |
| Max. Negotiated Rate |
$7,357.50 |
| Rate for Payer: Aetna of AZ Commercial |
$7,357.50
|
| Rate for Payer: Aetna of AZ Medicare |
$2,289.00
|
| Rate for Payer: Allwell Medicare |
$1,226.25
|
| Rate for Payer: Amerigroup Medicare |
$1,226.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3,053.36
|
| Rate for Payer: AZCH Complete Medicare |
$1,226.25
|
| Rate for Payer: Banner UC Health Medicare |
$1,226.25
|
| Rate for Payer: Bisbee Police All Plans |
$2,125.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5,559.00
|
| Rate for Payer: Cash Price |
$6,540.00
|
| Rate for Payer: Cigna of AZ Commercial |
$5,722.50
|
| Rate for Payer: Copperpoint Commercial |
$2,023.31
|
| Rate for Payer: Health Net of AZ Commercial |
$4,905.00
|
| Rate for Payer: Health Net of AZ Medicare |
$2,289.00
|
| Rate for Payer: Humana of AZ Medicare |
$1,226.25
|
| Rate for Payer: Self Pay Self Pay |
$6,540.00
|
| Rate for Payer: TriWest Medicare |
$1,226.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4,766.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,471.50
|
|
|
HALLU LOCK C PLACE SIZE 2 RIGHT
|
Facility
|
IP
|
$8,175.00
|
|
| Hospital Charge Code |
27595621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,125.50 |
| Max. Negotiated Rate |
$7,357.50 |
| Rate for Payer: Aetna of AZ Commercial |
$7,357.50
|
| Rate for Payer: Bisbee Police All Plans |
$2,125.50
|
| Rate for Payer: Cash Price |
$6,540.00
|
| Rate for Payer: Self Pay Self Pay |
$6,540.00
|
|
|
HALLU LOCK C PLATE SIZE 0 LEFT
|
Facility
|
IP
|
$4,087.00
|
|
| Hospital Charge Code |
27341819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,062.62 |
| Max. Negotiated Rate |
$3,678.30 |
| Rate for Payer: Aetna of AZ Commercial |
$3,678.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,062.62
|
| Rate for Payer: Cash Price |
$3,269.60
|
| Rate for Payer: Self Pay Self Pay |
$3,269.60
|
|
|
HALLU LOCK C PLATE SIZE 0 LEFT
|
Facility
|
OP
|
$4,087.00
|
|
| Hospital Charge Code |
27341819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$613.05 |
| Max. Negotiated Rate |
$3,678.30 |
| Rate for Payer: Aetna of AZ Commercial |
$3,678.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,144.36
|
| Rate for Payer: Allwell Medicare |
$613.05
|
| Rate for Payer: Amerigroup Medicare |
$613.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,526.49
|
| Rate for Payer: AZCH Complete Medicare |
$613.05
|
| Rate for Payer: Banner UC Health Medicare |
$613.05
|
| Rate for Payer: Bisbee Police All Plans |
$1,062.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,779.16
|
| Rate for Payer: Cash Price |
$3,269.60
|
| Rate for Payer: Cigna of AZ Commercial |
$2,860.90
|
| Rate for Payer: Copperpoint Commercial |
$1,011.53
|
| Rate for Payer: Health Net of AZ Commercial |
$2,452.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,144.36
|
| Rate for Payer: Humana of AZ Medicare |
$613.05
|
| Rate for Payer: Self Pay Self Pay |
$3,269.60
|
| Rate for Payer: TriWest Medicare |
$613.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,382.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$735.66
|
|
|
HALLU LOCK C PLATE SIZE 0 RIGHT
|
Facility
|
OP
|
$4,087.00
|
|
| Hospital Charge Code |
27340121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$613.05 |
| Max. Negotiated Rate |
$3,678.30 |
| Rate for Payer: Aetna of AZ Commercial |
$3,678.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,144.36
|
| Rate for Payer: Allwell Medicare |
$613.05
|
| Rate for Payer: Amerigroup Medicare |
$613.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,526.49
|
| Rate for Payer: AZCH Complete Medicare |
$613.05
|
| Rate for Payer: Banner UC Health Medicare |
$613.05
|
| Rate for Payer: Bisbee Police All Plans |
$1,062.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,779.16
|
| Rate for Payer: Cash Price |
$3,269.60
|
| Rate for Payer: Cigna of AZ Commercial |
$2,860.90
|
| Rate for Payer: Copperpoint Commercial |
$1,011.53
|
| Rate for Payer: Health Net of AZ Commercial |
$2,452.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,144.36
|
| Rate for Payer: Humana of AZ Medicare |
$613.05
|
| Rate for Payer: Self Pay Self Pay |
$3,269.60
|
| Rate for Payer: TriWest Medicare |
$613.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,382.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$735.66
|
|
|
HALLU LOCK C PLATE SIZE 0 RIGHT
|
Facility
|
IP
|
$4,087.00
|
|
| Hospital Charge Code |
27340121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,062.62 |
| Max. Negotiated Rate |
$3,678.30 |
| Rate for Payer: Aetna of AZ Commercial |
$3,678.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,062.62
|
| Rate for Payer: Cash Price |
$3,269.60
|
| Rate for Payer: Self Pay Self Pay |
$3,269.60
|
|
|
HALLU LOCK C PLATE SIZE 1 RIGHT
|
Facility
|
OP
|
$8,174.00
|
|
| Hospital Charge Code |
24415636
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,226.10 |
| Max. Negotiated Rate |
$7,356.60 |
| Rate for Payer: Aetna of AZ Commercial |
$7,356.60
|
| Rate for Payer: Aetna of AZ Medicare |
$2,288.72
|
| Rate for Payer: Allwell Medicare |
$1,226.10
|
| Rate for Payer: Amerigroup Medicare |
$1,226.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3,052.99
|
| Rate for Payer: AZCH Complete Medicare |
$1,226.10
|
| Rate for Payer: Banner UC Health Medicare |
$1,226.10
|
| Rate for Payer: Bisbee Police All Plans |
$2,125.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5,558.32
|
| Rate for Payer: Cash Price |
$6,539.20
|
| Rate for Payer: Cigna of AZ Commercial |
$5,721.80
|
| Rate for Payer: Copperpoint Commercial |
$2,023.06
|
| Rate for Payer: Health Net of AZ Commercial |
$4,904.40
|
| Rate for Payer: Health Net of AZ Medicare |
$2,288.72
|
| Rate for Payer: Humana of AZ Medicare |
$1,226.10
|
| Rate for Payer: Self Pay Self Pay |
$6,539.20
|
| Rate for Payer: TriWest Medicare |
$1,226.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4,765.44
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,471.32
|
|
|
HALLU LOCK C PLATE SIZE 1 RIGHT
|
Facility
|
IP
|
$8,174.00
|
|
| Hospital Charge Code |
24415636
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,125.24 |
| Max. Negotiated Rate |
$7,356.60 |
| Rate for Payer: Aetna of AZ Commercial |
$7,356.60
|
| Rate for Payer: Bisbee Police All Plans |
$2,125.24
|
| Rate for Payer: Cash Price |
$6,539.20
|
| Rate for Payer: Self Pay Self Pay |
$6,539.20
|
|
|
HALLULOCK R S PLATE 5 DEGREE
|
Facility
|
OP
|
$8,997.00
|
|
| Hospital Charge Code |
27663803
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,349.55 |
| Max. Negotiated Rate |
$8,097.30 |
| Rate for Payer: Aetna of AZ Commercial |
$8,097.30
|
| Rate for Payer: Aetna of AZ Medicare |
$2,519.16
|
| Rate for Payer: Allwell Medicare |
$1,349.55
|
| Rate for Payer: Amerigroup Medicare |
$1,349.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3,360.38
|
| Rate for Payer: AZCH Complete Medicare |
$1,349.55
|
| Rate for Payer: Banner UC Health Medicare |
$1,349.55
|
| Rate for Payer: Bisbee Police All Plans |
$2,339.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6,117.96
|
| Rate for Payer: Cash Price |
$7,197.60
|
| Rate for Payer: Cigna of AZ Commercial |
$6,297.90
|
| Rate for Payer: Copperpoint Commercial |
$2,226.76
|
| Rate for Payer: Health Net of AZ Commercial |
$5,398.20
|
| Rate for Payer: Health Net of AZ Medicare |
$2,519.16
|
| Rate for Payer: Humana of AZ Medicare |
$1,349.55
|
| Rate for Payer: Self Pay Self Pay |
$7,197.60
|
| Rate for Payer: TriWest Medicare |
$1,349.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5,245.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,619.46
|
|
|
HALLULOCK R S PLATE 5 DEGREE
|
Facility
|
IP
|
$8,997.00
|
|
| Hospital Charge Code |
27663803
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,339.22 |
| Max. Negotiated Rate |
$8,097.30 |
| Rate for Payer: Aetna of AZ Commercial |
$8,097.30
|
| Rate for Payer: Bisbee Police All Plans |
$2,339.22
|
| Rate for Payer: Cash Price |
$7,197.60
|
| Rate for Payer: Self Pay Self Pay |
$7,197.60
|
|
|
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY DEBRIDEMENT AND CAPSULAR RELEASE OF
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
CPT 28291
|
| Hospital Charge Code |
24043295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$582.92 |
| Max. Negotiated Rate |
$2,017.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,017.80
|
| Rate for Payer: Bisbee Police All Plans |
$582.92
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Self Pay Self Pay |
$1,793.60
|
|
|
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY DEBRIDEMENT AND CAPSULAR RELEASE OF
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
CPT 28291
|
| Hospital Charge Code |
24043295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$336.30 |
| Max. Negotiated Rate |
$9,084.18 |
| Rate for Payer: Aetna of AZ Commercial |
$2,017.80
|
| Rate for Payer: Aetna of AZ Medicare |
$627.76
|
| Rate for Payer: AHCCCS Medicaid |
$9,084.18
|
| Rate for Payer: Allwell Medicaid |
$9,084.18
|
| Rate for Payer: Allwell Medicare |
$336.30
|
| Rate for Payer: Amerigroup Medicare |
$336.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$837.39
|
| Rate for Payer: AZCH Complete Medicaid |
$9,084.18
|
| Rate for Payer: AZCH Complete Medicare |
$336.30
|
| Rate for Payer: Banner UC Health Medicaid |
$9,084.18
|
| Rate for Payer: Banner UC Health Medicare |
$336.30
|
| Rate for Payer: Bisbee Police All Plans |
$582.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,524.56
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,121.00
|
| Rate for Payer: Copperpoint Commercial |
$554.90
|
| Rate for Payer: Health Net of AZ Commercial |
$1,345.20
|
| Rate for Payer: Health Net of AZ Medicare |
$627.76
|
| Rate for Payer: Humana of AZ Medicare |
$336.30
|
| Rate for Payer: Mercy Care Medicaid |
$9,084.18
|
| Rate for Payer: Self Pay Self Pay |
$1,793.60
|
| Rate for Payer: TriWest Medicare |
$336.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5,265.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$403.56
|
|
