|
36420 IV CUTDOWN<1Y
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 36420
|
| Hospital Charge Code |
22282908
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$279.00
|
| Rate for Payer: Aetna of AZ Medicare |
$86.80
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$46.50
|
| Rate for Payer: Amerigroup Medicare |
$46.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$115.78
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$46.50
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$46.50
|
| Rate for Payer: Bisbee Police All Plans |
$80.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$210.80
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna of AZ Commercial |
$217.00
|
| Rate for Payer: Copperpoint Commercial |
$76.72
|
| Rate for Payer: Health Net of AZ Commercial |
$186.00
|
| Rate for Payer: Health Net of AZ Medicare |
$86.80
|
| Rate for Payer: Humana of AZ Medicare |
$46.50
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$248.00
|
| Rate for Payer: TriWest Medicare |
$46.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.80
|
|
|
36425 IV CUTDOWN AGE 1 OR OVER
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 36425
|
| Hospital Charge Code |
22282909
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$174.60
|
| Rate for Payer: Aetna of AZ Medicare |
$54.32
|
| Rate for Payer: AHCCCS Medicaid |
$391.82
|
| Rate for Payer: Allwell Medicaid |
$391.82
|
| Rate for Payer: Allwell Medicare |
$29.10
|
| Rate for Payer: Amerigroup Medicare |
$29.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$72.46
|
| Rate for Payer: AZCH Complete Medicaid |
$391.82
|
| Rate for Payer: AZCH Complete Medicare |
$29.10
|
| Rate for Payer: Banner UC Health Medicaid |
$391.82
|
| Rate for Payer: Banner UC Health Medicare |
$29.10
|
| Rate for Payer: Bisbee Police All Plans |
$50.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cigna of AZ Commercial |
$135.80
|
| Rate for Payer: Copperpoint Commercial |
$48.02
|
| Rate for Payer: Health Net of AZ Commercial |
$116.40
|
| Rate for Payer: Health Net of AZ Medicare |
$54.32
|
| Rate for Payer: Humana of AZ Medicare |
$29.10
|
| Rate for Payer: Mercy Care Medicaid |
$391.82
|
| Rate for Payer: Self Pay Self Pay |
$155.20
|
| Rate for Payer: TriWest Medicare |
$29.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$34.92
|
|
|
36425 IV CUTDOWN AGE 1 OR OVER
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 36425
|
| Hospital Charge Code |
22282909
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Aetna of AZ Commercial |
$174.60
|
| Rate for Payer: Bisbee Police All Plans |
$50.44
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Self Pay Self Pay |
$155.20
|
|
|
36430 BLOOD PRODUCT TRANSFUSION
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
22282910
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$249.08 |
| Max. Negotiated Rate |
$862.20 |
| Rate for Payer: Aetna of AZ Commercial |
$862.20
|
| Rate for Payer: Bisbee Police All Plans |
$249.08
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Self Pay Self Pay |
$766.40
|
|
|
36430 BLOOD PRODUCT TRANSFUSION
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
22282910
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$143.70 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$862.20
|
| Rate for Payer: Aetna of AZ Medicare |
$268.24
|
| Rate for Payer: AHCCCS Medicaid |
$575.74
|
| Rate for Payer: Allwell Medicaid |
$575.74
|
| Rate for Payer: Allwell Medicare |
$143.70
|
| Rate for Payer: Amerigroup Medicare |
$143.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$357.81
|
| Rate for Payer: AZCH Complete Medicaid |
$575.74
|
| Rate for Payer: AZCH Complete Medicare |
$143.70
|
| Rate for Payer: Banner UC Health Medicaid |
$575.74
|
| Rate for Payer: Banner UC Health Medicare |
$143.70
|
| Rate for Payer: Bisbee Police All Plans |
$249.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$651.44
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cigna of AZ Commercial |
$670.60
|
| Rate for Payer: Copperpoint Commercial |
$237.10
|
| Rate for Payer: Health Net of AZ Commercial |
$574.80
|
| Rate for Payer: Health Net of AZ Medicare |
$268.24
|
| Rate for Payer: Humana of AZ Medicare |
$143.70
|
| Rate for Payer: Mercy Care Medicaid |
$575.74
|
| Rate for Payer: Self Pay Self Pay |
$766.40
|
| Rate for Payer: TriWest Medicare |
$143.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$172.44
|
|
|
36510 UMBIL VEIN CATH
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
22282911
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$209.70
|
| Rate for Payer: Aetna of AZ Medicare |
$65.24
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$34.95
|
| Rate for Payer: Amerigroup Medicare |
$34.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$87.03
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$34.95
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$34.95
|
| Rate for Payer: Bisbee Police All Plans |
$60.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$158.44
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cigna of AZ Commercial |
$163.10
|
| Rate for Payer: Copperpoint Commercial |
$57.67
|
| Rate for Payer: Health Net of AZ Commercial |
$139.80
|
| Rate for Payer: Health Net of AZ Medicare |
$65.24
|
| Rate for Payer: Humana of AZ Medicare |
$34.95
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$186.40
|
| Rate for Payer: TriWest Medicare |
$34.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.94
|
|
|
36510 UMBIL VEIN CATH
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
22282911
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$209.70 |
| Rate for Payer: Aetna of AZ Commercial |
$209.70
|
| Rate for Payer: Bisbee Police All Plans |
$60.58
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Self Pay Self Pay |
$186.40
|
|
|
36550 THROMBOLYTIC AGENT
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 36550
|
| Hospital Charge Code |
22282912
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of AZ Commercial |
$81.90
|
| Rate for Payer: Bisbee Police All Plans |
$23.66
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Self Pay Self Pay |
$72.80
|
|
|
36550 THROMBOLYTIC AGENT
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 36550
|
| Hospital Charge Code |
22282912
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of AZ Commercial |
$81.90
|
| Rate for Payer: Aetna of AZ Medicare |
$25.48
|
| Rate for Payer: Allwell Medicare |
$13.65
|
| Rate for Payer: Amerigroup Medicare |
$13.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$33.99
|
| Rate for Payer: AZCH Complete Medicare |
$13.65
|
| Rate for Payer: Banner UC Health Medicare |
$13.65
|
| Rate for Payer: Bisbee Police All Plans |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$61.88
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cigna of AZ Commercial |
$63.70
|
| Rate for Payer: Copperpoint Commercial |
$22.52
|
| Rate for Payer: Health Net of AZ Commercial |
$54.60
|
| Rate for Payer: Health Net of AZ Medicare |
$25.48
|
| Rate for Payer: Humana of AZ Medicare |
$13.65
|
| Rate for Payer: Self Pay Self Pay |
$72.80
|
| Rate for Payer: TriWest Medicare |
$13.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$53.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$16.38
|
|
|
36556 CENTRAL LINE INSERTION
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
22282913
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$4,149.40 |
| Rate for Payer: Aetna of AZ Commercial |
$261.00
|
| Rate for Payer: Aetna of AZ Medicare |
$81.20
|
| Rate for Payer: AHCCCS Medicaid |
$4,149.40
|
| Rate for Payer: Allwell Medicaid |
$4,149.40
|
| 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 Medicaid |
$4,149.40
|
| Rate for Payer: AZCH Complete Medicare |
$43.50
|
| Rate for Payer: Banner UC Health Medicaid |
$4,149.40
|
| 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: 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: Mercy Care Medicaid |
$4,149.40
|
| Rate for Payer: Self Pay Self Pay |
$232.00
|
| Rate for Payer: TriWest Medicare |
$43.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$52.20
|
|
|
36556 CENTRAL LINE INSERTION
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
22282913
|
|
Hospital Revenue Code
|
760
|
| 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
|
|
|
36600 ART PUNCTURE DIANOSTIC
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
22282915
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna of AZ Commercial |
$99.90
|
| Rate for Payer: Bisbee Police All Plans |
$28.86
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Self Pay Self Pay |
$88.80
|
|
|
36600 ART PUNCTURE DIANOSTIC
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
22282915
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$99.90
|
| Rate for Payer: Aetna of AZ Medicare |
$31.08
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$16.65
|
| Rate for Payer: Amerigroup Medicare |
$16.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$41.46
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$16.65
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$16.65
|
| Rate for Payer: Bisbee Police All Plans |
$28.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$75.48
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna of AZ Commercial |
$77.70
|
| Rate for Payer: Copperpoint Commercial |
$27.47
|
| Rate for Payer: Health Net of AZ Commercial |
$66.60
|
| Rate for Payer: Health Net of AZ Medicare |
$31.08
|
| Rate for Payer: Humana of AZ Medicare |
$16.65
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$88.80
|
| Rate for Payer: TriWest Medicare |
$16.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.98
|
|
|
36620 ARTCANN/SAMPL MNT
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
22282916
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$304.20
|
| Rate for Payer: Aetna of AZ Medicare |
$94.64
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$50.70
|
| Rate for Payer: Amerigroup Medicare |
$50.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$126.24
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$50.70
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$50.70
|
| Rate for Payer: Bisbee Police All Plans |
$87.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$229.84
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cigna of AZ Commercial |
$236.60
|
| Rate for Payer: Copperpoint Commercial |
$83.66
|
| Rate for Payer: Health Net of AZ Commercial |
$202.80
|
| Rate for Payer: Health Net of AZ Medicare |
$94.64
|
| Rate for Payer: Humana of AZ Medicare |
$50.70
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$270.40
|
| Rate for Payer: TriWest Medicare |
$50.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$60.84
|
|
|
36620 ARTCANN/SAMPL MNT
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
22282916
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.88 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of AZ Commercial |
$304.20
|
| Rate for Payer: Bisbee Police All Plans |
$87.88
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Self Pay Self Pay |
$270.40
|
|
|
36680 INTRAOSSEOUS CNNULA PLCM
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
22282917
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna of AZ Commercial |
$388.80
|
| Rate for Payer: Bisbee Police All Plans |
$112.32
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Self Pay Self Pay |
$345.60
|
|
|
36680 INTRAOSSEOUS CNNULA PLCM
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
22282917
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$388.80
|
| Rate for Payer: Aetna of AZ Medicare |
$120.96
|
| Rate for Payer: AHCCCS Medicaid |
$391.82
|
| Rate for Payer: Allwell Medicaid |
$391.82
|
| Rate for Payer: Allwell Medicare |
$64.80
|
| Rate for Payer: Amerigroup Medicare |
$64.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$161.35
|
| Rate for Payer: AZCH Complete Medicaid |
$391.82
|
| Rate for Payer: AZCH Complete Medicare |
$64.80
|
| Rate for Payer: Banner UC Health Medicaid |
$391.82
|
| Rate for Payer: Banner UC Health Medicare |
$64.80
|
| Rate for Payer: Bisbee Police All Plans |
$112.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$293.76
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna of AZ Commercial |
$302.40
|
| Rate for Payer: Copperpoint Commercial |
$106.92
|
| Rate for Payer: Health Net of AZ Commercial |
$259.20
|
| Rate for Payer: Health Net of AZ Medicare |
$120.96
|
| Rate for Payer: Humana of AZ Medicare |
$64.80
|
| Rate for Payer: Mercy Care Medicaid |
$391.82
|
| Rate for Payer: Self Pay Self Pay |
$345.60
|
| Rate for Payer: TriWest Medicare |
$64.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$77.76
|
|
|
4-0 Ethilon KS
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
22926442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of AZ Commercial |
$11.70
|
| Rate for Payer: Bisbee Police All Plans |
$3.38
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Self Pay Self Pay |
$10.40
|
|
|
4-0 Ethilon KS
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
22926442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of AZ Commercial |
$11.70
|
| Rate for Payer: Aetna of AZ Medicare |
$3.64
|
| Rate for Payer: Allwell Medicare |
$1.95
|
| Rate for Payer: Amerigroup Medicare |
$1.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4.86
|
| Rate for Payer: AZCH Complete Medicare |
$1.95
|
| Rate for Payer: Banner UC Health Medicare |
$1.95
|
| Rate for Payer: Bisbee Police All Plans |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$8.84
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cigna of AZ Commercial |
$9.10
|
| Rate for Payer: Copperpoint Commercial |
$3.22
|
| Rate for Payer: Health Net of AZ Commercial |
$7.80
|
| Rate for Payer: Health Net of AZ Medicare |
$3.64
|
| Rate for Payer: Humana of AZ Medicare |
$1.95
|
| Rate for Payer: Self Pay Self Pay |
$10.40
|
| Rate for Payer: TriWest Medicare |
$1.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$7.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.34
|
|
|
4-0 Surgigut
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
22926447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna of AZ Commercial |
$45.90
|
| Rate for Payer: Aetna of AZ Medicare |
$14.28
|
| Rate for Payer: Allwell Medicare |
$7.65
|
| Rate for Payer: Amerigroup Medicare |
$7.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$19.05
|
| Rate for Payer: AZCH Complete Medicare |
$7.65
|
| Rate for Payer: Banner UC Health Medicare |
$7.65
|
| Rate for Payer: Bisbee Police All Plans |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$34.68
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna of AZ Commercial |
$35.70
|
| Rate for Payer: Copperpoint Commercial |
$12.62
|
| Rate for Payer: Health Net of AZ Commercial |
$30.60
|
| Rate for Payer: Health Net of AZ Medicare |
$14.28
|
| Rate for Payer: Humana of AZ Medicare |
$7.65
|
| Rate for Payer: Self Pay Self Pay |
$40.80
|
| Rate for Payer: TriWest Medicare |
$7.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$29.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$9.18
|
|
|
4-0 Surgigut
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
22926447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna of AZ Commercial |
$45.90
|
| Rate for Payer: Bisbee Police All Plans |
$13.26
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Self Pay Self Pay |
$40.80
|
|
|
4.0 x 28MM POLY SCREW
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354175
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$484.90 |
| Max. Negotiated Rate |
$1,678.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,678.50
|
| Rate for Payer: Bisbee Police All Plans |
$484.90
|
| Rate for Payer: Cash Price |
$1,492.00
|
| Rate for Payer: Self Pay Self Pay |
$1,492.00
|
|
|
4.0 x 28MM POLY SCREW
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354175
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1,678.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,678.50
|
| Rate for Payer: Aetna of AZ Medicare |
$522.20
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$279.75
|
| Rate for Payer: Amerigroup Medicare |
$279.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$696.58
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$279.75
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$279.75
|
| Rate for Payer: Bisbee Police All Plans |
$484.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,268.20
|
| Rate for Payer: Cash Price |
$1,492.00
|
| Rate for Payer: Cash Price |
$1,492.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,305.50
|
| Rate for Payer: Copperpoint Commercial |
$461.59
|
| Rate for Payer: Health Net of AZ Commercial |
$1,119.00
|
| Rate for Payer: Health Net of AZ Medicare |
$522.20
|
| Rate for Payer: Humana of AZ Medicare |
$279.75
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$1,492.00
|
| Rate for Payer: TriWest Medicare |
$279.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,087.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$335.70
|
|
|
4.0 X 32MM POLY CANN SCREW
|
Facility
|
OP
|
$1,976.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354198
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1,778.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,778.40
|
| Rate for Payer: Aetna of AZ Medicare |
$553.28
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$296.40
|
| Rate for Payer: Amerigroup Medicare |
$296.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$738.04
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$296.40
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$296.40
|
| Rate for Payer: Bisbee Police All Plans |
$513.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,343.68
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,383.20
|
| Rate for Payer: Copperpoint Commercial |
$489.06
|
| Rate for Payer: Health Net of AZ Commercial |
$1,185.60
|
| Rate for Payer: Health Net of AZ Medicare |
$553.28
|
| Rate for Payer: Humana of AZ Medicare |
$296.40
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$1,580.80
|
| Rate for Payer: TriWest Medicare |
$296.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,152.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$355.68
|
|
|
4.0 X 32MM POLY CANN SCREW
|
Facility
|
IP
|
$1,976.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354198
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$513.76 |
| Max. Negotiated Rate |
$1,778.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,778.40
|
| Rate for Payer: Bisbee Police All Plans |
$513.76
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Self Pay Self Pay |
$1,580.80
|
|
