36406 OTHER VEIN IV <3Y
|
Facility
|
IP
|
$53.00
|
|
Service Code
|
CPT 36406
|
Hospital Charge Code |
22282906
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$13.78 |
Max. Negotiated Rate |
$47.70 |
Rate for Payer: Aetna of AZ Commercial |
$47.70
|
Rate for Payer: Bisbee Police All Plans |
$13.78
|
Rate for Payer: Cash Price |
$42.40
|
Rate for Payer: Self Pay Self Pay |
$42.40
|
|
36410 VENIPUNCTURE PHYSICIAN
|
Facility
|
IP
|
$77.00
|
|
Service Code
|
CPT 36410
|
Hospital Charge Code |
22282907
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$20.02 |
Max. Negotiated Rate |
$69.30 |
Rate for Payer: Aetna of AZ Commercial |
$69.30
|
Rate for Payer: Bisbee Police All Plans |
$20.02
|
Rate for Payer: Cash Price |
$61.60
|
Rate for Payer: Self Pay Self Pay |
$61.60
|
|
36410 VENIPUNCTURE PHYSICIAN
|
Facility
|
OP
|
$77.00
|
|
Service Code
|
CPT 36410
|
Hospital Charge Code |
22282907
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$12.32 |
Max. Negotiated Rate |
$69.30 |
Rate for Payer: Aetna of AZ Commercial |
$69.30
|
Rate for Payer: Aetna of AZ Medicare |
$21.56
|
Rate for Payer: Allwell Medicare |
$12.32
|
Rate for Payer: Amerigroup Medicare |
$12.32
|
Rate for Payer: APIPA Medicare/Medicaid |
$28.76
|
Rate for Payer: AZCH Complete Medicare |
$12.32
|
Rate for Payer: Banner UC Health Medicare |
$12.32
|
Rate for Payer: Bisbee Police All Plans |
$20.02
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$52.36
|
Rate for Payer: Cash Price |
$61.60
|
Rate for Payer: Cigna of AZ Commercial |
$53.90
|
Rate for Payer: Copperpoint Commercial |
$19.06
|
Rate for Payer: Health Net of AZ Commercial |
$46.20
|
Rate for Payer: Health Net of AZ Medicare |
$21.56
|
Rate for Payer: Humana of AZ Medicare |
$12.32
|
Rate for Payer: Self Pay Self Pay |
$61.60
|
Rate for Payer: TriWest Medicare |
$12.32
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$44.89
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.86
|
|
36420 IV CUTDOWN<1Y
|
Facility
|
OP
|
$310.00
|
|
Service Code
|
CPT 36420
|
Hospital Charge Code |
22282908
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$49.60 |
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: Allwell Medicare |
$49.60
|
Rate for Payer: Amerigroup Medicare |
$49.60
|
Rate for Payer: APIPA Medicare/Medicaid |
$115.78
|
Rate for Payer: AZCH Complete Medicare |
$49.60
|
Rate for Payer: Banner UC Health Medicare |
$49.60
|
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 |
$49.60
|
Rate for Payer: Self Pay Self Pay |
$248.00
|
Rate for Payer: TriWest Medicare |
$49.60
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.80
|
|
36420 IV CUTDOWN<1Y
|
Facility
|
IP
|
$310.00
|
|
Service Code
|
CPT 36420
|
Hospital Charge Code |
22282908
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$80.60 |
Max. Negotiated Rate |
$279.00 |
Rate for Payer: Aetna of AZ Commercial |
$279.00
|
Rate for Payer: Bisbee Police All Plans |
$80.60
|
Rate for Payer: Cash Price |
$248.00
|
Rate for Payer: Self Pay Self Pay |
$248.00
|
|
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 |
$31.04 |
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: Allwell Medicare |
$31.04
|
Rate for Payer: Amerigroup Medicare |
$31.04
|
Rate for Payer: APIPA Medicare/Medicaid |
$72.46
|
Rate for Payer: AZCH Complete Medicare |
$31.04
|
Rate for Payer: Banner UC Health Medicare |
$31.04
|
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 |
$31.04
|
Rate for Payer: Self Pay Self Pay |
$155.20
|
Rate for Payer: TriWest Medicare |
$31.04
|
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
|
$908.00
|
|
Service Code
|
CPT 36430
|
Hospital Charge Code |
22282910
|
Hospital Revenue Code
|
391
|
Min. Negotiated Rate |
$236.08 |
Max. Negotiated Rate |
$817.20 |
Rate for Payer: Aetna of AZ Commercial |
$817.20
|
Rate for Payer: Bisbee Police All Plans |
$236.08
|
Rate for Payer: Cash Price |
$726.40
|
Rate for Payer: Self Pay Self Pay |
$726.40
|
|
36430 BLOOD PRODUCT TRANSFUSION
|
Facility
|
OP
|
$908.00
|
|
Service Code
|
CPT 36430
|
Hospital Charge Code |
22282910
|
Hospital Revenue Code
|
391
|
Min. Negotiated Rate |
$145.28 |
Max. Negotiated Rate |
$2,161.00 |
Rate for Payer: Aetna of AZ Commercial |
$817.20
|
Rate for Payer: Aetna of AZ Medicare |
$254.24
|
Rate for Payer: AHCCCS Medicaid |
$287.87
|
Rate for Payer: Allwell Medicaid |
$287.87
|
Rate for Payer: Allwell Medicare |
$145.28
|
Rate for Payer: Amerigroup Medicare |
$145.28
|
Rate for Payer: APIPA Medicare/Medicaid |
$339.14
|
Rate for Payer: AZCH Complete Medicaid |
$287.87
|
Rate for Payer: AZCH Complete Medicare |
$145.28
|
Rate for Payer: Banner UC Health Medicaid |
$287.87
|
Rate for Payer: Banner UC Health Medicare |
$145.28
|
Rate for Payer: Bisbee Police All Plans |
$236.08
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$617.44
|
Rate for Payer: Cash Price |
$726.40
|
Rate for Payer: Cash Price |
$726.40
|
Rate for Payer: Cigna of AZ Commercial |
$635.60
|
Rate for Payer: Copperpoint Commercial |
$224.73
|
Rate for Payer: Health Net of AZ Commercial |
$544.80
|
Rate for Payer: Health Net of AZ Medicare |
$254.24
|
Rate for Payer: Humana of AZ Medicare |
$145.28
|
Rate for Payer: Mercy Care Medicaid |
$287.87
|
Rate for Payer: Self Pay Self Pay |
$726.40
|
Rate for Payer: TriWest Medicare |
$145.28
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$163.44
|
|
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
|
|
36510 UMBIL VEIN CATH
|
Facility
|
OP
|
$233.00
|
|
Service Code
|
CPT 36510
|
Hospital Charge Code |
22282911
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$37.28 |
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: Allwell Medicare |
$37.28
|
Rate for Payer: Amerigroup Medicare |
$37.28
|
Rate for Payer: APIPA Medicare/Medicaid |
$87.03
|
Rate for Payer: AZCH Complete Medicare |
$37.28
|
Rate for Payer: Banner UC Health Medicare |
$37.28
|
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 |
$37.28
|
Rate for Payer: Self Pay Self Pay |
$186.40
|
Rate for Payer: TriWest Medicare |
$37.28
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.94
|
|
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 |
$14.56 |
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 |
$14.56
|
Rate for Payer: Amerigroup Medicare |
$14.56
|
Rate for Payer: APIPA Medicare/Medicaid |
$33.99
|
Rate for Payer: AZCH Complete Medicare |
$14.56
|
Rate for Payer: Banner UC Health Medicare |
$14.56
|
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 |
$14.56
|
Rate for Payer: Self Pay Self Pay |
$72.80
|
Rate for Payer: TriWest Medicare |
$14.56
|
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
|
IP
|
$392.00
|
|
Service Code
|
CPT 36556
|
Hospital Charge Code |
22282913
|
Hospital Revenue Code
|
760
|
Min. Negotiated Rate |
$101.92 |
Max. Negotiated Rate |
$352.80 |
Rate for Payer: Aetna of AZ Commercial |
$352.80
|
Rate for Payer: Bisbee Police All Plans |
$101.92
|
Rate for Payer: Cash Price |
$313.60
|
Rate for Payer: Self Pay Self Pay |
$313.60
|
|
36556 CENTRAL LINE INSERTION
|
Facility
|
OP
|
$392.00
|
|
Service Code
|
CPT 36556
|
Hospital Charge Code |
22282913
|
Hospital Revenue Code
|
760
|
Min. Negotiated Rate |
$62.72 |
Max. Negotiated Rate |
$2,507.00 |
Rate for Payer: Aetna of AZ Commercial |
$352.80
|
Rate for Payer: Aetna of AZ Medicare |
$109.76
|
Rate for Payer: AHCCCS Medicaid |
$2,074.70
|
Rate for Payer: Allwell Medicaid |
$2,074.70
|
Rate for Payer: Allwell Medicare |
$62.72
|
Rate for Payer: Amerigroup Medicare |
$62.72
|
Rate for Payer: APIPA Medicare/Medicaid |
$146.41
|
Rate for Payer: AZCH Complete Medicaid |
$2,074.70
|
Rate for Payer: AZCH Complete Medicare |
$62.72
|
Rate for Payer: Banner UC Health Medicaid |
$2,074.70
|
Rate for Payer: Banner UC Health Medicare |
$62.72
|
Rate for Payer: Bisbee Police All Plans |
$101.92
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$266.56
|
Rate for Payer: Cash Price |
$313.60
|
Rate for Payer: Cash Price |
$313.60
|
Rate for Payer: Cigna of AZ Commercial |
$274.40
|
Rate for Payer: Copperpoint Commercial |
$97.02
|
Rate for Payer: Health Net of AZ Commercial |
$235.20
|
Rate for Payer: Health Net of AZ Medicare |
$109.76
|
Rate for Payer: Humana of AZ Medicare |
$62.72
|
Rate for Payer: Mercy Care Medicaid |
$2,074.70
|
Rate for Payer: Self Pay Self Pay |
$313.60
|
Rate for Payer: TriWest Medicare |
$62.72
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$70.56
|
|
36600 ART PUNCTURE DIANOSTIC
|
Facility
|
OP
|
$111.00
|
|
Service Code
|
CPT 36600
|
Hospital Charge Code |
22282915
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$17.76 |
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: Allwell Medicare |
$17.76
|
Rate for Payer: Amerigroup Medicare |
$17.76
|
Rate for Payer: APIPA Medicare/Medicaid |
$41.46
|
Rate for Payer: AZCH Complete Medicare |
$17.76
|
Rate for Payer: Banner UC Health Medicare |
$17.76
|
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 |
$17.76
|
Rate for Payer: Self Pay Self Pay |
$88.80
|
Rate for Payer: TriWest Medicare |
$17.76
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.98
|
|
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
|
|
36620 ARTCANN/SAMPL MNT
|
Facility
|
OP
|
$338.00
|
|
Service Code
|
CPT 36620
|
Hospital Charge Code |
22282916
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$54.08 |
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: Allwell Medicare |
$54.08
|
Rate for Payer: Amerigroup Medicare |
$54.08
|
Rate for Payer: APIPA Medicare/Medicaid |
$126.24
|
Rate for Payer: AZCH Complete Medicare |
$54.08
|
Rate for Payer: Banner UC Health Medicare |
$54.08
|
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 |
$54.08
|
Rate for Payer: Self Pay Self Pay |
$270.40
|
Rate for Payer: TriWest Medicare |
$54.08
|
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
|
OP
|
$471.00
|
|
Service Code
|
CPT 36680
|
Hospital Charge Code |
22282917
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$75.36 |
Max. Negotiated Rate |
$2,161.00 |
Rate for Payer: Aetna of AZ Commercial |
$423.90
|
Rate for Payer: Aetna of AZ Medicare |
$131.88
|
Rate for Payer: AHCCCS Medicaid |
$195.91
|
Rate for Payer: Allwell Medicaid |
$195.91
|
Rate for Payer: Allwell Medicare |
$75.36
|
Rate for Payer: Amerigroup Medicare |
$75.36
|
Rate for Payer: APIPA Medicare/Medicaid |
$175.92
|
Rate for Payer: AZCH Complete Medicaid |
$195.91
|
Rate for Payer: AZCH Complete Medicare |
$75.36
|
Rate for Payer: Banner UC Health Medicaid |
$195.91
|
Rate for Payer: Banner UC Health Medicare |
$75.36
|
Rate for Payer: Bisbee Police All Plans |
$122.46
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$320.28
|
Rate for Payer: Cash Price |
$376.80
|
Rate for Payer: Cash Price |
$376.80
|
Rate for Payer: Cigna of AZ Commercial |
$329.70
|
Rate for Payer: Copperpoint Commercial |
$116.57
|
Rate for Payer: Health Net of AZ Commercial |
$282.60
|
Rate for Payer: Health Net of AZ Medicare |
$131.88
|
Rate for Payer: Humana of AZ Medicare |
$75.36
|
Rate for Payer: Mercy Care Medicaid |
$195.91
|
Rate for Payer: Self Pay Self Pay |
$376.80
|
Rate for Payer: TriWest Medicare |
$75.36
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$84.78
|
|
36680 INTRAOSSEOUS CNNULA PLCM
|
Facility
|
IP
|
$471.00
|
|
Service Code
|
CPT 36680
|
Hospital Charge Code |
22282917
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$122.46 |
Max. Negotiated Rate |
$423.90 |
Rate for Payer: Aetna of AZ Commercial |
$423.90
|
Rate for Payer: Bisbee Police All Plans |
$122.46
|
Rate for Payer: Cash Price |
$376.80
|
Rate for Payer: Self Pay Self Pay |
$376.80
|
|
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 |
$2.08 |
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 |
$2.08
|
Rate for Payer: Amerigroup Medicare |
$2.08
|
Rate for Payer: APIPA Medicare/Medicaid |
$4.86
|
Rate for Payer: AZCH Complete Medicare |
$2.08
|
Rate for Payer: Banner UC Health Medicare |
$2.08
|
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 |
$2.08
|
Rate for Payer: Self Pay Self Pay |
$10.40
|
Rate for Payer: TriWest Medicare |
$2.08
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$7.58
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.34
|
|
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 Surgigut
|
Facility
|
OP
|
$51.00
|
|
Hospital Charge Code |
22926447
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$8.16 |
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 |
$8.16
|
Rate for Payer: Amerigroup Medicare |
$8.16
|
Rate for Payer: APIPA Medicare/Medicaid |
$19.05
|
Rate for Payer: AZCH Complete Medicare |
$8.16
|
Rate for Payer: Banner UC Health Medicare |
$8.16
|
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 |
$8.16
|
Rate for Payer: Self Pay Self Pay |
$40.80
|
Rate for Payer: TriWest Medicare |
$8.16
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$29.73
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$9.18
|
|