|
RAM NASAL OXYGEN CANNULA NEWBORN
|
Facility
OP
|
$90.23
|
|
| Hospital Charge Code |
27554772
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$81.21 |
| Rate for Payer: SELF PAY |
$72.18
|
| Rate for Payer: Aetna POS, PPO, HMO |
$81.21
|
| Rate for Payer: Aetna Medicare |
$25.26
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.34
|
| Rate for Payer: Amerigroup Medicare |
$15.34
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$33.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.34
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.46
|
| Rate for Payer: Cigna All Products |
$63.16
|
| Rate for Payer: Copperpoint |
$25.31
|
| Rate for Payer: HealthNet Commercial |
$54.14
|
| Rate for Payer: HealthNet Medicare |
$25.26
|
| Rate for Payer: Humana Medicare |
$15.34
|
| Rate for Payer: Veterans (Triwest) |
$15.34
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$52.60
|
| Rate for Payer: United Healthcare Medicare |
$16.24
|
|
|
RAM NASAL OXYGEN CANNULA PREMMIE
|
Facility
OP
|
$90.26
|
|
| Hospital Charge Code |
27554770
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$81.23 |
| Rate for Payer: Aetna POS, PPO, HMO |
$81.23
|
| Rate for Payer: Aetna Medicare |
$25.27
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.34
|
| Rate for Payer: Amerigroup Medicare |
$15.34
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$33.71
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.34
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.47
|
| Rate for Payer: Cigna All Products |
$63.18
|
| Rate for Payer: Copperpoint |
$25.32
|
| Rate for Payer: HealthNet Commercial |
$54.16
|
| Rate for Payer: HealthNet Medicare |
$25.27
|
| Rate for Payer: Humana Medicare |
$15.34
|
| Rate for Payer: SELF PAY |
$72.21
|
| Rate for Payer: Veterans (Triwest) |
$15.34
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$52.62
|
| Rate for Payer: United Healthcare Medicare |
$16.25
|
|
|
RAM NASAL OXYGEN CANNULA PREMMIE
|
Facility
IP
|
$90.26
|
|
| Hospital Charge Code |
27554770
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$81.23 |
| Rate for Payer: Aetna POS, PPO, HMO |
$81.23
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.34
|
| Rate for Payer: Amerigroup Medicare |
$15.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.34
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.47
|
| Rate for Payer: Copperpoint |
$25.32
|
| Rate for Payer: Humana Medicare |
$15.34
|
| Rate for Payer: SELF PAY |
$72.21
|
| Rate for Payer: Veterans (Triwest) |
$15.34
|
|
|
RBC CP2D AS3 500 LR
|
Facility
IP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857613
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
|
|
RBC CP2D AS3 500 LR
|
Facility
OP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857613
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Aetna Medicare |
$213.08
|
| Rate for Payer: AHCCCS Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$284.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$273.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: Banner University Family Care Medicaid |
$273.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Cigna All Products |
$494.65
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: HealthNet Commercial |
$456.60
|
| Rate for Payer: HealthNet Medicare |
$213.08
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: Mercy Care Medicaid |
$273.34
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$443.66
|
| Rate for Payer: United Healthcare Medicare |
$136.98
|
|
|
RBC CP2D AS3 500 LR Irr
|
Facility
OP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857635
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Aetna Medicare |
$213.08
|
| Rate for Payer: AHCCCS Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$284.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$273.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: Banner University Family Care Medicaid |
$273.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Cigna All Products |
$494.65
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: HealthNet Commercial |
$456.60
|
| Rate for Payer: HealthNet Medicare |
$213.08
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: Mercy Care Medicaid |
$273.34
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$443.66
|
| Rate for Payer: United Healthcare Medicare |
$136.98
|
|
|
RBC CP2D AS3 500 LR Irr
|
Facility
IP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857635
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
|
|
RBC CPD 500 LR
|
Facility
IP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857651
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
|
|
RBC CPD 500 LR
|
Facility
OP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857651
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Aetna Medicare |
$213.08
|
| Rate for Payer: AHCCCS Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$284.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$273.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: Banner University Family Care Medicaid |
$273.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Cigna All Products |
$494.65
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: HealthNet Commercial |
$456.60
|
| Rate for Payer: HealthNet Medicare |
$213.08
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: Mercy Care Medicaid |
$273.34
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$443.66
|
| Rate for Payer: United Healthcare Medicare |
$136.98
|
|
|
RBC CPD 500 LR Irr
|
Facility
IP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857652
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
|
|
RBC CPD 500 LR Irr
|
Facility
OP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857652
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Aetna Medicare |
$213.08
|
| Rate for Payer: AHCCCS Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$284.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$273.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: Banner University Family Care Medicaid |
$273.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Cigna All Products |
$494.65
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: HealthNet Commercial |
$456.60
|
| Rate for Payer: HealthNet Medicare |
$213.08
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: Mercy Care Medicaid |
$273.34
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$443.66
|
| Rate for Payer: United Healthcare Medicare |
$136.98
|
|
|
RBC CPD AS1 500 LR
|
Facility
IP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857663
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
|
|
RBC CPD AS1 500 LR
|
Facility
OP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857663
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Aetna Medicare |
$213.08
|
| Rate for Payer: AHCCCS Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$284.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$273.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: Banner University Family Care Medicaid |
$273.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Cigna All Products |
$494.65
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: HealthNet Commercial |
$456.60
|
| Rate for Payer: HealthNet Medicare |
$213.08
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: Mercy Care Medicaid |
$273.34
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$443.66
|
| Rate for Payer: United Healthcare Medicare |
$136.98
|
|
|
RBC CPD AS1 500 LR Irr
|
Facility
OP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857630
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Aetna Medicare |
$213.08
|
| Rate for Payer: AHCCCS Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$273.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$284.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$273.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: Banner University Family Care Medicaid |
$273.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Cigna All Products |
$494.65
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: HealthNet Commercial |
$456.60
|
| Rate for Payer: HealthNet Medicare |
$213.08
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: Mercy Care Medicaid |
$273.34
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$443.66
|
| Rate for Payer: United Healthcare Medicare |
$136.98
|
|
|
RBC CPD AS1 500 LR Irr
|
Facility
IP
|
$761.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
857630
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
|
|
RECHARGER BELT
|
Facility
OP
|
$250.00
|
|
| Hospital Charge Code |
27400598
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$225.00
|
| Rate for Payer: Aetna Medicare |
$70.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$42.50
|
| Rate for Payer: Amerigroup Medicare |
$42.50
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$93.38
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$42.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$42.50
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$65.00
|
| Rate for Payer: Cigna All Products |
$175.00
|
| Rate for Payer: Copperpoint |
$70.12
|
| Rate for Payer: HealthNet Commercial |
$150.00
|
| Rate for Payer: HealthNet Medicare |
$70.00
|
| Rate for Payer: Humana Medicare |
$42.50
|
| Rate for Payer: SELF PAY |
$200.00
|
| Rate for Payer: Veterans (Triwest) |
$42.50
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$145.75
|
| Rate for Payer: United Healthcare Medicare |
$45.00
|
|
|
RECHARGER BELT
|
Facility
IP
|
$250.00
|
|
| Hospital Charge Code |
27400598
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$225.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$42.50
|
| Rate for Payer: Amerigroup Medicare |
$42.50
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$42.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$42.50
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$65.00
|
| Rate for Payer: Copperpoint |
$70.12
|
| Rate for Payer: Humana Medicare |
$42.50
|
| Rate for Payer: SELF PAY |
$200.00
|
| Rate for Payer: Veterans (Triwest) |
$42.50
|
|
|
RECHARGER KIT
|
Facility
IP
|
$6,750.00
|
|
| Hospital Charge Code |
27400597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,147.50 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$6,075.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1,147.50
|
| Rate for Payer: Amerigroup Medicare |
$1,147.50
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1,147.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1,147.50
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,755.00
|
| Rate for Payer: Copperpoint |
$1,893.38
|
| Rate for Payer: Humana Medicare |
$1,147.50
|
| Rate for Payer: SELF PAY |
$5,400.00
|
| Rate for Payer: Veterans (Triwest) |
$1,147.50
|
|
|
RECHARGER KIT
|
Facility
OP
|
$6,750.00
|
|
| Hospital Charge Code |
27400597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,147.50 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$6,075.00
|
| Rate for Payer: Aetna Medicare |
$1,890.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1,147.50
|
| Rate for Payer: Amerigroup Medicare |
$1,147.50
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$2,521.12
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1,147.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1,147.50
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,755.00
|
| Rate for Payer: Cigna All Products |
$4,725.00
|
| Rate for Payer: Copperpoint |
$1,893.38
|
| Rate for Payer: HealthNet Commercial |
$4,050.00
|
| Rate for Payer: HealthNet Medicare |
$1,890.00
|
| Rate for Payer: Humana Medicare |
$1,147.50
|
| Rate for Payer: SELF PAY |
$5,400.00
|
| Rate for Payer: Veterans (Triwest) |
$1,147.50
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$3,935.25
|
| Rate for Payer: United Healthcare Medicare |
$1,215.00
|
|
|
RECONSTRUCTION (ADVANCEMENT) POSTERIOR TIBIAL TENDON WITH EXCISION OF
|
Facility
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 28238
|
| Hospital Charge Code |
24043294
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$384.54 |
| Max. Negotiated Rate |
$9,084.18 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,035.80
|
| Rate for Payer: Aetna Medicare |
$633.36
|
| Rate for Payer: AHCCCS Medicaid |
$9,084.18
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$9,084.18
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$384.54
|
| Rate for Payer: Amerigroup Medicare |
$384.54
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$844.86
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$9,084.18
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$384.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$384.54
|
| Rate for Payer: Banner University Family Care Medicaid |
$9,084.18
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$588.12
|
| Rate for Payer: Cigna All Products |
$1,131.00
|
| Rate for Payer: Copperpoint |
$634.49
|
| Rate for Payer: HealthNet Commercial |
$1,357.20
|
| Rate for Payer: HealthNet Medicare |
$633.36
|
| Rate for Payer: Humana Medicare |
$384.54
|
| Rate for Payer: Mercy Care Medicaid |
$9,084.18
|
| Rate for Payer: SELF PAY |
$1,809.60
|
| Rate for Payer: Veterans (Triwest) |
$384.54
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,318.75
|
| Rate for Payer: United Healthcare Medicare |
$407.16
|
|
|
RECONSTRUCTION (ADVANCEMENT) POSTERIOR TIBIAL TENDON WITH EXCISION OF
|
Facility
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 28238
|
| Hospital Charge Code |
24043294
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$384.54 |
| Max. Negotiated Rate |
$2,035.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,035.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$384.54
|
| Rate for Payer: Amerigroup Medicare |
$384.54
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$384.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$384.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$588.12
|
| Rate for Payer: Copperpoint |
$634.49
|
| Rate for Payer: Humana Medicare |
$384.54
|
| Rate for Payer: SELF PAY |
$1,809.60
|
| Rate for Payer: Veterans (Triwest) |
$384.54
|
|
|
RECONSTRUCTION ANGULAR DEFORMITY OF TOE SOFT TISSUE PROCEDURES ONLY
|
Facility
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
24043320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$279.48 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,479.60
|
| Rate for Payer: Aetna Medicare |
$460.32
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4,104.08
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$279.48
|
| Rate for Payer: Amerigroup Medicare |
$279.48
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$614.03
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4,104.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$279.48
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$279.48
|
| Rate for Payer: Banner University Family Care Medicaid |
$4,104.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$427.44
|
| Rate for Payer: Cigna All Products |
$822.00
|
| Rate for Payer: Copperpoint |
$461.14
|
| Rate for Payer: HealthNet Commercial |
$986.40
|
| Rate for Payer: HealthNet Medicare |
$460.32
|
| Rate for Payer: Humana Medicare |
$279.48
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: SELF PAY |
$1,315.20
|
| Rate for Payer: Veterans (Triwest) |
$279.48
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$958.45
|
| Rate for Payer: United Healthcare Medicare |
$295.92
|
|
|
RECONSTRUCTION ANGULAR DEFORMITY OF TOE SOFT TISSUE PROCEDURES ONLY
|
Facility
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
24043320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$279.48 |
| Max. Negotiated Rate |
$1,479.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,479.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$279.48
|
| Rate for Payer: Amerigroup Medicare |
$279.48
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$279.48
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$279.48
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$427.44
|
| Rate for Payer: Copperpoint |
$461.14
|
| Rate for Payer: Humana Medicare |
$279.48
|
| Rate for Payer: SELF PAY |
$1,315.20
|
| Rate for Payer: Veterans (Triwest) |
$279.48
|
|
|
Rectovaginal Fistula closure abdominal
|
Facility
OP
|
$5,070.00
|
|
|
Service Code
|
CPT 57305
|
| Hospital Charge Code |
27291797
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$861.90 |
| Max. Negotiated Rate |
$4,563.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4,563.00
|
| Rate for Payer: Aetna Medicare |
$1,419.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$861.90
|
| Rate for Payer: Amerigroup Medicare |
$861.90
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,893.64
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$861.90
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$861.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,318.20
|
| Rate for Payer: Cigna All Products |
$2,535.00
|
| Rate for Payer: Copperpoint |
$1,422.14
|
| Rate for Payer: HealthNet Commercial |
$3,042.00
|
| Rate for Payer: HealthNet Medicare |
$1,419.60
|
| Rate for Payer: Humana Medicare |
$861.90
|
| Rate for Payer: SELF PAY |
$4,056.00
|
| Rate for Payer: Veterans (Triwest) |
$861.90
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2,955.81
|
| Rate for Payer: United Healthcare Medicare |
$912.60
|
|
|
Rectovaginal Fistula closure abdominal
|
Facility
IP
|
$5,070.00
|
|
|
Service Code
|
CPT 57305
|
| Hospital Charge Code |
27291797
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$861.90 |
| Max. Negotiated Rate |
$4,563.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4,563.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$861.90
|
| Rate for Payer: Amerigroup Medicare |
$861.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$861.90
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$861.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,318.20
|
| Rate for Payer: Copperpoint |
$1,422.14
|
| Rate for Payer: Humana Medicare |
$861.90
|
| Rate for Payer: SELF PAY |
$4,056.00
|
| Rate for Payer: Veterans (Triwest) |
$861.90
|
|