|
Respiratory Malignancy
|
Facility
IP
|
$8,765.40
|
|
|
Service Code
|
APRDRG 1363
|
| Hospital Charge Code |
APRDRG1363
|
| Min. Negotiated Rate |
$8,765.40 |
| Max. Negotiated Rate |
$8,765.40 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$8,765.40
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$8,765.40
|
| Rate for Payer: Banner University Family Care Medicaid |
$8,765.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,765.40
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
IP
|
$3,584.15
|
|
|
Service Code
|
APRDRG 1441
|
| Hospital Charge Code |
APRDRG1441
|
| Min. Negotiated Rate |
$3,584.15 |
| Max. Negotiated Rate |
$3,584.15 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3,584.15
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3,584.15
|
| Rate for Payer: Banner University Family Care Medicaid |
$3,584.15
|
| Rate for Payer: Mercy Care Medicaid |
$3,584.15
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
IP
|
$4,564.01
|
|
|
Service Code
|
APRDRG 1442
|
| Hospital Charge Code |
APRDRG1442
|
| Min. Negotiated Rate |
$4,564.01 |
| Max. Negotiated Rate |
$4,564.01 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4,564.01
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4,564.01
|
| Rate for Payer: Banner University Family Care Medicaid |
$4,564.01
|
| Rate for Payer: Mercy Care Medicaid |
$4,564.01
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
IP
|
$10,920.10
|
|
|
Service Code
|
APRDRG 1444
|
| Hospital Charge Code |
APRDRG1444
|
| Min. Negotiated Rate |
$10,920.10 |
| Max. Negotiated Rate |
$10,920.10 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$10,920.10
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$10,920.10
|
| Rate for Payer: Banner University Family Care Medicaid |
$10,920.10
|
| Rate for Payer: Mercy Care Medicaid |
$10,920.10
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
IP
|
$6,396.07
|
|
|
Service Code
|
APRDRG 1443
|
| Hospital Charge Code |
APRDRG1443
|
| Min. Negotiated Rate |
$6,396.07 |
| Max. Negotiated Rate |
$6,396.07 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$6,396.07
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$6,396.07
|
| Rate for Payer: Banner University Family Care Medicaid |
$6,396.07
|
| Rate for Payer: Mercy Care Medicaid |
$6,396.07
|
|
|
Respiratory Syncytial Virus (RSV)
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
787102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.67 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$225.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$42.67
|
| Rate for Payer: Amerigroup Medicare |
$42.67
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$42.67
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$42.67
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$155.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$65.26
|
| Rate for Payer: Copperpoint |
$70.41
|
| Rate for Payer: Humana Medicare |
$42.67
|
| Rate for Payer: SELF PAY |
$200.80
|
| Rate for Payer: Veterans (Triwest) |
$42.67
|
|
|
Respiratory Syncytial Virus (RSV)
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
787102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$225.90
|
| Rate for Payer: Aetna Medicare |
$70.28
|
| Rate for Payer: AHCCCS Medicaid |
$13.10
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$42.67
|
| Rate for Payer: Amerigroup Medicare |
$42.67
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$93.75
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13.10
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$42.67
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$42.67
|
| Rate for Payer: Banner University Family Care Medicaid |
$13.10
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$155.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$65.26
|
| Rate for Payer: Cigna All Products |
$163.15
|
| Rate for Payer: Copperpoint |
$70.41
|
| Rate for Payer: HealthNet Commercial |
$150.60
|
| Rate for Payer: HealthNet Medicare |
$70.28
|
| Rate for Payer: Humana Medicare |
$42.67
|
| Rate for Payer: Mercy Care Medicaid |
$13.10
|
| Rate for Payer: SELF PAY |
$200.80
|
| Rate for Payer: Veterans (Triwest) |
$42.67
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$146.33
|
| Rate for Payer: United Healthcare Medicare |
$45.18
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
IP
|
$35,760.18
|
|
|
Service Code
|
APRDRG 1304
|
| Hospital Charge Code |
APRDRG1304
|
| Min. Negotiated Rate |
$35,760.18 |
| Max. Negotiated Rate |
$35,760.18 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$35,760.18
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$35,760.18
|
| Rate for Payer: Banner University Family Care Medicaid |
$35,760.18
|
| Rate for Payer: Mercy Care Medicaid |
$35,760.18
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
IP
|
$22,654.52
|
|
|
Service Code
|
APRDRG 1302
|
| Hospital Charge Code |
APRDRG1302
|
| Min. Negotiated Rate |
$22,654.52 |
| Max. Negotiated Rate |
$22,654.52 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$22,654.52
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$22,654.52
|
| Rate for Payer: Banner University Family Care Medicaid |
$22,654.52
|
| Rate for Payer: Mercy Care Medicaid |
$22,654.52
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
IP
|
$26,639.87
|
|
|
Service Code
|
APRDRG 1303
|
| Hospital Charge Code |
APRDRG1303
|
| Min. Negotiated Rate |
$26,639.87 |
| Max. Negotiated Rate |
$26,639.87 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$26,639.87
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$26,639.87
|
| Rate for Payer: Banner University Family Care Medicaid |
$26,639.87
|
| Rate for Payer: Mercy Care Medicaid |
$26,639.87
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
IP
|
$19,074.57
|
|
|
Service Code
|
APRDRG 1301
|
| Hospital Charge Code |
APRDRG1301
|
| Min. Negotiated Rate |
$19,074.57 |
| Max. Negotiated Rate |
$19,074.57 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$19,074.57
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$19,074.57
|
| Rate for Payer: Banner University Family Care Medicaid |
$19,074.57
|
| Rate for Payer: Mercy Care Medicaid |
$19,074.57
|
|
|
Respiratory Therapy
|
Facility
IP
|
$855.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
884915
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$769.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.35
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$145.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$558.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$222.30
|
| Rate for Payer: Copperpoint |
$239.83
|
| Rate for Payer: Humana Medicare |
$145.35
|
| Rate for Payer: SELF PAY |
$684.00
|
| Rate for Payer: Veterans (Triwest) |
$145.35
|
|
|
Respiratory Therapy
|
Facility
OP
|
$367.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
853605
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.39 |
| Max. Negotiated Rate |
$330.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$330.30
|
| Rate for Payer: Aetna Medicare |
$102.76
|
| Rate for Payer: AHCCCS Medicaid |
$202.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$202.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$62.39
|
| Rate for Payer: Amerigroup Medicare |
$62.39
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$137.07
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$202.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$62.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$62.39
|
| Rate for Payer: Banner University Family Care Medicaid |
$202.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$95.42
|
| Rate for Payer: Cigna All Products |
$256.90
|
| Rate for Payer: Copperpoint |
$102.94
|
| Rate for Payer: HealthNet Commercial |
$220.20
|
| Rate for Payer: HealthNet Medicare |
$102.76
|
| Rate for Payer: Humana Medicare |
$62.39
|
| Rate for Payer: Mercy Care Medicaid |
$202.34
|
| Rate for Payer: SELF PAY |
$293.60
|
| Rate for Payer: Veterans (Triwest) |
$62.39
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$213.96
|
| Rate for Payer: United Healthcare Medicare |
$66.06
|
|
|
Respiratory Therapy
|
Facility
IP
|
$367.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
853605
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.39 |
| Max. Negotiated Rate |
$330.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$330.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$62.39
|
| Rate for Payer: Amerigroup Medicare |
$62.39
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$62.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$62.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$95.42
|
| Rate for Payer: Copperpoint |
$102.94
|
| Rate for Payer: Humana Medicare |
$62.39
|
| Rate for Payer: SELF PAY |
$293.60
|
| Rate for Payer: Veterans (Triwest) |
$62.39
|
|
|
Respiratory Therapy
|
Facility
OP
|
$855.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
884915
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$769.50
|
| Rate for Payer: Aetna Medicare |
$239.40
|
| Rate for Payer: AHCCCS Medicaid |
$383.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$383.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.35
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$319.34
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$383.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$145.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$145.35
|
| Rate for Payer: Banner University Family Care Medicaid |
$383.46
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$558.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$222.30
|
| Rate for Payer: Cigna All Products |
$598.50
|
| Rate for Payer: Copperpoint |
$239.83
|
| Rate for Payer: HealthNet Commercial |
$513.00
|
| Rate for Payer: HealthNet Medicare |
$239.40
|
| Rate for Payer: Humana Medicare |
$145.35
|
| Rate for Payer: Mercy Care Medicaid |
$383.46
|
| Rate for Payer: SELF PAY |
$684.00
|
| Rate for Payer: Veterans (Triwest) |
$145.35
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$498.46
|
| Rate for Payer: United Healthcare Medicare |
$153.90
|
|
|
RESTRAINT LIMB
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
22354291
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: SELF PAY |
$14.40
|
| Rate for Payer: Aetna POS, PPO, HMO |
$16.20
|
| Rate for Payer: Aetna Medicare |
$5.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.06
|
| Rate for Payer: Amerigroup Medicare |
$3.06
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$6.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.06
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.06
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$4.68
|
| Rate for Payer: Cigna All Products |
$12.60
|
| Rate for Payer: Copperpoint |
$5.05
|
| Rate for Payer: HealthNet Commercial |
$10.80
|
| Rate for Payer: HealthNet Medicare |
$5.04
|
| Rate for Payer: Humana Medicare |
$3.06
|
| Rate for Payer: Veterans (Triwest) |
$3.06
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$3.24
|
|
|
RESTRAINT LIMB
|
Facility
IP
|
$18.00
|
|
| Hospital Charge Code |
22354291
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$16.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.06
|
| Rate for Payer: Amerigroup Medicare |
$3.06
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.06
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.06
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$4.68
|
| Rate for Payer: Copperpoint |
$5.05
|
| Rate for Payer: Humana Medicare |
$3.06
|
| Rate for Payer: SELF PAY |
$14.40
|
| Rate for Payer: Veterans (Triwest) |
$3.06
|
|
|
RESUSCITATION
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
1886871
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$383.46 |
| Rate for Payer: Aetna POS, PPO, HMO |
$221.40
|
| Rate for Payer: Aetna Medicare |
$68.88
|
| Rate for Payer: AHCCCS Medicaid |
$383.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$383.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$41.82
|
| Rate for Payer: Amerigroup Medicare |
$41.82
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$91.88
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$383.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$41.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$41.82
|
| Rate for Payer: Banner University Family Care Medicaid |
$383.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$63.96
|
| Rate for Payer: Cigna All Products |
$172.20
|
| Rate for Payer: Copperpoint |
$69.00
|
| Rate for Payer: HealthNet Commercial |
$147.60
|
| Rate for Payer: HealthNet Medicare |
$68.88
|
| Rate for Payer: Humana Medicare |
$41.82
|
| Rate for Payer: Mercy Care Medicaid |
$383.46
|
| Rate for Payer: SELF PAY |
$196.80
|
| Rate for Payer: Veterans (Triwest) |
$41.82
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$143.42
|
| Rate for Payer: United Healthcare Medicare |
$44.28
|
|
|
RESUSCITATION
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
1886871
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$221.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$41.82
|
| Rate for Payer: Amerigroup Medicare |
$41.82
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$41.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$41.82
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$63.96
|
| Rate for Payer: Copperpoint |
$69.00
|
| Rate for Payer: Humana Medicare |
$41.82
|
| Rate for Payer: SELF PAY |
$196.80
|
| Rate for Payer: Veterans (Triwest) |
$41.82
|
|
|
Reticulocyte Count LC
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
1909555
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$52.20
|
| Rate for Payer: Aetna Medicare |
$16.24
|
| Rate for Payer: AHCCCS Medicaid |
$3.99
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3.99
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$9.86
|
| Rate for Payer: Amerigroup Medicare |
$9.86
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$21.66
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3.99
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$9.86
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$9.86
|
| Rate for Payer: Banner University Family Care Medicaid |
$3.99
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$15.08
|
| Rate for Payer: Cigna All Products |
$37.70
|
| Rate for Payer: Copperpoint |
$16.27
|
| Rate for Payer: HealthNet Commercial |
$34.80
|
| Rate for Payer: HealthNet Medicare |
$16.24
|
| Rate for Payer: Humana Medicare |
$9.86
|
| Rate for Payer: Mercy Care Medicaid |
$3.99
|
| Rate for Payer: SELF PAY |
$46.40
|
| Rate for Payer: Veterans (Triwest) |
$9.86
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$33.81
|
| Rate for Payer: United Healthcare Medicare |
$10.44
|
|
|
Reticulocyte Count LC
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
1909555
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$52.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$9.86
|
| Rate for Payer: Amerigroup Medicare |
$9.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$9.86
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$9.86
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$15.08
|
| Rate for Payer: Copperpoint |
$16.27
|
| Rate for Payer: Humana Medicare |
$9.86
|
| Rate for Payer: SELF PAY |
$46.40
|
| Rate for Payer: Veterans (Triwest) |
$9.86
|
|
|
RETRACTOR BALLOON
|
Facility
OP
|
$399.00
|
|
| Hospital Charge Code |
22354815
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.83 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$359.10
|
| Rate for Payer: Aetna Medicare |
$111.72
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$67.83
|
| Rate for Payer: Amerigroup Medicare |
$67.83
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$149.03
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$67.83
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$67.83
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$103.74
|
| Rate for Payer: Cigna All Products |
$279.30
|
| Rate for Payer: Copperpoint |
$111.92
|
| Rate for Payer: HealthNet Commercial |
$239.40
|
| Rate for Payer: HealthNet Medicare |
$111.72
|
| Rate for Payer: Humana Medicare |
$67.83
|
| Rate for Payer: SELF PAY |
$319.20
|
| Rate for Payer: Veterans (Triwest) |
$67.83
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$232.62
|
| Rate for Payer: United Healthcare Medicare |
$71.82
|
|
|
RETRACTOR BALLOON
|
Facility
IP
|
$399.00
|
|
| Hospital Charge Code |
22354815
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.83 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$359.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$67.83
|
| Rate for Payer: Amerigroup Medicare |
$67.83
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$67.83
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$67.83
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$103.74
|
| Rate for Payer: Copperpoint |
$111.92
|
| Rate for Payer: Humana Medicare |
$67.83
|
| Rate for Payer: SELF PAY |
$319.20
|
| Rate for Payer: Veterans (Triwest) |
$67.83
|
|
|
RETRACTOR RING 31.8X18.3CM DISP
|
Facility
IP
|
$254.00
|
|
| Hospital Charge Code |
22354167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.18 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$228.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$43.18
|
| Rate for Payer: Amerigroup Medicare |
$43.18
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$43.18
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$43.18
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$66.04
|
| Rate for Payer: Copperpoint |
$71.25
|
| Rate for Payer: Humana Medicare |
$43.18
|
| Rate for Payer: SELF PAY |
$203.20
|
| Rate for Payer: Veterans (Triwest) |
$43.18
|
|
|
RETRACTOR RING 31.8X18.3CM DISP
|
Facility
OP
|
$254.00
|
|
| Hospital Charge Code |
22354167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.18 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$228.60
|
| Rate for Payer: Aetna Medicare |
$71.12
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$43.18
|
| Rate for Payer: Amerigroup Medicare |
$43.18
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$94.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$43.18
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$43.18
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$66.04
|
| Rate for Payer: Cigna All Products |
$177.80
|
| Rate for Payer: Copperpoint |
$71.25
|
| Rate for Payer: HealthNet Commercial |
$152.40
|
| Rate for Payer: HealthNet Medicare |
$71.12
|
| Rate for Payer: Humana Medicare |
$43.18
|
| Rate for Payer: SELF PAY |
$203.20
|
| Rate for Payer: Veterans (Triwest) |
$43.18
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$148.08
|
| Rate for Payer: United Healthcare Medicare |
$45.72
|
|