|
Services performed by qualified Physical Therapist in the ho
|
Facility
OP
|
$205.00
|
|
|
Service Code
|
CPT G0151
|
| Hospital Charge Code |
27342346
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$184.50
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$34.85
|
| Rate for Payer: Amerigroup Medicare |
$34.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$76.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$34.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$34.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$53.30
|
| Rate for Payer: Cigna All Products |
$143.50
|
| Rate for Payer: Copperpoint |
$57.50
|
| Rate for Payer: HealthNet Commercial |
$123.00
|
| Rate for Payer: HealthNet Medicare |
$57.40
|
| Rate for Payer: Humana Medicare |
$34.85
|
| Rate for Payer: SELF PAY |
$164.00
|
| Rate for Payer: Veterans (Triwest) |
$34.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$119.51
|
| Rate for Payer: United Healthcare Medicare |
$36.90
|
|
|
Services performed by qualified Physical Therapist in the ho
|
Facility
IP
|
$205.00
|
|
|
Service Code
|
CPT G0151
|
| Hospital Charge Code |
27342346
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$184.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$34.85
|
| Rate for Payer: Amerigroup Medicare |
$34.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$34.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$34.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$53.30
|
| Rate for Payer: Copperpoint |
$57.50
|
| Rate for Payer: Humana Medicare |
$34.85
|
| Rate for Payer: SELF PAY |
$164.00
|
| Rate for Payer: Veterans (Triwest) |
$34.85
|
|
|
Services provided by Occupational therapist in the home or h
|
Facility
IP
|
$205.00
|
|
|
Service Code
|
CPT G0152
|
| Hospital Charge Code |
27377828
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$184.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$34.85
|
| Rate for Payer: Amerigroup Medicare |
$34.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$34.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$34.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$53.30
|
| Rate for Payer: Copperpoint |
$57.50
|
| Rate for Payer: Humana Medicare |
$34.85
|
| Rate for Payer: SELF PAY |
$164.00
|
| Rate for Payer: Veterans (Triwest) |
$34.85
|
|
|
Services provided by Occupational therapist in the home or h
|
Facility
OP
|
$205.00
|
|
|
Service Code
|
CPT G0152
|
| Hospital Charge Code |
27377828
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: SELF PAY |
$164.00
|
| Rate for Payer: Aetna POS, PPO, HMO |
$184.50
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$34.85
|
| Rate for Payer: Amerigroup Medicare |
$34.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$76.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$34.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$34.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$53.30
|
| Rate for Payer: Cigna All Products |
$143.50
|
| Rate for Payer: Copperpoint |
$57.50
|
| Rate for Payer: HealthNet Commercial |
$123.00
|
| Rate for Payer: HealthNet Medicare |
$57.40
|
| Rate for Payer: Humana Medicare |
$34.85
|
| Rate for Payer: Veterans (Triwest) |
$34.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$119.51
|
| Rate for Payer: United Healthcare Medicare |
$36.90
|
|
|
SESAMOIDECTOMY FIRST TOE (SEPARATE PROCEDURE)
|
Facility
OP
|
$1,514.00
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
24043328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$257.38 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,362.60
|
| Rate for Payer: Aetna Medicare |
$423.92
|
| 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 |
$257.38
|
| Rate for Payer: Amerigroup Medicare |
$257.38
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$565.48
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4,104.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$257.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$257.38
|
| Rate for Payer: Banner University Family Care Medicaid |
$4,104.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$393.64
|
| Rate for Payer: Cigna All Products |
$757.00
|
| Rate for Payer: Copperpoint |
$424.68
|
| Rate for Payer: HealthNet Commercial |
$908.40
|
| Rate for Payer: HealthNet Medicare |
$423.92
|
| Rate for Payer: Humana Medicare |
$257.38
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: SELF PAY |
$1,211.20
|
| Rate for Payer: Veterans (Triwest) |
$257.38
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$882.66
|
| Rate for Payer: United Healthcare Medicare |
$272.52
|
|
|
SESAMOIDECTOMY FIRST TOE (SEPARATE PROCEDURE)
|
Facility
IP
|
$1,514.00
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
24043328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$257.38 |
| Max. Negotiated Rate |
$1,362.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,362.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$257.38
|
| Rate for Payer: Amerigroup Medicare |
$257.38
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$257.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$257.38
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$393.64
|
| Rate for Payer: Copperpoint |
$424.68
|
| Rate for Payer: Humana Medicare |
$257.38
|
| Rate for Payer: SELF PAY |
$1,211.20
|
| Rate for Payer: Veterans (Triwest) |
$257.38
|
|
|
SET BLOOD Y-TYPE HOSPIRA LIFESHIELD
|
Facility
OP
|
$96.00
|
|
| Hospital Charge Code |
22355308
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$86.40
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.32
|
| Rate for Payer: Amerigroup Medicare |
$16.32
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$35.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.32
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$24.96
|
| Rate for Payer: Cigna All Products |
$67.20
|
| Rate for Payer: Copperpoint |
$26.93
|
| Rate for Payer: HealthNet Commercial |
$57.60
|
| Rate for Payer: HealthNet Medicare |
$26.88
|
| Rate for Payer: Humana Medicare |
$16.32
|
| Rate for Payer: SELF PAY |
$76.80
|
| Rate for Payer: Veterans (Triwest) |
$16.32
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$55.97
|
| Rate for Payer: United Healthcare Medicare |
$17.28
|
|
|
SET BLOOD Y-TYPE HOSPIRA LIFESHIELD
|
Facility
IP
|
$96.00
|
|
| Hospital Charge Code |
22355308
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$86.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.32
|
| Rate for Payer: Amerigroup Medicare |
$16.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.32
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$24.96
|
| Rate for Payer: Copperpoint |
$26.93
|
| Rate for Payer: Humana Medicare |
$16.32
|
| Rate for Payer: SELF PAY |
$76.80
|
| Rate for Payer: Veterans (Triwest) |
$16.32
|
|
|
SET CATH RUTNER SUPRAPUBIC 16F COOK
|
Facility
IP
|
$226.00
|
|
| Hospital Charge Code |
22354213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$203.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.42
|
| Rate for Payer: Amerigroup Medicare |
$38.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.42
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$58.76
|
| Rate for Payer: Copperpoint |
$63.39
|
| Rate for Payer: Humana Medicare |
$38.42
|
| Rate for Payer: SELF PAY |
$180.80
|
| Rate for Payer: Veterans (Triwest) |
$38.42
|
|
|
SET CATH RUTNER SUPRAPUBIC 16F COOK
|
Facility
OP
|
$226.00
|
|
| Hospital Charge Code |
22354213
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$203.40
|
| Rate for Payer: Aetna Medicare |
$63.28
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.42
|
| Rate for Payer: Amerigroup Medicare |
$38.42
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$84.41
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.42
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$58.76
|
| Rate for Payer: Cigna All Products |
$158.20
|
| Rate for Payer: Copperpoint |
$63.39
|
| Rate for Payer: HealthNet Commercial |
$135.60
|
| Rate for Payer: HealthNet Medicare |
$63.28
|
| Rate for Payer: Humana Medicare |
$38.42
|
| Rate for Payer: SELF PAY |
$180.80
|
| Rate for Payer: Veterans (Triwest) |
$38.42
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$131.76
|
| Rate for Payer: United Healthcare Medicare |
$40.68
|
|
|
SET CATH SUPRAPUBIC COOK
|
Facility
IP
|
$259.00
|
|
| Hospital Charge Code |
22354225
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.03 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$233.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$44.03
|
| Rate for Payer: Amerigroup Medicare |
$44.03
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$44.03
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$44.03
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$67.34
|
| Rate for Payer: Copperpoint |
$72.65
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: SELF PAY |
$207.20
|
| Rate for Payer: Veterans (Triwest) |
$44.03
|
|
|
SET CATH SUPRAPUBIC COOK
|
Facility
OP
|
$259.00
|
|
| Hospital Charge Code |
22354225
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.03 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$233.10
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$44.03
|
| Rate for Payer: Amerigroup Medicare |
$44.03
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$96.74
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$44.03
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$44.03
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$67.34
|
| Rate for Payer: Cigna All Products |
$181.30
|
| Rate for Payer: Copperpoint |
$72.65
|
| Rate for Payer: HealthNet Commercial |
$155.40
|
| Rate for Payer: HealthNet Medicare |
$72.52
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: SELF PAY |
$207.20
|
| Rate for Payer: Veterans (Triwest) |
$44.03
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$151.00
|
| Rate for Payer: United Healthcare Medicare |
$46.62
|
|
|
SET CYSTO
|
Facility
OP
|
$35.00
|
|
| Hospital Charge Code |
22355110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$31.50
|
| Rate for Payer: Aetna Medicare |
$9.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.95
|
| Rate for Payer: Amerigroup Medicare |
$5.95
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$13.07
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.95
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$9.10
|
| Rate for Payer: Cigna All Products |
$24.50
|
| Rate for Payer: Copperpoint |
$9.82
|
| Rate for Payer: HealthNet Commercial |
$21.00
|
| Rate for Payer: HealthNet Medicare |
$9.80
|
| Rate for Payer: Humana Medicare |
$5.95
|
| Rate for Payer: SELF PAY |
$28.00
|
| Rate for Payer: Veterans (Triwest) |
$5.95
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$20.40
|
| Rate for Payer: United Healthcare Medicare |
$6.30
|
|
|
SET CYSTO
|
Facility
IP
|
$35.00
|
|
| Hospital Charge Code |
22355110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$31.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.95
|
| Rate for Payer: Amerigroup Medicare |
$5.95
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.95
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$9.10
|
| Rate for Payer: Copperpoint |
$9.82
|
| Rate for Payer: Humana Medicare |
$5.95
|
| Rate for Payer: SELF PAY |
$28.00
|
| Rate for Payer: Veterans (Triwest) |
$5.95
|
|
|
SET PUMP KANGAROO 1000ML
|
Facility
IP
|
$52.00
|
|
| Hospital Charge Code |
22355436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$46.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$8.84
|
| Rate for Payer: Amerigroup Medicare |
$8.84
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$8.84
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$8.84
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$13.52
|
| Rate for Payer: Copperpoint |
$14.59
|
| Rate for Payer: Humana Medicare |
$8.84
|
| Rate for Payer: SELF PAY |
$41.60
|
| Rate for Payer: Veterans (Triwest) |
$8.84
|
|
|
SET PUMP KANGAROO 1000ML
|
Facility
OP
|
$52.00
|
|
| Hospital Charge Code |
22355436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$46.80
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$8.84
|
| Rate for Payer: Amerigroup Medicare |
$8.84
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$19.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$8.84
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$8.84
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$13.52
|
| Rate for Payer: Cigna All Products |
$36.40
|
| Rate for Payer: Copperpoint |
$14.59
|
| Rate for Payer: HealthNet Commercial |
$31.20
|
| Rate for Payer: HealthNet Medicare |
$14.56
|
| Rate for Payer: Humana Medicare |
$8.84
|
| Rate for Payer: SELF PAY |
$41.60
|
| Rate for Payer: Veterans (Triwest) |
$8.84
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$30.32
|
| Rate for Payer: United Healthcare Medicare |
$9.36
|
|
|
Sex Hormone Binding Globulin LC
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2275527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.07 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$243.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$46.07
|
| Rate for Payer: Amerigroup Medicare |
$46.07
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$46.07
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$46.07
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$70.46
|
| Rate for Payer: Copperpoint |
$76.02
|
| Rate for Payer: Humana Medicare |
$46.07
|
| Rate for Payer: SELF PAY |
$216.80
|
| Rate for Payer: Veterans (Triwest) |
$46.07
|
|
|
Sex Hormone Binding Globulin LC
|
Facility
OP
|
$271.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2275527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$243.90
|
| Rate for Payer: Aetna Medicare |
$75.88
|
| Rate for Payer: AHCCCS Medicaid |
$21.73
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$21.73
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$46.07
|
| Rate for Payer: Amerigroup Medicare |
$46.07
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$101.22
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$21.73
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$46.07
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$46.07
|
| Rate for Payer: Banner University Family Care Medicaid |
$21.73
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$70.46
|
| Rate for Payer: Cigna All Products |
$176.15
|
| Rate for Payer: Copperpoint |
$76.02
|
| Rate for Payer: HealthNet Commercial |
$162.60
|
| Rate for Payer: HealthNet Medicare |
$75.88
|
| Rate for Payer: Humana Medicare |
$46.07
|
| Rate for Payer: Mercy Care Medicaid |
$21.73
|
| Rate for Payer: SELF PAY |
$216.80
|
| Rate for Payer: Veterans (Triwest) |
$46.07
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$157.99
|
| Rate for Payer: United Healthcare Medicare |
$48.78
|
|
|
SHEATH FLEXOR PARALLEL 35CM
|
Facility
IP
|
$668.00
|
|
| Hospital Charge Code |
22354226
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$601.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$113.56
|
| Rate for Payer: Amerigroup Medicare |
$113.56
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$113.56
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$113.56
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$173.68
|
| Rate for Payer: Copperpoint |
$187.37
|
| Rate for Payer: Humana Medicare |
$113.56
|
| Rate for Payer: SELF PAY |
$534.40
|
| Rate for Payer: Veterans (Triwest) |
$113.56
|
|
|
SHEATH FLEXOR PARALLEL 35CM
|
Facility
OP
|
$668.00
|
|
| Hospital Charge Code |
22354226
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$601.20
|
| Rate for Payer: Aetna Medicare |
$187.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$113.56
|
| Rate for Payer: Amerigroup Medicare |
$113.56
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$249.50
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$113.56
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$113.56
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$173.68
|
| Rate for Payer: Cigna All Products |
$467.60
|
| Rate for Payer: Copperpoint |
$187.37
|
| Rate for Payer: HealthNet Commercial |
$400.80
|
| Rate for Payer: HealthNet Medicare |
$187.04
|
| Rate for Payer: Humana Medicare |
$113.56
|
| Rate for Payer: SELF PAY |
$534.40
|
| Rate for Payer: Veterans (Triwest) |
$113.56
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$389.44
|
| Rate for Payer: United Healthcare Medicare |
$120.24
|
|
|
SHEATH FLEXOR URETERAL ACCESS 35CM COOK
|
Facility
IP
|
$509.00
|
|
| Hospital Charge Code |
22354221
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.53 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$458.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$86.53
|
| Rate for Payer: Amerigroup Medicare |
$86.53
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$86.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$86.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$132.34
|
| Rate for Payer: Copperpoint |
$142.77
|
| Rate for Payer: Humana Medicare |
$86.53
|
| Rate for Payer: SELF PAY |
$407.20
|
| Rate for Payer: Veterans (Triwest) |
$86.53
|
|
|
SHEATH FLEXOR URETERAL ACCESS 35CM COOK
|
Facility
OP
|
$509.00
|
|
| Hospital Charge Code |
22354221
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.53 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$458.10
|
| Rate for Payer: Aetna Medicare |
$142.52
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$86.53
|
| Rate for Payer: Amerigroup Medicare |
$86.53
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$190.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$86.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$86.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$132.34
|
| Rate for Payer: Cigna All Products |
$356.30
|
| Rate for Payer: Copperpoint |
$142.77
|
| Rate for Payer: HealthNet Commercial |
$305.40
|
| Rate for Payer: HealthNet Medicare |
$142.52
|
| Rate for Payer: Humana Medicare |
$86.53
|
| Rate for Payer: SELF PAY |
$407.20
|
| Rate for Payer: Veterans (Triwest) |
$86.53
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$296.75
|
| Rate for Payer: United Healthcare Medicare |
$91.62
|
|
|
SHEATH URETERAL ACCESS 24CM ACMI UROPASS
|
Facility
IP
|
$505.00
|
|
| Hospital Charge Code |
22354818
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$454.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$85.85
|
| Rate for Payer: Amerigroup Medicare |
$85.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$85.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$85.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$131.30
|
| Rate for Payer: Copperpoint |
$141.65
|
| Rate for Payer: Humana Medicare |
$85.85
|
| Rate for Payer: SELF PAY |
$404.00
|
| Rate for Payer: Veterans (Triwest) |
$85.85
|
|
|
SHEATH URETERAL ACCESS 24CM ACMI UROPASS
|
Facility
OP
|
$505.00
|
|
| Hospital Charge Code |
22354818
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$454.50
|
| Rate for Payer: Aetna Medicare |
$141.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$85.85
|
| Rate for Payer: Amerigroup Medicare |
$85.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$188.62
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$85.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$85.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$131.30
|
| Rate for Payer: Cigna All Products |
$353.50
|
| Rate for Payer: Copperpoint |
$141.65
|
| Rate for Payer: HealthNet Commercial |
$303.00
|
| Rate for Payer: HealthNet Medicare |
$141.40
|
| Rate for Payer: Humana Medicare |
$85.85
|
| Rate for Payer: SELF PAY |
$404.00
|
| Rate for Payer: Veterans (Triwest) |
$85.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$294.41
|
| Rate for Payer: United Healthcare Medicare |
$90.90
|
|
|
SHEATH URETERAL ACCESS 38CM ACMI UROPASS
|
Facility
OP
|
$505.00
|
|
| Hospital Charge Code |
22354819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$454.50
|
| Rate for Payer: Aetna Medicare |
$141.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$85.85
|
| Rate for Payer: Amerigroup Medicare |
$85.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$188.62
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$85.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$85.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$131.30
|
| Rate for Payer: Cigna All Products |
$353.50
|
| Rate for Payer: Copperpoint |
$141.65
|
| Rate for Payer: HealthNet Commercial |
$303.00
|
| Rate for Payer: HealthNet Medicare |
$141.40
|
| Rate for Payer: Humana Medicare |
$85.85
|
| Rate for Payer: SELF PAY |
$404.00
|
| Rate for Payer: Veterans (Triwest) |
$85.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$294.41
|
| Rate for Payer: United Healthcare Medicare |
$90.90
|
|