|
SHEATH URETERAL ACCESS 38CM ACMI UROPASS
|
Facility
IP
|
$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: 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 DBL LUMEN 12X35
|
Facility
OP
|
$509.00
|
|
| Hospital Charge Code |
22354224
|
|
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 DBL LUMEN 12X35
|
Facility
IP
|
$509.00
|
|
| Hospital Charge Code |
22354224
|
|
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
|
|
|
SHIGA-TOXIN 1 AG
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
22272337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$53.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
|
|
SHIGA-TOXIN 1 AG
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
22272337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Aetna Medicare |
$23.24
|
| Rate for Payer: AHCCCS Medicaid |
$16.07
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$16.07
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$31.00
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$16.07
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: Banner University Family Care Medicaid |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$53.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Cigna All Products |
$53.95
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: HealthNet Commercial |
$49.80
|
| Rate for Payer: HealthNet Medicare |
$23.24
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: Mercy Care Medicaid |
$16.07
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$48.39
|
| Rate for Payer: United Healthcare Medicare |
$14.94
|
|
|
SHIGA-TOXIN 2 AG
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
22272338
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$53.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
|
|
SHIGA-TOXIN 2 AG
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
22272338
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Aetna Medicare |
$23.24
|
| Rate for Payer: AHCCCS Medicaid |
$16.07
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$16.07
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$31.00
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$16.07
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: Banner University Family Care Medicaid |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$53.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Cigna All Products |
$53.95
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: HealthNet Commercial |
$49.80
|
| Rate for Payer: HealthNet Medicare |
$23.24
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: Mercy Care Medicaid |
$16.07
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$48.39
|
| Rate for Payer: United Healthcare Medicare |
$14.94
|
|
|
SHOE POST-OP FEMALE LARGE
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Aetna Medicare |
$23.24
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$31.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Cigna All Products |
$58.10
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: HealthNet Commercial |
$49.80
|
| Rate for Payer: HealthNet Medicare |
$23.24
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$48.39
|
| Rate for Payer: United Healthcare Medicare |
$14.94
|
|
|
SHOE POST-OP FEMALE LARGE
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
|
|
SHOE POST-OP FEMALE MEDIUM
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$54.00
|
| Rate for Payer: Aetna Medicare |
$16.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.20
|
| Rate for Payer: Amerigroup Medicare |
$10.20
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$22.41
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.20
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.20
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$15.60
|
| Rate for Payer: Cigna All Products |
$42.00
|
| Rate for Payer: Copperpoint |
$16.83
|
| Rate for Payer: HealthNet Commercial |
$36.00
|
| Rate for Payer: HealthNet Medicare |
$16.80
|
| Rate for Payer: Humana Medicare |
$10.20
|
| Rate for Payer: SELF PAY |
$48.00
|
| Rate for Payer: Veterans (Triwest) |
$10.20
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$34.98
|
| Rate for Payer: United Healthcare Medicare |
$10.80
|
|
|
SHOE POST-OP FEMALE MEDIUM
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$54.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.20
|
| Rate for Payer: Amerigroup Medicare |
$10.20
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.20
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.20
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$15.60
|
| Rate for Payer: Copperpoint |
$16.83
|
| Rate for Payer: Humana Medicare |
$10.20
|
| Rate for Payer: SELF PAY |
$48.00
|
| Rate for Payer: Veterans (Triwest) |
$10.20
|
|
|
SHOE POST-OP FEMALE SMALL
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354282
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Aetna Medicare |
$23.24
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$31.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Cigna All Products |
$58.10
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: HealthNet Commercial |
$49.80
|
| Rate for Payer: HealthNet Medicare |
$23.24
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$48.39
|
| Rate for Payer: United Healthcare Medicare |
$14.94
|
|
|
SHOE POST-OP FEMALE SMALL
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354282
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
|
|
SHOE POST-OP MALE LARGE
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
|
|
SHOE POST-OP MALE LARGE
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Aetna Medicare |
$23.24
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$31.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Cigna All Products |
$58.10
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: HealthNet Commercial |
$49.80
|
| Rate for Payer: HealthNet Medicare |
$23.24
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$48.39
|
| Rate for Payer: United Healthcare Medicare |
$14.94
|
|
|
SHOE POST-OP MALE MEDIUM
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354286
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
|
|
SHOE POST-OP MALE MEDIUM
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354286
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Aetna Medicare |
$23.24
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$31.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Cigna All Products |
$58.10
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: HealthNet Commercial |
$49.80
|
| Rate for Payer: HealthNet Medicare |
$23.24
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$48.39
|
| Rate for Payer: United Healthcare Medicare |
$14.94
|
|
|
SHOE POST-OP MALE SMALL
|
Facility
OP
|
$31.30
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354285
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$28.17 |
| Rate for Payer: Aetna POS, PPO, HMO |
$28.17
|
| Rate for Payer: Aetna Medicare |
$8.76
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.32
|
| Rate for Payer: Amerigroup Medicare |
$5.32
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$11.69
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.32
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$8.14
|
| Rate for Payer: Cigna All Products |
$21.91
|
| Rate for Payer: Copperpoint |
$8.78
|
| Rate for Payer: HealthNet Commercial |
$18.78
|
| Rate for Payer: HealthNet Medicare |
$8.76
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: SELF PAY |
$25.04
|
| Rate for Payer: Veterans (Triwest) |
$5.32
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$18.25
|
| Rate for Payer: United Healthcare Medicare |
$5.63
|
|
|
SHOE POST-OP MALE SMALL
|
Facility
IP
|
$31.30
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354285
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$28.17 |
| Rate for Payer: Aetna POS, PPO, HMO |
$28.17
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.32
|
| Rate for Payer: Amerigroup Medicare |
$5.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.32
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$8.14
|
| Rate for Payer: Copperpoint |
$8.78
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: SELF PAY |
$25.04
|
| Rate for Payer: Veterans (Triwest) |
$5.32
|
|
|
SHOE POST-OP MALE X-SMALL
|
Facility
IP
|
$31.30
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354306
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$28.17 |
| Rate for Payer: Aetna POS, PPO, HMO |
$28.17
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.32
|
| Rate for Payer: Amerigroup Medicare |
$5.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.32
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$8.14
|
| Rate for Payer: Copperpoint |
$8.78
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: SELF PAY |
$25.04
|
| Rate for Payer: Veterans (Triwest) |
$5.32
|
|
|
SHOE POST-OP MALE X-SMALL
|
Facility
OP
|
$31.30
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354306
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$28.17 |
| Rate for Payer: Aetna POS, PPO, HMO |
$28.17
|
| Rate for Payer: Aetna Medicare |
$8.76
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.32
|
| Rate for Payer: Amerigroup Medicare |
$5.32
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$11.69
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.32
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$8.14
|
| Rate for Payer: Cigna All Products |
$21.91
|
| Rate for Payer: Copperpoint |
$8.78
|
| Rate for Payer: HealthNet Commercial |
$18.78
|
| Rate for Payer: HealthNet Medicare |
$8.76
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: SELF PAY |
$25.04
|
| Rate for Payer: Veterans (Triwest) |
$5.32
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$18.25
|
| Rate for Payer: United Healthcare Medicare |
$5.63
|
|
|
SHOE POST OP XL
|
Facility
OP
|
$31.30
|
|
| Hospital Charge Code |
24045512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$28.17 |
| Rate for Payer: Aetna POS, PPO, HMO |
$28.17
|
| Rate for Payer: Aetna Medicare |
$8.76
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.32
|
| Rate for Payer: Amerigroup Medicare |
$5.32
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$11.69
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.32
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$8.14
|
| Rate for Payer: Cigna All Products |
$21.91
|
| Rate for Payer: Copperpoint |
$8.78
|
| Rate for Payer: HealthNet Commercial |
$18.78
|
| Rate for Payer: HealthNet Medicare |
$8.76
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: SELF PAY |
$25.04
|
| Rate for Payer: Veterans (Triwest) |
$5.32
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$18.25
|
| Rate for Payer: United Healthcare Medicare |
$5.63
|
|
|
SHOE POST OP XL
|
Facility
IP
|
$31.30
|
|
| Hospital Charge Code |
24045512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$28.17 |
| Rate for Payer: Aetna POS, PPO, HMO |
$28.17
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.32
|
| Rate for Payer: Amerigroup Medicare |
$5.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.32
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$8.14
|
| Rate for Payer: Copperpoint |
$8.78
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: SELF PAY |
$25.04
|
| Rate for Payer: Veterans (Triwest) |
$5.32
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
IP
|
$15,847.43
|
|
|
Service Code
|
APRDRG 3223
|
| Hospital Charge Code |
APRDRG3223
|
| Min. Negotiated Rate |
$15,847.43 |
| Max. Negotiated Rate |
$15,847.43 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$15,847.43
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$15,847.43
|
| Rate for Payer: Banner University Family Care Medicaid |
$15,847.43
|
| Rate for Payer: Mercy Care Medicaid |
$15,847.43
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
IP
|
$10,051.76
|
|
|
Service Code
|
APRDRG 3221
|
| Hospital Charge Code |
APRDRG3221
|
| Min. Negotiated Rate |
$10,051.76 |
| Max. Negotiated Rate |
$10,051.76 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$10,051.76
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$10,051.76
|
| Rate for Payer: Banner University Family Care Medicaid |
$10,051.76
|
| Rate for Payer: Mercy Care Medicaid |
$10,051.76
|
|