|
SLEEVE ALP CALF
|
Facility
IP
|
$93.00
|
|
| Hospital Charge Code |
22354965
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$83.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.81
|
| Rate for Payer: Amerigroup Medicare |
$15.81
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.81
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.81
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$24.18
|
| Rate for Payer: Copperpoint |
$26.09
|
| Rate for Payer: Humana Medicare |
$15.81
|
| Rate for Payer: SELF PAY |
$74.40
|
| Rate for Payer: Veterans (Triwest) |
$15.81
|
|
|
SLEEVE ALP CALF
|
Facility
OP
|
$93.00
|
|
| Hospital Charge Code |
22354965
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$83.70
|
| Rate for Payer: Aetna Medicare |
$26.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.81
|
| Rate for Payer: Amerigroup Medicare |
$15.81
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$34.74
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.81
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.81
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$24.18
|
| Rate for Payer: Cigna All Products |
$65.10
|
| Rate for Payer: Copperpoint |
$26.09
|
| Rate for Payer: HealthNet Commercial |
$55.80
|
| Rate for Payer: HealthNet Medicare |
$26.04
|
| Rate for Payer: Humana Medicare |
$15.81
|
| Rate for Payer: SELF PAY |
$74.40
|
| Rate for Payer: Veterans (Triwest) |
$15.81
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$54.22
|
| Rate for Payer: United Healthcare Medicare |
$16.74
|
|
|
SLEEVE TROCARE 5CM STR REFLEX
|
Facility
OP
|
$101.00
|
|
| Hospital Charge Code |
22706520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$90.90
|
| Rate for Payer: Aetna Medicare |
$28.28
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.17
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$37.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.17
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$26.26
|
| Rate for Payer: Cigna All Products |
$70.70
|
| Rate for Payer: Copperpoint |
$28.33
|
| Rate for Payer: HealthNet Commercial |
$60.60
|
| Rate for Payer: HealthNet Medicare |
$28.28
|
| Rate for Payer: Humana Medicare |
$17.17
|
| Rate for Payer: SELF PAY |
$80.80
|
| Rate for Payer: Veterans (Triwest) |
$17.17
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$58.88
|
| Rate for Payer: United Healthcare Medicare |
$18.18
|
|
|
SLEEVE TROCARE 5CM STR REFLEX
|
Facility
IP
|
$101.00
|
|
| Hospital Charge Code |
22706520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$90.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.17
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.17
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$26.26
|
| Rate for Payer: Copperpoint |
$28.33
|
| Rate for Payer: Humana Medicare |
$17.17
|
| Rate for Payer: SELF PAY |
$80.80
|
| Rate for Payer: Veterans (Triwest) |
$17.17
|
|
|
Slide Coagulase
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
634041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$29.70
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: AHCCCS Medicaid |
$5.18
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$5.18
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.61
|
| Rate for Payer: Amerigroup Medicare |
$5.61
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$12.33
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$5.18
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.61
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.61
|
| Rate for Payer: Banner University Family Care Medicaid |
$5.18
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$8.58
|
| Rate for Payer: Cigna All Products |
$21.45
|
| Rate for Payer: Copperpoint |
$9.26
|
| Rate for Payer: HealthNet Commercial |
$19.80
|
| Rate for Payer: HealthNet Medicare |
$9.24
|
| Rate for Payer: Humana Medicare |
$5.61
|
| Rate for Payer: Mercy Care Medicaid |
$5.18
|
| Rate for Payer: SELF PAY |
$26.40
|
| Rate for Payer: Veterans (Triwest) |
$5.61
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$19.24
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
Slide Coagulase
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
634041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$29.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.61
|
| Rate for Payer: Amerigroup Medicare |
$5.61
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.61
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.61
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$8.58
|
| Rate for Payer: Copperpoint |
$9.26
|
| Rate for Payer: Humana Medicare |
$5.61
|
| Rate for Payer: SELF PAY |
$26.40
|
| Rate for Payer: Veterans (Triwest) |
$5.61
|
|
|
SLING ARM LARGE
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354278
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$26.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$4.93
|
| Rate for Payer: Amerigroup Medicare |
$4.93
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$4.93
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$4.93
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$7.54
|
| Rate for Payer: Copperpoint |
$8.13
|
| Rate for Payer: Humana Medicare |
$4.93
|
| Rate for Payer: SELF PAY |
$23.20
|
| Rate for Payer: Veterans (Triwest) |
$4.93
|
|
|
SLING ARM LARGE
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354278
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$26.10
|
| Rate for Payer: Aetna Medicare |
$8.12
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$4.93
|
| Rate for Payer: Amerigroup Medicare |
$4.93
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$10.83
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$4.93
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$4.93
|
| Rate for Payer: Banner University Family Care Medicaid |
$13.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$7.54
|
| Rate for Payer: Cigna All Products |
$20.30
|
| Rate for Payer: Copperpoint |
$8.13
|
| Rate for Payer: HealthNet Commercial |
$17.40
|
| Rate for Payer: HealthNet Medicare |
$8.12
|
| Rate for Payer: Humana Medicare |
$4.93
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: SELF PAY |
$23.20
|
| Rate for Payer: Veterans (Triwest) |
$4.93
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$16.91
|
| Rate for Payer: United Healthcare Medicare |
$5.22
|
|
|
SLING ARM LG
|
Facility
OP
|
$24.00
|
|
| Hospital Charge Code |
22354133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$21.60
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$4.08
|
| Rate for Payer: Amerigroup Medicare |
$4.08
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$8.96
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$4.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$4.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$6.24
|
| Rate for Payer: Cigna All Products |
$16.80
|
| Rate for Payer: Copperpoint |
$6.73
|
| Rate for Payer: HealthNet Commercial |
$14.40
|
| Rate for Payer: HealthNet Medicare |
$6.72
|
| Rate for Payer: Humana Medicare |
$4.08
|
| Rate for Payer: SELF PAY |
$19.20
|
| Rate for Payer: Veterans (Triwest) |
$4.08
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$13.99
|
| Rate for Payer: United Healthcare Medicare |
$4.32
|
|
|
SLING ARM LG
|
Facility
IP
|
$24.00
|
|
| Hospital Charge Code |
22354133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$21.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$4.08
|
| Rate for Payer: Amerigroup Medicare |
$4.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$4.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$4.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$6.24
|
| Rate for Payer: Copperpoint |
$6.73
|
| Rate for Payer: Humana Medicare |
$4.08
|
| Rate for Payer: SELF PAY |
$19.20
|
| Rate for Payer: Veterans (Triwest) |
$4.08
|
|
|
SLING ARM LG ZIMMER
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$36.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.80
|
| Rate for Payer: Amerigroup Medicare |
$6.80
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.40
|
| Rate for Payer: Copperpoint |
$11.22
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: SELF PAY |
$32.00
|
| Rate for Payer: Veterans (Triwest) |
$6.80
|
|
|
SLING ARM LG ZIMMER
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$36.00
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.80
|
| Rate for Payer: Amerigroup Medicare |
$6.80
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$14.94
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.80
|
| Rate for Payer: Banner University Family Care Medicaid |
$13.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.40
|
| Rate for Payer: Cigna All Products |
$28.00
|
| Rate for Payer: Copperpoint |
$11.22
|
| Rate for Payer: HealthNet Commercial |
$24.00
|
| Rate for Payer: HealthNet Medicare |
$11.20
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: SELF PAY |
$32.00
|
| Rate for Payer: Veterans (Triwest) |
$6.80
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$23.32
|
| Rate for Payer: United Healthcare Medicare |
$7.20
|
|
|
SLING ARM MD ZIMMER
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$36.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.80
|
| Rate for Payer: Amerigroup Medicare |
$6.80
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.40
|
| Rate for Payer: Copperpoint |
$11.22
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: SELF PAY |
$32.00
|
| Rate for Payer: Veterans (Triwest) |
$6.80
|
|
|
SLING ARM MD ZIMMER
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$36.00
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.80
|
| Rate for Payer: Amerigroup Medicare |
$6.80
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$14.94
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.80
|
| Rate for Payer: Banner University Family Care Medicaid |
$13.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.40
|
| Rate for Payer: Cigna All Products |
$28.00
|
| Rate for Payer: Copperpoint |
$11.22
|
| Rate for Payer: HealthNet Commercial |
$24.00
|
| Rate for Payer: HealthNet Medicare |
$11.20
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: SELF PAY |
$32.00
|
| Rate for Payer: Veterans (Triwest) |
$6.80
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$23.32
|
| Rate for Payer: United Healthcare Medicare |
$7.20
|
|
|
SLING ARM MEDIUM
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$19.80
|
| Rate for Payer: Aetna Medicare |
$6.16
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.74
|
| Rate for Payer: Amerigroup Medicare |
$3.74
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$8.22
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.74
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.74
|
| Rate for Payer: Banner University Family Care Medicaid |
$13.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$5.72
|
| Rate for Payer: Cigna All Products |
$15.40
|
| Rate for Payer: Copperpoint |
$6.17
|
| Rate for Payer: HealthNet Commercial |
$13.20
|
| Rate for Payer: HealthNet Medicare |
$6.16
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: SELF PAY |
$17.60
|
| Rate for Payer: Veterans (Triwest) |
$3.74
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$12.83
|
| Rate for Payer: United Healthcare Medicare |
$3.96
|
|
|
SLING ARM MEDIUM
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$19.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.74
|
| Rate for Payer: Amerigroup Medicare |
$3.74
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.74
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.74
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$5.72
|
| Rate for Payer: Copperpoint |
$6.17
|
| Rate for Payer: Humana Medicare |
$3.74
|
| Rate for Payer: SELF PAY |
$17.60
|
| Rate for Payer: Veterans (Triwest) |
$3.74
|
|
|
SLING ARM SM ZIMMER
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$36.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.80
|
| Rate for Payer: Amerigroup Medicare |
$6.80
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.40
|
| Rate for Payer: Copperpoint |
$11.22
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: SELF PAY |
$32.00
|
| Rate for Payer: Veterans (Triwest) |
$6.80
|
|
|
SLING ARM SM ZIMMER
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$36.00
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.80
|
| Rate for Payer: Amerigroup Medicare |
$6.80
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$14.94
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.80
|
| Rate for Payer: Banner University Family Care Medicaid |
$13.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.40
|
| Rate for Payer: Cigna All Products |
$28.00
|
| Rate for Payer: Copperpoint |
$11.22
|
| Rate for Payer: HealthNet Commercial |
$24.00
|
| Rate for Payer: HealthNet Medicare |
$11.20
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: SELF PAY |
$32.00
|
| Rate for Payer: Veterans (Triwest) |
$6.80
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$23.32
|
| Rate for Payer: United Healthcare Medicare |
$7.20
|
|
|
SLING ARM XL ZIMMER
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$36.00
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.80
|
| Rate for Payer: Amerigroup Medicare |
$6.80
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$14.94
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.80
|
| Rate for Payer: Banner University Family Care Medicaid |
$13.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.40
|
| Rate for Payer: Cigna All Products |
$28.00
|
| Rate for Payer: Copperpoint |
$11.22
|
| Rate for Payer: HealthNet Commercial |
$24.00
|
| Rate for Payer: HealthNet Medicare |
$11.20
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: SELF PAY |
$32.00
|
| Rate for Payer: Veterans (Triwest) |
$6.80
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$23.32
|
| Rate for Payer: United Healthcare Medicare |
$7.20
|
|
|
SLING ARM XL ZIMMER
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$36.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.80
|
| Rate for Payer: Amerigroup Medicare |
$6.80
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.40
|
| Rate for Payer: Copperpoint |
$11.22
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: SELF PAY |
$32.00
|
| Rate for Payer: Veterans (Triwest) |
$6.80
|
|
|
SLING ARM XS-CHILD ZIMMER
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: SELF PAY |
$60.80
|
| Rate for Payer: Aetna POS, PPO, HMO |
$68.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$12.92
|
| Rate for Payer: Amerigroup Medicare |
$12.92
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$12.92
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$12.92
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$19.76
|
| Rate for Payer: Copperpoint |
$21.32
|
| Rate for Payer: Humana Medicare |
$12.92
|
| Rate for Payer: Veterans (Triwest) |
$12.92
|
|
|
SLING ARM XS-CHILD ZIMMER
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$68.40
|
| Rate for Payer: Aetna Medicare |
$21.28
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$12.92
|
| Rate for Payer: Amerigroup Medicare |
$12.92
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$28.39
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$12.92
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$12.92
|
| Rate for Payer: Banner University Family Care Medicaid |
$13.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$19.76
|
| Rate for Payer: Cigna All Products |
$53.20
|
| Rate for Payer: Copperpoint |
$21.32
|
| Rate for Payer: HealthNet Commercial |
$45.60
|
| Rate for Payer: HealthNet Medicare |
$21.28
|
| Rate for Payer: Humana Medicare |
$12.92
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: SELF PAY |
$60.80
|
| Rate for Payer: Veterans (Triwest) |
$12.92
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$44.31
|
| Rate for Payer: United Healthcare Medicare |
$13.68
|
|
|
SLING BLADDER SPARC
|
Facility
OP
|
$3,305.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$561.85 |
| Max. Negotiated Rate |
$2,974.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,974.50
|
| Rate for Payer: Aetna Medicare |
$925.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$561.85
|
| Rate for Payer: Amerigroup Medicare |
$561.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,234.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$561.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$561.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$859.30
|
| Rate for Payer: Cigna All Products |
$2,313.50
|
| Rate for Payer: Copperpoint |
$927.05
|
| Rate for Payer: HealthNet Commercial |
$1,983.00
|
| Rate for Payer: HealthNet Medicare |
$925.40
|
| Rate for Payer: Humana Medicare |
$561.85
|
| Rate for Payer: SELF PAY |
$2,644.00
|
| Rate for Payer: Veterans (Triwest) |
$561.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,926.81
|
| Rate for Payer: United Healthcare Medicare |
$594.90
|
|
|
SLING BLADDER SPARC
|
Facility
IP
|
$3,305.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$561.85 |
| Max. Negotiated Rate |
$2,974.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,974.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$561.85
|
| Rate for Payer: Amerigroup Medicare |
$561.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$561.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$561.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$859.30
|
| Rate for Payer: Copperpoint |
$927.05
|
| Rate for Payer: Humana Medicare |
$561.85
|
| Rate for Payer: SELF PAY |
$2,644.00
|
| Rate for Payer: Veterans (Triwest) |
$561.85
|
|
|
SLING MINIARC PRECISE SINGLE INCISION
|
Facility
OP
|
$4,205.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$714.85 |
| Max. Negotiated Rate |
$3,784.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,784.50
|
| Rate for Payer: Aetna Medicare |
$1,177.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$714.85
|
| Rate for Payer: Amerigroup Medicare |
$714.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,570.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$714.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$714.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,093.30
|
| Rate for Payer: Cigna All Products |
$2,943.50
|
| Rate for Payer: Copperpoint |
$1,179.50
|
| Rate for Payer: HealthNet Commercial |
$2,523.00
|
| Rate for Payer: HealthNet Medicare |
$1,177.40
|
| Rate for Payer: Humana Medicare |
$714.85
|
| Rate for Payer: SELF PAY |
$3,364.00
|
| Rate for Payer: Veterans (Triwest) |
$714.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2,451.51
|
| Rate for Payer: United Healthcare Medicare |
$756.90
|
|