|
SLING MINIARC PRECISE SINGLE INCISION
|
Facility
IP
|
$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: Allwell from Arizona Complete Health Medicare Advantage |
$714.85
|
| Rate for Payer: Amerigroup Medicare |
$714.85
|
| 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: Copperpoint |
$1,179.50
|
| Rate for Payer: Humana Medicare |
$714.85
|
| Rate for Payer: SELF PAY |
$3,364.00
|
| Rate for Payer: Veterans (Triwest) |
$714.85
|
|
|
SLING MINIARC SINGLE INCISION
|
Facility
IP
|
$3,809.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$647.53 |
| Max. Negotiated Rate |
$3,428.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,428.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$647.53
|
| Rate for Payer: Amerigroup Medicare |
$647.53
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$647.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$647.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$990.34
|
| Rate for Payer: Copperpoint |
$1,068.42
|
| Rate for Payer: Humana Medicare |
$647.53
|
| Rate for Payer: SELF PAY |
$3,047.20
|
| Rate for Payer: Veterans (Triwest) |
$647.53
|
|
|
SLING MINIARC SINGLE INCISION
|
Facility
OP
|
$3,809.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$647.53 |
| Max. Negotiated Rate |
$3,428.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,428.10
|
| Rate for Payer: Aetna Medicare |
$1,066.52
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$647.53
|
| Rate for Payer: Amerigroup Medicare |
$647.53
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,422.66
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$647.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$647.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$990.34
|
| Rate for Payer: Cigna All Products |
$2,666.30
|
| Rate for Payer: Copperpoint |
$1,068.42
|
| Rate for Payer: HealthNet Commercial |
$2,285.40
|
| Rate for Payer: HealthNet Medicare |
$1,066.52
|
| Rate for Payer: Humana Medicare |
$647.53
|
| Rate for Payer: SELF PAY |
$3,047.20
|
| Rate for Payer: Veterans (Triwest) |
$647.53
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2,220.65
|
| Rate for Payer: United Healthcare Medicare |
$685.62
|
|
|
SLING MONARC
|
Facility
IP
|
$3,809.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$647.53 |
| Max. Negotiated Rate |
$3,428.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,428.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$647.53
|
| Rate for Payer: Amerigroup Medicare |
$647.53
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$647.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$647.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$990.34
|
| Rate for Payer: Copperpoint |
$1,068.42
|
| Rate for Payer: Humana Medicare |
$647.53
|
| Rate for Payer: SELF PAY |
$3,047.20
|
| Rate for Payer: Veterans (Triwest) |
$647.53
|
|
|
SLING MONARC
|
Facility
OP
|
$3,809.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$647.53 |
| Max. Negotiated Rate |
$3,428.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,428.10
|
| Rate for Payer: Aetna Medicare |
$1,066.52
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$647.53
|
| Rate for Payer: Amerigroup Medicare |
$647.53
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,422.66
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$647.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$647.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$990.34
|
| Rate for Payer: Cigna All Products |
$2,666.30
|
| Rate for Payer: Copperpoint |
$1,068.42
|
| Rate for Payer: HealthNet Commercial |
$2,285.40
|
| Rate for Payer: HealthNet Medicare |
$1,066.52
|
| Rate for Payer: Humana Medicare |
$647.53
|
| Rate for Payer: SELF PAY |
$3,047.20
|
| Rate for Payer: Veterans (Triwest) |
$647.53
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2,220.65
|
| Rate for Payer: United Healthcare Medicare |
$685.62
|
|
|
SLING PROLAPSE ELEVATE POSTERIOR
|
Facility
OP
|
$4,860.00
|
|
| Hospital Charge Code |
22354152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$826.20 |
| Max. Negotiated Rate |
$4,374.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4,374.00
|
| Rate for Payer: Aetna Medicare |
$1,360.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$826.20
|
| Rate for Payer: Amerigroup Medicare |
$826.20
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,815.21
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$826.20
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$826.20
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,263.60
|
| Rate for Payer: Cigna All Products |
$3,402.00
|
| Rate for Payer: Copperpoint |
$1,363.23
|
| Rate for Payer: HealthNet Commercial |
$2,916.00
|
| Rate for Payer: HealthNet Medicare |
$1,360.80
|
| Rate for Payer: Humana Medicare |
$826.20
|
| Rate for Payer: SELF PAY |
$3,888.00
|
| Rate for Payer: Veterans (Triwest) |
$826.20
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2,833.38
|
| Rate for Payer: United Healthcare Medicare |
$874.80
|
|
|
SLING PROLAPSE ELEVATE POSTERIOR
|
Facility
IP
|
$4,860.00
|
|
| Hospital Charge Code |
22354152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$826.20 |
| Max. Negotiated Rate |
$4,374.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4,374.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$826.20
|
| Rate for Payer: Amerigroup Medicare |
$826.20
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$826.20
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$826.20
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,263.60
|
| Rate for Payer: Copperpoint |
$1,363.23
|
| Rate for Payer: Humana Medicare |
$826.20
|
| Rate for Payer: SELF PAY |
$3,888.00
|
| Rate for Payer: Veterans (Triwest) |
$826.20
|
|
|
Sling (Removal or Revision)
|
Facility
IP
|
$3,805.00
|
|
|
Service Code
|
CPT 57287
|
| Hospital Charge Code |
27267790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$646.85 |
| Max. Negotiated Rate |
$3,424.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,424.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$646.85
|
| Rate for Payer: Amerigroup Medicare |
$646.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$646.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$646.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$989.30
|
| Rate for Payer: Copperpoint |
$1,067.30
|
| Rate for Payer: Humana Medicare |
$646.85
|
| Rate for Payer: SELF PAY |
$3,044.00
|
| Rate for Payer: Veterans (Triwest) |
$646.85
|
|
|
Sling (Removal or Revision)
|
Facility
OP
|
$3,805.00
|
|
|
Service Code
|
CPT 57287
|
| Hospital Charge Code |
27267790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$646.85 |
| Max. Negotiated Rate |
$3,803.66 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,424.50
|
| Rate for Payer: Aetna Medicare |
$1,065.40
|
| Rate for Payer: AHCCCS Medicaid |
$3,803.66
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3,803.66
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$646.85
|
| Rate for Payer: Amerigroup Medicare |
$646.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,421.17
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3,803.66
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$646.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$646.85
|
| Rate for Payer: Banner University Family Care Medicaid |
$3,803.66
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$989.30
|
| Rate for Payer: Cigna All Products |
$1,902.50
|
| Rate for Payer: Copperpoint |
$1,067.30
|
| Rate for Payer: HealthNet Commercial |
$2,283.00
|
| Rate for Payer: HealthNet Medicare |
$1,065.40
|
| Rate for Payer: Humana Medicare |
$646.85
|
| Rate for Payer: Mercy Care Medicaid |
$3,803.66
|
| Rate for Payer: SELF PAY |
$3,044.00
|
| Rate for Payer: Veterans (Triwest) |
$646.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2,218.32
|
| Rate for Payer: United Healthcare Medicare |
$684.90
|
|
|
SLING SUPRAPUBIC ALIGN URETHRAL SUPPORT
|
Facility
IP
|
$2,494.00
|
|
| Hospital Charge Code |
22354161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$423.98 |
| Max. Negotiated Rate |
$2,244.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,244.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$423.98
|
| Rate for Payer: Amerigroup Medicare |
$423.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$423.98
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$423.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$648.44
|
| Rate for Payer: Copperpoint |
$699.57
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: SELF PAY |
$1,995.20
|
| Rate for Payer: Veterans (Triwest) |
$423.98
|
|
|
SLING SUPRAPUBIC ALIGN URETHRAL SUPPORT
|
Facility
OP
|
$2,494.00
|
|
| Hospital Charge Code |
22354161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$423.98 |
| Max. Negotiated Rate |
$2,244.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,244.60
|
| Rate for Payer: Aetna Medicare |
$698.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$423.98
|
| Rate for Payer: Amerigroup Medicare |
$423.98
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$931.51
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$423.98
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$423.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$648.44
|
| Rate for Payer: Cigna All Products |
$1,745.80
|
| Rate for Payer: Copperpoint |
$699.57
|
| Rate for Payer: HealthNet Commercial |
$1,496.40
|
| Rate for Payer: HealthNet Medicare |
$698.32
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: SELF PAY |
$1,995.20
|
| Rate for Payer: Veterans (Triwest) |
$423.98
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,454.00
|
| Rate for Payer: United Healthcare Medicare |
$448.92
|
|
|
SLING SWATH ADULT
|
Facility
IP
|
$60.00
|
|
| Hospital Charge Code |
22354186
|
|
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
|
|
|
SLING SWATH ADULT
|
Facility
OP
|
$60.00
|
|
| Hospital Charge Code |
22354186
|
|
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
|
|
|
SLING SWATH PED
|
Facility
IP
|
$100.00
|
|
| Hospital Charge Code |
22354242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$90.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.00
|
| Rate for Payer: Amerigroup Medicare |
$17.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$26.00
|
| Rate for Payer: Copperpoint |
$28.05
|
| Rate for Payer: Humana Medicare |
$17.00
|
| Rate for Payer: SELF PAY |
$80.00
|
| Rate for Payer: Veterans (Triwest) |
$17.00
|
|
|
SLING SWATH PED
|
Facility
OP
|
$100.00
|
|
| Hospital Charge Code |
22354242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$90.00
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.00
|
| Rate for Payer: Amerigroup Medicare |
$17.00
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$37.35
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$26.00
|
| Rate for Payer: Cigna All Products |
$70.00
|
| Rate for Payer: Copperpoint |
$28.05
|
| Rate for Payer: HealthNet Commercial |
$60.00
|
| Rate for Payer: HealthNet Medicare |
$28.00
|
| Rate for Payer: Humana Medicare |
$17.00
|
| Rate for Payer: SELF PAY |
$80.00
|
| Rate for Payer: Veterans (Triwest) |
$17.00
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$58.30
|
| Rate for Payer: United Healthcare Medicare |
$18.00
|
|
|
SLIPPER SOCKS EXTRA LARGE
|
Facility
IP
|
$6.00
|
|
| Hospital Charge Code |
22355542
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$5.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.02
|
| Rate for Payer: Amerigroup Medicare |
$1.02
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.02
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.02
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.56
|
| Rate for Payer: Copperpoint |
$1.68
|
| Rate for Payer: Humana Medicare |
$1.02
|
| Rate for Payer: SELF PAY |
$4.80
|
| Rate for Payer: Veterans (Triwest) |
$1.02
|
|
|
SLIPPER SOCKS EXTRA LARGE
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
22355542
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: SELF PAY |
$4.80
|
| Rate for Payer: Aetna POS, PPO, HMO |
$5.40
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.02
|
| Rate for Payer: Amerigroup Medicare |
$1.02
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$2.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.02
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.02
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.56
|
| Rate for Payer: Cigna All Products |
$4.20
|
| Rate for Payer: Copperpoint |
$1.68
|
| Rate for Payer: HealthNet Commercial |
$3.60
|
| Rate for Payer: HealthNet Medicare |
$1.68
|
| Rate for Payer: Humana Medicare |
$1.02
|
| Rate for Payer: Veterans (Triwest) |
$1.02
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$1.08
|
|
|
SMART TOE 2 IMPLANT 15MM
|
Facility
IP
|
$11,395.00
|
|
| Hospital Charge Code |
27519891
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,937.15 |
| Max. Negotiated Rate |
$10,255.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$10,255.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1,937.15
|
| Rate for Payer: Amerigroup Medicare |
$1,937.15
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1,937.15
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1,937.15
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2,962.70
|
| Rate for Payer: Copperpoint |
$3,196.30
|
| Rate for Payer: Humana Medicare |
$1,937.15
|
| Rate for Payer: SELF PAY |
$9,116.00
|
| Rate for Payer: Veterans (Triwest) |
$1,937.15
|
|
|
SMART TOE 2 IMPLANT 15MM
|
Facility
OP
|
$11,395.00
|
|
| Hospital Charge Code |
27519891
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,937.15 |
| Max. Negotiated Rate |
$10,255.50 |
| Rate for Payer: SELF PAY |
$9,116.00
|
| Rate for Payer: Aetna POS, PPO, HMO |
$10,255.50
|
| Rate for Payer: Aetna Medicare |
$3,190.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1,937.15
|
| Rate for Payer: Amerigroup Medicare |
$1,937.15
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$4,256.03
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1,937.15
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1,937.15
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2,962.70
|
| Rate for Payer: Cigna All Products |
$7,976.50
|
| Rate for Payer: Copperpoint |
$3,196.30
|
| Rate for Payer: HealthNet Commercial |
$6,837.00
|
| Rate for Payer: HealthNet Medicare |
$3,190.60
|
| Rate for Payer: Humana Medicare |
$1,937.15
|
| Rate for Payer: Veterans (Triwest) |
$1,937.15
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$6,643.28
|
| Rate for Payer: United Healthcare Medicare |
$2,051.10
|
|
|
SMOKING CESSATION OVER 10 MIN
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
853513
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$51.30
|
| Rate for Payer: Aetna Medicare |
$15.96
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$9.69
|
| Rate for Payer: Amerigroup Medicare |
$9.69
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$21.29
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$9.69
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$9.69
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$14.82
|
| Rate for Payer: Cigna All Products |
$39.90
|
| Rate for Payer: Copperpoint |
$15.99
|
| Rate for Payer: HealthNet Commercial |
$34.20
|
| Rate for Payer: HealthNet Medicare |
$15.96
|
| Rate for Payer: Humana Medicare |
$9.69
|
| Rate for Payer: SELF PAY |
$45.60
|
| Rate for Payer: Veterans (Triwest) |
$9.69
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$33.23
|
| Rate for Payer: United Healthcare Medicare |
$10.26
|
|
|
SMOKING CESSATION OVER 10 MIN
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
853513
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$51.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$9.69
|
| Rate for Payer: Amerigroup Medicare |
$9.69
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$9.69
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$9.69
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$14.82
|
| Rate for Payer: Copperpoint |
$15.99
|
| Rate for Payer: Humana Medicare |
$9.69
|
| Rate for Payer: SELF PAY |
$45.60
|
| Rate for Payer: Veterans (Triwest) |
$9.69
|
|
|
SNAP CARTRIDGE 125 MM
|
Facility
IP
|
$639.00
|
|
| Hospital Charge Code |
22355019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$575.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$575.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$108.63
|
| Rate for Payer: Amerigroup Medicare |
$108.63
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$108.63
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$108.63
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$166.14
|
| Rate for Payer: Copperpoint |
$179.24
|
| Rate for Payer: Humana Medicare |
$108.63
|
| Rate for Payer: SELF PAY |
$511.20
|
| Rate for Payer: Veterans (Triwest) |
$108.63
|
|
|
SNAP CARTRIDGE 125 MM
|
Facility
OP
|
$639.00
|
|
| Hospital Charge Code |
22355019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$575.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$575.10
|
| Rate for Payer: Aetna Medicare |
$178.92
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$108.63
|
| Rate for Payer: Amerigroup Medicare |
$108.63
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$238.67
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$108.63
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$108.63
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$166.14
|
| Rate for Payer: Cigna All Products |
$447.30
|
| Rate for Payer: Copperpoint |
$179.24
|
| Rate for Payer: HealthNet Commercial |
$383.40
|
| Rate for Payer: HealthNet Medicare |
$178.92
|
| Rate for Payer: Humana Medicare |
$108.63
|
| Rate for Payer: SELF PAY |
$511.20
|
| Rate for Payer: Veterans (Triwest) |
$108.63
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$372.54
|
| Rate for Payer: United Healthcare Medicare |
$115.02
|
|
|
SNAP DRESSING KIT W FOAM 10X10
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
22355018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$180.00
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$34.00
|
| Rate for Payer: Amerigroup Medicare |
$34.00
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$74.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$34.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$34.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$52.00
|
| Rate for Payer: Cigna All Products |
$140.00
|
| Rate for Payer: Copperpoint |
$56.10
|
| Rate for Payer: HealthNet Commercial |
$120.00
|
| Rate for Payer: HealthNet Medicare |
$56.00
|
| Rate for Payer: Humana Medicare |
$34.00
|
| Rate for Payer: SELF PAY |
$160.00
|
| Rate for Payer: Veterans (Triwest) |
$34.00
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$116.60
|
| Rate for Payer: United Healthcare Medicare |
$36.00
|
|
|
SNAP DRESSING KIT W FOAM 10X10
|
Facility
IP
|
$200.00
|
|
| Hospital Charge Code |
22355018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$180.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$34.00
|
| Rate for Payer: Amerigroup Medicare |
$34.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$34.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$34.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$52.00
|
| Rate for Payer: Copperpoint |
$56.10
|
| Rate for Payer: Humana Medicare |
$34.00
|
| Rate for Payer: SELF PAY |
$160.00
|
| Rate for Payer: Veterans (Triwest) |
$34.00
|
|