|
SNARE MASTER PLUS 10MM
|
Facility
IP
|
$75.60
|
|
| Hospital Charge Code |
23733630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$68.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$12.85
|
| Rate for Payer: Amerigroup Medicare |
$12.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$12.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$12.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$19.66
|
| Rate for Payer: Copperpoint |
$21.21
|
| Rate for Payer: Humana Medicare |
$12.85
|
| Rate for Payer: SELF PAY |
$60.48
|
| Rate for Payer: Veterans (Triwest) |
$12.85
|
|
|
SNARE MASTER PLUS 10MM
|
Facility
OP
|
$75.60
|
|
| Hospital Charge Code |
23733630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$68.04
|
| Rate for Payer: Aetna Medicare |
$21.17
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$12.85
|
| Rate for Payer: Amerigroup Medicare |
$12.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$28.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$12.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$12.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$19.66
|
| Rate for Payer: Cigna All Products |
$52.92
|
| Rate for Payer: Copperpoint |
$21.21
|
| Rate for Payer: HealthNet Commercial |
$45.36
|
| Rate for Payer: HealthNet Medicare |
$21.17
|
| Rate for Payer: Humana Medicare |
$12.85
|
| Rate for Payer: SELF PAY |
$60.48
|
| Rate for Payer: Veterans (Triwest) |
$12.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$44.07
|
| Rate for Payer: United Healthcare Medicare |
$13.61
|
|
|
SNARE OVAL FLEXIBLE MEDIUM
|
Facility
OP
|
$115.00
|
|
| Hospital Charge Code |
23589498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$103.50
|
| Rate for Payer: Aetna Medicare |
$32.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$19.55
|
| Rate for Payer: Amerigroup Medicare |
$19.55
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$42.95
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$19.55
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$19.55
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$29.90
|
| Rate for Payer: Cigna All Products |
$80.50
|
| Rate for Payer: Copperpoint |
$32.26
|
| Rate for Payer: HealthNet Commercial |
$69.00
|
| Rate for Payer: HealthNet Medicare |
$32.20
|
| Rate for Payer: Humana Medicare |
$19.55
|
| Rate for Payer: SELF PAY |
$92.00
|
| Rate for Payer: Veterans (Triwest) |
$19.55
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$67.05
|
| Rate for Payer: United Healthcare Medicare |
$20.70
|
|
|
SNARE OVAL FLEXIBLE MEDIUM
|
Facility
IP
|
$115.00
|
|
| Hospital Charge Code |
23589498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$103.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$19.55
|
| Rate for Payer: Amerigroup Medicare |
$19.55
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$19.55
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$19.55
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$29.90
|
| Rate for Payer: Copperpoint |
$32.26
|
| Rate for Payer: Humana Medicare |
$19.55
|
| Rate for Payer: SELF PAY |
$92.00
|
| Rate for Payer: Veterans (Triwest) |
$19.55
|
|
|
SNARE OVAL FLEX MEDIUM
|
Facility
OP
|
$1,188.00
|
|
| Hospital Charge Code |
22354316
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.96 |
| Max. Negotiated Rate |
$1,069.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,069.20
|
| Rate for Payer: Aetna Medicare |
$332.64
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$201.96
|
| Rate for Payer: Amerigroup Medicare |
$201.96
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$443.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$201.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$201.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$308.88
|
| Rate for Payer: Cigna All Products |
$831.60
|
| Rate for Payer: Copperpoint |
$333.23
|
| Rate for Payer: HealthNet Commercial |
$712.80
|
| Rate for Payer: HealthNet Medicare |
$332.64
|
| Rate for Payer: Humana Medicare |
$201.96
|
| Rate for Payer: SELF PAY |
$950.40
|
| Rate for Payer: Veterans (Triwest) |
$201.96
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$692.60
|
| Rate for Payer: United Healthcare Medicare |
$213.84
|
|
|
SNARE OVAL FLEX MEDIUM
|
Facility
IP
|
$1,188.00
|
|
| Hospital Charge Code |
22354316
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.96 |
| Max. Negotiated Rate |
$1,069.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,069.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$201.96
|
| Rate for Payer: Amerigroup Medicare |
$201.96
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$201.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$201.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$308.88
|
| Rate for Payer: Copperpoint |
$333.23
|
| Rate for Payer: Humana Medicare |
$201.96
|
| Rate for Payer: SELF PAY |
$950.40
|
| Rate for Payer: Veterans (Triwest) |
$201.96
|
|
|
SNARE POLYPECTOMY SML OVAL CONMED
|
Facility
OP
|
$1,492.00
|
|
| Hospital Charge Code |
22354206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$253.64 |
| Max. Negotiated Rate |
$1,342.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,342.80
|
| Rate for Payer: Aetna Medicare |
$417.76
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$253.64
|
| Rate for Payer: Amerigroup Medicare |
$253.64
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$557.26
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$253.64
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$253.64
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$387.92
|
| Rate for Payer: Cigna All Products |
$1,044.40
|
| Rate for Payer: Copperpoint |
$418.51
|
| Rate for Payer: HealthNet Commercial |
$895.20
|
| Rate for Payer: HealthNet Medicare |
$417.76
|
| Rate for Payer: Humana Medicare |
$253.64
|
| Rate for Payer: SELF PAY |
$1,193.60
|
| Rate for Payer: Veterans (Triwest) |
$253.64
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$869.84
|
| Rate for Payer: United Healthcare Medicare |
$268.56
|
|
|
SNARE POLYPECTOMY SML OVAL CONMED
|
Facility
IP
|
$1,492.00
|
|
| Hospital Charge Code |
22354206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$253.64 |
| Max. Negotiated Rate |
$1,342.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,342.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$253.64
|
| Rate for Payer: Amerigroup Medicare |
$253.64
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$253.64
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$253.64
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$387.92
|
| Rate for Payer: Copperpoint |
$418.51
|
| Rate for Payer: Humana Medicare |
$253.64
|
| Rate for Payer: SELF PAY |
$1,193.60
|
| Rate for Payer: Veterans (Triwest) |
$253.64
|
|
|
Sodium Level
|
Facility
OP
|
$69.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$62.10
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: AHCCCS Medicaid |
$4.81
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.81
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.73
|
| Rate for Payer: Amerigroup Medicare |
$11.73
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$25.77
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4.81
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.73
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.73
|
| Rate for Payer: Banner University Family Care Medicaid |
$4.81
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$17.94
|
| Rate for Payer: Cigna All Products |
$44.85
|
| Rate for Payer: Copperpoint |
$19.35
|
| Rate for Payer: HealthNet Commercial |
$41.40
|
| Rate for Payer: HealthNet Medicare |
$19.32
|
| Rate for Payer: Humana Medicare |
$11.73
|
| Rate for Payer: Mercy Care Medicaid |
$4.81
|
| Rate for Payer: SELF PAY |
$55.20
|
| Rate for Payer: Veterans (Triwest) |
$11.73
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$40.23
|
| Rate for Payer: United Healthcare Medicare |
$12.42
|
|
|
Sodium Level
|
Facility
IP
|
$69.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$62.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.73
|
| Rate for Payer: Amerigroup Medicare |
$11.73
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.73
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.73
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$17.94
|
| Rate for Payer: Copperpoint |
$19.35
|
| Rate for Payer: Humana Medicare |
$11.73
|
| Rate for Payer: SELF PAY |
$55.20
|
| Rate for Payer: Veterans (Triwest) |
$11.73
|
|
|
Sodium Level 24 Hour Urine
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$79.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.96
|
| Rate for Payer: Amerigroup Medicare |
$14.96
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$22.88
|
| Rate for Payer: Copperpoint |
$24.68
|
| Rate for Payer: Humana Medicare |
$14.96
|
| Rate for Payer: SELF PAY |
$70.40
|
| Rate for Payer: Veterans (Triwest) |
$14.96
|
|
|
Sodium Level 24 Hour Urine
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$79.20
|
| Rate for Payer: Aetna Medicare |
$24.64
|
| Rate for Payer: AHCCCS Medicaid |
$5.06
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$5.06
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.96
|
| Rate for Payer: Amerigroup Medicare |
$14.96
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$32.87
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$5.06
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.96
|
| Rate for Payer: Banner University Family Care Medicaid |
$5.06
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$22.88
|
| Rate for Payer: Cigna All Products |
$57.20
|
| Rate for Payer: Copperpoint |
$24.68
|
| Rate for Payer: HealthNet Commercial |
$52.80
|
| Rate for Payer: HealthNet Medicare |
$24.64
|
| Rate for Payer: Humana Medicare |
$14.96
|
| Rate for Payer: Mercy Care Medicaid |
$5.06
|
| Rate for Payer: SELF PAY |
$70.40
|
| Rate for Payer: Veterans (Triwest) |
$14.96
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$51.30
|
| Rate for Payer: United Healthcare Medicare |
$15.84
|
|
|
Sodium Level Urine
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
887730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$79.20
|
| Rate for Payer: Aetna Medicare |
$24.64
|
| Rate for Payer: AHCCCS Medicaid |
$5.06
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$5.06
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.96
|
| Rate for Payer: Amerigroup Medicare |
$14.96
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$32.87
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$5.06
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.96
|
| Rate for Payer: Banner University Family Care Medicaid |
$5.06
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$22.88
|
| Rate for Payer: Cigna All Products |
$57.20
|
| Rate for Payer: Copperpoint |
$24.68
|
| Rate for Payer: HealthNet Commercial |
$52.80
|
| Rate for Payer: HealthNet Medicare |
$24.64
|
| Rate for Payer: Humana Medicare |
$14.96
|
| Rate for Payer: Mercy Care Medicaid |
$5.06
|
| Rate for Payer: SELF PAY |
$70.40
|
| Rate for Payer: Veterans (Triwest) |
$14.96
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$51.30
|
| Rate for Payer: United Healthcare Medicare |
$15.84
|
|
|
Sodium Level Urine
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
887730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$79.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.96
|
| Rate for Payer: Amerigroup Medicare |
$14.96
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$22.88
|
| Rate for Payer: Copperpoint |
$24.68
|
| Rate for Payer: Humana Medicare |
$14.96
|
| Rate for Payer: SELF PAY |
$70.40
|
| Rate for Payer: Veterans (Triwest) |
$14.96
|
|
|
SOLIDIFIER ISOSORB 3000
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
22354547
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$20.70
|
| Rate for Payer: Aetna Medicare |
$6.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.91
|
| Rate for Payer: Amerigroup Medicare |
$3.91
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$8.59
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.91
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.91
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$5.98
|
| Rate for Payer: Cigna All Products |
$16.10
|
| Rate for Payer: Copperpoint |
$6.45
|
| Rate for Payer: HealthNet Commercial |
$13.80
|
| Rate for Payer: HealthNet Medicare |
$6.44
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: SELF PAY |
$18.40
|
| Rate for Payer: Veterans (Triwest) |
$3.91
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$13.41
|
| Rate for Payer: United Healthcare Medicare |
$4.14
|
|
|
SOLIDIFIER ISOSORB 3000
|
Facility
IP
|
$23.00
|
|
| Hospital Charge Code |
22354547
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$20.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.91
|
| Rate for Payer: Amerigroup Medicare |
$3.91
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.91
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.91
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$5.98
|
| Rate for Payer: Copperpoint |
$6.45
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: SELF PAY |
$18.40
|
| Rate for Payer: Veterans (Triwest) |
$3.91
|
|
|
SOL IRRG D/W 500 BOTTLE
|
Facility
IP
|
$29.00
|
|
| Hospital Charge Code |
22355366
|
|
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
|
|
|
SOL IRRG D/W 500 BOTTLE
|
Facility
OP
|
$29.00
|
|
| Hospital Charge Code |
22355366
|
|
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: 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 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: 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: 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
|
|
|
SOL IRRIG 1000ML DW
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
24154073
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$27.00
|
| Rate for Payer: Aetna Medicare |
$8.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.10
|
| Rate for Payer: Amerigroup Medicare |
$5.10
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$11.21
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.10
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.10
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$7.80
|
| Rate for Payer: Cigna All Products |
$21.00
|
| Rate for Payer: Copperpoint |
$8.42
|
| Rate for Payer: HealthNet Commercial |
$18.00
|
| Rate for Payer: HealthNet Medicare |
$8.40
|
| Rate for Payer: Humana Medicare |
$5.10
|
| Rate for Payer: SELF PAY |
$24.00
|
| Rate for Payer: Veterans (Triwest) |
$5.10
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$17.49
|
| Rate for Payer: United Healthcare Medicare |
$5.40
|
|
|
SOL IRRIG 1000ML DW
|
Facility
IP
|
$30.00
|
|
| Hospital Charge Code |
24154073
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$27.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.10
|
| Rate for Payer: Amerigroup Medicare |
$5.10
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.10
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.10
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$7.80
|
| Rate for Payer: Copperpoint |
$8.42
|
| Rate for Payer: Humana Medicare |
$5.10
|
| Rate for Payer: SELF PAY |
$24.00
|
| Rate for Payer: Veterans (Triwest) |
$5.10
|
|
|
SOL IRRIG 3000ML DW
|
Facility
IP
|
$69.00
|
|
| Hospital Charge Code |
24153497
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$62.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.73
|
| Rate for Payer: Amerigroup Medicare |
$11.73
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.73
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.73
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$17.94
|
| Rate for Payer: Copperpoint |
$19.35
|
| Rate for Payer: Humana Medicare |
$11.73
|
| Rate for Payer: SELF PAY |
$55.20
|
| Rate for Payer: Veterans (Triwest) |
$11.73
|
|
|
SOL IRRIG 3000ML DW
|
Facility
OP
|
$69.00
|
|
| Hospital Charge Code |
24153497
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$62.10
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.73
|
| Rate for Payer: Amerigroup Medicare |
$11.73
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$25.77
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.73
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.73
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$17.94
|
| Rate for Payer: Cigna All Products |
$48.30
|
| Rate for Payer: Copperpoint |
$19.35
|
| Rate for Payer: HealthNet Commercial |
$41.40
|
| Rate for Payer: HealthNet Medicare |
$19.32
|
| Rate for Payer: Humana Medicare |
$11.73
|
| Rate for Payer: SELF PAY |
$55.20
|
| Rate for Payer: Veterans (Triwest) |
$11.73
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$40.23
|
| Rate for Payer: United Healthcare Medicare |
$12.42
|
|
|
SOL IRRIG N/S 1000 BOTTLE
|
Facility
IP
|
$29.00
|
|
| Hospital Charge Code |
27571817
|
|
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
|
|
|
SOL IRRIG N/S 1000 BOTTLE
|
Facility
IP
|
$29.00
|
|
| Hospital Charge Code |
22355109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: SELF PAY |
$23.20
|
| 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: Veterans (Triwest) |
$4.93
|
|
|
SOL IRRIG N/S 1000 BOTTLE
|
Facility
OP
|
$29.00
|
|
| Hospital Charge Code |
22355109
|
|
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: 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 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: 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: 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
|
|