|
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 500 BOTTLE
|
Facility
OP
|
$29.00
|
|
| Hospital Charge Code |
22355365
|
|
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 N/S 500 BOTTLE
|
Facility
IP
|
$29.00
|
|
| Hospital Charge Code |
22355365
|
|
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
|
|
|
SPACER OR CHAMBER FOR MDI
|
Facility
IP
|
$92.00
|
|
| Hospital Charge Code |
22354981
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$82.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.64
|
| Rate for Payer: Amerigroup Medicare |
$15.64
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.64
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.64
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.92
|
| Rate for Payer: Copperpoint |
$25.81
|
| Rate for Payer: Humana Medicare |
$15.64
|
| Rate for Payer: SELF PAY |
$73.60
|
| Rate for Payer: Veterans (Triwest) |
$15.64
|
|
|
SPACER OR CHAMBER FOR MDI
|
Facility
OP
|
$92.00
|
|
| Hospital Charge Code |
22354981
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$82.80
|
| Rate for Payer: Aetna Medicare |
$25.76
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.64
|
| Rate for Payer: Amerigroup Medicare |
$15.64
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$34.36
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.64
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.64
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.92
|
| Rate for Payer: Cigna All Products |
$64.40
|
| Rate for Payer: Copperpoint |
$25.81
|
| Rate for Payer: HealthNet Commercial |
$55.20
|
| Rate for Payer: HealthNet Medicare |
$25.76
|
| Rate for Payer: Humana Medicare |
$15.64
|
| Rate for Payer: SELF PAY |
$73.60
|
| Rate for Payer: Veterans (Triwest) |
$15.64
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$53.64
|
| Rate for Payer: United Healthcare Medicare |
$16.56
|
|
|
SPACER RIGID RECLOSABLE BAG
|
Facility
OP
|
$23.76
|
|
| Hospital Charge Code |
23589698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna POS, PPO, HMO |
$21.38
|
| Rate for Payer: Aetna Medicare |
$6.65
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$4.04
|
| Rate for Payer: Amerigroup Medicare |
$4.04
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$8.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$4.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$4.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$6.18
|
| Rate for Payer: Cigna All Products |
$16.63
|
| Rate for Payer: Copperpoint |
$6.66
|
| Rate for Payer: HealthNet Commercial |
$14.26
|
| Rate for Payer: HealthNet Medicare |
$6.65
|
| Rate for Payer: Humana Medicare |
$4.04
|
| Rate for Payer: SELF PAY |
$19.01
|
| Rate for Payer: Veterans (Triwest) |
$4.04
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$13.85
|
| Rate for Payer: United Healthcare Medicare |
$4.28
|
|
|
SPACER RIGID RECLOSABLE BAG
|
Facility
IP
|
$23.76
|
|
| Hospital Charge Code |
23589698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$21.38 |
| Rate for Payer: Aetna POS, PPO, HMO |
$21.38
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$4.04
|
| Rate for Payer: Amerigroup Medicare |
$4.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$4.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$4.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$6.18
|
| Rate for Payer: Copperpoint |
$6.66
|
| Rate for Payer: Humana Medicare |
$4.04
|
| Rate for Payer: SELF PAY |
$19.01
|
| Rate for Payer: Veterans (Triwest) |
$4.04
|
|
|
SPACER RIGID RECLOSABLE BAG W/ PED MASK
|
Facility
IP
|
$67.00
|
|
| Hospital Charge Code |
23589699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$60.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.39
|
| Rate for Payer: Amerigroup Medicare |
$11.39
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$17.42
|
| Rate for Payer: Copperpoint |
$18.79
|
| Rate for Payer: Humana Medicare |
$11.39
|
| Rate for Payer: SELF PAY |
$53.60
|
| Rate for Payer: Veterans (Triwest) |
$11.39
|
|
|
SPACER RIGID RECLOSABLE BAG W/ PED MASK
|
Facility
OP
|
$67.00
|
|
| Hospital Charge Code |
23589699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$60.30
|
| Rate for Payer: Aetna Medicare |
$18.76
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.39
|
| Rate for Payer: Amerigroup Medicare |
$11.39
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$25.02
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$17.42
|
| Rate for Payer: Cigna All Products |
$46.90
|
| Rate for Payer: Copperpoint |
$18.79
|
| Rate for Payer: HealthNet Commercial |
$40.20
|
| Rate for Payer: HealthNet Medicare |
$18.76
|
| Rate for Payer: Humana Medicare |
$11.39
|
| Rate for Payer: SELF PAY |
$53.60
|
| Rate for Payer: Veterans (Triwest) |
$11.39
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$39.06
|
| Rate for Payer: United Healthcare Medicare |
$12.06
|
|
|
SPECIAL STAINS GROUP 1
|
Facility
IP
|
$1,788.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
22545719
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$303.96 |
| Max. Negotiated Rate |
$1,609.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,609.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$303.96
|
| Rate for Payer: Amerigroup Medicare |
$303.96
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$303.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$303.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$464.88
|
| Rate for Payer: Copperpoint |
$501.53
|
| Rate for Payer: Humana Medicare |
$303.96
|
| Rate for Payer: SELF PAY |
$1,430.40
|
| Rate for Payer: Veterans (Triwest) |
$303.96
|
|
|
SPECIAL STAINS GROUP 1
|
Facility
OP
|
$1,788.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
22545719
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$1,609.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,609.20
|
| Rate for Payer: Aetna Medicare |
$500.64
|
| Rate for Payer: AHCCCS Medicaid |
$36.08
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$36.08
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$303.96
|
| Rate for Payer: Amerigroup Medicare |
$303.96
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$667.82
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$36.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$303.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$303.96
|
| Rate for Payer: Banner University Family Care Medicaid |
$36.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$464.88
|
| Rate for Payer: Cigna All Products |
$1,162.20
|
| Rate for Payer: Copperpoint |
$501.53
|
| Rate for Payer: HealthNet Commercial |
$1,072.80
|
| Rate for Payer: HealthNet Medicare |
$500.64
|
| Rate for Payer: Humana Medicare |
$303.96
|
| Rate for Payer: Mercy Care Medicaid |
$36.08
|
| Rate for Payer: SELF PAY |
$1,430.40
|
| Rate for Payer: Veterans (Triwest) |
$303.96
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,042.40
|
| Rate for Payer: United Healthcare Medicare |
$321.84
|
|
|
SPECIAL STAINS GROUP 2
|
Facility
IP
|
$1,373.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
22545721
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$233.41 |
| Max. Negotiated Rate |
$1,235.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,235.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$233.41
|
| Rate for Payer: Amerigroup Medicare |
$233.41
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$233.41
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$233.41
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$356.98
|
| Rate for Payer: Copperpoint |
$385.13
|
| Rate for Payer: Humana Medicare |
$233.41
|
| Rate for Payer: SELF PAY |
$1,098.40
|
| Rate for Payer: Veterans (Triwest) |
$233.41
|
|
|
SPECIAL STAINS GROUP 2
|
Facility
OP
|
$1,373.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
22545721
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$1,235.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,235.70
|
| Rate for Payer: Aetna Medicare |
$384.44
|
| Rate for Payer: AHCCCS Medicaid |
$24.53
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$24.53
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$233.41
|
| Rate for Payer: Amerigroup Medicare |
$233.41
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$512.82
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$24.53
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$233.41
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$233.41
|
| Rate for Payer: Banner University Family Care Medicaid |
$24.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$356.98
|
| Rate for Payer: Cigna All Products |
$892.45
|
| Rate for Payer: Copperpoint |
$385.13
|
| Rate for Payer: HealthNet Commercial |
$823.80
|
| Rate for Payer: HealthNet Medicare |
$384.44
|
| Rate for Payer: Humana Medicare |
$233.41
|
| Rate for Payer: Mercy Care Medicaid |
$24.53
|
| Rate for Payer: SELF PAY |
$1,098.40
|
| Rate for Payer: Veterans (Triwest) |
$233.41
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$800.46
|
| Rate for Payer: United Healthcare Medicare |
$247.14
|
|
|
SPECIMEN TRAPS 70CC
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
22355566
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$10.80
|
| Rate for Payer: Aetna Medicare |
$3.36
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.04
|
| Rate for Payer: Amerigroup Medicare |
$2.04
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$4.48
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.12
|
| Rate for Payer: Cigna All Products |
$8.40
|
| Rate for Payer: Copperpoint |
$3.37
|
| Rate for Payer: HealthNet Commercial |
$7.20
|
| Rate for Payer: HealthNet Medicare |
$3.36
|
| Rate for Payer: Humana Medicare |
$2.04
|
| Rate for Payer: SELF PAY |
$9.60
|
| Rate for Payer: Veterans (Triwest) |
$2.04
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$7.00
|
| Rate for Payer: United Healthcare Medicare |
$2.16
|
|
|
SPECIMEN TRAPS 70CC
|
Facility
IP
|
$12.00
|
|
| Hospital Charge Code |
22355566
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$10.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.04
|
| Rate for Payer: Amerigroup Medicare |
$2.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.12
|
| Rate for Payer: Copperpoint |
$3.37
|
| Rate for Payer: Humana Medicare |
$2.04
|
| Rate for Payer: SELF PAY |
$9.60
|
| Rate for Payer: Veterans (Triwest) |
$2.04
|
|
|
SPEC RETR BAG 10MM, 3CM CONMED
|
Facility
OP
|
$326.00
|
|
| Hospital Charge Code |
22354853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$293.40
|
| Rate for Payer: Aetna Medicare |
$91.28
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$55.42
|
| Rate for Payer: Amerigroup Medicare |
$55.42
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$121.76
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$55.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$55.42
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$84.76
|
| Rate for Payer: Cigna All Products |
$228.20
|
| Rate for Payer: Copperpoint |
$91.44
|
| Rate for Payer: HealthNet Commercial |
$195.60
|
| Rate for Payer: HealthNet Medicare |
$91.28
|
| Rate for Payer: Humana Medicare |
$55.42
|
| Rate for Payer: SELF PAY |
$260.80
|
| Rate for Payer: Veterans (Triwest) |
$55.42
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$190.06
|
| Rate for Payer: United Healthcare Medicare |
$58.68
|
|
|
SPEC RETR BAG 10MM, 3CM CONMED
|
Facility
IP
|
$326.00
|
|
| Hospital Charge Code |
22354853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$293.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$55.42
|
| Rate for Payer: Amerigroup Medicare |
$55.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$55.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$55.42
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$84.76
|
| Rate for Payer: Copperpoint |
$91.44
|
| Rate for Payer: Humana Medicare |
$55.42
|
| Rate for Payer: SELF PAY |
$260.80
|
| Rate for Payer: Veterans (Triwest) |
$55.42
|
|
|
SPECULUM VAGINAL MEDIUM
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
22355372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$8.10
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.53
|
| Rate for Payer: Amerigroup Medicare |
$1.53
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$3.36
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2.34
|
| Rate for Payer: Cigna All Products |
$6.30
|
| Rate for Payer: Copperpoint |
$2.52
|
| Rate for Payer: HealthNet Commercial |
$5.40
|
| Rate for Payer: HealthNet Medicare |
$2.52
|
| Rate for Payer: Humana Medicare |
$1.53
|
| Rate for Payer: SELF PAY |
$7.20
|
| Rate for Payer: Veterans (Triwest) |
$1.53
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$5.25
|
| Rate for Payer: United Healthcare Medicare |
$1.62
|
|
|
SPECULUM VAGINAL MEDIUM
|
Facility
IP
|
$9.00
|
|
| Hospital Charge Code |
22355372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$8.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.53
|
| Rate for Payer: Amerigroup Medicare |
$1.53
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2.34
|
| Rate for Payer: Copperpoint |
$2.52
|
| Rate for Payer: Humana Medicare |
$1.53
|
| Rate for Payer: SELF PAY |
$7.20
|
| Rate for Payer: Veterans (Triwest) |
$1.53
|
|
|
SPECULUM VAGINAL SMALL
|
Facility
IP
|
$9.00
|
|
| Hospital Charge Code |
22354946
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$8.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.53
|
| Rate for Payer: Amerigroup Medicare |
$1.53
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2.34
|
| Rate for Payer: Copperpoint |
$2.52
|
| Rate for Payer: Humana Medicare |
$1.53
|
| Rate for Payer: SELF PAY |
$7.20
|
| Rate for Payer: Veterans (Triwest) |
$1.53
|
|
|
SPECULUM VAGINAL SMALL
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
22354946
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$8.10
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.53
|
| Rate for Payer: Amerigroup Medicare |
$1.53
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$3.36
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2.34
|
| Rate for Payer: Cigna All Products |
$6.30
|
| Rate for Payer: Copperpoint |
$2.52
|
| Rate for Payer: HealthNet Commercial |
$5.40
|
| Rate for Payer: HealthNet Medicare |
$2.52
|
| Rate for Payer: Humana Medicare |
$1.53
|
| Rate for Payer: SELF PAY |
$7.20
|
| Rate for Payer: Veterans (Triwest) |
$1.53
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$5.25
|
| Rate for Payer: United Healthcare Medicare |
$1.62
|
|
|
Speed Band Superview Super 7
|
Facility
IP
|
$1,164.00
|
|
| Hospital Charge Code |
22926474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$1,047.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,047.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$197.88
|
| Rate for Payer: Amerigroup Medicare |
$197.88
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$197.88
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$197.88
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$302.64
|
| Rate for Payer: Copperpoint |
$326.50
|
| Rate for Payer: Humana Medicare |
$197.88
|
| Rate for Payer: SELF PAY |
$931.20
|
| Rate for Payer: Veterans (Triwest) |
$197.88
|
|
|
Speed Band Superview Super 7
|
Facility
OP
|
$1,164.00
|
|
| Hospital Charge Code |
22926474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$1,047.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,047.60
|
| Rate for Payer: Aetna Medicare |
$325.92
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$197.88
|
| Rate for Payer: Amerigroup Medicare |
$197.88
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$434.75
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$197.88
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$197.88
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$302.64
|
| Rate for Payer: Cigna All Products |
$814.80
|
| Rate for Payer: Copperpoint |
$326.50
|
| Rate for Payer: HealthNet Commercial |
$698.40
|
| Rate for Payer: HealthNet Medicare |
$325.92
|
| Rate for Payer: Humana Medicare |
$197.88
|
| Rate for Payer: SELF PAY |
$931.20
|
| Rate for Payer: Veterans (Triwest) |
$197.88
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$678.61
|
| Rate for Payer: United Healthcare Medicare |
$209.52
|
|
|
Spinal Disorders And Injuries
|
Facility
IP
|
$6,868.11
|
|
|
Service Code
|
APRDRG 401
|
| Hospital Charge Code |
APRDRG401
|
| Min. Negotiated Rate |
$6,868.11 |
| Max. Negotiated Rate |
$6,868.11 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$6,868.11
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$6,868.11
|
| Rate for Payer: Banner University Family Care Medicaid |
$6,868.11
|
| Rate for Payer: Mercy Care Medicaid |
$6,868.11
|
|
|
Spinal Disorders And Injuries
|
Facility
IP
|
$23,362.23
|
|
|
Service Code
|
APRDRG 404
|
| Hospital Charge Code |
APRDRG404
|
| Min. Negotiated Rate |
$23,362.23 |
| Max. Negotiated Rate |
$23,362.23 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$23,362.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$23,362.23
|
| Rate for Payer: Banner University Family Care Medicaid |
$23,362.23
|
| Rate for Payer: Mercy Care Medicaid |
$23,362.23
|
|