|
Lamotrigine (Lamictal), Serum LC
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1905811
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.46 |
| Max. Negotiated Rate |
$288.90 |
| Rate for Payer: Aetna of AZ Commercial |
$288.90
|
| Rate for Payer: Bisbee Police All Plans |
$83.46
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Self Pay Self Pay |
$256.80
|
|
|
Lamotrigine (Lamictal), Serum LC
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1905811
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.36 |
| Max. Negotiated Rate |
$288.90 |
| Rate for Payer: Aetna of AZ Commercial |
$288.90
|
| Rate for Payer: Aetna of AZ Medicare |
$89.88
|
| Rate for Payer: Allwell Medicare |
$51.36
|
| Rate for Payer: Amerigroup Medicare |
$51.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$119.89
|
| Rate for Payer: AZCH Complete Medicare |
$51.36
|
| Rate for Payer: Banner UC Health Medicare |
$51.36
|
| Rate for Payer: Bisbee Police All Plans |
$83.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$218.28
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cigna of AZ Commercial |
$208.65
|
| Rate for Payer: Copperpoint Commercial |
$79.45
|
| Rate for Payer: Health Net of AZ Commercial |
$192.60
|
| Rate for Payer: Health Net of AZ Medicare |
$89.88
|
| Rate for Payer: Humana of AZ Medicare |
$51.36
|
| Rate for Payer: Self Pay Self Pay |
$256.80
|
| Rate for Payer: TriWest Medicare |
$51.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$187.14
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$57.78
|
|
|
Laparoscopic burch
|
Facility
|
OP
|
$4,037.00
|
|
|
Service Code
|
CPT 51990
|
| Hospital Charge Code |
27267839
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$645.92 |
| Max. Negotiated Rate |
$3,668.82 |
| Rate for Payer: Aetna of AZ Commercial |
$3,633.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,130.36
|
| Rate for Payer: AHCCCS Medicaid |
$3,668.82
|
| Rate for Payer: Allwell Medicaid |
$3,668.82
|
| Rate for Payer: Allwell Medicare |
$645.92
|
| Rate for Payer: Amerigroup Medicare |
$645.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,507.82
|
| Rate for Payer: AZCH Complete Medicaid |
$3,668.82
|
| Rate for Payer: AZCH Complete Medicare |
$645.92
|
| Rate for Payer: Banner UC Health Medicaid |
$3,668.82
|
| Rate for Payer: Banner UC Health Medicare |
$645.92
|
| Rate for Payer: Bisbee Police All Plans |
$1,049.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,745.16
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: Cigna of AZ Commercial |
$2,018.50
|
| Rate for Payer: Copperpoint Commercial |
$999.16
|
| Rate for Payer: Health Net of AZ Commercial |
$2,422.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,130.36
|
| Rate for Payer: Humana of AZ Medicare |
$645.92
|
| Rate for Payer: Mercy Care Medicaid |
$3,668.82
|
| Rate for Payer: Self Pay Self Pay |
$3,229.60
|
| Rate for Payer: TriWest Medicare |
$645.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,353.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$726.66
|
|
|
Laparoscopic burch
|
Facility
|
IP
|
$4,037.00
|
|
|
Service Code
|
CPT 51990
|
| Hospital Charge Code |
27267839
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,049.62 |
| Max. Negotiated Rate |
$3,633.30 |
| Rate for Payer: Aetna of AZ Commercial |
$3,633.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,049.62
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: Self Pay Self Pay |
$3,229.60
|
|
|
Laparoscopic myomectomy
|
Facility
|
OP
|
$5,082.00
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
27281908
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$813.12 |
| Max. Negotiated Rate |
$4,573.80 |
| Rate for Payer: Aetna of AZ Commercial |
$4,573.80
|
| Rate for Payer: Aetna of AZ Medicare |
$1,422.96
|
| Rate for Payer: Allwell Medicare |
$813.12
|
| Rate for Payer: Amerigroup Medicare |
$813.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,898.13
|
| Rate for Payer: AZCH Complete Medicare |
$813.12
|
| Rate for Payer: Banner UC Health Medicare |
$813.12
|
| Rate for Payer: Bisbee Police All Plans |
$1,321.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,455.76
|
| Rate for Payer: Cash Price |
$4,065.60
|
| Rate for Payer: Cigna of AZ Commercial |
$2,541.00
|
| Rate for Payer: Copperpoint Commercial |
$1,257.80
|
| Rate for Payer: Health Net of AZ Commercial |
$3,049.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,422.96
|
| Rate for Payer: Humana of AZ Medicare |
$813.12
|
| Rate for Payer: Self Pay Self Pay |
$4,065.60
|
| Rate for Payer: TriWest Medicare |
$813.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,962.81
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$914.76
|
|
|
Laparoscopic myomectomy
|
Facility
|
IP
|
$5,082.00
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
27281908
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,321.32 |
| Max. Negotiated Rate |
$4,573.80 |
| Rate for Payer: Aetna of AZ Commercial |
$4,573.80
|
| Rate for Payer: Bisbee Police All Plans |
$1,321.32
|
| Rate for Payer: Cash Price |
$4,065.60
|
| Rate for Payer: Self Pay Self Pay |
$4,065.60
|
|
|
Laparoscopy lysis of adhesiions
|
Facility
|
IP
|
$1,352.00
|
|
|
Service Code
|
CPT 58660
|
| Hospital Charge Code |
27281902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.52 |
| Max. Negotiated Rate |
$1,216.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,216.80
|
| Rate for Payer: Bisbee Police All Plans |
$351.52
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Self Pay Self Pay |
$1,081.60
|
|
|
Laparoscopy lysis of adhesiions
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
CPT 58660
|
| Hospital Charge Code |
27281902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$216.32 |
| Max. Negotiated Rate |
$3,668.82 |
| Rate for Payer: Aetna of AZ Commercial |
$1,216.80
|
| Rate for Payer: Aetna of AZ Medicare |
$378.56
|
| Rate for Payer: AHCCCS Medicaid |
$3,668.82
|
| Rate for Payer: Allwell Medicaid |
$3,668.82
|
| Rate for Payer: Allwell Medicare |
$216.32
|
| Rate for Payer: Amerigroup Medicare |
$216.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$504.97
|
| Rate for Payer: AZCH Complete Medicaid |
$3,668.82
|
| Rate for Payer: AZCH Complete Medicare |
$216.32
|
| Rate for Payer: Banner UC Health Medicaid |
$3,668.82
|
| Rate for Payer: Banner UC Health Medicare |
$216.32
|
| Rate for Payer: Bisbee Police All Plans |
$351.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$919.36
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cigna of AZ Commercial |
$676.00
|
| Rate for Payer: Copperpoint Commercial |
$334.62
|
| Rate for Payer: Health Net of AZ Commercial |
$811.20
|
| Rate for Payer: Health Net of AZ Medicare |
$378.56
|
| Rate for Payer: Humana of AZ Medicare |
$216.32
|
| Rate for Payer: Mercy Care Medicaid |
$3,668.82
|
| Rate for Payer: Self Pay Self Pay |
$1,081.60
|
| Rate for Payer: TriWest Medicare |
$216.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$788.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$243.36
|
|
|
LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS INCONTINEN
|
Facility
|
OP
|
$19,694.00
|
|
|
Service Code
|
CPT 51992
|
| Hospital Charge Code |
23093915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,151.04 |
| Max. Negotiated Rate |
$17,724.60 |
| Rate for Payer: Aetna of AZ Commercial |
$17,724.60
|
| Rate for Payer: Aetna of AZ Medicare |
$5,514.32
|
| Rate for Payer: AHCCCS Medicaid |
$3,668.82
|
| Rate for Payer: Allwell Medicaid |
$3,668.82
|
| Rate for Payer: Allwell Medicare |
$3,151.04
|
| Rate for Payer: Amerigroup Medicare |
$3,151.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$7,355.71
|
| Rate for Payer: AZCH Complete Medicaid |
$3,668.82
|
| Rate for Payer: AZCH Complete Medicare |
$3,151.04
|
| Rate for Payer: Banner UC Health Medicaid |
$3,668.82
|
| Rate for Payer: Banner UC Health Medicare |
$3,151.04
|
| Rate for Payer: Bisbee Police All Plans |
$5,120.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$13,391.92
|
| Rate for Payer: Cash Price |
$15,755.20
|
| Rate for Payer: Cash Price |
$15,755.20
|
| Rate for Payer: Cigna of AZ Commercial |
$9,847.00
|
| Rate for Payer: Copperpoint Commercial |
$4,874.27
|
| Rate for Payer: Health Net of AZ Commercial |
$11,816.40
|
| Rate for Payer: Health Net of AZ Medicare |
$5,514.32
|
| Rate for Payer: Humana of AZ Medicare |
$3,151.04
|
| Rate for Payer: Mercy Care Medicaid |
$3,668.82
|
| Rate for Payer: Self Pay Self Pay |
$15,755.20
|
| Rate for Payer: TriWest Medicare |
$3,151.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$11,481.60
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3,544.92
|
|
|
LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS INCONTINEN
|
Facility
|
IP
|
$19,694.00
|
|
|
Service Code
|
CPT 51992
|
| Hospital Charge Code |
23093915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,120.44 |
| Max. Negotiated Rate |
$17,724.60 |
| Rate for Payer: Aetna of AZ Commercial |
$17,724.60
|
| Rate for Payer: Bisbee Police All Plans |
$5,120.44
|
| Rate for Payer: Cash Price |
$15,755.20
|
| Rate for Payer: Self Pay Self Pay |
$15,755.20
|
|
|
LAPIPLASTY SPEEDPLATE QUAD 28X13X11
|
Facility
|
OP
|
$31,427.00
|
|
| Hospital Charge Code |
27733676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5,028.32 |
| Max. Negotiated Rate |
$28,284.30 |
| Rate for Payer: Aetna of AZ Commercial |
$28,284.30
|
| Rate for Payer: Aetna of AZ Medicare |
$8,799.56
|
| Rate for Payer: Allwell Medicare |
$5,028.32
|
| Rate for Payer: Amerigroup Medicare |
$5,028.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$11,737.98
|
| Rate for Payer: AZCH Complete Medicare |
$5,028.32
|
| Rate for Payer: Banner UC Health Medicare |
$5,028.32
|
| Rate for Payer: Bisbee Police All Plans |
$8,171.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$21,370.36
|
| Rate for Payer: Cash Price |
$25,141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$21,998.90
|
| Rate for Payer: Copperpoint Commercial |
$7,778.18
|
| Rate for Payer: Health Net of AZ Commercial |
$18,856.20
|
| Rate for Payer: Health Net of AZ Medicare |
$8,799.56
|
| Rate for Payer: Humana of AZ Medicare |
$5,028.32
|
| Rate for Payer: Self Pay Self Pay |
$25,141.60
|
| Rate for Payer: TriWest Medicare |
$5,028.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$18,321.94
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5,656.86
|
|
|
LAPIPLASTY SPEEDPLATE QUAD 28X13X11
|
Facility
|
IP
|
$31,427.00
|
|
| Hospital Charge Code |
27733676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8,171.02 |
| Max. Negotiated Rate |
$28,284.30 |
| Rate for Payer: Aetna of AZ Commercial |
$28,284.30
|
| Rate for Payer: Bisbee Police All Plans |
$8,171.02
|
| Rate for Payer: Cash Price |
$25,141.60
|
| Rate for Payer: Self Pay Self Pay |
$25,141.60
|
|
|
LAPIPLASTY SYSTEM 4
|
Facility
|
OP
|
$33,448.00
|
|
| Hospital Charge Code |
27431788
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5,351.68 |
| Max. Negotiated Rate |
$30,103.20 |
| Rate for Payer: Aetna of AZ Commercial |
$30,103.20
|
| Rate for Payer: Aetna of AZ Medicare |
$9,365.44
|
| Rate for Payer: Allwell Medicare |
$5,351.68
|
| Rate for Payer: Amerigroup Medicare |
$5,351.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$12,492.83
|
| Rate for Payer: AZCH Complete Medicare |
$5,351.68
|
| Rate for Payer: Banner UC Health Medicare |
$5,351.68
|
| Rate for Payer: Bisbee Police All Plans |
$8,696.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$22,744.64
|
| Rate for Payer: Cash Price |
$26,758.40
|
| Rate for Payer: Cigna of AZ Commercial |
$23,413.60
|
| Rate for Payer: Copperpoint Commercial |
$8,278.38
|
| Rate for Payer: Health Net of AZ Commercial |
$20,068.80
|
| Rate for Payer: Health Net of AZ Medicare |
$9,365.44
|
| Rate for Payer: Humana of AZ Medicare |
$5,351.68
|
| Rate for Payer: Self Pay Self Pay |
$26,758.40
|
| Rate for Payer: TriWest Medicare |
$5,351.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$19,500.18
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6,020.64
|
|
|
LAPIPLASTY SYSTEM 4
|
Facility
|
IP
|
$33,448.00
|
|
| Hospital Charge Code |
27431788
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8,696.48 |
| Max. Negotiated Rate |
$30,103.20 |
| Rate for Payer: Aetna of AZ Commercial |
$30,103.20
|
| Rate for Payer: Bisbee Police All Plans |
$8,696.48
|
| Rate for Payer: Cash Price |
$26,758.40
|
| Rate for Payer: Self Pay Self Pay |
$26,758.40
|
|
|
LAP-KIT INSTRUMENT HOLDER ETHOX
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
22561837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna of AZ Commercial |
$23.40
|
| Rate for Payer: Bisbee Police All Plans |
$6.76
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Self Pay Self Pay |
$20.80
|
|
|
LAP-KIT INSTRUMENT HOLDER ETHOX
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
22561837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna of AZ Commercial |
$23.40
|
| Rate for Payer: Aetna of AZ Medicare |
$7.28
|
| Rate for Payer: Allwell Medicare |
$4.16
|
| Rate for Payer: Amerigroup Medicare |
$4.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$9.71
|
| Rate for Payer: AZCH Complete Medicare |
$4.16
|
| Rate for Payer: Banner UC Health Medicare |
$4.16
|
| Rate for Payer: Bisbee Police All Plans |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$17.68
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cigna of AZ Commercial |
$18.20
|
| Rate for Payer: Copperpoint Commercial |
$6.43
|
| Rate for Payer: Health Net of AZ Commercial |
$15.60
|
| Rate for Payer: Health Net of AZ Medicare |
$7.28
|
| Rate for Payer: Humana of AZ Medicare |
$4.16
|
| Rate for Payer: Self Pay Self Pay |
$20.80
|
| Rate for Payer: TriWest Medicare |
$4.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$15.16
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.68
|
|
|
LAP KIT LAPAROSCOPIC INSTRUMENT HOLDER
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
27372824
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Aetna of AZ Medicare |
$9.24
|
| Rate for Payer: Allwell Medicare |
$5.28
|
| Rate for Payer: Amerigroup Medicare |
$5.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$12.33
|
| Rate for Payer: AZCH Complete Medicare |
$5.28
|
| Rate for Payer: Banner UC Health Medicare |
$5.28
|
| Rate for Payer: Bisbee Police All Plans |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$22.44
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of AZ Commercial |
$23.10
|
| Rate for Payer: Copperpoint Commercial |
$8.17
|
| Rate for Payer: Health Net of AZ Commercial |
$19.80
|
| Rate for Payer: Health Net of AZ Medicare |
$9.24
|
| Rate for Payer: Humana of AZ Medicare |
$5.28
|
| Rate for Payer: Self Pay Self Pay |
$26.40
|
| Rate for Payer: TriWest Medicare |
$5.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$19.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.94
|
|
|
LAP KIT LAPAROSCOPIC INSTRUMENT HOLDER
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
27372824
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Bisbee Police All Plans |
$8.58
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Self Pay Self Pay |
$26.40
|
|
|
LAPLPLASTY
|
Facility
|
OP
|
$32,550.00
|
|
| Hospital Charge Code |
24358101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5,208.00 |
| Max. Negotiated Rate |
$29,295.00 |
| Rate for Payer: Aetna of AZ Commercial |
$29,295.00
|
| Rate for Payer: Aetna of AZ Medicare |
$9,114.00
|
| Rate for Payer: Allwell Medicare |
$5,208.00
|
| Rate for Payer: Amerigroup Medicare |
$5,208.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$12,157.42
|
| Rate for Payer: AZCH Complete Medicare |
$5,208.00
|
| Rate for Payer: Banner UC Health Medicare |
$5,208.00
|
| Rate for Payer: Bisbee Police All Plans |
$8,463.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$22,134.00
|
| Rate for Payer: Cash Price |
$26,040.00
|
| Rate for Payer: Cigna of AZ Commercial |
$22,785.00
|
| Rate for Payer: Copperpoint Commercial |
$8,056.12
|
| Rate for Payer: Health Net of AZ Commercial |
$19,530.00
|
| Rate for Payer: Health Net of AZ Medicare |
$9,114.00
|
| Rate for Payer: Humana of AZ Medicare |
$5,208.00
|
| Rate for Payer: Self Pay Self Pay |
$26,040.00
|
| Rate for Payer: TriWest Medicare |
$5,208.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$18,976.65
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5,859.00
|
|
|
LAPLPLASTY
|
Facility
|
IP
|
$32,550.00
|
|
| Hospital Charge Code |
24358101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8,463.00 |
| Max. Negotiated Rate |
$29,295.00 |
| Rate for Payer: Aetna of AZ Commercial |
$29,295.00
|
| Rate for Payer: Bisbee Police All Plans |
$8,463.00
|
| Rate for Payer: Cash Price |
$26,040.00
|
| Rate for Payer: Self Pay Self Pay |
$26,040.00
|
|
|
LAPLPLASTY SAW BLADE 40MMX11MM STRYKER
|
Facility
|
IP
|
$788.00
|
|
| Hospital Charge Code |
24358103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$204.88 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Aetna of AZ Commercial |
$709.20
|
| Rate for Payer: Bisbee Police All Plans |
$204.88
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Self Pay Self Pay |
$630.40
|
|
|
LAPLPLASTY SAW BLADE 40MMX11MM STRYKER
|
Facility
|
OP
|
$788.00
|
|
| Hospital Charge Code |
24358103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Aetna of AZ Commercial |
$709.20
|
| Rate for Payer: Aetna of AZ Medicare |
$220.64
|
| Rate for Payer: Allwell Medicare |
$126.08
|
| Rate for Payer: Amerigroup Medicare |
$126.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$294.32
|
| Rate for Payer: AZCH Complete Medicare |
$126.08
|
| Rate for Payer: Banner UC Health Medicare |
$126.08
|
| Rate for Payer: Bisbee Police All Plans |
$204.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$535.84
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cigna of AZ Commercial |
$551.60
|
| Rate for Payer: Copperpoint Commercial |
$195.03
|
| Rate for Payer: Health Net of AZ Commercial |
$472.80
|
| Rate for Payer: Health Net of AZ Medicare |
$220.64
|
| Rate for Payer: Humana of AZ Medicare |
$126.08
|
| Rate for Payer: Self Pay Self Pay |
$630.40
|
| Rate for Payer: TriWest Medicare |
$126.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$459.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$141.84
|
|
|
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); DIAGNOSTIC
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
22209502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.68 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$628.20
|
| Rate for Payer: Aetna of AZ Medicare |
$195.44
|
| Rate for Payer: AHCCCS Medicaid |
$119.18
|
| Rate for Payer: Allwell Medicaid |
$119.18
|
| Rate for Payer: Allwell Medicare |
$111.68
|
| Rate for Payer: Amerigroup Medicare |
$111.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$260.70
|
| Rate for Payer: AZCH Complete Medicaid |
$119.18
|
| Rate for Payer: AZCH Complete Medicare |
$111.68
|
| Rate for Payer: Banner UC Health Medicaid |
$119.18
|
| Rate for Payer: Banner UC Health Medicare |
$111.68
|
| Rate for Payer: Bisbee Police All Plans |
$181.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$474.64
|
| Rate for Payer: Cash Price |
$558.40
|
| Rate for Payer: Cash Price |
$558.40
|
| Rate for Payer: Cigna of AZ Commercial |
$488.60
|
| Rate for Payer: Copperpoint Commercial |
$172.75
|
| Rate for Payer: Health Net of AZ Commercial |
$418.80
|
| Rate for Payer: Health Net of AZ Medicare |
$195.44
|
| Rate for Payer: Humana of AZ Medicare |
$111.68
|
| Rate for Payer: Mercy Care Medicaid |
$119.18
|
| Rate for Payer: Self Pay Self Pay |
$558.40
|
| Rate for Payer: TriWest Medicare |
$111.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$125.64
|
|
|
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); DIAGNOSTIC
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
22209502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.48 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Aetna of AZ Commercial |
$628.20
|
| Rate for Payer: Bisbee Police All Plans |
$181.48
|
| Rate for Payer: Cash Price |
$558.40
|
| Rate for Payer: Self Pay Self Pay |
$558.40
|
|
|
latanoprost Ophth 0.005% Sol [CQCH]
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
NDC 17478062512
|
| Hospital Charge Code |
105927842
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of AZ Commercial |
$1.98
|
| Rate for Payer: Aetna of AZ Medicare |
$0.62
|
| Rate for Payer: Allwell Medicare |
$0.35
|
| Rate for Payer: Amerigroup Medicare |
$0.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.82
|
| Rate for Payer: AZCH Complete Medicare |
$0.35
|
| Rate for Payer: Banner UC Health Medicare |
$0.35
|
| Rate for Payer: Bisbee Police All Plans |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cigna of AZ Commercial |
$1.43
|
| Rate for Payer: Copperpoint Commercial |
$0.54
|
| Rate for Payer: Health Net of AZ Commercial |
$1.32
|
| Rate for Payer: Health Net of AZ Medicare |
$0.62
|
| Rate for Payer: Humana of AZ Medicare |
$0.35
|
| Rate for Payer: Self Pay Self Pay |
$1.76
|
| Rate for Payer: TriWest Medicare |
$0.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.40
|
|
