|
LNCS ADULT ADHESIVE SPO2 SENSOR
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
24249671
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of AZ Commercial |
$47.70
|
| Rate for Payer: Aetna of AZ Medicare |
$14.84
|
| Rate for Payer: Allwell Medicare |
$8.48
|
| Rate for Payer: Amerigroup Medicare |
$8.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$19.80
|
| Rate for Payer: AZCH Complete Medicare |
$8.48
|
| Rate for Payer: Banner UC Health Medicare |
$8.48
|
| Rate for Payer: Bisbee Police All Plans |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$36.04
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cigna of AZ Commercial |
$37.10
|
| Rate for Payer: Copperpoint Commercial |
$13.12
|
| Rate for Payer: Health Net of AZ Commercial |
$31.80
|
| Rate for Payer: Health Net of AZ Medicare |
$14.84
|
| Rate for Payer: Humana of AZ Medicare |
$8.48
|
| Rate for Payer: Self Pay Self Pay |
$42.40
|
| Rate for Payer: TriWest Medicare |
$8.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$30.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$9.54
|
|
|
LNCS ADULT ADHESIVE SPO2 SENSOR
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
24249671
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of AZ Commercial |
$47.70
|
| Rate for Payer: Bisbee Police All Plans |
$13.78
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Self Pay Self Pay |
$42.40
|
|
|
LNCS E1 SINGLE PATIENT EAR SENSOR
|
Facility
|
OP
|
$122.00
|
|
| Hospital Charge Code |
27736622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of AZ Commercial |
$109.80
|
| Rate for Payer: Aetna of AZ Medicare |
$34.16
|
| Rate for Payer: Allwell Medicare |
$19.52
|
| Rate for Payer: Amerigroup Medicare |
$19.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$45.57
|
| Rate for Payer: AZCH Complete Medicare |
$19.52
|
| Rate for Payer: Banner UC Health Medicare |
$19.52
|
| Rate for Payer: Bisbee Police All Plans |
$31.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$82.96
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cigna of AZ Commercial |
$85.40
|
| Rate for Payer: Copperpoint Commercial |
$30.20
|
| Rate for Payer: Health Net of AZ Commercial |
$73.20
|
| Rate for Payer: Health Net of AZ Medicare |
$34.16
|
| Rate for Payer: Humana of AZ Medicare |
$19.52
|
| Rate for Payer: Self Pay Self Pay |
$97.60
|
| Rate for Payer: TriWest Medicare |
$19.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$71.13
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.96
|
|
|
LNCS E1 SINGLE PATIENT EAR SENSOR
|
Facility
|
IP
|
$122.00
|
|
| Hospital Charge Code |
27736622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of AZ Commercial |
$109.80
|
| Rate for Payer: Bisbee Police All Plans |
$31.72
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Self Pay Self Pay |
$97.60
|
|
|
LONE STAR STAYS 5MM
|
Facility
|
IP
|
$267.00
|
|
| Hospital Charge Code |
22354905
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Aetna of AZ Commercial |
$240.30
|
| Rate for Payer: Bisbee Police All Plans |
$69.42
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Self Pay Self Pay |
$213.60
|
|
|
LONE STAR STAYS 5MM
|
Facility
|
OP
|
$267.00
|
|
| Hospital Charge Code |
22354905
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Aetna of AZ Commercial |
$240.30
|
| Rate for Payer: Aetna of AZ Medicare |
$74.76
|
| Rate for Payer: Allwell Medicare |
$42.72
|
| Rate for Payer: Amerigroup Medicare |
$42.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$99.72
|
| Rate for Payer: AZCH Complete Medicare |
$42.72
|
| Rate for Payer: Banner UC Health Medicare |
$42.72
|
| Rate for Payer: Bisbee Police All Plans |
$69.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$181.56
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cigna of AZ Commercial |
$186.90
|
| Rate for Payer: Copperpoint Commercial |
$66.08
|
| Rate for Payer: Health Net of AZ Commercial |
$160.20
|
| Rate for Payer: Health Net of AZ Medicare |
$74.76
|
| Rate for Payer: Humana of AZ Medicare |
$42.72
|
| Rate for Payer: Self Pay Self Pay |
$213.60
|
| Rate for Payer: TriWest Medicare |
$42.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$155.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.06
|
|
|
LOOP EXCISION ELECTRODE 15MMX10MM CONMED
|
Facility
|
OP
|
$109.00
|
|
| Hospital Charge Code |
22554977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Aetna of AZ Medicare |
$30.52
|
| Rate for Payer: Allwell Medicare |
$17.44
|
| Rate for Payer: Amerigroup Medicare |
$17.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$40.71
|
| Rate for Payer: AZCH Complete Medicare |
$17.44
|
| Rate for Payer: Banner UC Health Medicare |
$17.44
|
| Rate for Payer: Bisbee Police All Plans |
$28.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$74.12
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cigna of AZ Commercial |
$76.30
|
| Rate for Payer: Copperpoint Commercial |
$26.98
|
| Rate for Payer: Health Net of AZ Commercial |
$65.40
|
| Rate for Payer: Health Net of AZ Medicare |
$30.52
|
| Rate for Payer: Humana of AZ Medicare |
$17.44
|
| Rate for Payer: Self Pay Self Pay |
$87.20
|
| Rate for Payer: TriWest Medicare |
$17.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$63.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.62
|
|
|
LOOP EXCISION ELECTRODE 15MMX10MM CONMED
|
Facility
|
IP
|
$109.00
|
|
| Hospital Charge Code |
22554977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Bisbee Police All Plans |
$28.34
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Self Pay Self Pay |
$87.20
|
|
|
LOOP EXCISION ELECTRODE 20MMX10MM CONMED
|
Facility
|
OP
|
$109.00
|
|
| Hospital Charge Code |
22554976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Aetna of AZ Medicare |
$30.52
|
| Rate for Payer: Allwell Medicare |
$17.44
|
| Rate for Payer: Amerigroup Medicare |
$17.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$40.71
|
| Rate for Payer: AZCH Complete Medicare |
$17.44
|
| Rate for Payer: Banner UC Health Medicare |
$17.44
|
| Rate for Payer: Bisbee Police All Plans |
$28.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$74.12
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cigna of AZ Commercial |
$76.30
|
| Rate for Payer: Copperpoint Commercial |
$26.98
|
| Rate for Payer: Health Net of AZ Commercial |
$65.40
|
| Rate for Payer: Health Net of AZ Medicare |
$30.52
|
| Rate for Payer: Humana of AZ Medicare |
$17.44
|
| Rate for Payer: Self Pay Self Pay |
$87.20
|
| Rate for Payer: TriWest Medicare |
$17.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$63.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.62
|
|
|
LOOP EXCISION ELECTRODE 20MMX10MM CONMED
|
Facility
|
IP
|
$109.00
|
|
| Hospital Charge Code |
22554976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Bisbee Police All Plans |
$28.34
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Self Pay Self Pay |
$87.20
|
|
|
loperamide 2 mg Cap [CQCH]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
105929610
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of AZ Commercial |
$0.55
|
| Rate for Payer: Aetna of AZ Medicare |
$0.17
|
| Rate for Payer: Allwell Medicare |
$0.10
|
| Rate for Payer: Amerigroup Medicare |
$0.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.23
|
| Rate for Payer: AZCH Complete Medicare |
$0.10
|
| Rate for Payer: Banner UC Health Medicare |
$0.10
|
| Rate for Payer: Bisbee Police All Plans |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of AZ Commercial |
$0.40
|
| Rate for Payer: Copperpoint Commercial |
$0.15
|
| Rate for Payer: Health Net of AZ Commercial |
$0.37
|
| Rate for Payer: Health Net of AZ Medicare |
$0.17
|
| Rate for Payer: Humana of AZ Medicare |
$0.10
|
| Rate for Payer: Self Pay Self Pay |
$0.49
|
| Rate for Payer: TriWest Medicare |
$0.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.36
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.11
|
|
|
loperamide 2 mg Cap [CQCH]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
105929610
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of AZ Commercial |
$0.55
|
| Rate for Payer: Bisbee Police All Plans |
$0.16
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Self Pay Self Pay |
$0.49
|
|
|
loratadine 10 mg Tab [CQCH]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 904685261
|
| Hospital Charge Code |
105929675
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of AZ Commercial |
$0.21
|
| Rate for Payer: Bisbee Police All Plans |
$0.06
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Self Pay Self Pay |
$0.18
|
|
|
loratadine 10 mg Tab [CQCH]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 904685261
|
| Hospital Charge Code |
105929675
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of AZ Commercial |
$0.21
|
| Rate for Payer: Aetna of AZ Medicare |
$0.06
|
| Rate for Payer: Allwell Medicare |
$0.04
|
| Rate for Payer: Amerigroup Medicare |
$0.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.09
|
| Rate for Payer: AZCH Complete Medicare |
$0.04
|
| Rate for Payer: Banner UC Health Medicare |
$0.04
|
| Rate for Payer: Bisbee Police All Plans |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of AZ Commercial |
$0.15
|
| Rate for Payer: Copperpoint Commercial |
$0.06
|
| Rate for Payer: Health Net of AZ Commercial |
$0.14
|
| Rate for Payer: Health Net of AZ Medicare |
$0.06
|
| Rate for Payer: Humana of AZ Medicare |
$0.04
|
| Rate for Payer: Self Pay Self Pay |
$0.18
|
| Rate for Payer: TriWest Medicare |
$0.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.13
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.04
|
|
|
LORazepam 0.5 mg Tab [CQCH]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 904600761
|
| Hospital Charge Code |
105929878
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of AZ Commercial |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Self Pay Self Pay |
$0.04
|
|
|
LORazepam 0.5 mg Tab [CQCH]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 904600761
|
| Hospital Charge Code |
105929878
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of AZ Commercial |
$0.05
|
| Rate for Payer: Aetna of AZ Medicare |
$0.01
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.02
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of AZ Commercial |
$0.03
|
| Rate for Payer: Copperpoint Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Commercial |
$0.03
|
| Rate for Payer: Health Net of AZ Medicare |
$0.01
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.04
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.03
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
LORazepam 1 mg Tab [CQCH]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 904600861
|
| Hospital Charge Code |
105929811
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of AZ Commercial |
$0.06
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
|
|
LORazepam 1 mg Tab [CQCH]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 904600861
|
| Hospital Charge Code |
105929811
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of AZ Commercial |
$0.06
|
| Rate for Payer: Aetna of AZ Medicare |
$0.02
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.03
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of AZ Commercial |
$0.05
|
| Rate for Payer: Copperpoint Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Commercial |
$0.04
|
| Rate for Payer: Health Net of AZ Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.04
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
LORazepam 2 mg/mL Sol[CQCH]
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
121468467
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna of AZ Commercial |
$0.47
|
| Rate for Payer: Bisbee Police All Plans |
$0.14
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Self Pay Self Pay |
$0.42
|
|
|
LORazepam 2 mg/mL Sol[CQCH]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
121468467
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna of AZ Commercial |
$0.47
|
| Rate for Payer: Aetna of AZ Medicare |
$0.15
|
| Rate for Payer: Allwell Medicare |
$0.08
|
| Rate for Payer: Amerigroup Medicare |
$0.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.19
|
| Rate for Payer: AZCH Complete Medicare |
$0.08
|
| Rate for Payer: Banner UC Health Medicare |
$0.08
|
| Rate for Payer: Bisbee Police All Plans |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.35
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of AZ Commercial |
$0.34
|
| Rate for Payer: Copperpoint Commercial |
$0.13
|
| Rate for Payer: Health Net of AZ Commercial |
$0.31
|
| Rate for Payer: Health Net of AZ Medicare |
$0.15
|
| Rate for Payer: Humana of AZ Medicare |
$0.08
|
| Rate for Payer: Self Pay Self Pay |
$0.42
|
| Rate for Payer: TriWest Medicare |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.09
|
|
|
losartan 50 mg Tab [CQCH]
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
NDC 904704861
|
| Hospital Charge Code |
105929945
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of AZ Commercial |
$0.28
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Self Pay Self Pay |
$0.25
|
|
|
losartan 50 mg Tab [CQCH]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 904704861
|
| Hospital Charge Code |
105929945
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of AZ Commercial |
$0.28
|
| Rate for Payer: Aetna of AZ Medicare |
$0.09
|
| Rate for Payer: Allwell Medicare |
$0.05
|
| Rate for Payer: Amerigroup Medicare |
$0.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.12
|
| Rate for Payer: AZCH Complete Medicare |
$0.05
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of AZ Commercial |
$0.20
|
| Rate for Payer: Copperpoint Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Commercial |
$0.19
|
| Rate for Payer: Health Net of AZ Medicare |
$0.09
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.25
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.18
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.06
|
|
|
Lower Extremity Arterial Procedures
|
Facility
|
IP
|
$9,384.03
|
|
|
Service Code
|
APR-DRG 1811
|
| Hospital Charge Code |
APRDRG1814
|
| Min. Negotiated Rate |
$9,384.03 |
| Max. Negotiated Rate |
$9,384.03 |
| Rate for Payer: AHCCCS Medicaid |
$9,384.03
|
| Rate for Payer: Allwell Medicaid |
$9,384.03
|
| Rate for Payer: AZCH Complete Medicaid |
$9,384.03
|
| Rate for Payer: Banner UC Health Medicaid |
$9,384.03
|
| Rate for Payer: Mercy Care Medicaid |
$9,384.03
|
|
|
Lower Extremity Arterial Procedures
|
Facility
|
IP
|
$9,384.03
|
|
|
Service Code
|
APR-DRG 1811
|
| Hospital Charge Code |
APRDRG1813
|
| Min. Negotiated Rate |
$9,384.03 |
| Max. Negotiated Rate |
$9,384.03 |
| Rate for Payer: AHCCCS Medicaid |
$9,384.03
|
| Rate for Payer: Allwell Medicaid |
$9,384.03
|
| Rate for Payer: AZCH Complete Medicaid |
$9,384.03
|
| Rate for Payer: Banner UC Health Medicaid |
$9,384.03
|
| Rate for Payer: Mercy Care Medicaid |
$9,384.03
|
|
|
Lower Extremity Arterial Procedures
|
Facility
|
IP
|
$13,613.47
|
|
|
Service Code
|
APR-DRG 1812
|
| Hospital Charge Code |
APRDRG1814
|
| Min. Negotiated Rate |
$13,613.47 |
| Max. Negotiated Rate |
$13,613.47 |
| Rate for Payer: AHCCCS Medicaid |
$13,613.47
|
| Rate for Payer: Allwell Medicaid |
$13,613.47
|
| Rate for Payer: AZCH Complete Medicaid |
$13,613.47
|
| Rate for Payer: Banner UC Health Medicaid |
$13,613.47
|
| Rate for Payer: Mercy Care Medicaid |
$13,613.47
|
|
