|
XR Wrist 2 Views Left
|
Facility
IP
|
$465.00
|
|
|
Service Code
|
CPT 73100 LT
|
| Hospital Charge Code |
823685
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$418.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.05
|
| Rate for Payer: Amerigroup Medicare |
$79.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$120.90
|
| Rate for Payer: Copperpoint |
$130.43
|
| Rate for Payer: Humana Medicare |
$79.05
|
| Rate for Payer: SELF PAY |
$372.00
|
| Rate for Payer: Veterans (Triwest) |
$79.05
|
|
|
XR Wrist 2 Views Right
|
Facility
IP
|
$465.00
|
|
|
Service Code
|
CPT 73100 RT
|
| Hospital Charge Code |
823683
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$418.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.05
|
| Rate for Payer: Amerigroup Medicare |
$79.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$120.90
|
| Rate for Payer: Copperpoint |
$130.43
|
| Rate for Payer: Humana Medicare |
$79.05
|
| Rate for Payer: SELF PAY |
$372.00
|
| Rate for Payer: Veterans (Triwest) |
$79.05
|
|
|
XR Wrist 2 Views Right
|
Facility
OP
|
$465.00
|
|
|
Service Code
|
CPT 73100 RT
|
| Hospital Charge Code |
823683
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$372.00
|
| Rate for Payer: Humana Medicare |
$79.05
|
| Rate for Payer: Aetna POS, PPO, HMO |
$418.50
|
| Rate for Payer: Aetna Medicare |
$130.20
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.05
|
| Rate for Payer: Amerigroup Medicare |
$79.05
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$173.68
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.05
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$120.90
|
| Rate for Payer: Cigna All Products |
$302.25
|
| Rate for Payer: Copperpoint |
$130.43
|
| Rate for Payer: HealthNet Commercial |
$279.00
|
| Rate for Payer: HealthNet Medicare |
$130.20
|
| Rate for Payer: Veterans (Triwest) |
$79.05
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$271.09
|
| Rate for Payer: United Healthcare Medicare |
$83.70
|
|
|
XR Wrist Complete Left
|
Facility
IP
|
$556.00
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
823681
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$500.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$94.52
|
| Rate for Payer: Amerigroup Medicare |
$94.52
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$94.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$94.52
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$363.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$144.56
|
| Rate for Payer: Copperpoint |
$155.96
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: SELF PAY |
$444.80
|
| Rate for Payer: Veterans (Triwest) |
$94.52
|
|
|
XR Wrist Complete Left
|
Facility
OP
|
$556.00
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
823681
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$500.40
|
| Rate for Payer: Aetna Medicare |
$155.68
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$94.52
|
| Rate for Payer: Amerigroup Medicare |
$94.52
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$207.67
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$94.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$94.52
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$363.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$144.56
|
| Rate for Payer: Cigna All Products |
$361.40
|
| Rate for Payer: Copperpoint |
$155.96
|
| Rate for Payer: HealthNet Commercial |
$333.60
|
| Rate for Payer: HealthNet Medicare |
$155.68
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$444.80
|
| Rate for Payer: Veterans (Triwest) |
$94.52
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$324.15
|
| Rate for Payer: United Healthcare Medicare |
$100.08
|
|
|
XR Wrist Complete Right
|
Facility
IP
|
$556.00
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
823679
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$500.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$94.52
|
| Rate for Payer: Amerigroup Medicare |
$94.52
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$94.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$94.52
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$363.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$144.56
|
| Rate for Payer: Copperpoint |
$155.96
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: SELF PAY |
$444.80
|
| Rate for Payer: Veterans (Triwest) |
$94.52
|
|
|
XR Wrist Complete Right
|
Facility
OP
|
$556.00
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
823679
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$500.40
|
| Rate for Payer: Aetna Medicare |
$155.68
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$94.52
|
| Rate for Payer: Amerigroup Medicare |
$94.52
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$207.67
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$94.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$94.52
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$363.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$144.56
|
| Rate for Payer: Cigna All Products |
$361.40
|
| Rate for Payer: Copperpoint |
$155.96
|
| Rate for Payer: HealthNet Commercial |
$333.60
|
| Rate for Payer: HealthNet Medicare |
$155.68
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$444.80
|
| Rate for Payer: Veterans (Triwest) |
$94.52
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$324.15
|
| Rate for Payer: United Healthcare Medicare |
$100.08
|
|
|
XR Zygomatic Arches
|
Facility
OP
|
$648.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
2620463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$583.20
|
| Rate for Payer: Aetna Medicare |
$181.44
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$110.16
|
| Rate for Payer: Amerigroup Medicare |
$110.16
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$242.03
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$110.16
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$110.16
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$168.48
|
| Rate for Payer: Cigna All Products |
$421.20
|
| Rate for Payer: Copperpoint |
$181.76
|
| Rate for Payer: HealthNet Commercial |
$388.80
|
| Rate for Payer: HealthNet Medicare |
$181.44
|
| Rate for Payer: Humana Medicare |
$110.16
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$518.40
|
| Rate for Payer: Veterans (Triwest) |
$110.16
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$377.78
|
| Rate for Payer: United Healthcare Medicare |
$116.64
|
|
|
XR Zygomatic Arches
|
Facility
IP
|
$648.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
2620463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$583.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$110.16
|
| Rate for Payer: Amerigroup Medicare |
$110.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$110.16
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$110.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$168.48
|
| Rate for Payer: Copperpoint |
$181.76
|
| Rate for Payer: Humana Medicare |
$110.16
|
| Rate for Payer: SELF PAY |
$518.40
|
| Rate for Payer: Veterans (Triwest) |
$110.16
|
|
|
YANKAUER 72
|
Facility
IP
|
$10.00
|
|
| Hospital Charge Code |
22355322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$9.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.70
|
| Rate for Payer: Amerigroup Medicare |
$1.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2.60
|
| Rate for Payer: Copperpoint |
$2.81
|
| Rate for Payer: Humana Medicare |
$1.70
|
| Rate for Payer: SELF PAY |
$8.00
|
| Rate for Payer: Veterans (Triwest) |
$1.70
|
|
|
YANKAUER 72
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
22355322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$9.00
|
| Rate for Payer: Aetna Medicare |
$2.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.70
|
| Rate for Payer: Amerigroup Medicare |
$1.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$3.73
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2.60
|
| Rate for Payer: Cigna All Products |
$7.00
|
| Rate for Payer: Copperpoint |
$2.81
|
| Rate for Payer: HealthNet Commercial |
$6.00
|
| Rate for Payer: HealthNet Medicare |
$2.80
|
| Rate for Payer: Humana Medicare |
$1.70
|
| Rate for Payer: SELF PAY |
$8.00
|
| Rate for Payer: Veterans (Triwest) |
$1.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$1.80
|
|
|
YANKAUER HANDLE ONLY
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
22355582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$6.30
|
| Rate for Payer: Aetna Medicare |
$1.96
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.19
|
| Rate for Payer: Amerigroup Medicare |
$1.19
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$2.61
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.19
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.19
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.82
|
| Rate for Payer: Cigna All Products |
$4.90
|
| Rate for Payer: Copperpoint |
$1.96
|
| Rate for Payer: HealthNet Commercial |
$4.20
|
| Rate for Payer: HealthNet Medicare |
$1.96
|
| Rate for Payer: Humana Medicare |
$1.19
|
| Rate for Payer: SELF PAY |
$5.60
|
| Rate for Payer: Veterans (Triwest) |
$1.19
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$4.08
|
| Rate for Payer: United Healthcare Medicare |
$1.26
|
|
|
YANKAUER HANDLE ONLY
|
Facility
IP
|
$7.00
|
|
| Hospital Charge Code |
22355582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$6.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.19
|
| Rate for Payer: Amerigroup Medicare |
$1.19
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.19
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.19
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.82
|
| Rate for Payer: Copperpoint |
$1.96
|
| Rate for Payer: Humana Medicare |
$1.19
|
| Rate for Payer: SELF PAY |
$5.60
|
| Rate for Payer: Veterans (Triwest) |
$1.19
|
|
|
YANKAUER TIP BULB VENTLESS
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
22552484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: SELF PAY |
$10.40
|
| Rate for Payer: Aetna POS, PPO, HMO |
$11.70
|
| Rate for Payer: Aetna Medicare |
$3.64
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.21
|
| Rate for Payer: Amerigroup Medicare |
$2.21
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$4.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.21
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.21
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.38
|
| Rate for Payer: Cigna All Products |
$9.10
|
| Rate for Payer: Copperpoint |
$3.65
|
| Rate for Payer: HealthNet Commercial |
$7.80
|
| Rate for Payer: HealthNet Medicare |
$3.64
|
| Rate for Payer: Humana Medicare |
$2.21
|
| Rate for Payer: Veterans (Triwest) |
$2.21
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$7.58
|
| Rate for Payer: United Healthcare Medicare |
$2.34
|
|
|
YANKAUER TIP BULB VENTLESS
|
Facility
IP
|
$13.00
|
|
| Hospital Charge Code |
22552484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$11.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.21
|
| Rate for Payer: Amerigroup Medicare |
$2.21
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.21
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.21
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.38
|
| Rate for Payer: Copperpoint |
$3.65
|
| Rate for Payer: Humana Medicare |
$2.21
|
| Rate for Payer: SELF PAY |
$10.40
|
| Rate for Payer: Veterans (Triwest) |
$2.21
|
|
|
YELLOW INTRAOSSEOUS MODULE PEDS
|
Facility
IP
|
$345.00
|
|
| Hospital Charge Code |
23175126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$310.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$58.65
|
| Rate for Payer: Amerigroup Medicare |
$58.65
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$58.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$58.65
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$89.70
|
| Rate for Payer: Copperpoint |
$96.77
|
| Rate for Payer: Humana Medicare |
$58.65
|
| Rate for Payer: SELF PAY |
$276.00
|
| Rate for Payer: Veterans (Triwest) |
$58.65
|
|
|
YELLOW INTRAOSSEOUS MODULE PEDS
|
Facility
OP
|
$345.00
|
|
| Hospital Charge Code |
23175126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$310.50
|
| Rate for Payer: Aetna Medicare |
$96.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$58.65
|
| Rate for Payer: Amerigroup Medicare |
$58.65
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$128.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$58.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$58.65
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$89.70
|
| Rate for Payer: Cigna All Products |
$241.50
|
| Rate for Payer: Copperpoint |
$96.77
|
| Rate for Payer: HealthNet Commercial |
$207.00
|
| Rate for Payer: HealthNet Medicare |
$96.60
|
| Rate for Payer: Humana Medicare |
$58.65
|
| Rate for Payer: SELF PAY |
$276.00
|
| Rate for Payer: Veterans (Triwest) |
$58.65
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$201.13
|
| Rate for Payer: United Healthcare Medicare |
$62.10
|
|
|
YELLOW INTUBATION MODULE PEDS
|
Facility
OP
|
$288.00
|
|
| Hospital Charge Code |
23175714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: SELF PAY |
$230.40
|
| Rate for Payer: Aetna POS, PPO, HMO |
$259.20
|
| Rate for Payer: Aetna Medicare |
$80.64
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$48.96
|
| Rate for Payer: Amerigroup Medicare |
$48.96
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$107.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$48.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$48.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$74.88
|
| Rate for Payer: Cigna All Products |
$201.60
|
| Rate for Payer: Copperpoint |
$80.78
|
| Rate for Payer: HealthNet Commercial |
$172.80
|
| Rate for Payer: HealthNet Medicare |
$80.64
|
| Rate for Payer: Humana Medicare |
$48.96
|
| Rate for Payer: Veterans (Triwest) |
$48.96
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$167.90
|
| Rate for Payer: United Healthcare Medicare |
$51.84
|
|
|
YELLOW INTUBATION MODULE PEDS
|
Facility
IP
|
$288.00
|
|
| Hospital Charge Code |
23175714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$259.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$48.96
|
| Rate for Payer: Amerigroup Medicare |
$48.96
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$48.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$48.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$74.88
|
| Rate for Payer: Copperpoint |
$80.78
|
| Rate for Payer: Humana Medicare |
$48.96
|
| Rate for Payer: SELF PAY |
$230.40
|
| Rate for Payer: Veterans (Triwest) |
$48.96
|
|
|
YELLOW IV DELIVERY MODULE PEDS
|
Facility
IP
|
$276.00
|
|
| Hospital Charge Code |
23175707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$248.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$46.92
|
| Rate for Payer: Amerigroup Medicare |
$46.92
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$46.92
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$46.92
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$71.76
|
| Rate for Payer: Copperpoint |
$77.42
|
| Rate for Payer: Humana Medicare |
$46.92
|
| Rate for Payer: SELF PAY |
$220.80
|
| Rate for Payer: Veterans (Triwest) |
$46.92
|
|
|
YELLOW IV DELIVERY MODULE PEDS
|
Facility
OP
|
$276.00
|
|
| Hospital Charge Code |
23175707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$248.40
|
| Rate for Payer: Aetna Medicare |
$77.28
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$46.92
|
| Rate for Payer: Amerigroup Medicare |
$46.92
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$103.09
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$46.92
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$46.92
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$71.76
|
| Rate for Payer: Cigna All Products |
$193.20
|
| Rate for Payer: Copperpoint |
$77.42
|
| Rate for Payer: HealthNet Commercial |
$165.60
|
| Rate for Payer: HealthNet Medicare |
$77.28
|
| Rate for Payer: Humana Medicare |
$46.92
|
| Rate for Payer: SELF PAY |
$220.80
|
| Rate for Payer: Veterans (Triwest) |
$46.92
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$160.91
|
| Rate for Payer: United Healthcare Medicare |
$49.68
|
|
|
YELLOW OXYGEN DELIVERY MODULE PEDS
|
Facility
IP
|
$115.00
|
|
| Hospital Charge Code |
23175700
|
|
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
|
|
|
YELLOW OXYGEN DELIVERY MODULE PEDS
|
Facility
OP
|
$115.00
|
|
| Hospital Charge Code |
23175700
|
|
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
|
|
|
Yes
|
Facility
OP
|
$325.00
|
|
| Hospital Charge Code |
1230419
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$292.50
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$55.25
|
| Rate for Payer: Amerigroup Medicare |
$55.25
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$121.39
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$55.25
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$55.25
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$84.50
|
| Rate for Payer: Cigna All Products |
$227.50
|
| Rate for Payer: Copperpoint |
$91.16
|
| Rate for Payer: HealthNet Commercial |
$195.00
|
| Rate for Payer: HealthNet Medicare |
$91.00
|
| Rate for Payer: Humana Medicare |
$55.25
|
| Rate for Payer: SELF PAY |
$260.00
|
| Rate for Payer: Veterans (Triwest) |
$55.25
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$189.47
|
| Rate for Payer: United Healthcare Medicare |
$58.50
|
|
|
Yes
|
Facility
IP
|
$325.00
|
|
| Hospital Charge Code |
1230419
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$292.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$55.25
|
| Rate for Payer: Amerigroup Medicare |
$55.25
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$55.25
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$55.25
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$84.50
|
| Rate for Payer: Copperpoint |
$91.16
|
| Rate for Payer: Humana Medicare |
$55.25
|
| Rate for Payer: SELF PAY |
$260.00
|
| Rate for Payer: Veterans (Triwest) |
$55.25
|
|