|
SLING ARM LG
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
22354133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of AZ Commercial |
$22.50
|
| Rate for Payer: Aetna of AZ Medicare |
$7.00
|
| Rate for Payer: Allwell Medicare |
$3.75
|
| Rate for Payer: Amerigroup Medicare |
$3.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$9.34
|
| Rate for Payer: AZCH Complete Medicare |
$3.75
|
| Rate for Payer: Banner UC Health Medicare |
$3.75
|
| Rate for Payer: Bisbee Police All Plans |
$6.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of AZ Commercial |
$17.50
|
| Rate for Payer: Copperpoint Commercial |
$6.19
|
| Rate for Payer: Health Net of AZ Commercial |
$15.00
|
| Rate for Payer: Health Net of AZ Medicare |
$7.00
|
| Rate for Payer: Humana of AZ Medicare |
$3.75
|
| Rate for Payer: Self Pay Self Pay |
$20.00
|
| Rate for Payer: TriWest Medicare |
$3.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$14.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.50
|
|
|
SLING ARM LG ZIMMER
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna of AZ Commercial |
$37.80
|
| Rate for Payer: Aetna of AZ Medicare |
$11.76
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicare |
$6.30
|
| Rate for Payer: Amerigroup Medicare |
$6.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.69
|
| Rate for Payer: AZCH Complete Medicaid |
$13.44
|
| Rate for Payer: AZCH Complete Medicare |
$6.30
|
| Rate for Payer: Banner UC Health Medicaid |
$13.44
|
| Rate for Payer: Banner UC Health Medicare |
$6.30
|
| Rate for Payer: Bisbee Police All Plans |
$10.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$28.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna of AZ Commercial |
$29.40
|
| Rate for Payer: Copperpoint Commercial |
$10.40
|
| Rate for Payer: Health Net of AZ Commercial |
$25.20
|
| Rate for Payer: Health Net of AZ Medicare |
$11.76
|
| Rate for Payer: Humana of AZ Medicare |
$6.30
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: Self Pay Self Pay |
$33.60
|
| Rate for Payer: TriWest Medicare |
$6.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$24.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.56
|
|
|
SLING ARM LG ZIMMER
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna of AZ Commercial |
$37.80
|
| Rate for Payer: Bisbee Police All Plans |
$10.92
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Self Pay Self Pay |
$33.60
|
|
|
SLING ARM MD ZIMMER
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna of AZ Commercial |
$37.80
|
| Rate for Payer: Aetna of AZ Medicare |
$11.76
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicare |
$6.30
|
| Rate for Payer: Amerigroup Medicare |
$6.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.69
|
| Rate for Payer: AZCH Complete Medicaid |
$13.44
|
| Rate for Payer: AZCH Complete Medicare |
$6.30
|
| Rate for Payer: Banner UC Health Medicaid |
$13.44
|
| Rate for Payer: Banner UC Health Medicare |
$6.30
|
| Rate for Payer: Bisbee Police All Plans |
$10.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$28.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna of AZ Commercial |
$29.40
|
| Rate for Payer: Copperpoint Commercial |
$10.40
|
| Rate for Payer: Health Net of AZ Commercial |
$25.20
|
| Rate for Payer: Health Net of AZ Medicare |
$11.76
|
| Rate for Payer: Humana of AZ Medicare |
$6.30
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: Self Pay Self Pay |
$33.60
|
| Rate for Payer: TriWest Medicare |
$6.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$24.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.56
|
|
|
SLING ARM MD ZIMMER
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna of AZ Commercial |
$37.80
|
| Rate for Payer: Bisbee Police All Plans |
$10.92
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Self Pay Self Pay |
$33.60
|
|
|
SLING ARM MEDIUM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna of AZ Commercial |
$20.70
|
| Rate for Payer: Bisbee Police All Plans |
$5.98
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Self Pay Self Pay |
$18.40
|
|
|
SLING ARM MEDIUM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna of AZ Commercial |
$20.70
|
| Rate for Payer: Aetna of AZ Medicare |
$6.44
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicare |
$3.45
|
| Rate for Payer: Amerigroup Medicare |
$3.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$8.59
|
| Rate for Payer: AZCH Complete Medicaid |
$13.44
|
| Rate for Payer: AZCH Complete Medicare |
$3.45
|
| Rate for Payer: Banner UC Health Medicaid |
$13.44
|
| Rate for Payer: Banner UC Health Medicare |
$3.45
|
| Rate for Payer: Bisbee Police All Plans |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$15.64
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cigna of AZ Commercial |
$16.10
|
| Rate for Payer: Copperpoint Commercial |
$5.69
|
| Rate for Payer: Health Net of AZ Commercial |
$13.80
|
| Rate for Payer: Health Net of AZ Medicare |
$6.44
|
| Rate for Payer: Humana of AZ Medicare |
$3.45
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: Self Pay Self Pay |
$18.40
|
| Rate for Payer: TriWest Medicare |
$3.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$13.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.14
|
|
|
SLING ARM SM ZIMMER
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna of AZ Commercial |
$37.80
|
| Rate for Payer: Bisbee Police All Plans |
$10.92
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Self Pay Self Pay |
$33.60
|
|
|
SLING ARM SM ZIMMER
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna of AZ Commercial |
$37.80
|
| Rate for Payer: Aetna of AZ Medicare |
$11.76
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicare |
$6.30
|
| Rate for Payer: Amerigroup Medicare |
$6.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.69
|
| Rate for Payer: AZCH Complete Medicaid |
$13.44
|
| Rate for Payer: AZCH Complete Medicare |
$6.30
|
| Rate for Payer: Banner UC Health Medicaid |
$13.44
|
| Rate for Payer: Banner UC Health Medicare |
$6.30
|
| Rate for Payer: Bisbee Police All Plans |
$10.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$28.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna of AZ Commercial |
$29.40
|
| Rate for Payer: Copperpoint Commercial |
$10.40
|
| Rate for Payer: Health Net of AZ Commercial |
$25.20
|
| Rate for Payer: Health Net of AZ Medicare |
$11.76
|
| Rate for Payer: Humana of AZ Medicare |
$6.30
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: Self Pay Self Pay |
$33.60
|
| Rate for Payer: TriWest Medicare |
$6.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$24.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.56
|
|
|
SLING ARM XL ZIMMER
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna of AZ Commercial |
$37.80
|
| Rate for Payer: Bisbee Police All Plans |
$10.92
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Self Pay Self Pay |
$33.60
|
|
|
SLING ARM XL ZIMMER
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna of AZ Commercial |
$37.80
|
| Rate for Payer: Aetna of AZ Medicare |
$11.76
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicare |
$6.30
|
| Rate for Payer: Amerigroup Medicare |
$6.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.69
|
| Rate for Payer: AZCH Complete Medicaid |
$13.44
|
| Rate for Payer: AZCH Complete Medicare |
$6.30
|
| Rate for Payer: Banner UC Health Medicaid |
$13.44
|
| Rate for Payer: Banner UC Health Medicare |
$6.30
|
| Rate for Payer: Bisbee Police All Plans |
$10.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$28.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna of AZ Commercial |
$29.40
|
| Rate for Payer: Copperpoint Commercial |
$10.40
|
| Rate for Payer: Health Net of AZ Commercial |
$25.20
|
| Rate for Payer: Health Net of AZ Medicare |
$11.76
|
| Rate for Payer: Humana of AZ Medicare |
$6.30
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: Self Pay Self Pay |
$33.60
|
| Rate for Payer: TriWest Medicare |
$6.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$24.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.56
|
|
|
SLING ARM XS-CHILD ZIMMER
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of AZ Commercial |
$72.00
|
| Rate for Payer: Aetna of AZ Medicare |
$22.40
|
| Rate for Payer: AHCCCS Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicaid |
$13.44
|
| Rate for Payer: Allwell Medicare |
$12.00
|
| Rate for Payer: Amerigroup Medicare |
$12.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$29.88
|
| Rate for Payer: AZCH Complete Medicaid |
$13.44
|
| Rate for Payer: AZCH Complete Medicare |
$12.00
|
| Rate for Payer: Banner UC Health Medicaid |
$13.44
|
| Rate for Payer: Banner UC Health Medicare |
$12.00
|
| Rate for Payer: Bisbee Police All Plans |
$20.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$54.40
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna of AZ Commercial |
$56.00
|
| Rate for Payer: Copperpoint Commercial |
$19.80
|
| Rate for Payer: Health Net of AZ Commercial |
$48.00
|
| Rate for Payer: Health Net of AZ Medicare |
$22.40
|
| Rate for Payer: Humana of AZ Medicare |
$12.00
|
| Rate for Payer: Mercy Care Medicaid |
$13.44
|
| Rate for Payer: Self Pay Self Pay |
$64.00
|
| Rate for Payer: TriWest Medicare |
$12.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$46.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.40
|
|
|
SLING ARM XS-CHILD ZIMMER
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
22354166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of AZ Commercial |
$72.00
|
| Rate for Payer: Bisbee Police All Plans |
$20.80
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Self Pay Self Pay |
$64.00
|
|
|
SLING BLADDER SPARC
|
Facility
|
IP
|
$3,470.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$902.20 |
| Max. Negotiated Rate |
$3,123.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,123.00
|
| Rate for Payer: Bisbee Police All Plans |
$902.20
|
| Rate for Payer: Cash Price |
$2,776.00
|
| Rate for Payer: Self Pay Self Pay |
$2,776.00
|
|
|
SLING BLADDER SPARC
|
Facility
|
OP
|
$3,470.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3,123.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,123.00
|
| Rate for Payer: Aetna of AZ Medicare |
$971.60
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$520.50
|
| Rate for Payer: Amerigroup Medicare |
$520.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,296.04
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$520.50
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$520.50
|
| Rate for Payer: Bisbee Police All Plans |
$902.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,359.60
|
| Rate for Payer: Cash Price |
$2,776.00
|
| Rate for Payer: Cash Price |
$2,776.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,429.00
|
| Rate for Payer: Copperpoint Commercial |
$858.82
|
| Rate for Payer: Health Net of AZ Commercial |
$2,082.00
|
| Rate for Payer: Health Net of AZ Medicare |
$971.60
|
| Rate for Payer: Humana of AZ Medicare |
$520.50
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$2,776.00
|
| Rate for Payer: TriWest Medicare |
$520.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,023.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$624.60
|
|
|
SLING MINIARC PRECISE SINGLE INCISION
|
Facility
|
OP
|
$4,415.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3,973.50 |
| Rate for Payer: Aetna of AZ Commercial |
$3,973.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1,236.20
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$662.25
|
| Rate for Payer: Amerigroup Medicare |
$662.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,649.00
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$662.25
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$662.25
|
| Rate for Payer: Bisbee Police All Plans |
$1,147.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,002.20
|
| Rate for Payer: Cash Price |
$3,532.00
|
| Rate for Payer: Cash Price |
$3,532.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3,090.50
|
| Rate for Payer: Copperpoint Commercial |
$1,092.71
|
| Rate for Payer: Health Net of AZ Commercial |
$2,649.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,236.20
|
| Rate for Payer: Humana of AZ Medicare |
$662.25
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$3,532.00
|
| Rate for Payer: TriWest Medicare |
$662.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,573.94
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$794.70
|
|
|
SLING MINIARC PRECISE SINGLE INCISION
|
Facility
|
IP
|
$4,415.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,147.90 |
| Max. Negotiated Rate |
$3,973.50 |
| Rate for Payer: Aetna of AZ Commercial |
$3,973.50
|
| Rate for Payer: Bisbee Police All Plans |
$1,147.90
|
| Rate for Payer: Cash Price |
$3,532.00
|
| Rate for Payer: Self Pay Self Pay |
$3,532.00
|
|
|
SLING MINIARC SINGLE INCISION
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,039.74 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Aetna of AZ Commercial |
$3,599.10
|
| Rate for Payer: Bisbee Police All Plans |
$1,039.74
|
| Rate for Payer: Cash Price |
$3,199.20
|
| Rate for Payer: Self Pay Self Pay |
$3,199.20
|
|
|
SLING MINIARC SINGLE INCISION
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Aetna of AZ Commercial |
$3,599.10
|
| Rate for Payer: Aetna of AZ Medicare |
$1,119.72
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$599.85
|
| Rate for Payer: Amerigroup Medicare |
$599.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,493.63
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$599.85
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$599.85
|
| Rate for Payer: Bisbee Police All Plans |
$1,039.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,719.32
|
| Rate for Payer: Cash Price |
$3,199.20
|
| Rate for Payer: Cash Price |
$3,199.20
|
| Rate for Payer: Cigna of AZ Commercial |
$2,799.30
|
| Rate for Payer: Copperpoint Commercial |
$989.75
|
| Rate for Payer: Health Net of AZ Commercial |
$2,399.40
|
| Rate for Payer: Health Net of AZ Medicare |
$1,119.72
|
| Rate for Payer: Humana of AZ Medicare |
$599.85
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$3,199.20
|
| Rate for Payer: TriWest Medicare |
$599.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,331.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$719.82
|
|
|
SLING MONARC
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Aetna of AZ Commercial |
$3,599.10
|
| Rate for Payer: Aetna of AZ Medicare |
$1,119.72
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$599.85
|
| Rate for Payer: Amerigroup Medicare |
$599.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,493.63
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$599.85
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$599.85
|
| Rate for Payer: Bisbee Police All Plans |
$1,039.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,719.32
|
| Rate for Payer: Cash Price |
$3,199.20
|
| Rate for Payer: Cash Price |
$3,199.20
|
| Rate for Payer: Cigna of AZ Commercial |
$2,799.30
|
| Rate for Payer: Copperpoint Commercial |
$989.75
|
| Rate for Payer: Health Net of AZ Commercial |
$2,399.40
|
| Rate for Payer: Health Net of AZ Medicare |
$1,119.72
|
| Rate for Payer: Humana of AZ Medicare |
$599.85
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$3,199.20
|
| Rate for Payer: TriWest Medicare |
$599.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,331.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$719.82
|
|
|
SLING MONARC
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,039.74 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Aetna of AZ Commercial |
$3,599.10
|
| Rate for Payer: Bisbee Police All Plans |
$1,039.74
|
| Rate for Payer: Cash Price |
$3,199.20
|
| Rate for Payer: Self Pay Self Pay |
$3,199.20
|
|
|
SLING PROLAPSE ELEVATE POSTERIOR
|
Facility
|
OP
|
$5,103.00
|
|
| Hospital Charge Code |
22354152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$765.45 |
| Max. Negotiated Rate |
$4,592.70 |
| Rate for Payer: Aetna of AZ Commercial |
$4,592.70
|
| Rate for Payer: Aetna of AZ Medicare |
$1,428.84
|
| Rate for Payer: Allwell Medicare |
$765.45
|
| Rate for Payer: Amerigroup Medicare |
$765.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,905.97
|
| Rate for Payer: AZCH Complete Medicare |
$765.45
|
| Rate for Payer: Banner UC Health Medicare |
$765.45
|
| Rate for Payer: Bisbee Police All Plans |
$1,326.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,470.04
|
| Rate for Payer: Cash Price |
$4,082.40
|
| Rate for Payer: Cigna of AZ Commercial |
$3,572.10
|
| Rate for Payer: Copperpoint Commercial |
$1,262.99
|
| Rate for Payer: Health Net of AZ Commercial |
$3,061.80
|
| Rate for Payer: Health Net of AZ Medicare |
$1,428.84
|
| Rate for Payer: Humana of AZ Medicare |
$765.45
|
| Rate for Payer: Self Pay Self Pay |
$4,082.40
|
| Rate for Payer: TriWest Medicare |
$765.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,975.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$918.54
|
|
|
SLING PROLAPSE ELEVATE POSTERIOR
|
Facility
|
IP
|
$5,103.00
|
|
| Hospital Charge Code |
22354152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,326.78 |
| Max. Negotiated Rate |
$4,592.70 |
| Rate for Payer: Aetna of AZ Commercial |
$4,592.70
|
| Rate for Payer: Bisbee Police All Plans |
$1,326.78
|
| Rate for Payer: Cash Price |
$4,082.40
|
| Rate for Payer: Self Pay Self Pay |
$4,082.40
|
|
|
Sling (Removal or Revision)
|
Facility
|
IP
|
$3,805.00
|
|
|
Service Code
|
CPT 57287
|
| Hospital Charge Code |
27267790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$989.30 |
| Max. Negotiated Rate |
$3,424.50 |
| Rate for Payer: Aetna of AZ Commercial |
$3,424.50
|
| Rate for Payer: Bisbee Police All Plans |
$989.30
|
| Rate for Payer: Cash Price |
$3,044.00
|
| Rate for Payer: Self Pay Self Pay |
$3,044.00
|
|
|
Sling (Removal or Revision)
|
Facility
|
OP
|
$3,805.00
|
|
|
Service Code
|
CPT 57287
|
| Hospital Charge Code |
27267790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.75 |
| Max. Negotiated Rate |
$3,914.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,424.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1,065.40
|
| Rate for Payer: AHCCCS Medicaid |
$3,803.66
|
| Rate for Payer: Allwell Medicaid |
$3,803.66
|
| Rate for Payer: Allwell Medicare |
$570.75
|
| Rate for Payer: Amerigroup Medicare |
$570.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,421.17
|
| Rate for Payer: AZCH Complete Medicaid |
$3,803.66
|
| Rate for Payer: AZCH Complete Medicare |
$570.75
|
| Rate for Payer: Banner UC Health Medicaid |
$3,803.66
|
| Rate for Payer: Banner UC Health Medicare |
$570.75
|
| Rate for Payer: Bisbee Police All Plans |
$989.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,587.40
|
| Rate for Payer: Cash Price |
$3,044.00
|
| Rate for Payer: Cash Price |
$3,044.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,902.50
|
| Rate for Payer: Copperpoint Commercial |
$941.74
|
| Rate for Payer: Health Net of AZ Commercial |
$2,283.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,065.40
|
| Rate for Payer: Humana of AZ Medicare |
$570.75
|
| Rate for Payer: Mercy Care Medicaid |
$3,803.66
|
| Rate for Payer: Self Pay Self Pay |
$3,044.00
|
| Rate for Payer: TriWest Medicare |
$570.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$684.90
|
|
