|
SLING SUPRAPUBIC ALIGN URETHRAL SUPPORT
|
Facility
IP
|
$2,619.00
|
|
| Hospital Charge Code |
22354161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$680.94 |
| Max. Negotiated Rate |
$2,357.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,357.10
|
| Rate for Payer: Bisbee Police All Plans |
$680.94
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Self Pay Self Pay |
$2,095.20
|
|
|
SLING SUPRAPUBIC ALIGN URETHRAL SUPPORT
|
Facility
OP
|
$2,619.00
|
|
| Hospital Charge Code |
22354161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$392.85 |
| Max. Negotiated Rate |
$2,357.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,357.10
|
| Rate for Payer: Aetna of AZ Medicare |
$733.32
|
| Rate for Payer: Allwell Medicare |
$392.85
|
| Rate for Payer: Amerigroup Medicare |
$392.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$978.20
|
| Rate for Payer: AZCH Complete Medicare |
$392.85
|
| Rate for Payer: Banner UC Health Medicare |
$392.85
|
| Rate for Payer: Bisbee Police All Plans |
$680.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,780.92
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,833.30
|
| Rate for Payer: Copperpoint Commercial |
$648.20
|
| Rate for Payer: Health Net of AZ Commercial |
$1,571.40
|
| Rate for Payer: Health Net of AZ Medicare |
$733.32
|
| Rate for Payer: Humana of AZ Medicare |
$392.85
|
| Rate for Payer: Self Pay Self Pay |
$2,095.20
|
| Rate for Payer: TriWest Medicare |
$392.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,526.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$471.42
|
|
|
SLING SWATH ADULT
|
Facility
IP
|
$63.00
|
|
| Hospital Charge Code |
22354186
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of AZ Commercial |
$56.70
|
| Rate for Payer: Bisbee Police All Plans |
$16.38
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Self Pay Self Pay |
$50.40
|
|
|
SLING SWATH ADULT
|
Facility
OP
|
$63.00
|
|
| Hospital Charge Code |
22354186
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of AZ Commercial |
$56.70
|
| Rate for Payer: Aetna of AZ Medicare |
$17.64
|
| Rate for Payer: Allwell Medicare |
$9.45
|
| Rate for Payer: Amerigroup Medicare |
$9.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$23.53
|
| Rate for Payer: AZCH Complete Medicare |
$9.45
|
| Rate for Payer: Banner UC Health Medicare |
$9.45
|
| Rate for Payer: Bisbee Police All Plans |
$16.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$42.84
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of AZ Commercial |
$44.10
|
| Rate for Payer: Copperpoint Commercial |
$15.59
|
| Rate for Payer: Health Net of AZ Commercial |
$37.80
|
| Rate for Payer: Health Net of AZ Medicare |
$17.64
|
| Rate for Payer: Humana of AZ Medicare |
$9.45
|
| Rate for Payer: Self Pay Self Pay |
$50.40
|
| Rate for Payer: TriWest Medicare |
$9.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$36.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$11.34
|
|
|
SLING SWATH PED
|
Facility
OP
|
$105.00
|
|
| Hospital Charge Code |
22354242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of AZ Commercial |
$94.50
|
| Rate for Payer: Aetna of AZ Medicare |
$29.40
|
| Rate for Payer: Allwell Medicare |
$15.75
|
| Rate for Payer: Amerigroup Medicare |
$15.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$39.22
|
| Rate for Payer: AZCH Complete Medicare |
$15.75
|
| Rate for Payer: Banner UC Health Medicare |
$15.75
|
| Rate for Payer: Bisbee Police All Plans |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna of AZ Commercial |
$73.50
|
| Rate for Payer: Copperpoint Commercial |
$25.99
|
| Rate for Payer: Health Net of AZ Commercial |
$63.00
|
| Rate for Payer: Health Net of AZ Medicare |
$29.40
|
| Rate for Payer: Humana of AZ Medicare |
$15.75
|
| Rate for Payer: Self Pay Self Pay |
$84.00
|
| Rate for Payer: TriWest Medicare |
$15.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$61.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.90
|
|
|
SLING SWATH PED
|
Facility
IP
|
$105.00
|
|
| Hospital Charge Code |
22354242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of AZ Commercial |
$94.50
|
| Rate for Payer: Bisbee Police All Plans |
$27.30
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Self Pay Self Pay |
$84.00
|
|
|
SLIPPER SOCKS EXTRA LARGE
|
Facility
IP
|
$6.00
|
|
| Hospital Charge Code |
22355542
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of AZ Commercial |
$5.40
|
| Rate for Payer: Bisbee Police All Plans |
$1.56
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Self Pay Self Pay |
$4.80
|
|
|
SLIPPER SOCKS EXTRA LARGE
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
22355542
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of AZ Commercial |
$5.40
|
| Rate for Payer: Aetna of AZ Medicare |
$1.68
|
| Rate for Payer: Allwell Medicare |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.24
|
| Rate for Payer: AZCH Complete Medicare |
$0.90
|
| Rate for Payer: Banner UC Health Medicare |
$0.90
|
| Rate for Payer: Bisbee Police All Plans |
$1.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4.08
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna of AZ Commercial |
$4.20
|
| Rate for Payer: Copperpoint Commercial |
$1.48
|
| Rate for Payer: Health Net of AZ Commercial |
$3.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1.68
|
| Rate for Payer: Humana of AZ Medicare |
$0.90
|
| Rate for Payer: Self Pay Self Pay |
$4.80
|
| Rate for Payer: TriWest Medicare |
$0.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.08
|
|
|
SMART TOE 2 IMPLANT 15MM
|
Facility
OP
|
$11,965.00
|
|
| Hospital Charge Code |
27519891
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,794.75 |
| Max. Negotiated Rate |
$10,768.50 |
| Rate for Payer: Aetna of AZ Commercial |
$10,768.50
|
| Rate for Payer: Aetna of AZ Medicare |
$3,350.20
|
| Rate for Payer: Allwell Medicare |
$1,794.75
|
| Rate for Payer: Amerigroup Medicare |
$1,794.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4,468.93
|
| Rate for Payer: AZCH Complete Medicare |
$1,794.75
|
| Rate for Payer: Banner UC Health Medicare |
$1,794.75
|
| Rate for Payer: Bisbee Police All Plans |
$3,110.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$8,136.20
|
| Rate for Payer: Cash Price |
$9,572.00
|
| Rate for Payer: Cigna of AZ Commercial |
$8,375.50
|
| Rate for Payer: Copperpoint Commercial |
$2,961.34
|
| Rate for Payer: Health Net of AZ Commercial |
$7,179.00
|
| Rate for Payer: Health Net of AZ Medicare |
$3,350.20
|
| Rate for Payer: Humana of AZ Medicare |
$1,794.75
|
| Rate for Payer: Self Pay Self Pay |
$9,572.00
|
| Rate for Payer: TriWest Medicare |
$1,794.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$6,975.60
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2,153.70
|
|
|
SMART TOE 2 IMPLANT 15MM
|
Facility
IP
|
$11,965.00
|
|
| Hospital Charge Code |
27519891
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,110.90 |
| Max. Negotiated Rate |
$10,768.50 |
| Rate for Payer: Aetna of AZ Commercial |
$10,768.50
|
| Rate for Payer: Bisbee Police All Plans |
$3,110.90
|
| Rate for Payer: Cash Price |
$9,572.00
|
| Rate for Payer: Self Pay Self Pay |
$9,572.00
|
|
|
SMOKING CESSATION OVER 10 MIN
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
853513
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of AZ Commercial |
$51.30
|
| Rate for Payer: Aetna of AZ Medicare |
$15.96
|
| Rate for Payer: Allwell Medicare |
$8.55
|
| Rate for Payer: Amerigroup Medicare |
$8.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$21.29
|
| Rate for Payer: AZCH Complete Medicare |
$8.55
|
| Rate for Payer: Banner UC Health Medicare |
$8.55
|
| Rate for Payer: Bisbee Police All Plans |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna of AZ Commercial |
$39.90
|
| Rate for Payer: Copperpoint Commercial |
$14.11
|
| Rate for Payer: Health Net of AZ Commercial |
$34.20
|
| Rate for Payer: Health Net of AZ Medicare |
$15.96
|
| Rate for Payer: Humana of AZ Medicare |
$8.55
|
| Rate for Payer: Self Pay Self Pay |
$45.60
|
| Rate for Payer: TriWest Medicare |
$8.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$33.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.26
|
|
|
SMOKING CESSATION OVER 10 MIN
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
853513
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of AZ Commercial |
$51.30
|
| Rate for Payer: Bisbee Police All Plans |
$14.82
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Self Pay Self Pay |
$45.60
|
|
|
SNAP CARTRIDGE 125 MM
|
Facility
OP
|
$671.00
|
|
| Hospital Charge Code |
22355019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.65 |
| Max. Negotiated Rate |
$603.90 |
| Rate for Payer: Aetna of AZ Commercial |
$603.90
|
| Rate for Payer: Aetna of AZ Medicare |
$187.88
|
| Rate for Payer: Allwell Medicare |
$100.65
|
| Rate for Payer: Amerigroup Medicare |
$100.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$250.62
|
| Rate for Payer: AZCH Complete Medicare |
$100.65
|
| Rate for Payer: Banner UC Health Medicare |
$100.65
|
| Rate for Payer: Bisbee Police All Plans |
$174.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$456.28
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cigna of AZ Commercial |
$469.70
|
| Rate for Payer: Copperpoint Commercial |
$166.07
|
| Rate for Payer: Health Net of AZ Commercial |
$402.60
|
| Rate for Payer: Health Net of AZ Medicare |
$187.88
|
| Rate for Payer: Humana of AZ Medicare |
$100.65
|
| Rate for Payer: Self Pay Self Pay |
$536.80
|
| Rate for Payer: TriWest Medicare |
$100.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$391.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$120.78
|
|
|
SNAP CARTRIDGE 125 MM
|
Facility
IP
|
$671.00
|
|
| Hospital Charge Code |
22355019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$174.46 |
| Max. Negotiated Rate |
$603.90 |
| Rate for Payer: Aetna of AZ Commercial |
$603.90
|
| Rate for Payer: Bisbee Police All Plans |
$174.46
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Self Pay Self Pay |
$536.80
|
|
|
SNAP DRESSING KIT W FOAM 10X10
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
22355018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of AZ Commercial |
$189.00
|
| Rate for Payer: Aetna of AZ Medicare |
$58.80
|
| Rate for Payer: Allwell Medicare |
$31.50
|
| Rate for Payer: Amerigroup Medicare |
$31.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$78.44
|
| Rate for Payer: AZCH Complete Medicare |
$31.50
|
| Rate for Payer: Banner UC Health Medicare |
$31.50
|
| Rate for Payer: Bisbee Police All Plans |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$142.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna of AZ Commercial |
$147.00
|
| Rate for Payer: Copperpoint Commercial |
$51.98
|
| Rate for Payer: Health Net of AZ Commercial |
$126.00
|
| Rate for Payer: Health Net of AZ Medicare |
$58.80
|
| Rate for Payer: Humana of AZ Medicare |
$31.50
|
| Rate for Payer: Self Pay Self Pay |
$168.00
|
| Rate for Payer: TriWest Medicare |
$31.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$122.43
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$37.80
|
|
|
SNAP DRESSING KIT W FOAM 10X10
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
22355018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of AZ Commercial |
$189.00
|
| Rate for Payer: Bisbee Police All Plans |
$54.60
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Self Pay Self Pay |
$168.00
|
|
|
SNARE MASTER PLUS 10MM
|
Facility
IP
|
$79.00
|
|
| Hospital Charge Code |
23733630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Aetna of AZ Commercial |
$71.10
|
| Rate for Payer: Bisbee Police All Plans |
$20.54
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Self Pay Self Pay |
$63.20
|
|
|
SNARE MASTER PLUS 10MM
|
Facility
OP
|
$79.00
|
|
| Hospital Charge Code |
23733630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Aetna of AZ Commercial |
$71.10
|
| Rate for Payer: Aetna of AZ Medicare |
$22.12
|
| Rate for Payer: Allwell Medicare |
$11.85
|
| Rate for Payer: Amerigroup Medicare |
$11.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$29.51
|
| Rate for Payer: AZCH Complete Medicare |
$11.85
|
| Rate for Payer: Banner UC Health Medicare |
$11.85
|
| Rate for Payer: Bisbee Police All Plans |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$53.72
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cigna of AZ Commercial |
$55.30
|
| Rate for Payer: Copperpoint Commercial |
$19.55
|
| Rate for Payer: Health Net of AZ Commercial |
$47.40
|
| Rate for Payer: Health Net of AZ Medicare |
$22.12
|
| Rate for Payer: Humana of AZ Medicare |
$11.85
|
| Rate for Payer: Self Pay Self Pay |
$63.20
|
| Rate for Payer: TriWest Medicare |
$11.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$46.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.22
|
|
|
SNARE OVAL FLEXIBLE MEDIUM
|
Facility
IP
|
$121.00
|
|
| Hospital Charge Code |
23589498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.46 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of AZ Commercial |
$108.90
|
| Rate for Payer: Bisbee Police All Plans |
$31.46
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Self Pay Self Pay |
$96.80
|
|
|
SNARE OVAL FLEXIBLE MEDIUM
|
Facility
OP
|
$121.00
|
|
| Hospital Charge Code |
23589498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of AZ Commercial |
$108.90
|
| Rate for Payer: Aetna of AZ Medicare |
$33.88
|
| Rate for Payer: Allwell Medicare |
$18.15
|
| Rate for Payer: Amerigroup Medicare |
$18.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$45.19
|
| Rate for Payer: AZCH Complete Medicare |
$18.15
|
| Rate for Payer: Banner UC Health Medicare |
$18.15
|
| Rate for Payer: Bisbee Police All Plans |
$31.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$82.28
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cigna of AZ Commercial |
$84.70
|
| Rate for Payer: Copperpoint Commercial |
$29.95
|
| Rate for Payer: Health Net of AZ Commercial |
$72.60
|
| Rate for Payer: Health Net of AZ Medicare |
$33.88
|
| Rate for Payer: Humana of AZ Medicare |
$18.15
|
| Rate for Payer: Self Pay Self Pay |
$96.80
|
| Rate for Payer: TriWest Medicare |
$18.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$70.54
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.78
|
|
|
SNARE OVAL FLEX MEDIUM
|
Facility
OP
|
$1,247.00
|
|
| Hospital Charge Code |
22354316
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$187.05 |
| Max. Negotiated Rate |
$1,122.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,122.30
|
| Rate for Payer: Aetna of AZ Medicare |
$349.16
|
| Rate for Payer: Allwell Medicare |
$187.05
|
| Rate for Payer: Amerigroup Medicare |
$187.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$465.75
|
| Rate for Payer: AZCH Complete Medicare |
$187.05
|
| Rate for Payer: Banner UC Health Medicare |
$187.05
|
| Rate for Payer: Bisbee Police All Plans |
$324.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$847.96
|
| Rate for Payer: Cash Price |
$997.60
|
| Rate for Payer: Cigna of AZ Commercial |
$872.90
|
| Rate for Payer: Copperpoint Commercial |
$308.63
|
| Rate for Payer: Health Net of AZ Commercial |
$748.20
|
| Rate for Payer: Health Net of AZ Medicare |
$349.16
|
| Rate for Payer: Humana of AZ Medicare |
$187.05
|
| Rate for Payer: Self Pay Self Pay |
$997.60
|
| Rate for Payer: TriWest Medicare |
$187.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$727.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$224.46
|
|
|
SNARE OVAL FLEX MEDIUM
|
Facility
IP
|
$1,247.00
|
|
| Hospital Charge Code |
22354316
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$324.22 |
| Max. Negotiated Rate |
$1,122.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,122.30
|
| Rate for Payer: Bisbee Police All Plans |
$324.22
|
| Rate for Payer: Cash Price |
$997.60
|
| Rate for Payer: Self Pay Self Pay |
$997.60
|
|
|
SNARE POLYPECTOMY SML OVAL CONMED
|
Facility
IP
|
$1,567.00
|
|
| Hospital Charge Code |
22354206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$407.42 |
| Max. Negotiated Rate |
$1,410.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,410.30
|
| Rate for Payer: Bisbee Police All Plans |
$407.42
|
| Rate for Payer: Cash Price |
$1,253.60
|
| Rate for Payer: Self Pay Self Pay |
$1,253.60
|
|
|
SNARE POLYPECTOMY SML OVAL CONMED
|
Facility
OP
|
$1,567.00
|
|
| Hospital Charge Code |
22354206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$235.05 |
| Max. Negotiated Rate |
$1,410.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,410.30
|
| Rate for Payer: Aetna of AZ Medicare |
$438.76
|
| Rate for Payer: Allwell Medicare |
$235.05
|
| Rate for Payer: Amerigroup Medicare |
$235.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$585.27
|
| Rate for Payer: AZCH Complete Medicare |
$235.05
|
| Rate for Payer: Banner UC Health Medicare |
$235.05
|
| Rate for Payer: Bisbee Police All Plans |
$407.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,065.56
|
| Rate for Payer: Cash Price |
$1,253.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,096.90
|
| Rate for Payer: Copperpoint Commercial |
$387.83
|
| Rate for Payer: Health Net of AZ Commercial |
$940.20
|
| Rate for Payer: Health Net of AZ Medicare |
$438.76
|
| Rate for Payer: Humana of AZ Medicare |
$235.05
|
| Rate for Payer: Self Pay Self Pay |
$1,253.60
|
| Rate for Payer: TriWest Medicare |
$235.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$913.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$282.06
|
|
|
sodium bicarbonate 4.2% (infant PFS)IV 10 mL [CQCH]
|
Facility
OP
|
$0.84
|
|
|
Service Code
|
NDC 409553434
|
| Hospital Charge Code |
105940804
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of AZ Commercial |
$0.76
|
| Rate for Payer: Aetna of AZ Medicare |
$0.24
|
| Rate for Payer: Allwell Medicare |
$0.13
|
| Rate for Payer: Amerigroup Medicare |
$0.13
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.31
|
| Rate for Payer: AZCH Complete Medicare |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$0.13
|
| Rate for Payer: Bisbee Police All Plans |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.57
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cigna of AZ Commercial |
$0.55
|
| Rate for Payer: Copperpoint Commercial |
$0.21
|
| Rate for Payer: Health Net of AZ Commercial |
$0.50
|
| Rate for Payer: Health Net of AZ Medicare |
$0.24
|
| Rate for Payer: Humana of AZ Medicare |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$0.67
|
| Rate for Payer: TriWest Medicare |
$0.13
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.15
|
|
