|
SLING MINIARC SINGLE INCISION
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
22354151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$639.84 |
| 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: Allwell Medicare |
$639.84
|
| Rate for Payer: Amerigroup Medicare |
$639.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,493.63
|
| Rate for Payer: AZCH Complete Medicare |
$639.84
|
| Rate for Payer: Banner UC Health Medicare |
$639.84
|
| 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: 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 |
$639.84
|
| Rate for Payer: Self Pay Self Pay |
$3,199.20
|
| Rate for Payer: TriWest Medicare |
$639.84
|
| 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 |
$639.84 |
| 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: Allwell Medicare |
$639.84
|
| Rate for Payer: Amerigroup Medicare |
$639.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,493.63
|
| Rate for Payer: AZCH Complete Medicare |
$639.84
|
| Rate for Payer: Banner UC Health Medicare |
$639.84
|
| 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: 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 |
$639.84
|
| Rate for Payer: Self Pay Self Pay |
$3,199.20
|
| Rate for Payer: TriWest Medicare |
$639.84
|
| 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 |
$816.48 |
| 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 |
$816.48
|
| Rate for Payer: Amerigroup Medicare |
$816.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,905.97
|
| Rate for Payer: AZCH Complete Medicare |
$816.48
|
| Rate for Payer: Banner UC Health Medicare |
$816.48
|
| 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 |
$816.48
|
| Rate for Payer: Self Pay Self Pay |
$4,082.40
|
| Rate for Payer: TriWest Medicare |
$816.48
|
| 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 |
$608.80 |
| Max. Negotiated Rate |
$3,424.50 |
| 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 |
$1,901.83
|
| Rate for Payer: Allwell Medicaid |
$1,901.83
|
| Rate for Payer: Allwell Medicare |
$608.80
|
| Rate for Payer: Amerigroup Medicare |
$608.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,421.17
|
| Rate for Payer: AZCH Complete Medicaid |
$1,901.83
|
| Rate for Payer: AZCH Complete Medicare |
$608.80
|
| Rate for Payer: Banner UC Health Medicaid |
$1,901.83
|
| Rate for Payer: Banner UC Health Medicare |
$608.80
|
| 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 |
$608.80
|
| Rate for Payer: Mercy Care Medicaid |
$1,901.83
|
| Rate for Payer: Self Pay Self Pay |
$3,044.00
|
| Rate for Payer: TriWest Medicare |
$608.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,218.32
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$684.90
|
|
|
SLING SUPRAPUBIC ALIGN URETHRAL SUPPORT
|
Facility
|
OP
|
$2,619.00
|
|
| Hospital Charge Code |
22354161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$419.04 |
| 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 |
$419.04
|
| Rate for Payer: Amerigroup Medicare |
$419.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$978.20
|
| Rate for Payer: AZCH Complete Medicare |
$419.04
|
| Rate for Payer: Banner UC Health Medicare |
$419.04
|
| 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 |
$419.04
|
| Rate for Payer: Self Pay Self Pay |
$2,095.20
|
| Rate for Payer: TriWest Medicare |
$419.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,526.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$471.42
|
|
|
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 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 |
$10.08 |
| 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 |
$10.08
|
| Rate for Payer: Amerigroup Medicare |
$10.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$23.53
|
| Rate for Payer: AZCH Complete Medicare |
$10.08
|
| Rate for Payer: Banner UC Health Medicare |
$10.08
|
| 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 |
$10.08
|
| Rate for Payer: Self Pay Self Pay |
$50.40
|
| Rate for Payer: TriWest Medicare |
$10.08
|
| 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 |
$16.80 |
| 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 |
$16.80
|
| Rate for Payer: Amerigroup Medicare |
$16.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$39.22
|
| Rate for Payer: AZCH Complete Medicare |
$16.80
|
| Rate for Payer: Banner UC Health Medicare |
$16.80
|
| 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 |
$16.80
|
| Rate for Payer: Self Pay Self Pay |
$84.00
|
| Rate for Payer: TriWest Medicare |
$16.80
|
| 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
|
OP
|
$6.00
|
|
| Hospital Charge Code |
22355542
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.96 |
| 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 |
$0.96
|
| Rate for Payer: Amerigroup Medicare |
$0.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.24
|
| Rate for Payer: AZCH Complete Medicare |
$0.96
|
| Rate for Payer: Banner UC Health Medicare |
$0.96
|
| 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 |
$1.49
|
| 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 |
$0.96
|
| Rate for Payer: Self Pay Self Pay |
$4.80
|
| Rate for Payer: TriWest Medicare |
$0.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.08
|
|
|
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
|
|
|
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
|
|
|
SMART TOE 2 IMPLANT 15MM
|
Facility
|
OP
|
$11,965.00
|
|
| Hospital Charge Code |
27519891
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,914.40 |
| 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 |
$1,914.40
|
| Rate for Payer: Amerigroup Medicare |
$1,914.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4,468.93
|
| Rate for Payer: AZCH Complete Medicare |
$1,914.40
|
| Rate for Payer: Banner UC Health Medicare |
$1,914.40
|
| 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 |
$1,914.40
|
| Rate for Payer: Self Pay Self Pay |
$9,572.00
|
| Rate for Payer: TriWest Medicare |
$1,914.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$6,975.60
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2,153.70
|
|
|
SMOKING CESSATION OVER 10 MIN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
853513
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna of AZ Commercial |
$48.60
|
| Rate for Payer: Bisbee Police All Plans |
$14.04
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Self Pay Self Pay |
$43.20
|
|
|
SMOKING CESSATION OVER 10 MIN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
853513
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna of AZ Commercial |
$48.60
|
| Rate for Payer: Aetna of AZ Medicare |
$15.12
|
| Rate for Payer: Allwell Medicare |
$8.64
|
| Rate for Payer: Amerigroup Medicare |
$8.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$20.17
|
| Rate for Payer: AZCH Complete Medicare |
$8.64
|
| Rate for Payer: Banner UC Health Medicare |
$8.64
|
| Rate for Payer: Bisbee Police All Plans |
$14.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$36.72
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of AZ Commercial |
$37.80
|
| Rate for Payer: Copperpoint Commercial |
$13.37
|
| Rate for Payer: Health Net of AZ Commercial |
$32.40
|
| Rate for Payer: Health Net of AZ Medicare |
$15.12
|
| Rate for Payer: Humana of AZ Medicare |
$8.64
|
| Rate for Payer: Self Pay Self Pay |
$43.20
|
| Rate for Payer: TriWest Medicare |
$8.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$31.48
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$9.72
|
|
|
SNAP CARTRIDGE 125 MM
|
Facility
|
OP
|
$671.00
|
|
| Hospital Charge Code |
22355019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.36 |
| 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 |
$107.36
|
| Rate for Payer: Amerigroup Medicare |
$107.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$250.62
|
| Rate for Payer: AZCH Complete Medicare |
$107.36
|
| Rate for Payer: Banner UC Health Medicare |
$107.36
|
| 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 |
$107.36
|
| Rate for Payer: Self Pay Self Pay |
$536.80
|
| Rate for Payer: TriWest Medicare |
$107.36
|
| 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
|
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
|
|
|
SNAP DRESSING KIT W FOAM 10X10
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
22355018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.60 |
| 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 |
$33.60
|
| Rate for Payer: Amerigroup Medicare |
$33.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$78.44
|
| Rate for Payer: AZCH Complete Medicare |
$33.60
|
| Rate for Payer: Banner UC Health Medicare |
$33.60
|
| 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 |
$33.60
|
| Rate for Payer: Self Pay Self Pay |
$168.00
|
| Rate for Payer: TriWest Medicare |
$33.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$122.43
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$37.80
|
|
|
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 |
$19.36 |
| 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 |
$19.36
|
| Rate for Payer: Amerigroup Medicare |
$19.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$45.19
|
| Rate for Payer: AZCH Complete Medicare |
$19.36
|
| Rate for Payer: Banner UC Health Medicare |
$19.36
|
| 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 |
$19.36
|
| Rate for Payer: Self Pay Self Pay |
$96.80
|
| Rate for Payer: TriWest Medicare |
$19.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$70.54
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.78
|
|