|
Synovial Fluid Cell Count Standard
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
22309857
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Bisbee Police All Plans |
$26.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Self Pay Self Pay |
$80.00
|
|
|
Synovial Fluid Cell Count Standard
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
22309857
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Aetna of AZ Medicare |
$28.00
|
| Rate for Payer: AHCCCS Medicaid |
$5.60
|
| Rate for Payer: Allwell Medicaid |
$5.60
|
| Rate for Payer: Allwell Medicare |
$15.00
|
| Rate for Payer: Amerigroup Medicare |
$15.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$37.35
|
| Rate for Payer: AZCH Complete Medicaid |
$5.60
|
| Rate for Payer: AZCH Complete Medicare |
$15.00
|
| Rate for Payer: Banner UC Health Medicaid |
$5.60
|
| Rate for Payer: Banner UC Health Medicare |
$15.00
|
| Rate for Payer: Bisbee Police All Plans |
$26.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$68.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna of AZ Commercial |
$65.00
|
| Rate for Payer: Copperpoint Commercial |
$24.75
|
| Rate for Payer: Health Net of AZ Commercial |
$60.00
|
| Rate for Payer: Health Net of AZ Medicare |
$28.00
|
| Rate for Payer: Humana of AZ Medicare |
$15.00
|
| Rate for Payer: Mercy Care Medicaid |
$5.60
|
| Rate for Payer: Self Pay Self Pay |
$80.00
|
| Rate for Payer: TriWest Medicare |
$15.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$58.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.00
|
|
|
SYR ASEPTO
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT A4322
|
| Hospital Charge Code |
22354240
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna of AZ Commercial |
$6.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1.96
|
| Rate for Payer: AHCCCS Medicaid |
$5.48
|
| Rate for Payer: Allwell Medicaid |
$5.48
|
| Rate for Payer: Allwell Medicare |
$1.05
|
| Rate for Payer: Amerigroup Medicare |
$1.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.61
|
| Rate for Payer: AZCH Complete Medicaid |
$5.48
|
| Rate for Payer: AZCH Complete Medicare |
$1.05
|
| Rate for Payer: Banner UC Health Medicaid |
$5.48
|
| Rate for Payer: Banner UC Health Medicare |
$1.05
|
| Rate for Payer: Bisbee Police All Plans |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4.76
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cigna of AZ Commercial |
$4.90
|
| Rate for Payer: Copperpoint Commercial |
$1.73
|
| Rate for Payer: Health Net of AZ Commercial |
$4.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1.96
|
| Rate for Payer: Humana of AZ Medicare |
$1.05
|
| Rate for Payer: Mercy Care Medicaid |
$5.48
|
| Rate for Payer: Self Pay Self Pay |
$5.60
|
| Rate for Payer: TriWest Medicare |
$1.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.26
|
|
|
SYR ASEPTO
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT A4322
|
| Hospital Charge Code |
22354240
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna of AZ Commercial |
$6.30
|
| Rate for Payer: Bisbee Police All Plans |
$1.82
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Self Pay Self Pay |
$5.60
|
|
|
.T3Free LC
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
22531069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna of AZ Commercial |
$427.50
|
| Rate for Payer: Bisbee Police All Plans |
$123.50
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Self Pay Self Pay |
$380.00
|
|
|
.T3Free LC
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
22531069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna of AZ Commercial |
$427.50
|
| Rate for Payer: Aetna of AZ Medicare |
$133.00
|
| Rate for Payer: AHCCCS Medicaid |
$16.94
|
| Rate for Payer: Allwell Medicaid |
$16.94
|
| Rate for Payer: Allwell Medicare |
$71.25
|
| Rate for Payer: Amerigroup Medicare |
$71.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$177.41
|
| Rate for Payer: AZCH Complete Medicaid |
$16.94
|
| Rate for Payer: AZCH Complete Medicare |
$71.25
|
| Rate for Payer: Banner UC Health Medicaid |
$16.94
|
| Rate for Payer: Banner UC Health Medicare |
$71.25
|
| Rate for Payer: Bisbee Police All Plans |
$123.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$323.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna of AZ Commercial |
$308.75
|
| Rate for Payer: Copperpoint Commercial |
$117.56
|
| Rate for Payer: Health Net of AZ Commercial |
$285.00
|
| Rate for Payer: Health Net of AZ Medicare |
$133.00
|
| Rate for Payer: Humana of AZ Medicare |
$71.25
|
| Rate for Payer: Mercy Care Medicaid |
$16.94
|
| Rate for Payer: Self Pay Self Pay |
$380.00
|
| Rate for Payer: TriWest Medicare |
$71.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$276.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$85.50
|
|
|
T3, Total
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
1281222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Aetna of AZ Commercial |
$232.20
|
| Rate for Payer: Bisbee Police All Plans |
$67.08
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Self Pay Self Pay |
$206.40
|
|
|
T3, Total
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
1281222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Aetna of AZ Commercial |
$232.20
|
| Rate for Payer: Aetna of AZ Medicare |
$72.24
|
| Rate for Payer: AHCCCS Medicaid |
$14.18
|
| Rate for Payer: Allwell Medicaid |
$14.18
|
| Rate for Payer: Allwell Medicare |
$38.70
|
| Rate for Payer: Amerigroup Medicare |
$38.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$96.36
|
| Rate for Payer: AZCH Complete Medicaid |
$14.18
|
| Rate for Payer: AZCH Complete Medicare |
$38.70
|
| Rate for Payer: Banner UC Health Medicaid |
$14.18
|
| Rate for Payer: Banner UC Health Medicare |
$38.70
|
| Rate for Payer: Bisbee Police All Plans |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$175.44
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna of AZ Commercial |
$167.70
|
| Rate for Payer: Copperpoint Commercial |
$63.86
|
| Rate for Payer: Health Net of AZ Commercial |
$154.80
|
| Rate for Payer: Health Net of AZ Medicare |
$72.24
|
| Rate for Payer: Humana of AZ Medicare |
$38.70
|
| Rate for Payer: Mercy Care Medicaid |
$14.18
|
| Rate for Payer: Self Pay Self Pay |
$206.40
|
| Rate for Payer: TriWest Medicare |
$38.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$150.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$46.44
|
|
|
T3 Uptake LC
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
1285538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of AZ Commercial |
$117.00
|
| Rate for Payer: Bisbee Police All Plans |
$33.80
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Self Pay Self Pay |
$104.00
|
|
|
T3 Uptake LC
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
1285538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of AZ Commercial |
$117.00
|
| Rate for Payer: Aetna of AZ Medicare |
$36.40
|
| Rate for Payer: AHCCCS Medicaid |
$6.47
|
| Rate for Payer: Allwell Medicaid |
$6.47
|
| Rate for Payer: Allwell Medicare |
$19.50
|
| Rate for Payer: Amerigroup Medicare |
$19.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$48.56
|
| Rate for Payer: AZCH Complete Medicaid |
$6.47
|
| Rate for Payer: AZCH Complete Medicare |
$19.50
|
| Rate for Payer: Banner UC Health Medicaid |
$6.47
|
| Rate for Payer: Banner UC Health Medicare |
$19.50
|
| Rate for Payer: Bisbee Police All Plans |
$33.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$88.40
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna of AZ Commercial |
$84.50
|
| Rate for Payer: Copperpoint Commercial |
$32.18
|
| Rate for Payer: Health Net of AZ Commercial |
$78.00
|
| Rate for Payer: Health Net of AZ Medicare |
$36.40
|
| Rate for Payer: Humana of AZ Medicare |
$19.50
|
| Rate for Payer: Mercy Care Medicaid |
$6.47
|
| Rate for Payer: Self Pay Self Pay |
$104.00
|
| Rate for Payer: TriWest Medicare |
$19.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$75.79
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$23.40
|
|
|
T4, Total
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
1281223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of AZ Commercial |
$109.80
|
| Rate for Payer: Aetna of AZ Medicare |
$34.16
|
| Rate for Payer: AHCCCS Medicaid |
$6.87
|
| Rate for Payer: Allwell Medicaid |
$6.87
|
| Rate for Payer: Allwell Medicare |
$18.30
|
| Rate for Payer: Amerigroup Medicare |
$18.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$45.57
|
| Rate for Payer: AZCH Complete Medicaid |
$6.87
|
| Rate for Payer: AZCH Complete Medicare |
$18.30
|
| Rate for Payer: Banner UC Health Medicaid |
$6.87
|
| Rate for Payer: Banner UC Health Medicare |
$18.30
|
| Rate for Payer: Bisbee Police All Plans |
$31.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$82.96
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cigna of AZ Commercial |
$79.30
|
| Rate for Payer: Copperpoint Commercial |
$30.20
|
| Rate for Payer: Health Net of AZ Commercial |
$73.20
|
| Rate for Payer: Health Net of AZ Medicare |
$34.16
|
| Rate for Payer: Humana of AZ Medicare |
$18.30
|
| Rate for Payer: Mercy Care Medicaid |
$6.87
|
| Rate for Payer: Self Pay Self Pay |
$97.60
|
| Rate for Payer: TriWest Medicare |
$18.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$71.13
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.96
|
|
|
T4, Total
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
1281223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna of AZ Commercial |
$109.80
|
| Rate for Payer: Bisbee Police All Plans |
$31.72
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Self Pay Self Pay |
$97.60
|
|
|
Tacrolimus (FK506), Blood LC
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
1902306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna of AZ Commercial |
$338.40
|
| Rate for Payer: Aetna of AZ Medicare |
$105.28
|
| Rate for Payer: AHCCCS Medicaid |
$13.73
|
| Rate for Payer: Allwell Medicaid |
$13.73
|
| Rate for Payer: Allwell Medicare |
$56.40
|
| Rate for Payer: Amerigroup Medicare |
$56.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$140.44
|
| Rate for Payer: AZCH Complete Medicaid |
$13.73
|
| Rate for Payer: AZCH Complete Medicare |
$56.40
|
| Rate for Payer: Banner UC Health Medicaid |
$13.73
|
| Rate for Payer: Banner UC Health Medicare |
$56.40
|
| Rate for Payer: Bisbee Police All Plans |
$97.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$255.68
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cigna of AZ Commercial |
$244.40
|
| Rate for Payer: Copperpoint Commercial |
$93.06
|
| Rate for Payer: Health Net of AZ Commercial |
$225.60
|
| Rate for Payer: Health Net of AZ Medicare |
$105.28
|
| Rate for Payer: Humana of AZ Medicare |
$56.40
|
| Rate for Payer: Mercy Care Medicaid |
$13.73
|
| Rate for Payer: Self Pay Self Pay |
$300.80
|
| Rate for Payer: TriWest Medicare |
$56.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$219.21
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$67.68
|
|
|
Tacrolimus (FK506), Blood LC
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
1902306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna of AZ Commercial |
$338.40
|
| Rate for Payer: Bisbee Police All Plans |
$97.76
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Self Pay Self Pay |
$300.80
|
|
|
TAH with Burch
|
Facility
|
IP
|
$6,767.00
|
|
|
Service Code
|
CPT 58152
|
| Hospital Charge Code |
27291786
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,759.42 |
| Max. Negotiated Rate |
$6,090.30 |
| Rate for Payer: Aetna of AZ Commercial |
$6,090.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,759.42
|
| Rate for Payer: Cash Price |
$5,413.60
|
| Rate for Payer: Self Pay Self Pay |
$5,413.60
|
|
|
TAH with Burch
|
Facility
|
OP
|
$6,767.00
|
|
|
Service Code
|
CPT 58152
|
| Hospital Charge Code |
27291786
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$6,090.30 |
| Rate for Payer: Aetna of AZ Commercial |
$6,090.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,894.76
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$1,015.05
|
| Rate for Payer: Amerigroup Medicare |
$1,015.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,527.47
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$1,015.05
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$1,015.05
|
| Rate for Payer: Bisbee Police All Plans |
$1,759.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4,601.56
|
| Rate for Payer: Cash Price |
$5,413.60
|
| Rate for Payer: Cash Price |
$5,413.60
|
| Rate for Payer: Cigna of AZ Commercial |
$3,383.50
|
| Rate for Payer: Copperpoint Commercial |
$1,674.83
|
| Rate for Payer: Health Net of AZ Commercial |
$4,060.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,894.76
|
| Rate for Payer: Humana of AZ Medicare |
$1,015.05
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$5,413.60
|
| Rate for Payer: TriWest Medicare |
$1,015.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,218.06
|
|
|
tamsulosin 0.4 mg Oral Cap [CQCH]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 904640161
|
| Hospital Charge Code |
105943045
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of AZ Commercial |
$0.31
|
| Rate for Payer: Bisbee Police All Plans |
$0.09
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Self Pay Self Pay |
$0.27
|
|
|
tamsulosin 0.4 mg Oral Cap [CQCH]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 904640161
|
| Hospital Charge Code |
105943045
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of AZ Commercial |
$0.31
|
| Rate for Payer: Aetna of AZ Medicare |
$0.10
|
| Rate for Payer: Allwell Medicare |
$0.05
|
| Rate for Payer: Amerigroup Medicare |
$0.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$0.05
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.23
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of AZ Commercial |
$0.22
|
| Rate for Payer: Copperpoint Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Commercial |
$0.20
|
| Rate for Payer: Health Net of AZ Medicare |
$0.10
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.27
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.06
|
|
|
TAPER POST BOSS 10MM
|
Facility
|
OP
|
$2,221.00
|
|
| Hospital Charge Code |
27745953
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$333.15 |
| Max. Negotiated Rate |
$1,998.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,998.90
|
| Rate for Payer: Aetna of AZ Medicare |
$621.88
|
| Rate for Payer: Allwell Medicare |
$333.15
|
| Rate for Payer: Amerigroup Medicare |
$333.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$829.54
|
| Rate for Payer: AZCH Complete Medicare |
$333.15
|
| Rate for Payer: Banner UC Health Medicare |
$333.15
|
| Rate for Payer: Bisbee Police All Plans |
$577.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,510.28
|
| Rate for Payer: Cash Price |
$1,776.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,554.70
|
| Rate for Payer: Copperpoint Commercial |
$549.70
|
| Rate for Payer: Health Net of AZ Commercial |
$1,332.60
|
| Rate for Payer: Health Net of AZ Medicare |
$621.88
|
| Rate for Payer: Humana of AZ Medicare |
$333.15
|
| Rate for Payer: Self Pay Self Pay |
$1,776.80
|
| Rate for Payer: TriWest Medicare |
$333.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,294.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$399.78
|
|
|
TAPER POST BOSS 10MM
|
Facility
|
IP
|
$2,221.00
|
|
| Hospital Charge Code |
27745953
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$577.46 |
| Max. Negotiated Rate |
$1,998.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,998.90
|
| Rate for Payer: Bisbee Police All Plans |
$577.46
|
| Rate for Payer: Cash Price |
$1,776.80
|
| Rate for Payer: Self Pay Self Pay |
$1,776.80
|
|
|
TC 3.0/4.0 OVERDRILL
|
Facility
|
IP
|
$945.00
|
|
| Hospital Charge Code |
24127774
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna of AZ Commercial |
$850.50
|
| Rate for Payer: Bisbee Police All Plans |
$245.70
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Self Pay Self Pay |
$756.00
|
|
|
TC 3.0/4.0 OVERDRILL
|
Facility
|
OP
|
$945.00
|
|
| Hospital Charge Code |
24127774
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna of AZ Commercial |
$850.50
|
| Rate for Payer: Aetna of AZ Medicare |
$264.60
|
| Rate for Payer: Allwell Medicare |
$141.75
|
| Rate for Payer: Amerigroup Medicare |
$141.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$352.96
|
| Rate for Payer: AZCH Complete Medicare |
$141.75
|
| Rate for Payer: Banner UC Health Medicare |
$141.75
|
| Rate for Payer: Bisbee Police All Plans |
$245.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$642.60
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna of AZ Commercial |
$661.50
|
| Rate for Payer: Copperpoint Commercial |
$233.89
|
| Rate for Payer: Health Net of AZ Commercial |
$567.00
|
| Rate for Payer: Health Net of AZ Medicare |
$264.60
|
| Rate for Payer: Humana of AZ Medicare |
$141.75
|
| Rate for Payer: Self Pay Self Pay |
$756.00
|
| Rate for Payer: TriWest Medicare |
$141.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$550.94
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$170.10
|
|
|
TCS SERIES CANN OVER DRILL 3.0/4.0MM SCREWS
|
Facility
|
IP
|
$1,096.00
|
|
| Hospital Charge Code |
24209394
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$284.96 |
| Max. Negotiated Rate |
$986.40 |
| Rate for Payer: Aetna of AZ Commercial |
$986.40
|
| Rate for Payer: Bisbee Police All Plans |
$284.96
|
| Rate for Payer: Cash Price |
$876.80
|
| Rate for Payer: Self Pay Self Pay |
$876.80
|
|
|
TCS SERIES CANN OVER DRILL 3.0/4.0MM SCREWS
|
Facility
|
OP
|
$1,096.00
|
|
| Hospital Charge Code |
24209394
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$986.40 |
| Rate for Payer: Aetna of AZ Commercial |
$986.40
|
| Rate for Payer: Aetna of AZ Medicare |
$306.88
|
| Rate for Payer: Allwell Medicare |
$164.40
|
| Rate for Payer: Amerigroup Medicare |
$164.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$409.36
|
| Rate for Payer: AZCH Complete Medicare |
$164.40
|
| Rate for Payer: Banner UC Health Medicare |
$164.40
|
| Rate for Payer: Bisbee Police All Plans |
$284.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$745.28
|
| Rate for Payer: Cash Price |
$876.80
|
| Rate for Payer: Cigna of AZ Commercial |
$767.20
|
| Rate for Payer: Copperpoint Commercial |
$271.26
|
| Rate for Payer: Health Net of AZ Commercial |
$657.60
|
| Rate for Payer: Health Net of AZ Medicare |
$306.88
|
| Rate for Payer: Humana of AZ Medicare |
$164.40
|
| Rate for Payer: Self Pay Self Pay |
$876.80
|
| Rate for Payer: TriWest Medicare |
$164.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$638.97
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$197.28
|
|
|
TEL 613-8S
|
Facility
|
IP
|
$861.00
|
|
| Hospital Charge Code |
22354822
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$774.90 |
| Rate for Payer: Aetna of AZ Commercial |
$774.90
|
| Rate for Payer: Bisbee Police All Plans |
$223.86
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Self Pay Self Pay |
$688.80
|
|
