|
XR Wrist 2 Views Left
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 73100 LT
|
| Hospital Charge Code |
823685
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
|
|
XR Wrist 2 Views Right
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 73100 RT
|
| Hospital Charge Code |
823683
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Aetna of AZ Medicare |
$136.64
|
| Rate for Payer: Allwell Medicare |
$73.20
|
| Rate for Payer: Amerigroup Medicare |
$73.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$182.27
|
| Rate for Payer: AZCH Complete Medicare |
$73.20
|
| Rate for Payer: Banner UC Health Medicare |
$73.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$331.84
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cigna of AZ Commercial |
$317.20
|
| Rate for Payer: Copperpoint Commercial |
$120.78
|
| Rate for Payer: Health Net of AZ Commercial |
$292.80
|
| Rate for Payer: Health Net of AZ Medicare |
$136.64
|
| Rate for Payer: Humana of AZ Medicare |
$73.20
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
| Rate for Payer: TriWest Medicare |
$73.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$284.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$87.84
|
|
|
XR Wrist 2 Views Right
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 73100 RT
|
| Hospital Charge Code |
823683
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
|
|
XR Wrist Complete Left
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
823681
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna of AZ Commercial |
$525.60
|
| Rate for Payer: Aetna of AZ Medicare |
$163.52
|
| Rate for Payer: Allwell Medicare |
$87.60
|
| Rate for Payer: Amerigroup Medicare |
$87.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$218.12
|
| Rate for Payer: AZCH Complete Medicare |
$87.60
|
| Rate for Payer: Banner UC Health Medicare |
$87.60
|
| Rate for Payer: Bisbee Police All Plans |
$151.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$397.12
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cigna of AZ Commercial |
$379.60
|
| Rate for Payer: Copperpoint Commercial |
$144.54
|
| Rate for Payer: Health Net of AZ Commercial |
$350.40
|
| Rate for Payer: Health Net of AZ Medicare |
$163.52
|
| Rate for Payer: Humana of AZ Medicare |
$87.60
|
| Rate for Payer: Self Pay Self Pay |
$467.20
|
| Rate for Payer: TriWest Medicare |
$87.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$340.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$105.12
|
|
|
XR Wrist Complete Left
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
823681
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.84 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna of AZ Commercial |
$525.60
|
| Rate for Payer: Bisbee Police All Plans |
$151.84
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Self Pay Self Pay |
$467.20
|
|
|
XR Wrist Complete Right
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
823679
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna of AZ Commercial |
$525.60
|
| Rate for Payer: Aetna of AZ Medicare |
$163.52
|
| Rate for Payer: Allwell Medicare |
$87.60
|
| Rate for Payer: Amerigroup Medicare |
$87.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$218.12
|
| Rate for Payer: AZCH Complete Medicare |
$87.60
|
| Rate for Payer: Banner UC Health Medicare |
$87.60
|
| Rate for Payer: Bisbee Police All Plans |
$151.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$397.12
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cigna of AZ Commercial |
$379.60
|
| Rate for Payer: Copperpoint Commercial |
$144.54
|
| Rate for Payer: Health Net of AZ Commercial |
$350.40
|
| Rate for Payer: Health Net of AZ Medicare |
$163.52
|
| Rate for Payer: Humana of AZ Medicare |
$87.60
|
| Rate for Payer: Self Pay Self Pay |
$467.20
|
| Rate for Payer: TriWest Medicare |
$87.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$340.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$105.12
|
|
|
XR Wrist Complete Right
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
823679
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.84 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna of AZ Commercial |
$525.60
|
| Rate for Payer: Bisbee Police All Plans |
$151.84
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Self Pay Self Pay |
$467.20
|
|
|
XR Zygomatic Arches
|
Facility
OP
|
$680.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
2620463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna of AZ Commercial |
$612.00
|
| Rate for Payer: Aetna of AZ Medicare |
$190.40
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$102.00
|
| Rate for Payer: Amerigroup Medicare |
$102.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$253.98
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$102.00
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$102.00
|
| Rate for Payer: Bisbee Police All Plans |
$176.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$462.40
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cigna of AZ Commercial |
$442.00
|
| Rate for Payer: Copperpoint Commercial |
$168.30
|
| Rate for Payer: Health Net of AZ Commercial |
$408.00
|
| Rate for Payer: Health Net of AZ Medicare |
$190.40
|
| Rate for Payer: Humana of AZ Medicare |
$102.00
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$544.00
|
| Rate for Payer: TriWest Medicare |
$102.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$396.44
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$122.40
|
|
|
XR Zygomatic Arches
|
Facility
IP
|
$680.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
2620463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna of AZ Commercial |
$612.00
|
| Rate for Payer: Bisbee Police All Plans |
$176.80
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Self Pay Self Pay |
$544.00
|
|
|
YANKAUER 72
|
Facility
IP
|
$11.00
|
|
| Hospital Charge Code |
22355322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna of AZ Commercial |
$9.90
|
| Rate for Payer: Bisbee Police All Plans |
$2.86
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Self Pay Self Pay |
$8.80
|
|
|
YANKAUER 72
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
22355322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna of AZ Commercial |
$9.90
|
| Rate for Payer: Aetna of AZ Medicare |
$3.08
|
| Rate for Payer: Allwell Medicare |
$1.65
|
| Rate for Payer: Amerigroup Medicare |
$1.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4.11
|
| Rate for Payer: AZCH Complete Medicare |
$1.65
|
| Rate for Payer: Banner UC Health Medicare |
$1.65
|
| Rate for Payer: Bisbee Police All Plans |
$2.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$7.48
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cigna of AZ Commercial |
$7.70
|
| Rate for Payer: Copperpoint Commercial |
$2.72
|
| Rate for Payer: Health Net of AZ Commercial |
$6.60
|
| Rate for Payer: Health Net of AZ Medicare |
$3.08
|
| Rate for Payer: Humana of AZ Medicare |
$1.65
|
| Rate for Payer: Self Pay Self Pay |
$8.80
|
| Rate for Payer: TriWest Medicare |
$1.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$6.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.98
|
|
|
YANKAUER HANDLE ONLY
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
22355582
|
|
Hospital Revenue Code
|
272
|
| 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: Allwell Medicare |
$1.05
|
| Rate for Payer: Amerigroup Medicare |
$1.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.61
|
| Rate for Payer: AZCH Complete Medicare |
$1.05
|
| 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: 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: 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
|
|
|
YANKAUER HANDLE ONLY
|
Facility
IP
|
$7.00
|
|
| Hospital Charge Code |
22355582
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
YANKAUER TIP BULB VENTLESS
|
Facility
IP
|
$14.00
|
|
| Hospital Charge Code |
22552484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of AZ Commercial |
$12.60
|
| Rate for Payer: Bisbee Police All Plans |
$3.64
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Self Pay Self Pay |
$11.20
|
|
|
YANKAUER TIP BULB VENTLESS
|
Facility
OP
|
$14.00
|
|
| Hospital Charge Code |
22552484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of AZ Commercial |
$12.60
|
| Rate for Payer: Aetna of AZ Medicare |
$3.92
|
| Rate for Payer: Allwell Medicare |
$2.10
|
| Rate for Payer: Amerigroup Medicare |
$2.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$5.23
|
| Rate for Payer: AZCH Complete Medicare |
$2.10
|
| Rate for Payer: Banner UC Health Medicare |
$2.10
|
| Rate for Payer: Bisbee Police All Plans |
$3.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$9.52
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cigna of AZ Commercial |
$9.80
|
| Rate for Payer: Copperpoint Commercial |
$3.46
|
| Rate for Payer: Health Net of AZ Commercial |
$8.40
|
| Rate for Payer: Health Net of AZ Medicare |
$3.92
|
| Rate for Payer: Humana of AZ Medicare |
$2.10
|
| Rate for Payer: Self Pay Self Pay |
$11.20
|
| Rate for Payer: TriWest Medicare |
$2.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$8.16
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.52
|
|
|
YELLOW INTRAOSSEOUS MODULE PEDS
|
Facility
OP
|
$362.00
|
|
| Hospital Charge Code |
23175126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Aetna of AZ Commercial |
$325.80
|
| Rate for Payer: Aetna of AZ Medicare |
$101.36
|
| Rate for Payer: Allwell Medicare |
$54.30
|
| Rate for Payer: Amerigroup Medicare |
$54.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$135.21
|
| Rate for Payer: AZCH Complete Medicare |
$54.30
|
| Rate for Payer: Banner UC Health Medicare |
$54.30
|
| Rate for Payer: Bisbee Police All Plans |
$94.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$246.16
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cigna of AZ Commercial |
$253.40
|
| Rate for Payer: Copperpoint Commercial |
$89.60
|
| Rate for Payer: Health Net of AZ Commercial |
$217.20
|
| Rate for Payer: Health Net of AZ Medicare |
$101.36
|
| Rate for Payer: Humana of AZ Medicare |
$54.30
|
| Rate for Payer: Self Pay Self Pay |
$289.60
|
| Rate for Payer: TriWest Medicare |
$54.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$211.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$65.16
|
|
|
YELLOW INTRAOSSEOUS MODULE PEDS
|
Facility
IP
|
$362.00
|
|
| Hospital Charge Code |
23175126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.12 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Aetna of AZ Commercial |
$325.80
|
| Rate for Payer: Bisbee Police All Plans |
$94.12
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Self Pay Self Pay |
$289.60
|
|
|
YELLOW INTUBATION MODULE PEDS
|
Facility
IP
|
$302.00
|
|
| Hospital Charge Code |
23175714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Aetna of AZ Commercial |
$271.80
|
| Rate for Payer: Bisbee Police All Plans |
$78.52
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Self Pay Self Pay |
$241.60
|
|
|
YELLOW INTUBATION MODULE PEDS
|
Facility
OP
|
$302.00
|
|
| Hospital Charge Code |
23175714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Aetna of AZ Commercial |
$271.80
|
| Rate for Payer: Aetna of AZ Medicare |
$84.56
|
| Rate for Payer: Allwell Medicare |
$45.30
|
| Rate for Payer: Amerigroup Medicare |
$45.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$112.80
|
| Rate for Payer: AZCH Complete Medicare |
$45.30
|
| Rate for Payer: Banner UC Health Medicare |
$45.30
|
| Rate for Payer: Bisbee Police All Plans |
$78.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$205.36
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cigna of AZ Commercial |
$211.40
|
| Rate for Payer: Copperpoint Commercial |
$74.74
|
| Rate for Payer: Health Net of AZ Commercial |
$181.20
|
| Rate for Payer: Health Net of AZ Medicare |
$84.56
|
| Rate for Payer: Humana of AZ Medicare |
$45.30
|
| Rate for Payer: Self Pay Self Pay |
$241.60
|
| Rate for Payer: TriWest Medicare |
$45.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$176.07
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$54.36
|
|
|
YELLOW IV DELIVERY MODULE PEDS
|
Facility
IP
|
$290.00
|
|
| Hospital Charge Code |
23175707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of AZ Commercial |
$261.00
|
| Rate for Payer: Bisbee Police All Plans |
$75.40
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Self Pay Self Pay |
$232.00
|
|
|
YELLOW IV DELIVERY MODULE PEDS
|
Facility
OP
|
$290.00
|
|
| Hospital Charge Code |
23175707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of AZ Commercial |
$261.00
|
| Rate for Payer: Aetna of AZ Medicare |
$81.20
|
| Rate for Payer: Allwell Medicare |
$43.50
|
| Rate for Payer: Amerigroup Medicare |
$43.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$108.32
|
| Rate for Payer: AZCH Complete Medicare |
$43.50
|
| Rate for Payer: Banner UC Health Medicare |
$43.50
|
| Rate for Payer: Bisbee Police All Plans |
$75.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$197.20
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cigna of AZ Commercial |
$203.00
|
| Rate for Payer: Copperpoint Commercial |
$71.78
|
| Rate for Payer: Health Net of AZ Commercial |
$174.00
|
| Rate for Payer: Health Net of AZ Medicare |
$81.20
|
| Rate for Payer: Humana of AZ Medicare |
$43.50
|
| Rate for Payer: Self Pay Self Pay |
$232.00
|
| Rate for Payer: TriWest Medicare |
$43.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$169.07
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$52.20
|
|
|
YELLOW OXYGEN DELIVERY MODULE PEDS
|
Facility
IP
|
$121.00
|
|
| Hospital Charge Code |
23175700
|
|
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
|
|
|
YELLOW OXYGEN DELIVERY MODULE PEDS
|
Facility
OP
|
$121.00
|
|
| Hospital Charge Code |
23175700
|
|
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
|
|
|
Yes
|
Facility
IP
|
$341.00
|
|
| Hospital Charge Code |
1230419
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$306.90 |
| Rate for Payer: Aetna of AZ Commercial |
$306.90
|
| Rate for Payer: Bisbee Police All Plans |
$88.66
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Self Pay Self Pay |
$272.80
|
|
|
Yes
|
Facility
OP
|
$341.00
|
|
| Hospital Charge Code |
1230419
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$306.90 |
| Rate for Payer: Aetna of AZ Commercial |
$306.90
|
| Rate for Payer: Aetna of AZ Medicare |
$95.48
|
| Rate for Payer: Allwell Medicare |
$51.15
|
| Rate for Payer: Amerigroup Medicare |
$51.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$127.36
|
| Rate for Payer: AZCH Complete Medicare |
$51.15
|
| Rate for Payer: Banner UC Health Medicare |
$51.15
|
| Rate for Payer: Bisbee Police All Plans |
$88.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$231.88
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cigna of AZ Commercial |
$238.70
|
| Rate for Payer: Copperpoint Commercial |
$84.40
|
| Rate for Payer: Health Net of AZ Commercial |
$204.60
|
| Rate for Payer: Health Net of AZ Medicare |
$95.48
|
| Rate for Payer: Humana of AZ Medicare |
$51.15
|
| Rate for Payer: Self Pay Self Pay |
$272.80
|
| Rate for Payer: TriWest Medicare |
$51.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$198.80
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$61.38
|
|
