|
CLIENT DRUG SCREEN RAPID
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 80100
|
| Hospital Charge Code |
22331245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of AZ Commercial |
$46.80
|
| Rate for Payer: Bisbee Police All Plans |
$13.52
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Self Pay Self Pay |
$41.60
|
|
|
CLIENT EKG (12 LEAD)
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
22331249
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of AZ Commercial |
$92.70
|
| Rate for Payer: Bisbee Police All Plans |
$26.78
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Self Pay Self Pay |
$82.40
|
|
|
CLIENT EKG (12 LEAD)
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
22331249
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$16.48 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of AZ Commercial |
$92.70
|
| Rate for Payer: Aetna of AZ Medicare |
$28.84
|
| Rate for Payer: AHCCCS Medicaid |
$25.99
|
| Rate for Payer: Allwell Medicaid |
$25.99
|
| Rate for Payer: Allwell Medicare |
$16.48
|
| Rate for Payer: Amerigroup Medicare |
$16.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$38.47
|
| Rate for Payer: AZCH Complete Medicaid |
$25.99
|
| Rate for Payer: AZCH Complete Medicare |
$16.48
|
| Rate for Payer: Banner UC Health Medicaid |
$25.99
|
| Rate for Payer: Banner UC Health Medicare |
$16.48
|
| Rate for Payer: Bisbee Police All Plans |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$70.04
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cigna of AZ Commercial |
$72.10
|
| Rate for Payer: Copperpoint Commercial |
$25.49
|
| Rate for Payer: Health Net of AZ Commercial |
$61.80
|
| Rate for Payer: Health Net of AZ Medicare |
$28.84
|
| Rate for Payer: Humana of AZ Medicare |
$16.48
|
| Rate for Payer: Mercy Care Medicaid |
$25.99
|
| Rate for Payer: Self Pay Self Pay |
$82.40
|
| Rate for Payer: TriWest Medicare |
$16.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$60.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.54
|
|
|
CLIENT EKG TRACING W/O INTERP
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
22331254
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of AZ Commercial |
$45.00
|
| Rate for Payer: Aetna of AZ Medicare |
$14.00
|
| Rate for Payer: Allwell Medicare |
$8.00
|
| Rate for Payer: Amerigroup Medicare |
$8.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$18.68
|
| Rate for Payer: AZCH Complete Medicare |
$8.00
|
| Rate for Payer: Banner UC Health Medicare |
$8.00
|
| Rate for Payer: Bisbee Police All Plans |
$13.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of AZ Commercial |
$35.00
|
| Rate for Payer: Copperpoint Commercial |
$12.38
|
| Rate for Payer: Health Net of AZ Commercial |
$30.00
|
| Rate for Payer: Health Net of AZ Medicare |
$14.00
|
| Rate for Payer: Humana of AZ Medicare |
$8.00
|
| Rate for Payer: Self Pay Self Pay |
$40.00
|
| Rate for Payer: TriWest Medicare |
$8.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$29.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$9.00
|
|
|
CLIENT EKG TRACING W/O INTERP
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
22331254
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of AZ Commercial |
$45.00
|
| Rate for Payer: Bisbee Police All Plans |
$13.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Self Pay Self Pay |
$40.00
|
|
|
CLIENT FLU VACCINE ADULT 0.5 ML
|
Facility
|
OP
|
$97.00
|
|
| Hospital Charge Code |
22331274
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna of AZ Commercial |
$87.30
|
| Rate for Payer: Aetna of AZ Medicare |
$27.16
|
| Rate for Payer: Allwell Medicare |
$15.52
|
| Rate for Payer: Amerigroup Medicare |
$15.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$36.23
|
| Rate for Payer: AZCH Complete Medicare |
$15.52
|
| Rate for Payer: Banner UC Health Medicare |
$15.52
|
| Rate for Payer: Bisbee Police All Plans |
$25.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$65.96
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cigna of AZ Commercial |
$63.05
|
| Rate for Payer: Copperpoint Commercial |
$24.01
|
| Rate for Payer: Health Net of AZ Commercial |
$58.20
|
| Rate for Payer: Health Net of AZ Medicare |
$27.16
|
| Rate for Payer: Humana of AZ Medicare |
$15.52
|
| Rate for Payer: Self Pay Self Pay |
$77.60
|
| Rate for Payer: TriWest Medicare |
$15.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$56.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$17.46
|
|
|
CLIENT FLU VACCINE ADULT 0.5 ML
|
Facility
|
IP
|
$97.00
|
|
| Hospital Charge Code |
22331274
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna of AZ Commercial |
$87.30
|
| Rate for Payer: Bisbee Police All Plans |
$25.22
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Self Pay Self Pay |
$77.60
|
|
|
CLIENT HAIR FOLLICLE TEST
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
22331294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna of AZ Commercial |
$26.10
|
| Rate for Payer: Bisbee Police All Plans |
$7.54
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Self Pay Self Pay |
$23.20
|
|
|
CLIENT HAIR FOLLICLE TEST
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
22331294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna of AZ Commercial |
$26.10
|
| Rate for Payer: Aetna of AZ Medicare |
$8.12
|
| Rate for Payer: Allwell Medicare |
$4.64
|
| Rate for Payer: Amerigroup Medicare |
$4.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$10.83
|
| Rate for Payer: AZCH Complete Medicare |
$4.64
|
| Rate for Payer: Banner UC Health Medicare |
$4.64
|
| Rate for Payer: Bisbee Police All Plans |
$7.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$19.72
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cigna of AZ Commercial |
$18.85
|
| Rate for Payer: Copperpoint Commercial |
$7.18
|
| Rate for Payer: Health Net of AZ Commercial |
$17.40
|
| Rate for Payer: Health Net of AZ Medicare |
$8.12
|
| Rate for Payer: Humana of AZ Medicare |
$4.64
|
| Rate for Payer: Self Pay Self Pay |
$23.20
|
| Rate for Payer: TriWest Medicare |
$4.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$16.91
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.22
|
|
|
CLIENT HEP B IMMUNIZATION
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
22331305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna of AZ Commercial |
$67.50
|
| Rate for Payer: Bisbee Police All Plans |
$19.50
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Self Pay Self Pay |
$60.00
|
|
|
CLIENT HEP B IMMUNIZATION
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
22331305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna of AZ Commercial |
$67.50
|
| Rate for Payer: Aetna of AZ Medicare |
$21.00
|
| Rate for Payer: Allwell Medicare |
$12.00
|
| Rate for Payer: Amerigroup Medicare |
$12.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$28.01
|
| Rate for Payer: AZCH Complete Medicare |
$12.00
|
| Rate for Payer: Banner UC Health Medicare |
$12.00
|
| Rate for Payer: Bisbee Police All Plans |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of AZ Commercial |
$52.50
|
| Rate for Payer: Copperpoint Commercial |
$18.56
|
| Rate for Payer: Health Net of AZ Commercial |
$45.00
|
| Rate for Payer: Health Net of AZ Medicare |
$21.00
|
| Rate for Payer: Humana of AZ Medicare |
$12.00
|
| Rate for Payer: Self Pay Self Pay |
$60.00
|
| Rate for Payer: TriWest Medicare |
$12.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$43.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.50
|
|
|
CLIENT HIP COMPLETE BILATERAL
|
Facility
|
IP
|
$41.33
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
22331313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$37.20 |
| Rate for Payer: Aetna of AZ Commercial |
$37.20
|
| Rate for Payer: Bisbee Police All Plans |
$10.75
|
| Rate for Payer: Cash Price |
$33.06
|
| Rate for Payer: Self Pay Self Pay |
$33.06
|
|
|
CLIENT HIP COMPLETE BILATERAL
|
Facility
|
OP
|
$41.33
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
22331313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$37.20 |
| Rate for Payer: Aetna of AZ Commercial |
$37.20
|
| Rate for Payer: Aetna of AZ Medicare |
$11.57
|
| Rate for Payer: Allwell Medicare |
$6.61
|
| Rate for Payer: Amerigroup Medicare |
$6.61
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.44
|
| Rate for Payer: AZCH Complete Medicare |
$6.61
|
| Rate for Payer: Banner UC Health Medicare |
$6.61
|
| Rate for Payer: Bisbee Police All Plans |
$10.75
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$28.10
|
| Rate for Payer: Cash Price |
$33.06
|
| Rate for Payer: Cigna of AZ Commercial |
$26.86
|
| Rate for Payer: Copperpoint Commercial |
$10.23
|
| Rate for Payer: Health Net of AZ Commercial |
$24.80
|
| Rate for Payer: Health Net of AZ Medicare |
$11.57
|
| Rate for Payer: Humana of AZ Medicare |
$6.61
|
| Rate for Payer: Self Pay Self Pay |
$33.06
|
| Rate for Payer: TriWest Medicare |
$6.61
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$24.10
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.44
|
|
|
CLIENT HIV
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
22331316
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of AZ Commercial |
$43.20
|
| Rate for Payer: Aetna of AZ Medicare |
$13.44
|
| Rate for Payer: Allwell Medicare |
$7.68
|
| Rate for Payer: Amerigroup Medicare |
$7.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$17.93
|
| Rate for Payer: AZCH Complete Medicare |
$7.68
|
| Rate for Payer: Banner UC Health Medicare |
$7.68
|
| Rate for Payer: Bisbee Police All Plans |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$32.64
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna of AZ Commercial |
$31.20
|
| Rate for Payer: Copperpoint Commercial |
$11.88
|
| Rate for Payer: Health Net of AZ Commercial |
$28.80
|
| Rate for Payer: Health Net of AZ Medicare |
$13.44
|
| Rate for Payer: Humana of AZ Medicare |
$7.68
|
| Rate for Payer: Self Pay Self Pay |
$38.40
|
| Rate for Payer: TriWest Medicare |
$7.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$27.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.64
|
|
|
CLIENT HIV
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
22331316
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of AZ Commercial |
$43.20
|
| Rate for Payer: Bisbee Police All Plans |
$12.48
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Self Pay Self Pay |
$38.40
|
|
|
CLIENT INCENTIVE SPIROMTRY
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
22331327
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna of AZ Commercial |
$148.50
|
| Rate for Payer: Bisbee Police All Plans |
$42.90
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Self Pay Self Pay |
$132.00
|
|
|
CLIENT INCENTIVE SPIROMTRY
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
22331327
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna of AZ Commercial |
$148.50
|
| Rate for Payer: Aetna of AZ Medicare |
$46.20
|
| Rate for Payer: Allwell Medicare |
$26.40
|
| Rate for Payer: Amerigroup Medicare |
$26.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$61.63
|
| Rate for Payer: AZCH Complete Medicare |
$26.40
|
| Rate for Payer: Banner UC Health Medicare |
$26.40
|
| Rate for Payer: Bisbee Police All Plans |
$42.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$112.20
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of AZ Commercial |
$115.50
|
| Rate for Payer: Copperpoint Commercial |
$40.84
|
| Rate for Payer: Health Net of AZ Commercial |
$99.00
|
| Rate for Payer: Health Net of AZ Medicare |
$46.20
|
| Rate for Payer: Humana of AZ Medicare |
$26.40
|
| Rate for Payer: Self Pay Self Pay |
$132.00
|
| Rate for Payer: TriWest Medicare |
$26.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$96.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$29.70
|
|
|
CLIENT INFLUENZA A SCREEN (RAPID)
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
22331329
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.80 |
| 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: Allwell Medicare |
$20.80
|
| Rate for Payer: Amerigroup Medicare |
$20.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$48.55
|
| Rate for Payer: AZCH Complete Medicare |
$20.80
|
| Rate for Payer: Banner UC Health Medicare |
$20.80
|
| 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: Cigna of AZ Commercial |
$84.50
|
| Rate for Payer: Copperpoint Commercial |
$32.17
|
| 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 |
$20.80
|
| Rate for Payer: Self Pay Self Pay |
$104.00
|
| Rate for Payer: TriWest Medicare |
$20.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$75.79
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$23.40
|
|
|
CLIENT INFLUENZA A SCREEN (RAPID)
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
22331329
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
CLIENT .IRON BINDING CAPACITY
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
22331086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.24 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Aetna of AZ Commercial |
$305.10
|
| Rate for Payer: Aetna of AZ Medicare |
$94.92
|
| Rate for Payer: Allwell Medicare |
$54.24
|
| Rate for Payer: Amerigroup Medicare |
$54.24
|
| Rate for Payer: APIPA Medicare/Medicaid |
$126.62
|
| Rate for Payer: AZCH Complete Medicare |
$54.24
|
| Rate for Payer: Banner UC Health Medicare |
$54.24
|
| Rate for Payer: Bisbee Police All Plans |
$88.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$230.52
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna of AZ Commercial |
$220.35
|
| Rate for Payer: Copperpoint Commercial |
$83.90
|
| Rate for Payer: Health Net of AZ Commercial |
$203.40
|
| Rate for Payer: Health Net of AZ Medicare |
$94.92
|
| Rate for Payer: Humana of AZ Medicare |
$54.24
|
| Rate for Payer: Self Pay Self Pay |
$271.20
|
| Rate for Payer: TriWest Medicare |
$54.24
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$197.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$61.02
|
|
|
CLIENT .IRON BINDING CAPACITY
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
22331086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.14 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Aetna of AZ Commercial |
$305.10
|
| Rate for Payer: Bisbee Police All Plans |
$88.14
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Self Pay Self Pay |
$271.20
|
|
|
CLIENT IV-LACTATED RINGERS : 1000 ML
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
22331338
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of AZ Commercial |
$27.00
|
| Rate for Payer: Aetna of AZ Medicare |
$8.40
|
| Rate for Payer: Allwell Medicare |
$4.80
|
| Rate for Payer: Amerigroup Medicare |
$4.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$11.21
|
| Rate for Payer: AZCH Complete Medicare |
$4.80
|
| Rate for Payer: Banner UC Health Medicare |
$4.80
|
| Rate for Payer: Bisbee Police All Plans |
$7.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$20.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna of AZ Commercial |
$19.50
|
| Rate for Payer: Copperpoint Commercial |
$7.42
|
| Rate for Payer: Health Net of AZ Commercial |
$18.00
|
| Rate for Payer: Health Net of AZ Medicare |
$8.40
|
| Rate for Payer: Humana of AZ Medicare |
$4.80
|
| Rate for Payer: Self Pay Self Pay |
$24.00
|
| Rate for Payer: TriWest Medicare |
$4.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$17.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.40
|
|
|
CLIENT IV-LACTATED RINGERS : 1000 ML
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
22331338
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of AZ Commercial |
$27.00
|
| Rate for Payer: Bisbee Police All Plans |
$7.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Self Pay Self Pay |
$24.00
|
|
|
CLIENT KNEE LIMITED RT
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
22331345
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$484.20 |
| Rate for Payer: Aetna of AZ Commercial |
$484.20
|
| Rate for Payer: Bisbee Police All Plans |
$139.88
|
| Rate for Payer: Cash Price |
$430.40
|
| Rate for Payer: Self Pay Self Pay |
$430.40
|
|
|
CLIENT KNEE LIMITED RT
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
22331345
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.08 |
| Max. Negotiated Rate |
$484.20 |
| Rate for Payer: Aetna of AZ Commercial |
$484.20
|
| Rate for Payer: Aetna of AZ Medicare |
$150.64
|
| Rate for Payer: Allwell Medicare |
$86.08
|
| Rate for Payer: Amerigroup Medicare |
$86.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$200.94
|
| Rate for Payer: AZCH Complete Medicare |
$86.08
|
| Rate for Payer: Banner UC Health Medicare |
$86.08
|
| Rate for Payer: Bisbee Police All Plans |
$139.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$365.84
|
| Rate for Payer: Cash Price |
$430.40
|
| Rate for Payer: Cigna of AZ Commercial |
$349.70
|
| Rate for Payer: Copperpoint Commercial |
$133.16
|
| Rate for Payer: Health Net of AZ Commercial |
$322.80
|
| Rate for Payer: Health Net of AZ Medicare |
$150.64
|
| Rate for Payer: Humana of AZ Medicare |
$86.08
|
| Rate for Payer: Self Pay Self Pay |
$430.40
|
| Rate for Payer: TriWest Medicare |
$86.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$313.65
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$96.84
|
|
