|
CLIENT TDAP
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
22331519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of AZ Commercial |
$64.80
|
| Rate for Payer: Bisbee Police All Plans |
$18.72
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Self Pay Self Pay |
$57.60
|
|
|
CLIENT TDAP
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
22331519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of AZ Commercial |
$64.80
|
| Rate for Payer: Aetna of AZ Medicare |
$20.16
|
| Rate for Payer: Allwell Medicare |
$10.80
|
| Rate for Payer: Amerigroup Medicare |
$10.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$26.89
|
| Rate for Payer: AZCH Complete Medicare |
$10.80
|
| Rate for Payer: Banner UC Health Medicare |
$10.80
|
| Rate for Payer: Bisbee Police All Plans |
$18.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$48.96
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of AZ Commercial |
$50.40
|
| Rate for Payer: Copperpoint Commercial |
$17.82
|
| Rate for Payer: Health Net of AZ Commercial |
$43.20
|
| Rate for Payer: Health Net of AZ Medicare |
$20.16
|
| Rate for Payer: Humana of AZ Medicare |
$10.80
|
| Rate for Payer: Self Pay Self Pay |
$57.60
|
| Rate for Payer: TriWest Medicare |
$10.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$41.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.96
|
|
|
CLIENT TRAUMA LEVEL 4
|
Facility
|
OP
|
$494.00
|
|
| Hospital Charge Code |
22331530
|
|
Hospital Revenue Code
|
684
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna of AZ Commercial |
$444.60
|
| Rate for Payer: Aetna of AZ Medicare |
$138.32
|
| Rate for Payer: Allwell Medicare |
$74.10
|
| Rate for Payer: Amerigroup Medicare |
$74.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$184.51
|
| Rate for Payer: AZCH Complete Medicare |
$74.10
|
| Rate for Payer: Banner UC Health Medicare |
$74.10
|
| Rate for Payer: Bisbee Police All Plans |
$128.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$335.92
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Cigna of AZ Commercial |
$345.80
|
| Rate for Payer: Copperpoint Commercial |
$122.26
|
| Rate for Payer: Health Net of AZ Commercial |
$296.40
|
| Rate for Payer: Health Net of AZ Medicare |
$138.32
|
| Rate for Payer: Humana of AZ Medicare |
$74.10
|
| Rate for Payer: Self Pay Self Pay |
$395.20
|
| Rate for Payer: TriWest Medicare |
$74.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$288.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$88.92
|
|
|
CLIENT TRAUMA LEVEL 4
|
Facility
|
IP
|
$494.00
|
|
| Hospital Charge Code |
22331530
|
|
Hospital Revenue Code
|
684
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna of AZ Commercial |
$444.60
|
| Rate for Payer: Bisbee Police All Plans |
$128.44
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Self Pay Self Pay |
$395.20
|
|
|
CLIENT URINALYSIS (W/ MICRO)
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
22331539
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of AZ Commercial |
$68.40
|
| Rate for Payer: Bisbee Police All Plans |
$19.76
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Self Pay Self Pay |
$60.80
|
|
|
CLIENT URINALYSIS (W/ MICRO)
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
22331539
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of AZ Commercial |
$68.40
|
| Rate for Payer: Aetna of AZ Medicare |
$21.28
|
| Rate for Payer: AHCCCS Medicaid |
$3.17
|
| Rate for Payer: Allwell Medicaid |
$3.17
|
| Rate for Payer: Allwell Medicare |
$11.40
|
| Rate for Payer: Amerigroup Medicare |
$11.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$28.39
|
| Rate for Payer: AZCH Complete Medicaid |
$3.17
|
| Rate for Payer: AZCH Complete Medicare |
$11.40
|
| Rate for Payer: Banner UC Health Medicaid |
$3.17
|
| Rate for Payer: Banner UC Health Medicare |
$11.40
|
| Rate for Payer: Bisbee Police All Plans |
$19.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$51.68
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cigna of AZ Commercial |
$49.40
|
| Rate for Payer: Copperpoint Commercial |
$18.81
|
| Rate for Payer: Health Net of AZ Commercial |
$45.60
|
| Rate for Payer: Health Net of AZ Medicare |
$21.28
|
| Rate for Payer: Humana of AZ Medicare |
$11.40
|
| Rate for Payer: Mercy Care Medicaid |
$3.17
|
| Rate for Payer: Self Pay Self Pay |
$60.80
|
| Rate for Payer: TriWest Medicare |
$11.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$44.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.68
|
|
|
CLIENT URINE COLLECTION (LC/SQ)
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
22331541
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of AZ Commercial |
$18.90
|
| Rate for Payer: Aetna of AZ Medicare |
$5.88
|
| Rate for Payer: Allwell Medicare |
$3.15
|
| Rate for Payer: Amerigroup Medicare |
$3.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$7.84
|
| Rate for Payer: AZCH Complete Medicare |
$3.15
|
| Rate for Payer: Banner UC Health Medicare |
$3.15
|
| Rate for Payer: Bisbee Police All Plans |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna of AZ Commercial |
$13.65
|
| Rate for Payer: Copperpoint Commercial |
$5.20
|
| Rate for Payer: Health Net of AZ Commercial |
$12.60
|
| Rate for Payer: Health Net of AZ Medicare |
$5.88
|
| Rate for Payer: Humana of AZ Medicare |
$3.15
|
| Rate for Payer: Self Pay Self Pay |
$16.80
|
| Rate for Payer: TriWest Medicare |
$3.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$12.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.78
|
|
|
CLIENT URINE COLLECTION (LC/SQ)
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
22331541
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of AZ Commercial |
$18.90
|
| Rate for Payer: Bisbee Police All Plans |
$5.46
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Self Pay Self Pay |
$16.80
|
|
|
CLIENT US ECHOGR Transrectal
|
Facility
|
IP
|
$617.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
22577967
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$160.42 |
| Max. Negotiated Rate |
$555.30 |
| Rate for Payer: Aetna of AZ Commercial |
$555.30
|
| Rate for Payer: Bisbee Police All Plans |
$160.42
|
| Rate for Payer: Cash Price |
$493.60
|
| Rate for Payer: Self Pay Self Pay |
$493.60
|
|
|
CLIENT US ECHOGR Transrectal
|
Facility
|
OP
|
$617.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
22577967
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$555.30 |
| Rate for Payer: Aetna of AZ Commercial |
$555.30
|
| Rate for Payer: Aetna of AZ Medicare |
$172.76
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$92.55
|
| Rate for Payer: Amerigroup Medicare |
$92.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$230.45
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$92.55
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$92.55
|
| Rate for Payer: Bisbee Police All Plans |
$160.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$419.56
|
| Rate for Payer: Cash Price |
$493.60
|
| Rate for Payer: Cash Price |
$493.60
|
| Rate for Payer: Cigna of AZ Commercial |
$431.90
|
| Rate for Payer: Copperpoint Commercial |
$152.71
|
| Rate for Payer: Health Net of AZ Commercial |
$370.20
|
| Rate for Payer: Health Net of AZ Medicare |
$172.76
|
| Rate for Payer: Humana of AZ Medicare |
$92.55
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$493.60
|
| Rate for Payer: TriWest Medicare |
$92.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$359.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$111.06
|
|
|
CLIENT VISION SCREEN
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
22331566
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of AZ Commercial |
$14.40
|
| Rate for Payer: Aetna of AZ Medicare |
$4.48
|
| Rate for Payer: Allwell Medicare |
$2.40
|
| Rate for Payer: Amerigroup Medicare |
$2.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$5.98
|
| Rate for Payer: AZCH Complete Medicare |
$2.40
|
| Rate for Payer: Banner UC Health Medicare |
$2.40
|
| Rate for Payer: Bisbee Police All Plans |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$10.88
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cigna of AZ Commercial |
$10.40
|
| Rate for Payer: Copperpoint Commercial |
$3.96
|
| Rate for Payer: Health Net of AZ Commercial |
$9.60
|
| Rate for Payer: Health Net of AZ Medicare |
$4.48
|
| Rate for Payer: Humana of AZ Medicare |
$2.40
|
| Rate for Payer: Self Pay Self Pay |
$12.80
|
| Rate for Payer: TriWest Medicare |
$2.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$9.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.88
|
|
|
CLIENT VISION SCREEN
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
22331566
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of AZ Commercial |
$14.40
|
| Rate for Payer: Bisbee Police All Plans |
$4.16
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Self Pay Self Pay |
$12.80
|
|
|
clindamycin 150 mg Cap [CQCH]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 63739005910
|
| Hospital Charge Code |
105916738
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of AZ Commercial |
$0.50
|
| Rate for Payer: Aetna of AZ Medicare |
$0.16
|
| Rate for Payer: Allwell Medicare |
$0.08
|
| Rate for Payer: Amerigroup Medicare |
$0.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.21
|
| Rate for Payer: AZCH Complete Medicare |
$0.08
|
| Rate for Payer: Banner UC Health Medicare |
$0.08
|
| Rate for Payer: Bisbee Police All Plans |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of AZ Commercial |
$0.36
|
| Rate for Payer: Copperpoint Commercial |
$0.14
|
| Rate for Payer: Health Net of AZ Commercial |
$0.34
|
| Rate for Payer: Health Net of AZ Medicare |
$0.16
|
| Rate for Payer: Humana of AZ Medicare |
$0.08
|
| Rate for Payer: Self Pay Self Pay |
$0.45
|
| Rate for Payer: TriWest Medicare |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.10
|
|
|
clindamycin 150 mg Cap [CQCH]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 63739005910
|
| Hospital Charge Code |
105916738
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of AZ Commercial |
$0.50
|
| Rate for Payer: Bisbee Police All Plans |
$0.15
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Self Pay Self Pay |
$0.45
|
|
|
clindamycin 150 mg/mL 2 mL Inj [CQCH]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
NDC 9030225
|
| Hospital Charge Code |
105916669
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna of AZ Commercial |
$0.71
|
| Rate for Payer: Aetna of AZ Medicare |
$0.22
|
| Rate for Payer: Allwell Medicare |
$0.12
|
| Rate for Payer: Amerigroup Medicare |
$0.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.30
|
| Rate for Payer: AZCH Complete Medicare |
$0.12
|
| Rate for Payer: Banner UC Health Medicare |
$0.12
|
| Rate for Payer: Bisbee Police All Plans |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of AZ Commercial |
$0.51
|
| Rate for Payer: Copperpoint Commercial |
$0.20
|
| Rate for Payer: Health Net of AZ Commercial |
$0.47
|
| Rate for Payer: Health Net of AZ Medicare |
$0.22
|
| Rate for Payer: Humana of AZ Medicare |
$0.12
|
| Rate for Payer: Self Pay Self Pay |
$0.63
|
| Rate for Payer: TriWest Medicare |
$0.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.46
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.14
|
|
|
clindamycin 150 mg/mL 2 mL Inj [CQCH]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
NDC 9030225
|
| Hospital Charge Code |
105916669
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna of AZ Commercial |
$0.71
|
| Rate for Payer: Bisbee Police All Plans |
$0.21
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Self Pay Self Pay |
$0.63
|
|
|
clindamycin 600 mg/50 mL D5W Soln[CQCH]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 338361224
|
| Hospital Charge Code |
121230525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of AZ Commercial |
$0.07
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
|
|
clindamycin 600 mg/50 mL D5W Soln[CQCH]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 338361224
|
| Hospital Charge Code |
121230525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of AZ Commercial |
$0.07
|
| Rate for Payer: Aetna of AZ Medicare |
$0.02
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.03
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of AZ Commercial |
$0.05
|
| Rate for Payer: Copperpoint Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Commercial |
$0.05
|
| Rate for Payer: Health Net of AZ Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
clindamycin 900 mg/50 mL D5W Sol[CQCH]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 338381424
|
| Hospital Charge Code |
125349014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of AZ Commercial |
$0.10
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Self Pay Self Pay |
$0.09
|
|
|
clindamycin 900 mg/50 mL D5W Sol[CQCH]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 338381424
|
| Hospital Charge Code |
125349014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of AZ Commercial |
$0.10
|
| Rate for Payer: Aetna of AZ Medicare |
$0.03
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.04
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of AZ Commercial |
$0.07
|
| Rate for Payer: Copperpoint Commercial |
$0.03
|
| Rate for Payer: Health Net of AZ Commercial |
$0.07
|
| Rate for Payer: Health Net of AZ Medicare |
$0.03
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.09
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
|
CLIP APPLIER MULTIPLE ENDOSCOPIC
|
Facility
|
IP
|
$734.00
|
|
| Hospital Charge Code |
22354781
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$660.60 |
| Rate for Payer: Aetna of AZ Commercial |
$660.60
|
| Rate for Payer: Bisbee Police All Plans |
$190.84
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Self Pay Self Pay |
$587.20
|
|
|
CLIP APPLIER MULTIPLE ENDOSCOPIC
|
Facility
|
OP
|
$734.00
|
|
| Hospital Charge Code |
22354781
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.10 |
| Max. Negotiated Rate |
$660.60 |
| Rate for Payer: Aetna of AZ Commercial |
$660.60
|
| Rate for Payer: Aetna of AZ Medicare |
$205.52
|
| Rate for Payer: Allwell Medicare |
$110.10
|
| Rate for Payer: Amerigroup Medicare |
$110.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$274.15
|
| Rate for Payer: AZCH Complete Medicare |
$110.10
|
| Rate for Payer: Banner UC Health Medicare |
$110.10
|
| Rate for Payer: Bisbee Police All Plans |
$190.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$499.12
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cigna of AZ Commercial |
$513.80
|
| Rate for Payer: Copperpoint Commercial |
$181.66
|
| Rate for Payer: Health Net of AZ Commercial |
$440.40
|
| Rate for Payer: Health Net of AZ Medicare |
$205.52
|
| Rate for Payer: Humana of AZ Medicare |
$110.10
|
| Rate for Payer: Self Pay Self Pay |
$587.20
|
| Rate for Payer: TriWest Medicare |
$110.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$427.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$132.12
|
|
|
CLIP HEMO LARGE
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
22926416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna of AZ Commercial |
$20.70
|
| Rate for Payer: Aetna of AZ Medicare |
$6.44
|
| Rate for Payer: Allwell Medicare |
$3.45
|
| Rate for Payer: Amerigroup Medicare |
$3.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$8.59
|
| Rate for Payer: AZCH Complete Medicare |
$3.45
|
| Rate for Payer: Banner UC Health Medicare |
$3.45
|
| Rate for Payer: Bisbee Police All Plans |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$15.64
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cigna of AZ Commercial |
$16.10
|
| Rate for Payer: Copperpoint Commercial |
$5.69
|
| Rate for Payer: Health Net of AZ Commercial |
$13.80
|
| Rate for Payer: Health Net of AZ Medicare |
$6.44
|
| Rate for Payer: Humana of AZ Medicare |
$3.45
|
| Rate for Payer: Self Pay Self Pay |
$18.40
|
| Rate for Payer: TriWest Medicare |
$3.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$13.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.14
|
|
|
CLIP HEMO LARGE
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
22926416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna of AZ Commercial |
$20.70
|
| Rate for Payer: Bisbee Police All Plans |
$5.98
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Self Pay Self Pay |
$18.40
|
|
|
CLL FISH Panel LC
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2029268
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna of AZ Commercial |
$184.50
|
| Rate for Payer: Bisbee Police All Plans |
$53.30
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Self Pay Self Pay |
$164.00
|
|
