|
CLIENT MMR VACCINE
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
22331364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of AZ Commercial |
$62.10
|
| Rate for Payer: Aetna of AZ Medicare |
$19.32
|
| Rate for Payer: Allwell Medicare |
$11.04
|
| Rate for Payer: Amerigroup Medicare |
$11.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$25.77
|
| Rate for Payer: AZCH Complete Medicare |
$11.04
|
| Rate for Payer: Banner UC Health Medicare |
$11.04
|
| Rate for Payer: Bisbee Police All Plans |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$46.92
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna of AZ Commercial |
$48.30
|
| Rate for Payer: Copperpoint Commercial |
$17.08
|
| Rate for Payer: Health Net of AZ Commercial |
$41.40
|
| Rate for Payer: Health Net of AZ Medicare |
$19.32
|
| Rate for Payer: Humana of AZ Medicare |
$11.04
|
| Rate for Payer: Self Pay Self Pay |
$55.20
|
| Rate for Payer: TriWest Medicare |
$11.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$40.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.42
|
|
|
CLIENT MMR VACCINE
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
22331364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of AZ Commercial |
$62.10
|
| Rate for Payer: Bisbee Police All Plans |
$17.94
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Self Pay Self Pay |
$55.20
|
|
|
CLIENT NON DOT CDC UDS COLLECTION
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
22331418
|
|
Hospital Revenue Code
|
301
|
| 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 NON DOT CDC UDS COLLECTION
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
22331418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.36 |
| 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 |
$3.36
|
| Rate for Payer: Amerigroup Medicare |
$3.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$7.84
|
| Rate for Payer: AZCH Complete Medicare |
$3.36
|
| Rate for Payer: Banner UC Health Medicare |
$3.36
|
| 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 |
$3.36
|
| Rate for Payer: Self Pay Self Pay |
$16.80
|
| Rate for Payer: TriWest Medicare |
$3.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$12.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.78
|
|
|
CLIENT PFT PRE/POST
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
22331441
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of AZ Commercial |
$97.20
|
| Rate for Payer: Bisbee Police All Plans |
$28.08
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Self Pay Self Pay |
$86.40
|
|
|
CLIENT PFT PRE/POST
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
22331441
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$191.73 |
| Rate for Payer: Aetna of AZ Commercial |
$97.20
|
| Rate for Payer: Aetna of AZ Medicare |
$30.24
|
| Rate for Payer: AHCCCS Medicaid |
$191.73
|
| Rate for Payer: Allwell Medicaid |
$191.73
|
| Rate for Payer: Allwell Medicare |
$17.28
|
| Rate for Payer: Amerigroup Medicare |
$17.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$40.34
|
| Rate for Payer: AZCH Complete Medicaid |
$191.73
|
| Rate for Payer: AZCH Complete Medicare |
$17.28
|
| Rate for Payer: Banner UC Health Medicaid |
$191.73
|
| Rate for Payer: Banner UC Health Medicare |
$17.28
|
| Rate for Payer: Bisbee Police All Plans |
$28.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$73.44
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of AZ Commercial |
$75.60
|
| Rate for Payer: Copperpoint Commercial |
$26.73
|
| Rate for Payer: Health Net of AZ Commercial |
$64.80
|
| Rate for Payer: Health Net of AZ Medicare |
$30.24
|
| Rate for Payer: Humana of AZ Medicare |
$17.28
|
| Rate for Payer: Mercy Care Medicaid |
$191.73
|
| Rate for Payer: Self Pay Self Pay |
$86.40
|
| Rate for Payer: TriWest Medicare |
$17.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$62.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.44
|
|
|
CLIENT PHYSICAN EXAM FEMALE OVER 39
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
22331443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of AZ Commercial |
$112.50
|
| Rate for Payer: Aetna of AZ Medicare |
$35.00
|
| Rate for Payer: Allwell Medicare |
$20.00
|
| Rate for Payer: Amerigroup Medicare |
$20.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$46.69
|
| Rate for Payer: AZCH Complete Medicare |
$20.00
|
| Rate for Payer: Banner UC Health Medicare |
$20.00
|
| Rate for Payer: Bisbee Police All Plans |
$32.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$85.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of AZ Commercial |
$81.25
|
| Rate for Payer: Copperpoint Commercial |
$30.94
|
| Rate for Payer: Health Net of AZ Commercial |
$75.00
|
| Rate for Payer: Health Net of AZ Medicare |
$35.00
|
| Rate for Payer: Humana of AZ Medicare |
$20.00
|
| Rate for Payer: Self Pay Self Pay |
$100.00
|
| Rate for Payer: TriWest Medicare |
$20.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$72.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$22.50
|
|
|
CLIENT PHYSICAN EXAM FEMALE OVER 39
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
22331443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of AZ Commercial |
$112.50
|
| Rate for Payer: Bisbee Police All Plans |
$32.50
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Self Pay Self Pay |
$100.00
|
|
|
CLIENT PHYSICAN EXAM FEMALE UNDER 39
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
22331444
|
|
Hospital Revenue Code
|
301
|
| 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 PHYSICAN EXAM FEMALE UNDER 39
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
22331444
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.52 |
| 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 |
$11.52
|
| Rate for Payer: Amerigroup Medicare |
$11.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$26.89
|
| Rate for Payer: AZCH Complete Medicare |
$11.52
|
| Rate for Payer: Banner UC Health Medicare |
$11.52
|
| 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 |
$46.80
|
| 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 |
$11.52
|
| Rate for Payer: Self Pay Self Pay |
$57.60
|
| Rate for Payer: TriWest Medicare |
$11.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$41.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.96
|
|
|
CLIENT PHYSICAN EXAM MALE OVER 39
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
22331445
|
|
Hospital Revenue Code
|
301
|
| 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 |
$68.25
|
| 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
|
|
|
CLIENT PHYSICAN EXAM MALE OVER 39
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
22331445
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
CLIENT PHYSICAN EXAM MALE UNDER 39
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
22331451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of AZ Commercial |
$63.00
|
| Rate for Payer: Aetna of AZ Medicare |
$19.60
|
| Rate for Payer: Allwell Medicare |
$11.20
|
| Rate for Payer: Amerigroup Medicare |
$11.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$26.14
|
| Rate for Payer: AZCH Complete Medicare |
$11.20
|
| Rate for Payer: Banner UC Health Medicare |
$11.20
|
| Rate for Payer: Bisbee Police All Plans |
$18.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$47.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna of AZ Commercial |
$45.50
|
| Rate for Payer: Copperpoint Commercial |
$17.32
|
| Rate for Payer: Health Net of AZ Commercial |
$42.00
|
| Rate for Payer: Health Net of AZ Medicare |
$19.60
|
| Rate for Payer: Humana of AZ Medicare |
$11.20
|
| Rate for Payer: Self Pay Self Pay |
$56.00
|
| Rate for Payer: TriWest Medicare |
$11.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$40.81
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.60
|
|
|
CLIENT PHYSICAN EXAM MALE UNDER 39
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
22331451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of AZ Commercial |
$63.00
|
| Rate for Payer: Bisbee Police All Plans |
$18.20
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Self Pay Self Pay |
$56.00
|
|
|
CLIENT RABIES VACCINE INJ (IM)
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
22331466
|
|
Hospital Revenue Code
|
252
|
| Min. Negotiated Rate |
$77.44 |
| Max. Negotiated Rate |
$435.60 |
| Rate for Payer: Aetna of AZ Commercial |
$435.60
|
| Rate for Payer: Aetna of AZ Medicare |
$135.52
|
| Rate for Payer: Allwell Medicare |
$77.44
|
| Rate for Payer: Amerigroup Medicare |
$77.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$180.77
|
| Rate for Payer: AZCH Complete Medicare |
$77.44
|
| Rate for Payer: Banner UC Health Medicare |
$77.44
|
| Rate for Payer: Bisbee Police All Plans |
$125.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$329.12
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cigna of AZ Commercial |
$314.60
|
| Rate for Payer: Copperpoint Commercial |
$119.79
|
| Rate for Payer: Health Net of AZ Commercial |
$290.40
|
| Rate for Payer: Health Net of AZ Medicare |
$135.52
|
| Rate for Payer: Humana of AZ Medicare |
$77.44
|
| Rate for Payer: Self Pay Self Pay |
$387.20
|
| Rate for Payer: TriWest Medicare |
$77.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$282.17
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$87.12
|
|
|
CLIENT RABIES VACCINE INJ (IM)
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
22331466
|
|
Hospital Revenue Code
|
252
|
| Min. Negotiated Rate |
$125.84 |
| Max. Negotiated Rate |
$435.60 |
| Rate for Payer: Aetna of AZ Commercial |
$435.60
|
| Rate for Payer: Bisbee Police All Plans |
$125.84
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Self Pay Self Pay |
$387.20
|
|
|
CLIENT RESPIRATOR FIT TEST
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
22331471
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.36 |
| 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 |
$3.36
|
| Rate for Payer: Amerigroup Medicare |
$3.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$7.84
|
| Rate for Payer: AZCH Complete Medicare |
$3.36
|
| Rate for Payer: Banner UC Health Medicare |
$3.36
|
| 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 |
$3.36
|
| Rate for Payer: Self Pay Self Pay |
$16.80
|
| Rate for Payer: TriWest Medicare |
$3.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$12.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.78
|
|
|
CLIENT RESPIRATOR FIT TEST
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
22331471
|
|
Hospital Revenue Code
|
301
|
| 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 RESPITATOR QUESTIONNAIRE REVIEW
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
22331472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of AZ Commercial |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$5.20
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Self Pay Self Pay |
$16.00
|
|
|
CLIENT RESPITATOR QUESTIONNAIRE REVIEW
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
22331472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of AZ Commercial |
$18.00
|
| Rate for Payer: Aetna of AZ Medicare |
$5.60
|
| Rate for Payer: Allwell Medicare |
$3.20
|
| Rate for Payer: Amerigroup Medicare |
$3.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$7.47
|
| Rate for Payer: AZCH Complete Medicare |
$3.20
|
| Rate for Payer: Banner UC Health Medicare |
$3.20
|
| Rate for Payer: Bisbee Police All Plans |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$13.60
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna of AZ Commercial |
$13.00
|
| Rate for Payer: Copperpoint Commercial |
$4.95
|
| Rate for Payer: Health Net of AZ Commercial |
$12.00
|
| Rate for Payer: Health Net of AZ Medicare |
$5.60
|
| Rate for Payer: Humana of AZ Medicare |
$3.20
|
| Rate for Payer: Self Pay Self Pay |
$16.00
|
| Rate for Payer: TriWest Medicare |
$3.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$11.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.60
|
|
|
CLIENT SLING ARM LARGE
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
22331497
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of AZ Commercial |
$22.50
|
| Rate for Payer: Bisbee Police All Plans |
$6.50
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Self Pay Self Pay |
$20.00
|
|
|
CLIENT SLING ARM LARGE
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
22331497
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna of AZ Commercial |
$22.50
|
| Rate for Payer: Aetna of AZ Medicare |
$7.00
|
| Rate for Payer: Allwell Medicare |
$4.00
|
| Rate for Payer: Amerigroup Medicare |
$4.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$9.34
|
| Rate for Payer: AZCH Complete Medicare |
$4.00
|
| Rate for Payer: Banner UC Health Medicare |
$4.00
|
| Rate for Payer: Bisbee Police All Plans |
$6.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of AZ Commercial |
$17.50
|
| Rate for Payer: Copperpoint Commercial |
$6.19
|
| Rate for Payer: Health Net of AZ Commercial |
$15.00
|
| Rate for Payer: Health Net of AZ Medicare |
$7.00
|
| Rate for Payer: Humana of AZ Medicare |
$4.00
|
| Rate for Payer: Self Pay Self Pay |
$20.00
|
| Rate for Payer: TriWest Medicare |
$4.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$14.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.50
|
|
|
CLIENT TB SKIN TEST (0.1 ML)
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
22331518
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of AZ Commercial |
$32.40
|
| Rate for Payer: Bisbee Police All Plans |
$9.36
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Self Pay Self Pay |
$28.80
|
|
|
CLIENT TB SKIN TEST (0.1 ML)
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
22331518
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of AZ Commercial |
$32.40
|
| Rate for Payer: Aetna of AZ Medicare |
$10.08
|
| Rate for Payer: Allwell Medicare |
$5.76
|
| Rate for Payer: Amerigroup Medicare |
$5.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$13.45
|
| Rate for Payer: AZCH Complete Medicare |
$5.76
|
| Rate for Payer: Banner UC Health Medicare |
$5.76
|
| Rate for Payer: Bisbee Police All Plans |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$24.48
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of AZ Commercial |
$23.40
|
| Rate for Payer: Copperpoint Commercial |
$8.91
|
| Rate for Payer: Health Net of AZ Commercial |
$21.60
|
| Rate for Payer: Health Net of AZ Medicare |
$10.08
|
| Rate for Payer: Humana of AZ Medicare |
$5.76
|
| Rate for Payer: Self Pay Self Pay |
$28.80
|
| Rate for Payer: TriWest Medicare |
$5.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$20.99
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.48
|
|
|
CLIENT TDAP
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
22331519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.52 |
| 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 |
$11.52
|
| Rate for Payer: Amerigroup Medicare |
$11.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$26.89
|
| Rate for Payer: AZCH Complete Medicare |
$11.52
|
| Rate for Payer: Banner UC Health Medicare |
$11.52
|
| 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 |
$11.52
|
| Rate for Payer: Self Pay Self Pay |
$57.60
|
| Rate for Payer: TriWest Medicare |
$11.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$41.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.96
|
|
