|
COLLAR STIFF NECK PED
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
22354178
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of AZ Commercial |
$53.10
|
| Rate for Payer: Aetna of AZ Medicare |
$16.52
|
| Rate for Payer: AHCCCS Medicaid |
$51.38
|
| Rate for Payer: Allwell Medicaid |
$51.38
|
| Rate for Payer: Allwell Medicare |
$8.85
|
| Rate for Payer: Amerigroup Medicare |
$8.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$22.04
|
| Rate for Payer: AZCH Complete Medicaid |
$51.38
|
| Rate for Payer: AZCH Complete Medicare |
$8.85
|
| Rate for Payer: Banner UC Health Medicaid |
$51.38
|
| Rate for Payer: Banner UC Health Medicare |
$8.85
|
| Rate for Payer: Bisbee Police All Plans |
$15.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$40.12
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cigna of AZ Commercial |
$41.30
|
| Rate for Payer: Copperpoint Commercial |
$14.60
|
| Rate for Payer: Health Net of AZ Commercial |
$35.40
|
| Rate for Payer: Health Net of AZ Medicare |
$16.52
|
| Rate for Payer: Humana of AZ Medicare |
$8.85
|
| Rate for Payer: Mercy Care Medicaid |
$51.38
|
| Rate for Payer: Self Pay Self Pay |
$47.20
|
| Rate for Payer: TriWest Medicare |
$8.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$34.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.62
|
|
|
COLLAR STIFF NECK REGULAR
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
22354179
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.55 |
| 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: AHCCCS Medicaid |
$51.38
|
| Rate for Payer: Allwell Medicaid |
$51.38
|
| Rate for Payer: Allwell Medicare |
$14.55
|
| Rate for Payer: Amerigroup Medicare |
$14.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$36.23
|
| Rate for Payer: AZCH Complete Medicaid |
$51.38
|
| Rate for Payer: AZCH Complete Medicare |
$14.55
|
| Rate for Payer: Banner UC Health Medicaid |
$51.38
|
| Rate for Payer: Banner UC Health Medicare |
$14.55
|
| 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: Cash Price |
$77.60
|
| Rate for Payer: Cigna of AZ Commercial |
$67.90
|
| 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 |
$14.55
|
| Rate for Payer: Mercy Care Medicaid |
$51.38
|
| Rate for Payer: Self Pay Self Pay |
$77.60
|
| Rate for Payer: TriWest Medicare |
$14.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$56.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$17.46
|
|
|
COLLAR STIFF NECK REGULAR
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
22354179
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
COLLAR STIFF NECK SHORT
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
22354180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of AZ Commercial |
$53.10
|
| Rate for Payer: Aetna of AZ Medicare |
$16.52
|
| Rate for Payer: AHCCCS Medicaid |
$51.38
|
| Rate for Payer: Allwell Medicaid |
$51.38
|
| Rate for Payer: Allwell Medicare |
$8.85
|
| Rate for Payer: Amerigroup Medicare |
$8.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$22.04
|
| Rate for Payer: AZCH Complete Medicaid |
$51.38
|
| Rate for Payer: AZCH Complete Medicare |
$8.85
|
| Rate for Payer: Banner UC Health Medicaid |
$51.38
|
| Rate for Payer: Banner UC Health Medicare |
$8.85
|
| Rate for Payer: Bisbee Police All Plans |
$15.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$40.12
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cigna of AZ Commercial |
$41.30
|
| Rate for Payer: Copperpoint Commercial |
$14.60
|
| Rate for Payer: Health Net of AZ Commercial |
$35.40
|
| Rate for Payer: Health Net of AZ Medicare |
$16.52
|
| Rate for Payer: Humana of AZ Medicare |
$8.85
|
| Rate for Payer: Mercy Care Medicaid |
$51.38
|
| Rate for Payer: Self Pay Self Pay |
$47.20
|
| Rate for Payer: TriWest Medicare |
$8.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$34.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.62
|
|
|
COLLAR STIFF NECK SHORT
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
22354180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of AZ Commercial |
$53.10
|
| Rate for Payer: Bisbee Police All Plans |
$15.34
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Self Pay Self Pay |
$47.20
|
|
|
COLLAR STIFF NECK TALL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
22354181
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Aetna of AZ Commercial |
$50.40
|
| Rate for Payer: Aetna of AZ Medicare |
$15.68
|
| Rate for Payer: AHCCCS Medicaid |
$51.38
|
| Rate for Payer: Allwell Medicaid |
$51.38
|
| Rate for Payer: Allwell Medicare |
$8.40
|
| Rate for Payer: Amerigroup Medicare |
$8.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$20.92
|
| Rate for Payer: AZCH Complete Medicaid |
$51.38
|
| Rate for Payer: AZCH Complete Medicare |
$8.40
|
| Rate for Payer: Banner UC Health Medicaid |
$51.38
|
| Rate for Payer: Banner UC Health Medicare |
$8.40
|
| Rate for Payer: Bisbee Police All Plans |
$14.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$38.08
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cigna of AZ Commercial |
$39.20
|
| Rate for Payer: Copperpoint Commercial |
$13.86
|
| Rate for Payer: Health Net of AZ Commercial |
$33.60
|
| Rate for Payer: Health Net of AZ Medicare |
$15.68
|
| Rate for Payer: Humana of AZ Medicare |
$8.40
|
| Rate for Payer: Mercy Care Medicaid |
$51.38
|
| Rate for Payer: Self Pay Self Pay |
$44.80
|
| Rate for Payer: TriWest Medicare |
$8.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$32.65
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.08
|
|
|
COLLAR STIFF NECK TALL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
22354181
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of AZ Commercial |
$50.40
|
| Rate for Payer: Bisbee Police All Plans |
$14.56
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Self Pay Self Pay |
$44.80
|
|
|
COLLECTION: Capillary
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
796177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna of AZ Commercial |
$35.10
|
| Rate for Payer: Bisbee Police All Plans |
$10.14
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Self Pay Self Pay |
$31.20
|
|
|
COLLECTION: Capillary
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
796177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna of AZ Commercial |
$35.10
|
| Rate for Payer: Aetna of AZ Medicare |
$10.92
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$5.85
|
| Rate for Payer: Amerigroup Medicare |
$5.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$14.57
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$5.85
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$5.85
|
| Rate for Payer: Bisbee Police All Plans |
$10.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$26.52
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna of AZ Commercial |
$25.35
|
| Rate for Payer: Copperpoint Commercial |
$9.65
|
| Rate for Payer: Health Net of AZ Commercial |
$23.40
|
| Rate for Payer: Health Net of AZ Medicare |
$10.92
|
| Rate for Payer: Humana of AZ Medicare |
$5.85
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$31.20
|
| Rate for Payer: TriWest Medicare |
$5.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$22.74
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.02
|
|
|
COLLECTION: Fingerstick
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
796183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Bisbee Police All Plans |
$10.66
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Self Pay Self Pay |
$32.80
|
|
|
COLLECTION: Fingerstick
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
796183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Aetna of AZ Medicare |
$11.48
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$6.15
|
| Rate for Payer: Amerigroup Medicare |
$6.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.31
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$6.15
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$6.15
|
| Rate for Payer: Bisbee Police All Plans |
$10.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$27.88
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cigna of AZ Commercial |
$26.65
|
| Rate for Payer: Copperpoint Commercial |
$10.15
|
| Rate for Payer: Health Net of AZ Commercial |
$24.60
|
| Rate for Payer: Health Net of AZ Medicare |
$11.48
|
| Rate for Payer: Humana of AZ Medicare |
$6.15
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$32.80
|
| Rate for Payer: TriWest Medicare |
$6.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$23.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.38
|
|
|
Collection of Venous Blood by venipuncture
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
23597541
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Aetna of AZ Medicare |
$11.48
|
| Rate for Payer: AHCCCS Medicaid |
$6.00
|
| Rate for Payer: Allwell Medicaid |
$6.00
|
| Rate for Payer: Allwell Medicare |
$6.15
|
| Rate for Payer: Amerigroup Medicare |
$6.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.31
|
| Rate for Payer: AZCH Complete Medicaid |
$6.00
|
| Rate for Payer: AZCH Complete Medicare |
$6.15
|
| Rate for Payer: Banner UC Health Medicaid |
$6.00
|
| Rate for Payer: Banner UC Health Medicare |
$6.15
|
| Rate for Payer: Bisbee Police All Plans |
$10.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$27.88
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cigna of AZ Commercial |
$26.65
|
| Rate for Payer: Copperpoint Commercial |
$10.15
|
| Rate for Payer: Health Net of AZ Commercial |
$24.60
|
| Rate for Payer: Health Net of AZ Medicare |
$11.48
|
| Rate for Payer: Humana of AZ Medicare |
$6.15
|
| Rate for Payer: Mercy Care Medicaid |
$6.00
|
| Rate for Payer: Self Pay Self Pay |
$32.80
|
| Rate for Payer: TriWest Medicare |
$6.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$23.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.38
|
|
|
Collection of Venous Blood by venipuncture
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
23597541
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Bisbee Police All Plans |
$10.66
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Self Pay Self Pay |
$32.80
|
|
|
COLLECTION: Venous Draw
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
796180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Aetna of AZ Medicare |
$11.48
|
| Rate for Payer: AHCCCS Medicaid |
$6.00
|
| Rate for Payer: Allwell Medicaid |
$6.00
|
| Rate for Payer: Allwell Medicare |
$6.15
|
| Rate for Payer: Amerigroup Medicare |
$6.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.31
|
| Rate for Payer: AZCH Complete Medicaid |
$6.00
|
| Rate for Payer: AZCH Complete Medicare |
$6.15
|
| Rate for Payer: Banner UC Health Medicaid |
$6.00
|
| Rate for Payer: Banner UC Health Medicare |
$6.15
|
| Rate for Payer: Bisbee Police All Plans |
$10.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$27.88
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cigna of AZ Commercial |
$26.65
|
| Rate for Payer: Copperpoint Commercial |
$10.15
|
| Rate for Payer: Health Net of AZ Commercial |
$24.60
|
| Rate for Payer: Health Net of AZ Medicare |
$11.48
|
| Rate for Payer: Humana of AZ Medicare |
$6.15
|
| Rate for Payer: Mercy Care Medicaid |
$6.00
|
| Rate for Payer: Self Pay Self Pay |
$32.80
|
| Rate for Payer: TriWest Medicare |
$6.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$23.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.38
|
|
|
COLLECTION: Venous Draw
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
796180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Bisbee Police All Plans |
$10.66
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Self Pay Self Pay |
$32.80
|
|
|
Colonoscopy
|
Facility
|
OP
|
$3,684.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
22499690
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$552.60 |
| Max. Negotiated Rate |
$3,315.60 |
| Rate for Payer: Aetna of AZ Commercial |
$3,315.60
|
| Rate for Payer: Aetna of AZ Medicare |
$1,031.52
|
| Rate for Payer: AHCCCS Medicaid |
$1,150.80
|
| Rate for Payer: Allwell Medicaid |
$1,150.80
|
| Rate for Payer: Allwell Medicare |
$552.60
|
| Rate for Payer: Amerigroup Medicare |
$552.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,375.97
|
| Rate for Payer: AZCH Complete Medicaid |
$1,150.80
|
| Rate for Payer: AZCH Complete Medicare |
$552.60
|
| Rate for Payer: Banner UC Health Medicaid |
$1,150.80
|
| Rate for Payer: Banner UC Health Medicare |
$552.60
|
| Rate for Payer: Bisbee Police All Plans |
$957.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,505.12
|
| Rate for Payer: Cash Price |
$2,947.20
|
| Rate for Payer: Cash Price |
$2,947.20
|
| Rate for Payer: Cigna of AZ Commercial |
$2,578.80
|
| Rate for Payer: Copperpoint Commercial |
$911.79
|
| Rate for Payer: Health Net of AZ Commercial |
$2,210.40
|
| Rate for Payer: Health Net of AZ Medicare |
$1,031.52
|
| Rate for Payer: Humana of AZ Medicare |
$552.60
|
| Rate for Payer: Mercy Care Medicaid |
$1,150.80
|
| Rate for Payer: Self Pay Self Pay |
$2,947.20
|
| Rate for Payer: TriWest Medicare |
$552.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$663.12
|
|
|
Colonoscopy
|
Facility
|
IP
|
$3,684.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
22499690
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$957.84 |
| Max. Negotiated Rate |
$3,315.60 |
| Rate for Payer: Aetna of AZ Commercial |
$3,315.60
|
| Rate for Payer: Bisbee Police All Plans |
$957.84
|
| Rate for Payer: Cash Price |
$2,947.20
|
| Rate for Payer: Self Pay Self Pay |
$2,947.20
|
|
|
COLONOSCOPY
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
885907
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$260.10 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,560.60
|
| Rate for Payer: Aetna of AZ Medicare |
$485.52
|
| Rate for Payer: AHCCCS Medicaid |
$1,150.80
|
| Rate for Payer: Allwell Medicaid |
$1,150.80
|
| Rate for Payer: Allwell Medicare |
$260.10
|
| Rate for Payer: Amerigroup Medicare |
$260.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$647.65
|
| Rate for Payer: AZCH Complete Medicaid |
$1,150.80
|
| Rate for Payer: AZCH Complete Medicare |
$260.10
|
| Rate for Payer: Banner UC Health Medicaid |
$1,150.80
|
| Rate for Payer: Banner UC Health Medicare |
$260.10
|
| Rate for Payer: Bisbee Police All Plans |
$450.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,179.12
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,213.80
|
| Rate for Payer: Copperpoint Commercial |
$429.16
|
| Rate for Payer: Health Net of AZ Commercial |
$1,040.40
|
| Rate for Payer: Health Net of AZ Medicare |
$485.52
|
| Rate for Payer: Humana of AZ Medicare |
$260.10
|
| Rate for Payer: Mercy Care Medicaid |
$1,150.80
|
| Rate for Payer: Self Pay Self Pay |
$1,387.20
|
| Rate for Payer: TriWest Medicare |
$260.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$312.12
|
|
|
COLONOSCOPY
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
885907
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$450.84 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,560.60
|
| Rate for Payer: Bisbee Police All Plans |
$450.84
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Self Pay Self Pay |
$1,387.20
|
|
|
COLONOSCOPY BX
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 45380
|
| Hospital Charge Code |
1251755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$260.10 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,560.60
|
| Rate for Payer: Aetna of AZ Medicare |
$485.52
|
| Rate for Payer: AHCCCS Medicaid |
$1,503.60
|
| Rate for Payer: Allwell Medicaid |
$1,503.60
|
| Rate for Payer: Allwell Medicare |
$260.10
|
| Rate for Payer: Amerigroup Medicare |
$260.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$647.65
|
| Rate for Payer: AZCH Complete Medicaid |
$1,503.60
|
| Rate for Payer: AZCH Complete Medicare |
$260.10
|
| Rate for Payer: Banner UC Health Medicaid |
$1,503.60
|
| Rate for Payer: Banner UC Health Medicare |
$260.10
|
| Rate for Payer: Bisbee Police All Plans |
$450.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,179.12
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,213.80
|
| Rate for Payer: Copperpoint Commercial |
$429.16
|
| Rate for Payer: Health Net of AZ Commercial |
$1,040.40
|
| Rate for Payer: Health Net of AZ Medicare |
$485.52
|
| Rate for Payer: Humana of AZ Medicare |
$260.10
|
| Rate for Payer: Mercy Care Medicaid |
$1,503.60
|
| Rate for Payer: Self Pay Self Pay |
$1,387.20
|
| Rate for Payer: TriWest Medicare |
$260.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$312.12
|
|
|
COLONOSCOPY BX
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 45380
|
| Hospital Charge Code |
1251755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$450.84 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,560.60
|
| Rate for Payer: Bisbee Police All Plans |
$450.84
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Self Pay Self Pay |
$1,387.20
|
|
|
COLONOSCOPY BX ADD ON CHARGE
|
Facility
|
OP
|
$103.00
|
|
| Hospital Charge Code |
22331686
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$15.45 |
| 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: Allwell Medicare |
$15.45
|
| Rate for Payer: Amerigroup Medicare |
$15.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$38.47
|
| Rate for Payer: AZCH Complete Medicare |
$15.45
|
| Rate for Payer: Banner UC Health Medicare |
$15.45
|
| 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: 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 |
$15.45
|
| Rate for Payer: Self Pay Self Pay |
$82.40
|
| Rate for Payer: TriWest Medicare |
$15.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$60.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.54
|
|
|
COLONOSCOPY BX ADD ON CHARGE
|
Facility
|
IP
|
$103.00
|
|
| Hospital Charge Code |
22331686
|
|
Hospital Revenue Code
|
750
|
| 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
|
|
|
COLONOSCOPY WITH BANDING LITIGATION - TECH
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
CPT 45398
|
| Hospital Charge Code |
22043085
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$221.70 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,330.20
|
| Rate for Payer: Aetna of AZ Medicare |
$413.84
|
| Rate for Payer: AHCCCS Medicaid |
$1,503.60
|
| Rate for Payer: Allwell Medicaid |
$1,503.60
|
| Rate for Payer: Allwell Medicare |
$221.70
|
| Rate for Payer: Amerigroup Medicare |
$221.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$552.03
|
| Rate for Payer: AZCH Complete Medicaid |
$1,503.60
|
| Rate for Payer: AZCH Complete Medicare |
$221.70
|
| Rate for Payer: Banner UC Health Medicaid |
$1,503.60
|
| Rate for Payer: Banner UC Health Medicare |
$221.70
|
| Rate for Payer: Bisbee Police All Plans |
$384.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,005.04
|
| Rate for Payer: Cash Price |
$1,182.40
|
| Rate for Payer: Cash Price |
$1,182.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,034.60
|
| Rate for Payer: Copperpoint Commercial |
$365.80
|
| Rate for Payer: Health Net of AZ Commercial |
$886.80
|
| Rate for Payer: Health Net of AZ Medicare |
$413.84
|
| Rate for Payer: Humana of AZ Medicare |
$221.70
|
| Rate for Payer: Mercy Care Medicaid |
$1,503.60
|
| Rate for Payer: Self Pay Self Pay |
$1,182.40
|
| Rate for Payer: TriWest Medicare |
$221.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$266.04
|
|
|
COLONOSCOPY WITH BANDING LITIGATION - TECH
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
CPT 45398
|
| Hospital Charge Code |
22043085
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$384.28 |
| Max. Negotiated Rate |
$1,330.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,330.20
|
| Rate for Payer: Bisbee Police All Plans |
$384.28
|
| Rate for Payer: Cash Price |
$1,182.40
|
| Rate for Payer: Self Pay Self Pay |
$1,182.40
|
|
