|
COLONOSCOPY BX ADD ON CHARGE
|
Facility
|
OP
|
$103.00
|
|
| Hospital Charge Code |
22331686
|
|
Hospital Revenue Code
|
750
|
| 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: Allwell Medicare |
$16.48
|
| Rate for Payer: Amerigroup Medicare |
$16.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$38.47
|
| Rate for Payer: AZCH Complete Medicare |
$16.48
|
| 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: 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: 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
|
|
|
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 |
$236.48 |
| 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: Allwell Medicare |
$236.48
|
| Rate for Payer: Amerigroup Medicare |
$236.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$552.03
|
| Rate for Payer: AZCH Complete Medicare |
$236.48
|
| Rate for Payer: Banner UC Health Medicare |
$236.48
|
| 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 |
$365.81
|
| 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 |
$236.48
|
| Rate for Payer: Self Pay Self Pay |
$1,182.40
|
| Rate for Payer: TriWest Medicare |
$236.48
|
| 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
|
|
|
COLONOSCOPY W POLYPECT
|
Facility
|
OP
|
$1,734.00
|
|
| Hospital Charge Code |
1296770
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$277.44 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,560.60
|
| Rate for Payer: Aetna of AZ Medicare |
$485.52
|
| Rate for Payer: Allwell Medicare |
$277.44
|
| Rate for Payer: Amerigroup Medicare |
$277.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$647.65
|
| Rate for Payer: AZCH Complete Medicare |
$277.44
|
| Rate for Payer: Banner UC Health Medicare |
$277.44
|
| 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: Cigna of AZ Commercial |
$1,213.80
|
| Rate for Payer: Copperpoint Commercial |
$429.17
|
| 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 |
$277.44
|
| Rate for Payer: Self Pay Self Pay |
$1,387.20
|
| Rate for Payer: TriWest Medicare |
$277.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,010.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$312.12
|
|
|
COLONOSCOPY W POLYPECT
|
Facility
|
IP
|
$1,734.00
|
|
| Hospital Charge Code |
1296770
|
|
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 W POLYPECT ADD ON CHARGE
|
Facility
|
IP
|
$226.00
|
|
| Hospital Charge Code |
22331687
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna of AZ Commercial |
$203.40
|
| Rate for Payer: Bisbee Police All Plans |
$58.76
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Self Pay Self Pay |
$180.80
|
|
|
COLONOSCOPY W POLYPECT ADD ON CHARGE
|
Facility
|
OP
|
$226.00
|
|
| Hospital Charge Code |
22331687
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna of AZ Commercial |
$203.40
|
| Rate for Payer: Aetna of AZ Medicare |
$63.28
|
| Rate for Payer: Allwell Medicare |
$36.16
|
| Rate for Payer: Amerigroup Medicare |
$36.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$84.41
|
| Rate for Payer: AZCH Complete Medicare |
$36.16
|
| Rate for Payer: Banner UC Health Medicare |
$36.16
|
| Rate for Payer: Bisbee Police All Plans |
$58.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$153.68
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cigna of AZ Commercial |
$158.20
|
| Rate for Payer: Copperpoint Commercial |
$55.94
|
| Rate for Payer: Health Net of AZ Commercial |
$135.60
|
| Rate for Payer: Health Net of AZ Medicare |
$63.28
|
| Rate for Payer: Humana of AZ Medicare |
$36.16
|
| Rate for Payer: Self Pay Self Pay |
$180.80
|
| Rate for Payer: TriWest Medicare |
$36.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$131.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.68
|
|
|
COLONSCOPY FLEXIBLE WITH BAND LIGATION
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 45298
|
| Hospital Charge Code |
28068479
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of AZ Commercial |
$540.00
|
| Rate for Payer: Bisbee Police All Plans |
$156.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Self Pay Self Pay |
$480.00
|
|
|
COLONSCOPY FLEXIBLE WITH BAND LIGATION
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 45298
|
| Hospital Charge Code |
28068479
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of AZ Commercial |
$540.00
|
| Rate for Payer: Aetna of AZ Medicare |
$168.00
|
| Rate for Payer: Allwell Medicare |
$96.00
|
| Rate for Payer: Amerigroup Medicare |
$96.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$224.10
|
| Rate for Payer: AZCH Complete Medicare |
$96.00
|
| Rate for Payer: Banner UC Health Medicare |
$96.00
|
| Rate for Payer: Bisbee Police All Plans |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$408.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna of AZ Commercial |
$300.00
|
| Rate for Payer: Copperpoint Commercial |
$148.50
|
| Rate for Payer: Health Net of AZ Commercial |
$360.00
|
| Rate for Payer: Health Net of AZ Medicare |
$168.00
|
| Rate for Payer: Humana of AZ Medicare |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$480.00
|
| Rate for Payer: TriWest Medicare |
$96.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$349.80
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$108.00
|
|
|
Colpoclesis
|
Facility
|
IP
|
$2,877.00
|
|
|
Service Code
|
CPT 57120
|
| Hospital Charge Code |
27267824
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$748.02 |
| Max. Negotiated Rate |
$2,589.30 |
| Rate for Payer: Aetna of AZ Commercial |
$2,589.30
|
| Rate for Payer: Bisbee Police All Plans |
$748.02
|
| Rate for Payer: Cash Price |
$2,301.60
|
| Rate for Payer: Self Pay Self Pay |
$2,301.60
|
|
|
Colpoclesis
|
Facility
|
OP
|
$2,877.00
|
|
|
Service Code
|
CPT 57120
|
| Hospital Charge Code |
27267824
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$460.32 |
| Max. Negotiated Rate |
$3,196.92 |
| Rate for Payer: Aetna of AZ Commercial |
$2,589.30
|
| Rate for Payer: Aetna of AZ Medicare |
$805.56
|
| Rate for Payer: AHCCCS Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicare |
$460.32
|
| Rate for Payer: Amerigroup Medicare |
$460.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,074.56
|
| Rate for Payer: AZCH Complete Medicaid |
$3,196.92
|
| Rate for Payer: AZCH Complete Medicare |
$460.32
|
| Rate for Payer: Banner UC Health Medicaid |
$3,196.92
|
| Rate for Payer: Banner UC Health Medicare |
$460.32
|
| Rate for Payer: Bisbee Police All Plans |
$748.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,956.36
|
| Rate for Payer: Cash Price |
$2,301.60
|
| Rate for Payer: Cash Price |
$2,301.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,438.50
|
| Rate for Payer: Copperpoint Commercial |
$712.06
|
| Rate for Payer: Health Net of AZ Commercial |
$1,726.20
|
| Rate for Payer: Health Net of AZ Medicare |
$805.56
|
| Rate for Payer: Humana of AZ Medicare |
$460.32
|
| Rate for Payer: Mercy Care Medicaid |
$3,196.92
|
| Rate for Payer: Self Pay Self Pay |
$2,301.60
|
| Rate for Payer: TriWest Medicare |
$460.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,677.29
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$517.86
|
|
|
Colpoperineorrhaphy
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 57210
|
| Hospital Charge Code |
27267808
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.76 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,913.40
|
| Rate for Payer: Bisbee Police All Plans |
$552.76
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Self Pay Self Pay |
$1,700.80
|
|
|
Colpoperineorrhaphy
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 57210
|
| Hospital Charge Code |
27267808
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.16 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,913.40
|
| Rate for Payer: Aetna of AZ Medicare |
$595.28
|
| Rate for Payer: AHCCCS Medicaid |
$1,901.83
|
| Rate for Payer: Allwell Medicaid |
$1,901.83
|
| Rate for Payer: Allwell Medicare |
$340.16
|
| Rate for Payer: Amerigroup Medicare |
$340.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$794.06
|
| Rate for Payer: AZCH Complete Medicaid |
$1,901.83
|
| Rate for Payer: AZCH Complete Medicare |
$340.16
|
| Rate for Payer: Banner UC Health Medicaid |
$1,901.83
|
| Rate for Payer: Banner UC Health Medicare |
$340.16
|
| Rate for Payer: Bisbee Police All Plans |
$552.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,445.68
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,063.00
|
| Rate for Payer: Copperpoint Commercial |
$526.18
|
| Rate for Payer: Health Net of AZ Commercial |
$1,275.60
|
| Rate for Payer: Health Net of AZ Medicare |
$595.28
|
| Rate for Payer: Humana of AZ Medicare |
$340.16
|
| Rate for Payer: Mercy Care Medicaid |
$1,901.83
|
| Rate for Payer: Self Pay Self Pay |
$1,700.80
|
| Rate for Payer: TriWest Medicare |
$340.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$382.68
|
|
|
Colpopexy(abdominal sacral uterosacral)
|
Facility
|
OP
|
$5,261.00
|
|
|
Service Code
|
CPT 57280
|
| Hospital Charge Code |
27291792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$841.76 |
| Max. Negotiated Rate |
$4,734.90 |
| Rate for Payer: Aetna of AZ Commercial |
$4,734.90
|
| Rate for Payer: Aetna of AZ Medicare |
$1,473.08
|
| Rate for Payer: Allwell Medicare |
$841.76
|
| Rate for Payer: Amerigroup Medicare |
$841.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,964.98
|
| Rate for Payer: AZCH Complete Medicare |
$841.76
|
| Rate for Payer: Banner UC Health Medicare |
$841.76
|
| Rate for Payer: Bisbee Police All Plans |
$1,367.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,577.48
|
| Rate for Payer: Cash Price |
$4,208.80
|
| Rate for Payer: Cash Price |
$4,208.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,630.50
|
| Rate for Payer: Copperpoint Commercial |
$1,302.10
|
| Rate for Payer: Health Net of AZ Commercial |
$3,156.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,473.08
|
| Rate for Payer: Humana of AZ Medicare |
$841.76
|
| Rate for Payer: Self Pay Self Pay |
$4,208.80
|
| Rate for Payer: TriWest Medicare |
$841.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$946.98
|
|
|
Colpopexy(abdominal sacral uterosacral)
|
Facility
|
IP
|
$5,261.00
|
|
|
Service Code
|
CPT 57280
|
| Hospital Charge Code |
27291792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,367.86 |
| Max. Negotiated Rate |
$4,734.90 |
| Rate for Payer: Aetna of AZ Commercial |
$4,734.90
|
| Rate for Payer: Bisbee Police All Plans |
$1,367.86
|
| Rate for Payer: Cash Price |
$4,208.80
|
| Rate for Payer: Self Pay Self Pay |
$4,208.80
|
|
|
Colporrhaphy(repair injury site)
|
Facility
|
IP
|
$1,780.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
27267807
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$462.80 |
| Max. Negotiated Rate |
$1,602.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,602.00
|
| Rate for Payer: Bisbee Police All Plans |
$462.80
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Self Pay Self Pay |
$1,424.00
|
|
|
Colporrhaphy(repair injury site)
|
Facility
|
OP
|
$1,780.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
27267807
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$284.80 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,602.00
|
| Rate for Payer: Aetna of AZ Medicare |
$498.40
|
| Rate for Payer: AHCCCS Medicaid |
$1,901.83
|
| Rate for Payer: Allwell Medicaid |
$1,901.83
|
| Rate for Payer: Allwell Medicare |
$284.80
|
| Rate for Payer: Amerigroup Medicare |
$284.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$664.83
|
| Rate for Payer: AZCH Complete Medicaid |
$1,901.83
|
| Rate for Payer: AZCH Complete Medicare |
$284.80
|
| Rate for Payer: Banner UC Health Medicaid |
$1,901.83
|
| Rate for Payer: Banner UC Health Medicare |
$284.80
|
| Rate for Payer: Bisbee Police All Plans |
$462.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cigna of AZ Commercial |
$890.00
|
| Rate for Payer: Copperpoint Commercial |
$440.55
|
| Rate for Payer: Health Net of AZ Commercial |
$1,068.00
|
| Rate for Payer: Health Net of AZ Medicare |
$498.40
|
| Rate for Payer: Humana of AZ Medicare |
$284.80
|
| Rate for Payer: Mercy Care Medicaid |
$1,901.83
|
| Rate for Payer: Self Pay Self Pay |
$1,424.00
|
| Rate for Payer: TriWest Medicare |
$284.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$320.40
|
|
|
Colposcopy of the cervix incuding upper/adjacent vagina
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
22664756
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$236.86 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Aetna of AZ Commercial |
$819.90
|
| Rate for Payer: Bisbee Police All Plans |
$236.86
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Self Pay Self Pay |
$728.80
|
|
|
Colposcopy of the cervix incuding upper/adjacent vagina
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
22664756
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$819.90
|
| Rate for Payer: Aetna of AZ Medicare |
$255.08
|
| Rate for Payer: AHCCCS Medicaid |
$123.48
|
| Rate for Payer: Allwell Medicaid |
$123.48
|
| Rate for Payer: Allwell Medicare |
$145.76
|
| Rate for Payer: Amerigroup Medicare |
$145.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$340.26
|
| Rate for Payer: AZCH Complete Medicaid |
$123.48
|
| Rate for Payer: AZCH Complete Medicare |
$145.76
|
| Rate for Payer: Banner UC Health Medicaid |
$123.48
|
| Rate for Payer: Banner UC Health Medicare |
$145.76
|
| Rate for Payer: Bisbee Police All Plans |
$236.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$619.48
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cigna of AZ Commercial |
$455.50
|
| Rate for Payer: Copperpoint Commercial |
$225.47
|
| Rate for Payer: Health Net of AZ Commercial |
$546.60
|
| Rate for Payer: Health Net of AZ Medicare |
$255.08
|
| Rate for Payer: Humana of AZ Medicare |
$145.76
|
| Rate for Payer: Mercy Care Medicaid |
$123.48
|
| Rate for Payer: Self Pay Self Pay |
$728.80
|
| Rate for Payer: TriWest Medicare |
$145.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$163.98
|
|
|
Colposcopy of the cervix incuding upper/adjacent vagina with
|
Facility
|
IP
|
$1,236.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
22664757
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.36 |
| Max. Negotiated Rate |
$1,112.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,112.40
|
| Rate for Payer: Bisbee Police All Plans |
$321.36
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Self Pay Self Pay |
$988.80
|
|
|
Colposcopy of the cervix incuding upper/adjacent vagina with
|
Facility
|
IP
|
$1,236.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
22664758
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$321.36 |
| Max. Negotiated Rate |
$1,112.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,112.40
|
| Rate for Payer: Bisbee Police All Plans |
$321.36
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Self Pay Self Pay |
$988.80
|
|
|
Colposcopy of the cervix incuding upper/adjacent vagina with
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
22664758
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$197.76 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,112.40
|
| Rate for Payer: Aetna of AZ Medicare |
$346.08
|
| Rate for Payer: AHCCCS Medicaid |
$204.07
|
| Rate for Payer: Allwell Medicaid |
$204.07
|
| Rate for Payer: Allwell Medicare |
$197.76
|
| Rate for Payer: Amerigroup Medicare |
$197.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$461.65
|
| Rate for Payer: AZCH Complete Medicaid |
$204.07
|
| Rate for Payer: AZCH Complete Medicare |
$197.76
|
| Rate for Payer: Banner UC Health Medicaid |
$204.07
|
| Rate for Payer: Banner UC Health Medicare |
$197.76
|
| Rate for Payer: Bisbee Police All Plans |
$321.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$840.48
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cigna of AZ Commercial |
$865.20
|
| Rate for Payer: Copperpoint Commercial |
$305.91
|
| Rate for Payer: Health Net of AZ Commercial |
$741.60
|
| Rate for Payer: Health Net of AZ Medicare |
$346.08
|
| Rate for Payer: Humana of AZ Medicare |
$197.76
|
| Rate for Payer: Mercy Care Medicaid |
$204.07
|
| Rate for Payer: Self Pay Self Pay |
$988.80
|
| Rate for Payer: TriWest Medicare |
$197.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$222.48
|
|
|
Colposcopy of the cervix incuding upper/adjacent vagina with
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
22664759
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.32 |
| Max. Negotiated Rate |
$1,108.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,108.80
|
| Rate for Payer: Bisbee Police All Plans |
$320.32
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Self Pay Self Pay |
$985.60
|
|
|
Colposcopy of the cervix incuding upper/adjacent vagina with
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
22664757
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$197.76 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,112.40
|
| Rate for Payer: Aetna of AZ Medicare |
$346.08
|
| Rate for Payer: AHCCCS Medicaid |
$204.07
|
| Rate for Payer: Allwell Medicaid |
$204.07
|
| Rate for Payer: Allwell Medicare |
$197.76
|
| Rate for Payer: Amerigroup Medicare |
$197.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$461.65
|
| Rate for Payer: AZCH Complete Medicaid |
$204.07
|
| Rate for Payer: AZCH Complete Medicare |
$197.76
|
| Rate for Payer: Banner UC Health Medicaid |
$204.07
|
| Rate for Payer: Banner UC Health Medicare |
$197.76
|
| Rate for Payer: Bisbee Police All Plans |
$321.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$840.48
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cigna of AZ Commercial |
$618.00
|
| Rate for Payer: Copperpoint Commercial |
$305.91
|
| Rate for Payer: Health Net of AZ Commercial |
$741.60
|
| Rate for Payer: Health Net of AZ Medicare |
$346.08
|
| Rate for Payer: Humana of AZ Medicare |
$197.76
|
| Rate for Payer: Mercy Care Medicaid |
$204.07
|
| Rate for Payer: Self Pay Self Pay |
$988.80
|
| Rate for Payer: TriWest Medicare |
$197.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$222.48
|
|
|
Colposcopy of the cervix incuding upper/adjacent vagina with
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
22664759
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$197.12 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,108.80
|
| Rate for Payer: Aetna of AZ Medicare |
$344.96
|
| Rate for Payer: AHCCCS Medicaid |
$204.07
|
| Rate for Payer: Allwell Medicaid |
$204.07
|
| Rate for Payer: Allwell Medicare |
$197.12
|
| Rate for Payer: Amerigroup Medicare |
$197.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$460.15
|
| Rate for Payer: AZCH Complete Medicaid |
$204.07
|
| Rate for Payer: AZCH Complete Medicare |
$197.12
|
| Rate for Payer: Banner UC Health Medicaid |
$204.07
|
| Rate for Payer: Banner UC Health Medicare |
$197.12
|
| Rate for Payer: Bisbee Police All Plans |
$320.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$837.76
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cigna of AZ Commercial |
$616.00
|
| Rate for Payer: Copperpoint Commercial |
$304.92
|
| Rate for Payer: Health Net of AZ Commercial |
$739.20
|
| Rate for Payer: Health Net of AZ Medicare |
$344.96
|
| Rate for Payer: Humana of AZ Medicare |
$197.12
|
| Rate for Payer: Mercy Care Medicaid |
$204.07
|
| Rate for Payer: Self Pay Self Pay |
$985.60
|
| Rate for Payer: TriWest Medicare |
$197.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$221.76
|
|
