|
CRUSHING, FRAGMENTING, AND REMOVAL OF BLADDER STONES, LESS T
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
CPT 52317
|
| Hospital Charge Code |
27881569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$286.40 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,611.00
|
| Rate for Payer: Aetna of AZ Medicare |
$501.20
|
| Rate for Payer: AHCCCS Medicaid |
$2,230.35
|
| Rate for Payer: Allwell Medicaid |
$2,230.35
|
| Rate for Payer: Allwell Medicare |
$286.40
|
| Rate for Payer: Amerigroup Medicare |
$286.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$668.57
|
| Rate for Payer: AZCH Complete Medicaid |
$2,230.35
|
| Rate for Payer: AZCH Complete Medicare |
$286.40
|
| Rate for Payer: Banner UC Health Medicaid |
$2,230.35
|
| Rate for Payer: Banner UC Health Medicare |
$286.40
|
| Rate for Payer: Bisbee Police All Plans |
$465.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,217.20
|
| Rate for Payer: Cash Price |
$1,432.00
|
| Rate for Payer: Cash Price |
$1,432.00
|
| Rate for Payer: Cigna of AZ Commercial |
$895.00
|
| Rate for Payer: Copperpoint Commercial |
$443.02
|
| Rate for Payer: Health Net of AZ Commercial |
$1,074.00
|
| Rate for Payer: Health Net of AZ Medicare |
$501.20
|
| Rate for Payer: Humana of AZ Medicare |
$286.40
|
| Rate for Payer: Mercy Care Medicaid |
$2,230.35
|
| Rate for Payer: Self Pay Self Pay |
$1,432.00
|
| Rate for Payer: TriWest Medicare |
$286.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$322.20
|
|
|
CRUSHING OF STONE OF URETER USING AN ENDOSCOPE Tech
|
Facility
|
OP
|
$2,026.00
|
|
|
Service Code
|
CPT 52353
|
| Hospital Charge Code |
27880780
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$324.16 |
| Max. Negotiated Rate |
$3,200.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,823.40
|
| Rate for Payer: Aetna of AZ Medicare |
$567.28
|
| Rate for Payer: AHCCCS Medicaid |
$3,200.08
|
| Rate for Payer: Allwell Medicaid |
$3,200.08
|
| Rate for Payer: Allwell Medicare |
$324.16
|
| Rate for Payer: Amerigroup Medicare |
$324.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$756.71
|
| Rate for Payer: AZCH Complete Medicaid |
$3,200.08
|
| Rate for Payer: AZCH Complete Medicare |
$324.16
|
| Rate for Payer: Banner UC Health Medicaid |
$3,200.08
|
| Rate for Payer: Banner UC Health Medicare |
$324.16
|
| Rate for Payer: Bisbee Police All Plans |
$526.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,377.68
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,013.00
|
| Rate for Payer: Copperpoint Commercial |
$501.44
|
| Rate for Payer: Health Net of AZ Commercial |
$1,215.60
|
| Rate for Payer: Health Net of AZ Medicare |
$567.28
|
| Rate for Payer: Humana of AZ Medicare |
$324.16
|
| Rate for Payer: Mercy Care Medicaid |
$3,200.08
|
| Rate for Payer: Self Pay Self Pay |
$1,620.80
|
| Rate for Payer: TriWest Medicare |
$324.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,181.16
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$364.68
|
|
|
CRUSHING OF STONE OF URETER USING AN ENDOSCOPE Tech
|
Facility
|
IP
|
$2,026.00
|
|
|
Service Code
|
CPT 52353
|
| Hospital Charge Code |
27880780
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$526.76 |
| Max. Negotiated Rate |
$1,823.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,823.40
|
| Rate for Payer: Bisbee Police All Plans |
$526.76
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Self Pay Self Pay |
$1,620.80
|
|
|
CRUSHING OF STONE OF URETER WITH INSERTION OF STENT USING AN
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
28003378
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Aetna of AZ Commercial |
$774.00
|
| Rate for Payer: Bisbee Police All Plans |
$223.60
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Self Pay Self Pay |
$688.00
|
|
|
CRUSHING OF STONE OF URETER WITH INSERTION OF STENT USING AN
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
28003378
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$137.60 |
| Max. Negotiated Rate |
$3,200.08 |
| Rate for Payer: Aetna of AZ Commercial |
$774.00
|
| Rate for Payer: Aetna of AZ Medicare |
$240.80
|
| Rate for Payer: AHCCCS Medicaid |
$3,200.08
|
| Rate for Payer: Allwell Medicaid |
$3,200.08
|
| Rate for Payer: Allwell Medicare |
$137.60
|
| Rate for Payer: Amerigroup Medicare |
$137.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$321.21
|
| Rate for Payer: AZCH Complete Medicaid |
$3,200.08
|
| Rate for Payer: AZCH Complete Medicare |
$137.60
|
| Rate for Payer: Banner UC Health Medicaid |
$3,200.08
|
| Rate for Payer: Banner UC Health Medicare |
$137.60
|
| Rate for Payer: Bisbee Police All Plans |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$584.80
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cigna of AZ Commercial |
$602.00
|
| Rate for Payer: Copperpoint Commercial |
$212.85
|
| Rate for Payer: Health Net of AZ Commercial |
$516.00
|
| Rate for Payer: Health Net of AZ Medicare |
$240.80
|
| Rate for Payer: Humana of AZ Medicare |
$137.60
|
| Rate for Payer: Mercy Care Medicaid |
$3,200.08
|
| Rate for Payer: Self Pay Self Pay |
$688.00
|
| Rate for Payer: TriWest Medicare |
$137.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$501.38
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$154.80
|
|
|
CRUSHING OF STONE OF URETER WITH INSERTION OF STENT USING AN
|
Facility
|
OP
|
$2,149.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
27999760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$343.84 |
| Max. Negotiated Rate |
$3,200.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,934.10
|
| Rate for Payer: Aetna of AZ Medicare |
$601.72
|
| Rate for Payer: AHCCCS Medicaid |
$3,200.08
|
| Rate for Payer: Allwell Medicaid |
$3,200.08
|
| Rate for Payer: Allwell Medicare |
$343.84
|
| Rate for Payer: Amerigroup Medicare |
$343.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$802.65
|
| Rate for Payer: AZCH Complete Medicaid |
$3,200.08
|
| Rate for Payer: AZCH Complete Medicare |
$343.84
|
| Rate for Payer: Banner UC Health Medicaid |
$3,200.08
|
| Rate for Payer: Banner UC Health Medicare |
$343.84
|
| Rate for Payer: Bisbee Police All Plans |
$558.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,461.32
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,504.30
|
| Rate for Payer: Copperpoint Commercial |
$531.88
|
| Rate for Payer: Health Net of AZ Commercial |
$1,289.40
|
| Rate for Payer: Health Net of AZ Medicare |
$601.72
|
| Rate for Payer: Humana of AZ Medicare |
$343.84
|
| Rate for Payer: Mercy Care Medicaid |
$3,200.08
|
| Rate for Payer: Self Pay Self Pay |
$1,719.20
|
| Rate for Payer: TriWest Medicare |
$343.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,252.87
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$386.82
|
|
|
CRUSHING OF STONE OF URETER WITH INSERTION OF STENT USING AN
|
Facility
|
IP
|
$2,149.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
27999760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$558.74 |
| Max. Negotiated Rate |
$1,934.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,934.10
|
| Rate for Payer: Bisbee Police All Plans |
$558.74
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Self Pay Self Pay |
$1,719.20
|
|
|
CRUTCH ADULT
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT E0113
|
| Hospital Charge Code |
22354909
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of AZ Commercial |
$54.00
|
| Rate for Payer: Aetna of AZ Medicare |
$16.80
|
| Rate for Payer: Allwell Medicare |
$9.60
|
| Rate for Payer: Amerigroup Medicare |
$9.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$22.41
|
| Rate for Payer: AZCH Complete Medicare |
$9.60
|
| Rate for Payer: Banner UC Health Medicare |
$9.60
|
| Rate for Payer: Bisbee Police All Plans |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna of AZ Commercial |
$42.00
|
| Rate for Payer: Copperpoint Commercial |
$14.85
|
| Rate for Payer: Health Net of AZ Commercial |
$36.00
|
| Rate for Payer: Health Net of AZ Medicare |
$16.80
|
| Rate for Payer: Humana of AZ Medicare |
$9.60
|
| Rate for Payer: Self Pay Self Pay |
$48.00
|
| Rate for Payer: TriWest Medicare |
$9.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$34.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.80
|
|
|
CRUTCH ADULT
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT E0113
|
| Hospital Charge Code |
22354909
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of AZ Commercial |
$54.00
|
| Rate for Payer: Bisbee Police All Plans |
$15.60
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Self Pay Self Pay |
$48.00
|
|
|
CRUTCH ADULT TALL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT E0113
|
| Hospital Charge Code |
22354907
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of AZ Commercial |
$54.00
|
| Rate for Payer: Aetna of AZ Medicare |
$16.80
|
| Rate for Payer: Allwell Medicare |
$9.60
|
| Rate for Payer: Amerigroup Medicare |
$9.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$22.41
|
| Rate for Payer: AZCH Complete Medicare |
$9.60
|
| Rate for Payer: Banner UC Health Medicare |
$9.60
|
| Rate for Payer: Bisbee Police All Plans |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna of AZ Commercial |
$42.00
|
| Rate for Payer: Copperpoint Commercial |
$14.85
|
| Rate for Payer: Health Net of AZ Commercial |
$36.00
|
| Rate for Payer: Health Net of AZ Medicare |
$16.80
|
| Rate for Payer: Humana of AZ Medicare |
$9.60
|
| Rate for Payer: Self Pay Self Pay |
$48.00
|
| Rate for Payer: TriWest Medicare |
$9.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$34.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.80
|
|
|
CRUTCH ADULT TALL
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT E0113
|
| Hospital Charge Code |
22354907
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of AZ Commercial |
$54.00
|
| Rate for Payer: Bisbee Police All Plans |
$15.60
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Self Pay Self Pay |
$48.00
|
|
|
CRUTCH YOUTH
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT E0113
|
| Hospital Charge Code |
22354910
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of AZ Commercial |
$51.30
|
| Rate for Payer: Bisbee Police All Plans |
$14.82
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Self Pay Self Pay |
$45.60
|
|
|
CRUTCH YOUTH
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT E0113
|
| Hospital Charge Code |
22354910
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of AZ Commercial |
$51.30
|
| Rate for Payer: Aetna of AZ Medicare |
$15.96
|
| Rate for Payer: Allwell Medicare |
$9.12
|
| Rate for Payer: Amerigroup Medicare |
$9.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$21.29
|
| Rate for Payer: AZCH Complete Medicare |
$9.12
|
| Rate for Payer: Banner UC Health Medicare |
$9.12
|
| Rate for Payer: Bisbee Police All Plans |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna of AZ Commercial |
$39.90
|
| Rate for Payer: Copperpoint Commercial |
$14.11
|
| Rate for Payer: Health Net of AZ Commercial |
$34.20
|
| Rate for Payer: Health Net of AZ Medicare |
$15.96
|
| Rate for Payer: Humana of AZ Medicare |
$9.12
|
| Rate for Payer: Self Pay Self Pay |
$45.60
|
| Rate for Payer: TriWest Medicare |
$9.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$33.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.26
|
|
|
Cryo AHF
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
1011948
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.64 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of AZ Commercial |
$453.60
|
| Rate for Payer: Aetna of AZ Medicare |
$141.12
|
| Rate for Payer: Allwell Medicare |
$80.64
|
| Rate for Payer: Amerigroup Medicare |
$80.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$188.24
|
| Rate for Payer: AZCH Complete Medicare |
$80.64
|
| Rate for Payer: Banner UC Health Medicare |
$80.64
|
| Rate for Payer: Bisbee Police All Plans |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$342.72
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna of AZ Commercial |
$327.60
|
| Rate for Payer: Copperpoint Commercial |
$124.74
|
| Rate for Payer: Health Net of AZ Commercial |
$302.40
|
| Rate for Payer: Health Net of AZ Medicare |
$141.12
|
| Rate for Payer: Humana of AZ Medicare |
$80.64
|
| Rate for Payer: Self Pay Self Pay |
$403.20
|
| Rate for Payer: TriWest Medicare |
$80.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$293.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$90.72
|
|
|
Cryo AHF
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
1011948
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of AZ Commercial |
$453.60
|
| Rate for Payer: Bisbee Police All Plans |
$131.04
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Self Pay Self Pay |
$403.20
|
|
|
Cryoglobulin, Qualitative, Serum w/Quant Reflex LC
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
12581373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Bisbee Police All Plans |
$20.28
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
|
|
Cryoglobulin, Qualitative, Serum w/Quant Reflex LC
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
12581373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Aetna of AZ Medicare |
$21.84
|
| Rate for Payer: Allwell Medicare |
$12.48
|
| Rate for Payer: Amerigroup Medicare |
$12.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$29.13
|
| Rate for Payer: AZCH Complete Medicare |
$12.48
|
| Rate for Payer: Banner UC Health Medicare |
$12.48
|
| Rate for Payer: Bisbee Police All Plans |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$53.04
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna of AZ Commercial |
$50.70
|
| Rate for Payer: Copperpoint Commercial |
$19.30
|
| Rate for Payer: Health Net of AZ Commercial |
$46.80
|
| Rate for Payer: Health Net of AZ Medicare |
$21.84
|
| Rate for Payer: Humana of AZ Medicare |
$12.48
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
| Rate for Payer: TriWest Medicare |
$12.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$45.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.04
|
|
|
Cryo Pooled
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
1221762
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna of AZ Commercial |
$432.00
|
| Rate for Payer: Aetna of AZ Medicare |
$134.40
|
| Rate for Payer: Allwell Medicare |
$76.80
|
| Rate for Payer: Amerigroup Medicare |
$76.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$179.28
|
| Rate for Payer: AZCH Complete Medicare |
$76.80
|
| Rate for Payer: Banner UC Health Medicare |
$76.80
|
| Rate for Payer: Bisbee Police All Plans |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$326.40
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna of AZ Commercial |
$312.00
|
| Rate for Payer: Copperpoint Commercial |
$118.80
|
| Rate for Payer: Health Net of AZ Commercial |
$288.00
|
| Rate for Payer: Health Net of AZ Medicare |
$134.40
|
| Rate for Payer: Humana of AZ Medicare |
$76.80
|
| Rate for Payer: Self Pay Self Pay |
$384.00
|
| Rate for Payer: TriWest Medicare |
$76.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$279.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$86.40
|
|
|
Cryo Pooled
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
1221762
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna of AZ Commercial |
$432.00
|
| Rate for Payer: Bisbee Police All Plans |
$124.80
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Self Pay Self Pay |
$384.00
|
|
|
Crystal, Synovial/Fluid LC
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
3976233
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$174.98 |
| Max. Negotiated Rate |
$605.70 |
| Rate for Payer: Aetna of AZ Commercial |
$605.70
|
| Rate for Payer: Bisbee Police All Plans |
$174.98
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Self Pay Self Pay |
$538.40
|
|
|
Crystal, Synovial/Fluid LC
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
3976233
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.68 |
| Max. Negotiated Rate |
$605.70 |
| Rate for Payer: Aetna of AZ Commercial |
$605.70
|
| Rate for Payer: Aetna of AZ Medicare |
$188.44
|
| Rate for Payer: Allwell Medicare |
$107.68
|
| Rate for Payer: Amerigroup Medicare |
$107.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$251.37
|
| Rate for Payer: AZCH Complete Medicare |
$107.68
|
| Rate for Payer: Banner UC Health Medicare |
$107.68
|
| Rate for Payer: Bisbee Police All Plans |
$174.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$457.64
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cigna of AZ Commercial |
$437.45
|
| Rate for Payer: Copperpoint Commercial |
$166.57
|
| Rate for Payer: Health Net of AZ Commercial |
$403.80
|
| Rate for Payer: Health Net of AZ Medicare |
$188.44
|
| Rate for Payer: Humana of AZ Medicare |
$107.68
|
| Rate for Payer: Self Pay Self Pay |
$538.40
|
| Rate for Payer: TriWest Medicare |
$107.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$392.36
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$121.14
|
|
|
CSF Cell Count Standard
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
22308749
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of AZ Commercial |
$102.60
|
| Rate for Payer: Bisbee Police All Plans |
$29.64
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Self Pay Self Pay |
$91.20
|
|
|
CSF Cell Count Standard
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
22308749
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of AZ Commercial |
$102.60
|
| Rate for Payer: Aetna of AZ Medicare |
$31.92
|
| Rate for Payer: Allwell Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicare |
$18.24
|
| Rate for Payer: APIPA Medicare/Medicaid |
$42.58
|
| Rate for Payer: AZCH Complete Medicare |
$18.24
|
| Rate for Payer: Banner UC Health Medicare |
$18.24
|
| Rate for Payer: Bisbee Police All Plans |
$29.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$77.52
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna of AZ Commercial |
$74.10
|
| Rate for Payer: Copperpoint Commercial |
$28.21
|
| Rate for Payer: Health Net of AZ Commercial |
$68.40
|
| Rate for Payer: Health Net of AZ Medicare |
$31.92
|
| Rate for Payer: Humana of AZ Medicare |
$18.24
|
| Rate for Payer: Self Pay Self Pay |
$91.20
|
| Rate for Payer: TriWest Medicare |
$18.24
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$66.46
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$20.52
|
|
|
CSF Culture
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
858004
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of AZ Commercial |
$104.40
|
| Rate for Payer: Bisbee Police All Plans |
$30.16
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Self Pay Self Pay |
$92.80
|
|
|
CSF Culture
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
858004
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of AZ Commercial |
$104.40
|
| Rate for Payer: Aetna of AZ Medicare |
$32.48
|
| Rate for Payer: Allwell Medicare |
$18.56
|
| Rate for Payer: Amerigroup Medicare |
$18.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$43.33
|
| Rate for Payer: AZCH Complete Medicare |
$18.56
|
| Rate for Payer: Banner UC Health Medicare |
$18.56
|
| Rate for Payer: Bisbee Police All Plans |
$30.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$78.88
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cigna of AZ Commercial |
$75.40
|
| Rate for Payer: Copperpoint Commercial |
$28.71
|
| Rate for Payer: Health Net of AZ Commercial |
$69.60
|
| Rate for Payer: Health Net of AZ Medicare |
$32.48
|
| Rate for Payer: Humana of AZ Medicare |
$18.56
|
| Rate for Payer: Self Pay Self Pay |
$92.80
|
| Rate for Payer: TriWest Medicare |
$18.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$67.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$20.88
|
|
