|
CT Abdomen w/o Contrast
|
Facility
|
OP
|
$2,521.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
821330
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$2,268.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,268.90
|
| Rate for Payer: Aetna of AZ Medicare |
$705.88
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$378.15
|
| Rate for Payer: Amerigroup Medicare |
$378.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$941.59
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$378.15
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$378.15
|
| Rate for Payer: Bisbee Police All Plans |
$655.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,714.28
|
| Rate for Payer: Cash Price |
$2,016.80
|
| Rate for Payer: Cash Price |
$2,016.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,638.65
|
| Rate for Payer: Copperpoint Commercial |
$623.95
|
| Rate for Payer: Health Net of AZ Commercial |
$1,512.60
|
| Rate for Payer: Health Net of AZ Medicare |
$705.88
|
| Rate for Payer: Humana of AZ Medicare |
$378.15
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$2,016.80
|
| Rate for Payer: TriWest Medicare |
$378.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,469.74
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$453.78
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$3,862.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
821326
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$258.90 |
| Max. Negotiated Rate |
$3,475.80 |
| Rate for Payer: Aetna of AZ Commercial |
$3,475.80
|
| Rate for Payer: Aetna of AZ Medicare |
$1,081.36
|
| Rate for Payer: AHCCCS Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicare |
$579.30
|
| Rate for Payer: Amerigroup Medicare |
$579.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,442.46
|
| Rate for Payer: AZCH Complete Medicaid |
$258.90
|
| Rate for Payer: AZCH Complete Medicare |
$579.30
|
| Rate for Payer: Banner UC Health Medicaid |
$258.90
|
| Rate for Payer: Banner UC Health Medicare |
$579.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,004.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,626.16
|
| Rate for Payer: Cash Price |
$3,089.60
|
| Rate for Payer: Cash Price |
$3,089.60
|
| Rate for Payer: Cigna of AZ Commercial |
$2,510.30
|
| Rate for Payer: Copperpoint Commercial |
$955.84
|
| Rate for Payer: Health Net of AZ Commercial |
$2,317.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,081.36
|
| Rate for Payer: Humana of AZ Medicare |
$579.30
|
| Rate for Payer: Mercy Care Medicaid |
$258.90
|
| Rate for Payer: Self Pay Self Pay |
$3,089.60
|
| Rate for Payer: TriWest Medicare |
$579.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,251.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$695.16
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$3,862.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
821326
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,004.12 |
| Max. Negotiated Rate |
$3,475.80 |
| Rate for Payer: Aetna of AZ Commercial |
$3,475.80
|
| Rate for Payer: Bisbee Police All Plans |
$1,004.12
|
| Rate for Payer: Cash Price |
$3,089.60
|
| Rate for Payer: Self Pay Self Pay |
$3,089.60
|
|
|
CTA EXTREMITY W/
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
1185058
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$467.10 |
| Rate for Payer: Aetna of AZ Commercial |
$467.10
|
| Rate for Payer: Aetna of AZ Medicare |
$145.32
|
| Rate for Payer: AHCCCS Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicare |
$77.85
|
| Rate for Payer: Amerigroup Medicare |
$77.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$193.85
|
| Rate for Payer: AZCH Complete Medicaid |
$258.90
|
| Rate for Payer: AZCH Complete Medicare |
$77.85
|
| Rate for Payer: Banner UC Health Medicaid |
$258.90
|
| Rate for Payer: Banner UC Health Medicare |
$77.85
|
| Rate for Payer: Bisbee Police All Plans |
$134.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$352.92
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cigna of AZ Commercial |
$337.35
|
| Rate for Payer: Copperpoint Commercial |
$128.45
|
| Rate for Payer: Health Net of AZ Commercial |
$311.40
|
| Rate for Payer: Health Net of AZ Medicare |
$145.32
|
| Rate for Payer: Humana of AZ Medicare |
$77.85
|
| Rate for Payer: Mercy Care Medicaid |
$258.90
|
| Rate for Payer: Self Pay Self Pay |
$415.20
|
| Rate for Payer: TriWest Medicare |
$77.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$302.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$93.42
|
|
|
CTA EXTREMITY W/
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
1185058
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.94 |
| Max. Negotiated Rate |
$467.10 |
| Rate for Payer: Aetna of AZ Commercial |
$467.10
|
| Rate for Payer: Bisbee Police All Plans |
$134.94
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Self Pay Self Pay |
$415.20
|
|
|
CTA LOWER EXTERMITY W/
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
2213993
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$467.10 |
| Rate for Payer: Aetna of AZ Commercial |
$467.10
|
| Rate for Payer: Aetna of AZ Medicare |
$145.32
|
| Rate for Payer: AHCCCS Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicare |
$77.85
|
| Rate for Payer: Amerigroup Medicare |
$77.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$193.85
|
| Rate for Payer: AZCH Complete Medicaid |
$258.90
|
| Rate for Payer: AZCH Complete Medicare |
$77.85
|
| Rate for Payer: Banner UC Health Medicaid |
$258.90
|
| Rate for Payer: Banner UC Health Medicare |
$77.85
|
| Rate for Payer: Bisbee Police All Plans |
$134.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$352.92
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cigna of AZ Commercial |
$337.35
|
| Rate for Payer: Copperpoint Commercial |
$128.45
|
| Rate for Payer: Health Net of AZ Commercial |
$311.40
|
| Rate for Payer: Health Net of AZ Medicare |
$145.32
|
| Rate for Payer: Humana of AZ Medicare |
$77.85
|
| Rate for Payer: Mercy Care Medicaid |
$258.90
|
| Rate for Payer: Self Pay Self Pay |
$415.20
|
| Rate for Payer: TriWest Medicare |
$77.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$302.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$93.42
|
|
|
CTA LOWER EXTERMITY W/
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
2213993
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.94 |
| Max. Negotiated Rate |
$467.10 |
| Rate for Payer: Aetna of AZ Commercial |
$467.10
|
| Rate for Payer: Bisbee Police All Plans |
$134.94
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Self Pay Self Pay |
$415.20
|
|
|
CT Angiography Abdomen
|
Facility
|
OP
|
$1,753.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
1005124
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$258.90 |
| Max. Negotiated Rate |
$1,577.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,577.70
|
| Rate for Payer: Aetna of AZ Medicare |
$490.84
|
| Rate for Payer: AHCCCS Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicare |
$262.95
|
| Rate for Payer: Amerigroup Medicare |
$262.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$654.75
|
| Rate for Payer: AZCH Complete Medicaid |
$258.90
|
| Rate for Payer: AZCH Complete Medicare |
$262.95
|
| Rate for Payer: Banner UC Health Medicaid |
$258.90
|
| Rate for Payer: Banner UC Health Medicare |
$262.95
|
| Rate for Payer: Bisbee Police All Plans |
$455.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,192.04
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,139.45
|
| Rate for Payer: Copperpoint Commercial |
$433.87
|
| Rate for Payer: Health Net of AZ Commercial |
$1,051.80
|
| Rate for Payer: Health Net of AZ Medicare |
$490.84
|
| Rate for Payer: Humana of AZ Medicare |
$262.95
|
| Rate for Payer: Mercy Care Medicaid |
$258.90
|
| Rate for Payer: Self Pay Self Pay |
$1,402.40
|
| Rate for Payer: TriWest Medicare |
$262.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,022.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$315.54
|
|
|
CT Angiography Abdomen
|
Facility
|
IP
|
$1,753.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
1005124
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$455.78 |
| Max. Negotiated Rate |
$1,577.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,577.70
|
| Rate for Payer: Bisbee Police All Plans |
$455.78
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Self Pay Self Pay |
$1,402.40
|
|
|
CT Angiography Abdomen/Pelvis
|
Facility
|
OP
|
$5,630.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
4132928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$483.64 |
| Max. Negotiated Rate |
$5,067.00 |
| Rate for Payer: Aetna of AZ Commercial |
$5,067.00
|
| Rate for Payer: Aetna of AZ Medicare |
$1,576.40
|
| Rate for Payer: AHCCCS Medicaid |
$483.64
|
| Rate for Payer: Allwell Medicaid |
$483.64
|
| Rate for Payer: Allwell Medicare |
$844.50
|
| Rate for Payer: Amerigroup Medicare |
$844.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,102.80
|
| Rate for Payer: AZCH Complete Medicaid |
$483.64
|
| Rate for Payer: AZCH Complete Medicare |
$844.50
|
| Rate for Payer: Banner UC Health Medicaid |
$483.64
|
| Rate for Payer: Banner UC Health Medicare |
$844.50
|
| Rate for Payer: Bisbee Police All Plans |
$1,463.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,828.40
|
| Rate for Payer: Cash Price |
$4,504.00
|
| Rate for Payer: Cash Price |
$4,504.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3,659.50
|
| Rate for Payer: Copperpoint Commercial |
$1,393.42
|
| Rate for Payer: Health Net of AZ Commercial |
$3,378.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,576.40
|
| Rate for Payer: Humana of AZ Medicare |
$844.50
|
| Rate for Payer: Mercy Care Medicaid |
$483.64
|
| Rate for Payer: Self Pay Self Pay |
$4,504.00
|
| Rate for Payer: TriWest Medicare |
$844.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,282.29
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,013.40
|
|
|
CT Angiography Abdomen/Pelvis
|
Facility
|
IP
|
$5,630.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
4132928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,463.80 |
| Max. Negotiated Rate |
$5,067.00 |
| Rate for Payer: Aetna of AZ Commercial |
$5,067.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,463.80
|
| Rate for Payer: Cash Price |
$4,504.00
|
| Rate for Payer: Self Pay Self Pay |
$4,504.00
|
|
|
CT Angiography Chest w/ Contrast
|
Facility
|
OP
|
$4,385.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
1165683
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$258.90 |
| Max. Negotiated Rate |
$3,946.50 |
| Rate for Payer: Aetna of AZ Commercial |
$3,946.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1,227.80
|
| Rate for Payer: AHCCCS Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicare |
$657.75
|
| Rate for Payer: Amerigroup Medicare |
$657.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,637.80
|
| Rate for Payer: AZCH Complete Medicaid |
$258.90
|
| Rate for Payer: AZCH Complete Medicare |
$657.75
|
| Rate for Payer: Banner UC Health Medicaid |
$258.90
|
| Rate for Payer: Banner UC Health Medicare |
$657.75
|
| Rate for Payer: Bisbee Police All Plans |
$1,140.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,981.80
|
| Rate for Payer: Cash Price |
$3,508.00
|
| Rate for Payer: Cash Price |
$3,508.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,850.25
|
| Rate for Payer: Copperpoint Commercial |
$1,085.29
|
| Rate for Payer: Health Net of AZ Commercial |
$2,631.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,227.80
|
| Rate for Payer: Humana of AZ Medicare |
$657.75
|
| Rate for Payer: Mercy Care Medicaid |
$258.90
|
| Rate for Payer: Self Pay Self Pay |
$3,508.00
|
| Rate for Payer: TriWest Medicare |
$657.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,556.46
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$789.30
|
|
|
CT Angiography Chest w/ Contrast
|
Facility
|
IP
|
$4,385.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
1165683
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,140.10 |
| Max. Negotiated Rate |
$3,946.50 |
| Rate for Payer: Aetna of AZ Commercial |
$3,946.50
|
| Rate for Payer: Bisbee Police All Plans |
$1,140.10
|
| Rate for Payer: Cash Price |
$3,508.00
|
| Rate for Payer: Self Pay Self Pay |
$3,508.00
|
|
|
CT Angiography Head w/ Contrast
|
Facility
|
IP
|
$4,326.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
22035134
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,124.76 |
| Max. Negotiated Rate |
$3,893.40 |
| Rate for Payer: Aetna of AZ Commercial |
$3,893.40
|
| Rate for Payer: Bisbee Police All Plans |
$1,124.76
|
| Rate for Payer: Cash Price |
$3,460.80
|
| Rate for Payer: Self Pay Self Pay |
$3,460.80
|
|
|
CT Angiography Head w/ Contrast
|
Facility
|
OP
|
$4,326.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
1477517
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$258.90 |
| Max. Negotiated Rate |
$3,893.40 |
| Rate for Payer: Aetna of AZ Commercial |
$3,893.40
|
| Rate for Payer: Aetna of AZ Medicare |
$1,211.28
|
| Rate for Payer: AHCCCS Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicare |
$648.90
|
| Rate for Payer: Amerigroup Medicare |
$648.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,615.76
|
| Rate for Payer: AZCH Complete Medicaid |
$258.90
|
| Rate for Payer: AZCH Complete Medicare |
$648.90
|
| Rate for Payer: Banner UC Health Medicaid |
$258.90
|
| Rate for Payer: Banner UC Health Medicare |
$648.90
|
| Rate for Payer: Bisbee Police All Plans |
$1,124.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,941.68
|
| Rate for Payer: Cash Price |
$3,460.80
|
| Rate for Payer: Cash Price |
$3,460.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,811.90
|
| Rate for Payer: Copperpoint Commercial |
$1,070.68
|
| Rate for Payer: Health Net of AZ Commercial |
$2,595.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,211.28
|
| Rate for Payer: Humana of AZ Medicare |
$648.90
|
| Rate for Payer: Mercy Care Medicaid |
$258.90
|
| Rate for Payer: Self Pay Self Pay |
$3,460.80
|
| Rate for Payer: TriWest Medicare |
$648.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,522.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$778.68
|
|
|
CT Angiography Head w/ Contrast
|
Facility
|
IP
|
$4,326.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
1477517
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,124.76 |
| Max. Negotiated Rate |
$3,893.40 |
| Rate for Payer: Aetna of AZ Commercial |
$3,893.40
|
| Rate for Payer: Bisbee Police All Plans |
$1,124.76
|
| Rate for Payer: Cash Price |
$3,460.80
|
| Rate for Payer: Self Pay Self Pay |
$3,460.80
|
|
|
CT Angiography Head w/ Contrast
|
Facility
|
OP
|
$4,326.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
22035134
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$258.90 |
| Max. Negotiated Rate |
$3,893.40 |
| Rate for Payer: Aetna of AZ Commercial |
$3,893.40
|
| Rate for Payer: Aetna of AZ Medicare |
$1,211.28
|
| Rate for Payer: AHCCCS Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicare |
$648.90
|
| Rate for Payer: Amerigroup Medicare |
$648.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,615.76
|
| Rate for Payer: AZCH Complete Medicaid |
$258.90
|
| Rate for Payer: AZCH Complete Medicare |
$648.90
|
| Rate for Payer: Banner UC Health Medicaid |
$258.90
|
| Rate for Payer: Banner UC Health Medicare |
$648.90
|
| Rate for Payer: Bisbee Police All Plans |
$1,124.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,941.68
|
| Rate for Payer: Cash Price |
$3,460.80
|
| Rate for Payer: Cash Price |
$3,460.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,811.90
|
| Rate for Payer: Copperpoint Commercial |
$1,070.68
|
| Rate for Payer: Health Net of AZ Commercial |
$2,595.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,211.28
|
| Rate for Payer: Humana of AZ Medicare |
$648.90
|
| Rate for Payer: Mercy Care Medicaid |
$258.90
|
| Rate for Payer: Self Pay Self Pay |
$3,460.80
|
| Rate for Payer: TriWest Medicare |
$648.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,522.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$778.68
|
|
|
CT Angiography Neck w/ Contrast
|
Facility
|
IP
|
$4,323.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
1021517
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,123.98 |
| Max. Negotiated Rate |
$3,890.70 |
| Rate for Payer: Aetna of AZ Commercial |
$3,890.70
|
| Rate for Payer: Bisbee Police All Plans |
$1,123.98
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Self Pay Self Pay |
$3,458.40
|
|
|
CT Angiography Neck w/ Contrast
|
Facility
|
OP
|
$4,323.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
1021517
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$258.90 |
| Max. Negotiated Rate |
$3,890.70 |
| Rate for Payer: Aetna of AZ Commercial |
$3,890.70
|
| Rate for Payer: Aetna of AZ Medicare |
$1,210.44
|
| Rate for Payer: AHCCCS Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicare |
$648.45
|
| Rate for Payer: Amerigroup Medicare |
$648.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,614.64
|
| Rate for Payer: AZCH Complete Medicaid |
$258.90
|
| Rate for Payer: AZCH Complete Medicare |
$648.45
|
| Rate for Payer: Banner UC Health Medicaid |
$258.90
|
| Rate for Payer: Banner UC Health Medicare |
$648.45
|
| Rate for Payer: Bisbee Police All Plans |
$1,123.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,939.64
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Cigna of AZ Commercial |
$2,809.95
|
| Rate for Payer: Copperpoint Commercial |
$1,069.94
|
| Rate for Payer: Health Net of AZ Commercial |
$2,593.80
|
| Rate for Payer: Health Net of AZ Medicare |
$1,210.44
|
| Rate for Payer: Humana of AZ Medicare |
$648.45
|
| Rate for Payer: Mercy Care Medicaid |
$258.90
|
| Rate for Payer: Self Pay Self Pay |
$3,458.40
|
| Rate for Payer: TriWest Medicare |
$648.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,520.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$778.14
|
|
|
CT Chest W/Contrast
|
Facility
|
OP
|
$2,386.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
1005140
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$258.90 |
| Max. Negotiated Rate |
$2,147.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,147.40
|
| Rate for Payer: Aetna of AZ Medicare |
$668.08
|
| Rate for Payer: AHCCCS Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicare |
$357.90
|
| Rate for Payer: Amerigroup Medicare |
$357.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$891.17
|
| Rate for Payer: AZCH Complete Medicaid |
$258.90
|
| Rate for Payer: AZCH Complete Medicare |
$357.90
|
| Rate for Payer: Banner UC Health Medicaid |
$258.90
|
| Rate for Payer: Banner UC Health Medicare |
$357.90
|
| Rate for Payer: Bisbee Police All Plans |
$620.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,622.48
|
| Rate for Payer: Cash Price |
$1,908.80
|
| Rate for Payer: Cash Price |
$1,908.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,550.90
|
| Rate for Payer: Copperpoint Commercial |
$590.54
|
| Rate for Payer: Health Net of AZ Commercial |
$1,431.60
|
| Rate for Payer: Health Net of AZ Medicare |
$668.08
|
| Rate for Payer: Humana of AZ Medicare |
$357.90
|
| Rate for Payer: Mercy Care Medicaid |
$258.90
|
| Rate for Payer: Self Pay Self Pay |
$1,908.80
|
| Rate for Payer: TriWest Medicare |
$357.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,391.04
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$429.48
|
|
|
CT Chest W/Contrast
|
Facility
|
IP
|
$2,386.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
1005140
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$620.36 |
| Max. Negotiated Rate |
$2,147.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,147.40
|
| Rate for Payer: Bisbee Police All Plans |
$620.36
|
| Rate for Payer: Cash Price |
$1,908.80
|
| Rate for Payer: Self Pay Self Pay |
$1,908.80
|
|
|
CT Chest W/O Contrast
|
Facility
|
OP
|
$2,053.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
1005143
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$1,847.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,847.70
|
| Rate for Payer: Aetna of AZ Medicare |
$574.84
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$307.95
|
| Rate for Payer: Amerigroup Medicare |
$307.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$766.80
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$307.95
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$307.95
|
| Rate for Payer: Bisbee Police All Plans |
$533.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,396.04
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,334.45
|
| Rate for Payer: Copperpoint Commercial |
$508.12
|
| Rate for Payer: Health Net of AZ Commercial |
$1,231.80
|
| Rate for Payer: Health Net of AZ Medicare |
$574.84
|
| Rate for Payer: Humana of AZ Medicare |
$307.95
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$1,642.40
|
| Rate for Payer: TriWest Medicare |
$307.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,196.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$369.54
|
|
|
CT Chest W/O Contrast
|
Facility
|
IP
|
$2,053.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
1005143
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$533.78 |
| Max. Negotiated Rate |
$1,847.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,847.70
|
| Rate for Payer: Bisbee Police All Plans |
$533.78
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Self Pay Self Pay |
$1,642.40
|
|
|
CT Chest W/WO Contrast
|
Facility
|
IP
|
$3,062.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
1005146
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$796.12 |
| Max. Negotiated Rate |
$2,755.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,755.80
|
| Rate for Payer: Bisbee Police All Plans |
$796.12
|
| Rate for Payer: Cash Price |
$2,449.60
|
| Rate for Payer: Self Pay Self Pay |
$2,449.60
|
|
|
CT Chest W/WO Contrast
|
Facility
|
OP
|
$3,062.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
1005146
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$258.90 |
| Max. Negotiated Rate |
$2,755.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,755.80
|
| Rate for Payer: Aetna of AZ Medicare |
$857.36
|
| Rate for Payer: AHCCCS Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicaid |
$258.90
|
| Rate for Payer: Allwell Medicare |
$459.30
|
| Rate for Payer: Amerigroup Medicare |
$459.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,143.66
|
| Rate for Payer: AZCH Complete Medicaid |
$258.90
|
| Rate for Payer: AZCH Complete Medicare |
$459.30
|
| Rate for Payer: Banner UC Health Medicaid |
$258.90
|
| Rate for Payer: Banner UC Health Medicare |
$459.30
|
| Rate for Payer: Bisbee Police All Plans |
$796.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,082.16
|
| Rate for Payer: Cash Price |
$2,449.60
|
| Rate for Payer: Cash Price |
$2,449.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,990.30
|
| Rate for Payer: Copperpoint Commercial |
$757.84
|
| Rate for Payer: Health Net of AZ Commercial |
$1,837.20
|
| Rate for Payer: Health Net of AZ Medicare |
$857.36
|
| Rate for Payer: Humana of AZ Medicare |
$459.30
|
| Rate for Payer: Mercy Care Medicaid |
$258.90
|
| Rate for Payer: Self Pay Self Pay |
$2,449.60
|
| Rate for Payer: TriWest Medicare |
$459.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,785.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$551.16
|
|
