|
CT Upper Extremity w/ Contrast Right
|
Facility
|
IP
|
$2,734.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
821386
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$710.84 |
| Max. Negotiated Rate |
$2,460.60 |
| Rate for Payer: Aetna of AZ Commercial |
$2,460.60
|
| Rate for Payer: Bisbee Police All Plans |
$710.84
|
| Rate for Payer: Cash Price |
$2,187.20
|
| Rate for Payer: Self Pay Self Pay |
$2,187.20
|
|
|
CT Upper Extremity w/o Contrast Left
|
Facility
|
IP
|
$2,352.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
821388
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$611.52 |
| Max. Negotiated Rate |
$2,116.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,116.80
|
| Rate for Payer: Bisbee Police All Plans |
$611.52
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Self Pay Self Pay |
$1,881.60
|
|
|
CT Upper Extremity w/o Contrast Left
|
Facility
|
OP
|
$2,352.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
821388
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$2,116.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,116.80
|
| Rate for Payer: Aetna of AZ Medicare |
$658.56
|
| Rate for Payer: Allwell Medicare |
$352.80
|
| Rate for Payer: Amerigroup Medicare |
$352.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$878.47
|
| Rate for Payer: AZCH Complete Medicare |
$352.80
|
| Rate for Payer: Banner UC Health Medicare |
$352.80
|
| Rate for Payer: Bisbee Police All Plans |
$611.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,599.36
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,528.80
|
| Rate for Payer: Copperpoint Commercial |
$582.12
|
| Rate for Payer: Health Net of AZ Commercial |
$1,411.20
|
| Rate for Payer: Health Net of AZ Medicare |
$658.56
|
| Rate for Payer: Humana of AZ Medicare |
$352.80
|
| Rate for Payer: Self Pay Self Pay |
$1,881.60
|
| Rate for Payer: TriWest Medicare |
$352.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,371.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$423.36
|
|
|
CT Upper Extremity w/o Contrast Right
|
Facility
|
OP
|
$2,352.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
821390
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$2,116.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,116.80
|
| Rate for Payer: Aetna of AZ Medicare |
$658.56
|
| Rate for Payer: Allwell Medicare |
$352.80
|
| Rate for Payer: Amerigroup Medicare |
$352.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$878.47
|
| Rate for Payer: AZCH Complete Medicare |
$352.80
|
| Rate for Payer: Banner UC Health Medicare |
$352.80
|
| Rate for Payer: Bisbee Police All Plans |
$611.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,599.36
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,528.80
|
| Rate for Payer: Copperpoint Commercial |
$582.12
|
| Rate for Payer: Health Net of AZ Commercial |
$1,411.20
|
| Rate for Payer: Health Net of AZ Medicare |
$658.56
|
| Rate for Payer: Humana of AZ Medicare |
$352.80
|
| Rate for Payer: Self Pay Self Pay |
$1,881.60
|
| Rate for Payer: TriWest Medicare |
$352.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,371.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$423.36
|
|
|
CT Upper Extremity w/o Contrast Right
|
Facility
|
IP
|
$2,352.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
821390
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$611.52 |
| Max. Negotiated Rate |
$2,116.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,116.80
|
| Rate for Payer: Bisbee Police All Plans |
$611.52
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Self Pay Self Pay |
$1,881.60
|
|
|
CT Upper Extremity w/ + w/o Contrast Left
|
Facility
|
OP
|
$3,603.00
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
1005229
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$540.45 |
| Max. Negotiated Rate |
$3,242.70 |
| Rate for Payer: Aetna of AZ Commercial |
$3,242.70
|
| Rate for Payer: Aetna of AZ Medicare |
$1,008.84
|
| Rate for Payer: Allwell Medicare |
$540.45
|
| Rate for Payer: Amerigroup Medicare |
$540.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,345.72
|
| Rate for Payer: AZCH Complete Medicare |
$540.45
|
| Rate for Payer: Banner UC Health Medicare |
$540.45
|
| Rate for Payer: Bisbee Police All Plans |
$936.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,450.04
|
| Rate for Payer: Cash Price |
$2,882.40
|
| Rate for Payer: Cigna of AZ Commercial |
$2,341.95
|
| Rate for Payer: Copperpoint Commercial |
$891.74
|
| Rate for Payer: Health Net of AZ Commercial |
$2,161.80
|
| Rate for Payer: Health Net of AZ Medicare |
$1,008.84
|
| Rate for Payer: Humana of AZ Medicare |
$540.45
|
| Rate for Payer: Self Pay Self Pay |
$2,882.40
|
| Rate for Payer: TriWest Medicare |
$540.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,100.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$648.54
|
|
|
CT Upper Extremity w/ + w/o Contrast Left
|
Facility
|
IP
|
$3,603.00
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
1005229
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$936.78 |
| Max. Negotiated Rate |
$3,242.70 |
| Rate for Payer: Aetna of AZ Commercial |
$3,242.70
|
| Rate for Payer: Bisbee Police All Plans |
$936.78
|
| Rate for Payer: Cash Price |
$2,882.40
|
| Rate for Payer: Self Pay Self Pay |
$2,882.40
|
|
|
CT Upper Extremity w/ + w/o Contrast Right
|
Facility
|
OP
|
$2,521.00
|
|
|
Service Code
|
CPT 73202 RT
|
| Hospital Charge Code |
1005231
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$378.15 |
| 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: Allwell Medicare |
$378.15
|
| Rate for Payer: Amerigroup Medicare |
$378.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$941.59
|
| Rate for Payer: AZCH Complete Medicare |
$378.15
|
| 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: 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: 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 Upper Extremity w/ + w/o Contrast Right
|
Facility
|
IP
|
$2,521.00
|
|
|
Service Code
|
CPT 73202 RT
|
| Hospital Charge Code |
1005231
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$2,268.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,268.90
|
| Rate for Payer: Bisbee Police All Plans |
$655.46
|
| Rate for Payer: Cash Price |
$2,016.80
|
| Rate for Payer: Self Pay Self Pay |
$2,016.80
|
|
|
Culdoplasty Enterocele Repair abdominal
|
Facility
|
IP
|
$4,215.00
|
|
|
Service Code
|
CPT 57270
|
| Hospital Charge Code |
27267814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,095.90 |
| Max. Negotiated Rate |
$3,793.50 |
| Rate for Payer: Aetna of AZ Commercial |
$3,793.50
|
| Rate for Payer: Bisbee Police All Plans |
$1,095.90
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Self Pay Self Pay |
$3,372.00
|
|
|
Culdoplasty Enterocele Repair abdominal
|
Facility
|
OP
|
$4,215.00
|
|
|
Service Code
|
CPT 57270
|
| Hospital Charge Code |
27267814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3,793.50 |
| Rate for Payer: Aetna of AZ Commercial |
$3,793.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1,180.20
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$632.25
|
| Rate for Payer: Amerigroup Medicare |
$632.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,574.30
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$632.25
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$632.25
|
| Rate for Payer: Bisbee Police All Plans |
$1,095.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,866.20
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,107.50
|
| Rate for Payer: Copperpoint Commercial |
$1,043.21
|
| Rate for Payer: Health Net of AZ Commercial |
$2,529.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,180.20
|
| Rate for Payer: Humana of AZ Medicare |
$632.25
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$3,372.00
|
| Rate for Payer: TriWest Medicare |
$632.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$758.70
|
|
|
CUT LINEAR 35
|
Facility
|
OP
|
$720.00
|
|
| Hospital Charge Code |
22354789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of AZ Commercial |
$648.00
|
| Rate for Payer: Aetna of AZ Medicare |
$201.60
|
| Rate for Payer: Allwell Medicare |
$108.00
|
| Rate for Payer: Amerigroup Medicare |
$108.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$268.92
|
| Rate for Payer: AZCH Complete Medicare |
$108.00
|
| Rate for Payer: Banner UC Health Medicare |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$489.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna of AZ Commercial |
$504.00
|
| Rate for Payer: Copperpoint Commercial |
$178.20
|
| Rate for Payer: Health Net of AZ Commercial |
$432.00
|
| Rate for Payer: Health Net of AZ Medicare |
$201.60
|
| Rate for Payer: Humana of AZ Medicare |
$108.00
|
| Rate for Payer: Self Pay Self Pay |
$576.00
|
| Rate for Payer: TriWest Medicare |
$108.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$419.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$129.60
|
|
|
CUT LINEAR 35
|
Facility
|
IP
|
$720.00
|
|
| Hospital Charge Code |
22354789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna of AZ Commercial |
$648.00
|
| Rate for Payer: Bisbee Police All Plans |
$187.20
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Self Pay Self Pay |
$576.00
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$8,899.36
|
|
|
Service Code
|
APR-DRG 0453
|
| Hospital Charge Code |
APRDRG0453
|
| Min. Negotiated Rate |
$8,899.36 |
| Max. Negotiated Rate |
$8,899.36 |
| Rate for Payer: AHCCCS Medicaid |
$8,899.36
|
| Rate for Payer: Allwell Medicaid |
$8,899.36
|
| Rate for Payer: AZCH Complete Medicaid |
$8,899.36
|
| Rate for Payer: Banner UC Health Medicaid |
$8,899.36
|
| Rate for Payer: Mercy Care Medicaid |
$8,899.36
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$4,900.68
|
|
|
Service Code
|
APR-DRG 0451
|
| Hospital Charge Code |
APRDRG0451
|
| Min. Negotiated Rate |
$4,900.68 |
| Max. Negotiated Rate |
$4,900.68 |
| Rate for Payer: AHCCCS Medicaid |
$4,900.68
|
| Rate for Payer: Allwell Medicaid |
$4,900.68
|
| Rate for Payer: AZCH Complete Medicaid |
$4,900.68
|
| Rate for Payer: Banner UC Health Medicaid |
$4,900.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,900.68
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$4,900.68
|
|
|
Service Code
|
APR-DRG 0451
|
| Hospital Charge Code |
APRDRG0452
|
| Min. Negotiated Rate |
$4,900.68 |
| Max. Negotiated Rate |
$4,900.68 |
| Rate for Payer: AHCCCS Medicaid |
$4,900.68
|
| Rate for Payer: Allwell Medicaid |
$4,900.68
|
| Rate for Payer: AZCH Complete Medicaid |
$4,900.68
|
| Rate for Payer: Banner UC Health Medicaid |
$4,900.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,900.68
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$6,159.69
|
|
|
Service Code
|
APR-DRG 0452
|
| Hospital Charge Code |
APRDRG0453
|
| Min. Negotiated Rate |
$6,159.69 |
| Max. Negotiated Rate |
$6,159.69 |
| Rate for Payer: AHCCCS Medicaid |
$6,159.69
|
| Rate for Payer: Allwell Medicaid |
$6,159.69
|
| Rate for Payer: AZCH Complete Medicaid |
$6,159.69
|
| Rate for Payer: Banner UC Health Medicaid |
$6,159.69
|
| Rate for Payer: Mercy Care Medicaid |
$6,159.69
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$8,899.36
|
|
|
Service Code
|
APR-DRG 0453
|
| Hospital Charge Code |
APRDRG0451
|
| Min. Negotiated Rate |
$8,899.36 |
| Max. Negotiated Rate |
$8,899.36 |
| Rate for Payer: AHCCCS Medicaid |
$8,899.36
|
| Rate for Payer: Allwell Medicaid |
$8,899.36
|
| Rate for Payer: AZCH Complete Medicaid |
$8,899.36
|
| Rate for Payer: Banner UC Health Medicaid |
$8,899.36
|
| Rate for Payer: Mercy Care Medicaid |
$8,899.36
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$8,899.36
|
|
|
Service Code
|
APR-DRG 0453
|
| Hospital Charge Code |
APRDRG0452
|
| Min. Negotiated Rate |
$8,899.36 |
| Max. Negotiated Rate |
$8,899.36 |
| Rate for Payer: AHCCCS Medicaid |
$8,899.36
|
| Rate for Payer: Allwell Medicaid |
$8,899.36
|
| Rate for Payer: AZCH Complete Medicaid |
$8,899.36
|
| Rate for Payer: Banner UC Health Medicaid |
$8,899.36
|
| Rate for Payer: Mercy Care Medicaid |
$8,899.36
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$16,038.21
|
|
|
Service Code
|
APR-DRG 0454
|
| Hospital Charge Code |
APRDRG0451
|
| Min. Negotiated Rate |
$16,038.21 |
| Max. Negotiated Rate |
$16,038.21 |
| Rate for Payer: AHCCCS Medicaid |
$16,038.21
|
| Rate for Payer: Allwell Medicaid |
$16,038.21
|
| Rate for Payer: AZCH Complete Medicaid |
$16,038.21
|
| Rate for Payer: Banner UC Health Medicaid |
$16,038.21
|
| Rate for Payer: Mercy Care Medicaid |
$16,038.21
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$4,900.68
|
|
|
Service Code
|
APR-DRG 0451
|
| Hospital Charge Code |
APRDRG0453
|
| Min. Negotiated Rate |
$4,900.68 |
| Max. Negotiated Rate |
$4,900.68 |
| Rate for Payer: AHCCCS Medicaid |
$4,900.68
|
| Rate for Payer: Allwell Medicaid |
$4,900.68
|
| Rate for Payer: AZCH Complete Medicaid |
$4,900.68
|
| Rate for Payer: Banner UC Health Medicaid |
$4,900.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,900.68
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$8,899.36
|
|
|
Service Code
|
APR-DRG 0453
|
| Hospital Charge Code |
APRDRG0454
|
| Min. Negotiated Rate |
$8,899.36 |
| Max. Negotiated Rate |
$8,899.36 |
| Rate for Payer: AHCCCS Medicaid |
$8,899.36
|
| Rate for Payer: Allwell Medicaid |
$8,899.36
|
| Rate for Payer: AZCH Complete Medicaid |
$8,899.36
|
| Rate for Payer: Banner UC Health Medicaid |
$8,899.36
|
| Rate for Payer: Mercy Care Medicaid |
$8,899.36
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$6,159.69
|
|
|
Service Code
|
APR-DRG 0452
|
| Hospital Charge Code |
APRDRG0451
|
| Min. Negotiated Rate |
$6,159.69 |
| Max. Negotiated Rate |
$6,159.69 |
| Rate for Payer: AHCCCS Medicaid |
$6,159.69
|
| Rate for Payer: Allwell Medicaid |
$6,159.69
|
| Rate for Payer: AZCH Complete Medicaid |
$6,159.69
|
| Rate for Payer: Banner UC Health Medicaid |
$6,159.69
|
| Rate for Payer: Mercy Care Medicaid |
$6,159.69
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$4,900.68
|
|
|
Service Code
|
APR-DRG 0451
|
| Hospital Charge Code |
APRDRG0454
|
| Min. Negotiated Rate |
$4,900.68 |
| Max. Negotiated Rate |
$4,900.68 |
| Rate for Payer: AHCCCS Medicaid |
$4,900.68
|
| Rate for Payer: Allwell Medicaid |
$4,900.68
|
| Rate for Payer: AZCH Complete Medicaid |
$4,900.68
|
| Rate for Payer: Banner UC Health Medicaid |
$4,900.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,900.68
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$6,159.69
|
|
|
Service Code
|
APR-DRG 0452
|
| Hospital Charge Code |
APRDRG0452
|
| Min. Negotiated Rate |
$6,159.69 |
| Max. Negotiated Rate |
$6,159.69 |
| Rate for Payer: AHCCCS Medicaid |
$6,159.69
|
| Rate for Payer: Allwell Medicaid |
$6,159.69
|
| Rate for Payer: AZCH Complete Medicaid |
$6,159.69
|
| Rate for Payer: Banner UC Health Medicaid |
$6,159.69
|
| Rate for Payer: Mercy Care Medicaid |
$6,159.69
|
|
