|
31502 TRACH TUBE CHANGE
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
22282898
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$203.40
|
| Rate for Payer: Aetna of AZ Medicare |
$63.28
|
| Rate for Payer: AHCCCS Medicaid |
$306.82
|
| Rate for Payer: Allwell Medicaid |
$306.82
|
| Rate for Payer: Allwell Medicare |
$33.90
|
| Rate for Payer: Amerigroup Medicare |
$33.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$84.41
|
| Rate for Payer: AZCH Complete Medicaid |
$306.82
|
| Rate for Payer: AZCH Complete Medicare |
$33.90
|
| Rate for Payer: Banner UC Health Medicaid |
$306.82
|
| Rate for Payer: Banner UC Health Medicare |
$33.90
|
| 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: 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 |
$33.90
|
| Rate for Payer: Mercy Care Medicaid |
$306.82
|
| Rate for Payer: Self Pay Self Pay |
$180.80
|
| Rate for Payer: TriWest Medicare |
$33.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.68
|
|
|
31502 TRACH TUBE CHANGE
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
22282898
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
31579 EXAM TO ASSESS MOVEMENT OF VOCAL CORD FLAPS USING AN E
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
27724317
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$170.82 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna of AZ Commercial |
$591.30
|
| Rate for Payer: Bisbee Police All Plans |
$170.82
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Self Pay Self Pay |
$525.60
|
|
|
31579 EXAM TO ASSESS MOVEMENT OF VOCAL CORD FLAPS USING AN E
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
27724317
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$98.55 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$591.30
|
| Rate for Payer: Aetna of AZ Medicare |
$183.96
|
| Rate for Payer: AHCCCS Medicaid |
$545.94
|
| Rate for Payer: Allwell Medicaid |
$545.94
|
| Rate for Payer: Allwell Medicare |
$98.55
|
| Rate for Payer: Amerigroup Medicare |
$98.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$245.39
|
| Rate for Payer: AZCH Complete Medicaid |
$545.94
|
| Rate for Payer: AZCH Complete Medicare |
$98.55
|
| Rate for Payer: Banner UC Health Medicaid |
$545.94
|
| Rate for Payer: Banner UC Health Medicare |
$98.55
|
| Rate for Payer: Bisbee Police All Plans |
$170.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$446.76
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna of AZ Commercial |
$459.90
|
| Rate for Payer: Copperpoint Commercial |
$162.61
|
| Rate for Payer: Health Net of AZ Commercial |
$394.20
|
| Rate for Payer: Health Net of AZ Medicare |
$183.96
|
| Rate for Payer: Humana of AZ Medicare |
$98.55
|
| Rate for Payer: Mercy Care Medicaid |
$545.94
|
| Rate for Payer: Self Pay Self Pay |
$525.60
|
| Rate for Payer: TriWest Medicare |
$98.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$118.26
|
|
|
32036 THORACOSTOMY W/O PENDING
|
Facility
|
OP
|
$4,019.00
|
|
|
Service Code
|
CPT 32036
|
| Hospital Charge Code |
22282899
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3,617.10 |
| Rate for Payer: Aetna of AZ Commercial |
$3,617.10
|
| Rate for Payer: Aetna of AZ Medicare |
$1,125.32
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$602.85
|
| Rate for Payer: Amerigroup Medicare |
$602.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,501.10
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$602.85
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$602.85
|
| Rate for Payer: Bisbee Police All Plans |
$1,044.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,732.92
|
| Rate for Payer: Cash Price |
$3,215.20
|
| Rate for Payer: Cash Price |
$3,215.20
|
| Rate for Payer: Cigna of AZ Commercial |
$2,813.30
|
| Rate for Payer: Copperpoint Commercial |
$994.70
|
| Rate for Payer: Health Net of AZ Commercial |
$2,411.40
|
| Rate for Payer: Health Net of AZ Medicare |
$1,125.32
|
| Rate for Payer: Humana of AZ Medicare |
$602.85
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$3,215.20
|
| Rate for Payer: TriWest Medicare |
$602.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$723.42
|
|
|
32036 THORACOSTOMY W/O PENDING
|
Facility
|
IP
|
$4,019.00
|
|
|
Service Code
|
CPT 32036
|
| Hospital Charge Code |
22282899
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,044.94 |
| Max. Negotiated Rate |
$3,617.10 |
| Rate for Payer: Aetna of AZ Commercial |
$3,617.10
|
| Rate for Payer: Bisbee Police All Plans |
$1,044.94
|
| Rate for Payer: Cash Price |
$3,215.20
|
| Rate for Payer: Self Pay Self Pay |
$3,215.20
|
|
|
32095 THORACOSTOMY LIMITED
|
Facility
|
OP
|
$3,747.00
|
|
|
Service Code
|
CPT 32095
|
| Hospital Charge Code |
22282900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$562.05 |
| Max. Negotiated Rate |
$3,372.30 |
| Rate for Payer: Aetna of AZ Commercial |
$3,372.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,049.16
|
| Rate for Payer: Allwell Medicare |
$562.05
|
| Rate for Payer: Amerigroup Medicare |
$562.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,399.50
|
| Rate for Payer: AZCH Complete Medicare |
$562.05
|
| Rate for Payer: Banner UC Health Medicare |
$562.05
|
| Rate for Payer: Bisbee Police All Plans |
$974.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,547.96
|
| Rate for Payer: Cash Price |
$2,997.60
|
| Rate for Payer: Cigna of AZ Commercial |
$2,622.90
|
| Rate for Payer: Copperpoint Commercial |
$927.38
|
| Rate for Payer: Health Net of AZ Commercial |
$2,248.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,049.16
|
| Rate for Payer: Humana of AZ Medicare |
$562.05
|
| Rate for Payer: Self Pay Self Pay |
$2,997.60
|
| Rate for Payer: TriWest Medicare |
$562.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,184.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$674.46
|
|
|
32095 THORACOSTOMY LIMITED
|
Facility
|
IP
|
$3,747.00
|
|
|
Service Code
|
CPT 32095
|
| Hospital Charge Code |
22282900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$974.22 |
| Max. Negotiated Rate |
$3,372.30 |
| Rate for Payer: Aetna of AZ Commercial |
$3,372.30
|
| Rate for Payer: Bisbee Police All Plans |
$974.22
|
| Rate for Payer: Cash Price |
$2,997.60
|
| Rate for Payer: Self Pay Self Pay |
$2,997.60
|
|
|
32100 THORACOMY MAJOR
|
Facility
|
IP
|
$4,956.00
|
|
|
Service Code
|
CPT 32100
|
| Hospital Charge Code |
22282901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,288.56 |
| Max. Negotiated Rate |
$4,460.40 |
| Rate for Payer: Aetna of AZ Commercial |
$4,460.40
|
| Rate for Payer: Bisbee Police All Plans |
$1,288.56
|
| Rate for Payer: Cash Price |
$3,964.80
|
| Rate for Payer: Self Pay Self Pay |
$3,964.80
|
|
|
32100 THORACOMY MAJOR
|
Facility
|
OP
|
$4,956.00
|
|
|
Service Code
|
CPT 32100
|
| Hospital Charge Code |
22282901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$4,460.40 |
| Rate for Payer: Aetna of AZ Commercial |
$4,460.40
|
| Rate for Payer: Aetna of AZ Medicare |
$1,387.68
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$743.40
|
| Rate for Payer: Amerigroup Medicare |
$743.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,851.07
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$743.40
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$743.40
|
| Rate for Payer: Bisbee Police All Plans |
$1,288.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,370.08
|
| Rate for Payer: Cash Price |
$3,964.80
|
| Rate for Payer: Cash Price |
$3,964.80
|
| Rate for Payer: Cigna of AZ Commercial |
$3,469.20
|
| Rate for Payer: Copperpoint Commercial |
$1,226.61
|
| Rate for Payer: Health Net of AZ Commercial |
$2,973.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,387.68
|
| Rate for Payer: Humana of AZ Medicare |
$743.40
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$3,964.80
|
| Rate for Payer: TriWest Medicare |
$743.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$892.08
|
|
|
32551 CHEST TUBE INSRTATION
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
22282902
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,305.00
|
| Rate for Payer: Aetna of AZ Medicare |
$406.00
|
| Rate for Payer: AHCCCS Medicaid |
$2,038.90
|
| Rate for Payer: Allwell Medicaid |
$2,038.90
|
| Rate for Payer: Allwell Medicare |
$217.50
|
| Rate for Payer: Amerigroup Medicare |
$217.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$541.58
|
| Rate for Payer: AZCH Complete Medicaid |
$2,038.90
|
| Rate for Payer: AZCH Complete Medicare |
$217.50
|
| Rate for Payer: Banner UC Health Medicaid |
$2,038.90
|
| Rate for Payer: Banner UC Health Medicare |
$217.50
|
| Rate for Payer: Bisbee Police All Plans |
$377.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$986.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,015.00
|
| Rate for Payer: Copperpoint Commercial |
$358.88
|
| Rate for Payer: Health Net of AZ Commercial |
$870.00
|
| Rate for Payer: Health Net of AZ Medicare |
$406.00
|
| Rate for Payer: Humana of AZ Medicare |
$217.50
|
| Rate for Payer: Mercy Care Medicaid |
$2,038.90
|
| Rate for Payer: Self Pay Self Pay |
$1,160.00
|
| Rate for Payer: TriWest Medicare |
$217.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$261.00
|
|
|
32551 CHEST TUBE INSRTATION
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
22282902
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$377.00 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,305.00
|
| Rate for Payer: Bisbee Police All Plans |
$377.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Self Pay Self Pay |
$1,160.00
|
|
|
3.4MM DRILL CANNULA
|
Facility
|
IP
|
$683.00
|
|
| Hospital Charge Code |
22354196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$177.58 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Aetna of AZ Commercial |
$614.70
|
| Rate for Payer: Bisbee Police All Plans |
$177.58
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Self Pay Self Pay |
$546.40
|
|
|
3.4MM DRILL CANNULA
|
Facility
|
OP
|
$683.00
|
|
| Hospital Charge Code |
22354196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.45 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Aetna of AZ Commercial |
$614.70
|
| Rate for Payer: Aetna of AZ Medicare |
$191.24
|
| Rate for Payer: Allwell Medicare |
$102.45
|
| Rate for Payer: Amerigroup Medicare |
$102.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$255.10
|
| Rate for Payer: AZCH Complete Medicare |
$102.45
|
| Rate for Payer: Banner UC Health Medicare |
$102.45
|
| Rate for Payer: Bisbee Police All Plans |
$177.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$464.44
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cigna of AZ Commercial |
$478.10
|
| Rate for Payer: Copperpoint Commercial |
$169.04
|
| Rate for Payer: Health Net of AZ Commercial |
$409.80
|
| Rate for Payer: Health Net of AZ Medicare |
$191.24
|
| Rate for Payer: Humana of AZ Medicare |
$102.45
|
| Rate for Payer: Self Pay Self Pay |
$546.40
|
| Rate for Payer: TriWest Medicare |
$102.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$398.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$122.94
|
|
|
36011 IV CENTRAL VEIN
|
Facility
|
IP
|
$1,273.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
22282903
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$330.98 |
| Max. Negotiated Rate |
$1,145.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,145.70
|
| Rate for Payer: Bisbee Police All Plans |
$330.98
|
| Rate for Payer: Cash Price |
$1,018.40
|
| Rate for Payer: Self Pay Self Pay |
$1,018.40
|
|
|
36011 IV CENTRAL VEIN
|
Facility
|
OP
|
$1,273.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
22282903
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,145.70
|
| Rate for Payer: Aetna of AZ Medicare |
$356.44
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$190.95
|
| Rate for Payer: Amerigroup Medicare |
$190.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$475.47
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$190.95
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$190.95
|
| Rate for Payer: Bisbee Police All Plans |
$330.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$865.64
|
| Rate for Payer: Cash Price |
$1,018.40
|
| Rate for Payer: Cash Price |
$1,018.40
|
| Rate for Payer: Cigna of AZ Commercial |
$891.10
|
| Rate for Payer: Copperpoint Commercial |
$315.07
|
| Rate for Payer: Health Net of AZ Commercial |
$763.80
|
| Rate for Payer: Health Net of AZ Medicare |
$356.44
|
| Rate for Payer: Humana of AZ Medicare |
$190.95
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$1,018.40
|
| Rate for Payer: TriWest Medicare |
$190.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$229.14
|
|
|
36400 VENIPUNCTURE <3Y CENTRAL
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
22282904
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of AZ Commercial |
$47.70
|
| Rate for Payer: Bisbee Police All Plans |
$13.78
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Self Pay Self Pay |
$42.40
|
|
|
36400 VENIPUNCTURE <3Y CENTRAL
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
22282904
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of AZ Commercial |
$47.70
|
| Rate for Payer: Aetna of AZ Medicare |
$14.84
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$7.95
|
| Rate for Payer: Amerigroup Medicare |
$7.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$19.80
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$7.95
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$7.95
|
| Rate for Payer: Bisbee Police All Plans |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$36.04
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cigna of AZ Commercial |
$37.10
|
| Rate for Payer: Copperpoint Commercial |
$13.12
|
| Rate for Payer: Health Net of AZ Commercial |
$31.80
|
| Rate for Payer: Health Net of AZ Medicare |
$14.84
|
| Rate for Payer: Humana of AZ Medicare |
$7.95
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$42.40
|
| Rate for Payer: TriWest Medicare |
$7.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$30.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$9.54
|
|
|
36405 SCALP VEIN IV<3Y
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 36405
|
| Hospital Charge Code |
22282905
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of AZ Commercial |
$64.80
|
| Rate for Payer: Bisbee Police All Plans |
$18.72
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Self Pay Self Pay |
$57.60
|
|
|
36405 SCALP VEIN IV<3Y
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 36405
|
| Hospital Charge Code |
22282905
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of AZ Commercial |
$64.80
|
| Rate for Payer: Aetna of AZ Medicare |
$20.16
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$10.80
|
| Rate for Payer: Amerigroup Medicare |
$10.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$26.89
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$10.80
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$10.80
|
| Rate for Payer: Bisbee Police All Plans |
$18.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$48.96
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of AZ Commercial |
$50.40
|
| Rate for Payer: Copperpoint Commercial |
$17.82
|
| Rate for Payer: Health Net of AZ Commercial |
$43.20
|
| Rate for Payer: Health Net of AZ Medicare |
$20.16
|
| Rate for Payer: Humana of AZ Medicare |
$10.80
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$57.60
|
| Rate for Payer: TriWest Medicare |
$10.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$41.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.96
|
|
|
36406 OTHER VEIN IV <3Y
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 36406
|
| Hospital Charge Code |
22282906
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of AZ Commercial |
$47.70
|
| Rate for Payer: Bisbee Police All Plans |
$13.78
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Self Pay Self Pay |
$42.40
|
|
|
36406 OTHER VEIN IV <3Y
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 36406
|
| Hospital Charge Code |
22282906
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna of AZ Commercial |
$47.70
|
| Rate for Payer: Aetna of AZ Medicare |
$14.84
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$7.95
|
| Rate for Payer: Amerigroup Medicare |
$7.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$19.80
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$7.95
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$7.95
|
| Rate for Payer: Bisbee Police All Plans |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$36.04
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cigna of AZ Commercial |
$37.10
|
| Rate for Payer: Copperpoint Commercial |
$13.12
|
| Rate for Payer: Health Net of AZ Commercial |
$31.80
|
| Rate for Payer: Health Net of AZ Medicare |
$14.84
|
| Rate for Payer: Humana of AZ Medicare |
$7.95
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$42.40
|
| Rate for Payer: TriWest Medicare |
$7.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$30.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$9.54
|
|
|
36410 VENIPUNCTURE PHYSICIAN
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
22282907
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Bisbee Police All Plans |
$20.02
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Self Pay Self Pay |
$61.60
|
|
|
36410 VENIPUNCTURE PHYSICIAN
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
22282907
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Aetna of AZ Medicare |
$21.56
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$11.55
|
| Rate for Payer: Amerigroup Medicare |
$11.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$28.76
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$11.55
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$11.55
|
| Rate for Payer: Bisbee Police All Plans |
$20.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$52.36
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cigna of AZ Commercial |
$53.90
|
| Rate for Payer: Copperpoint Commercial |
$19.06
|
| Rate for Payer: Health Net of AZ Commercial |
$46.20
|
| Rate for Payer: Health Net of AZ Medicare |
$21.56
|
| Rate for Payer: Humana of AZ Medicare |
$11.55
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$61.60
|
| Rate for Payer: TriWest Medicare |
$11.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$44.89
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.86
|
|
|
36420 IV CUTDOWN<1Y
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 36420
|
| Hospital Charge Code |
22282908
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$279.00
|
| Rate for Payer: Aetna of AZ Medicare |
$86.80
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$46.50
|
| Rate for Payer: Amerigroup Medicare |
$46.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$115.78
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$46.50
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$46.50
|
| Rate for Payer: Bisbee Police All Plans |
$80.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$210.80
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna of AZ Commercial |
$217.00
|
| Rate for Payer: Copperpoint Commercial |
$76.72
|
| Rate for Payer: Health Net of AZ Commercial |
$186.00
|
| Rate for Payer: Health Net of AZ Medicare |
$86.80
|
| Rate for Payer: Humana of AZ Medicare |
$46.50
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$248.00
|
| Rate for Payer: TriWest Medicare |
$46.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.80
|
|
