|
Postpartum And Post Abortion Diagnoses Without Procedure
|
Facility
IP
|
$1,845.38
|
|
|
Service Code
|
APRDRG 5611
|
| Hospital Charge Code |
APRDRG5611
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$1,845.38 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$1,845.38
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$1,845.38
|
| Rate for Payer: Banner University Family Care Medicaid |
$1,845.38
|
| Rate for Payer: Mercy Care Medicaid |
$1,845.38
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
IP
|
$32,425.02
|
|
|
Service Code
|
APRDRG 5484
|
| Hospital Charge Code |
APRDRG5484
|
| Min. Negotiated Rate |
$32,425.02 |
| Max. Negotiated Rate |
$32,425.02 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$32,425.02
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$32,425.02
|
| Rate for Payer: Banner University Family Care Medicaid |
$32,425.02
|
| Rate for Payer: Mercy Care Medicaid |
$32,425.02
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
IP
|
$5,311.70
|
|
|
Service Code
|
APRDRG 5482
|
| Hospital Charge Code |
APRDRG5482
|
| Min. Negotiated Rate |
$5,311.70 |
| Max. Negotiated Rate |
$5,311.70 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$5,311.70
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$5,311.70
|
| Rate for Payer: Banner University Family Care Medicaid |
$5,311.70
|
| Rate for Payer: Mercy Care Medicaid |
$5,311.70
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
IP
|
$2,447.89
|
|
|
Service Code
|
APRDRG 5481
|
| Hospital Charge Code |
APRDRG5481
|
| Min. Negotiated Rate |
$2,447.89 |
| Max. Negotiated Rate |
$2,447.89 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,447.89
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,447.89
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,447.89
|
| Rate for Payer: Mercy Care Medicaid |
$2,447.89
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
IP
|
$10,381.42
|
|
|
Service Code
|
APRDRG 5483
|
| Hospital Charge Code |
APRDRG5483
|
| Min. Negotiated Rate |
$10,381.42 |
| Max. Negotiated Rate |
$10,381.42 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$10,381.42
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$10,381.42
|
| Rate for Payer: Banner University Family Care Medicaid |
$10,381.42
|
| Rate for Payer: Mercy Care Medicaid |
$10,381.42
|
|
|
Potassium 24 hr urine
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633618
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$63.90
|
| Rate for Payer: Aetna Medicare |
$19.88
|
| Rate for Payer: AHCCCS Medicaid |
$4.73
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.73
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$12.07
|
| Rate for Payer: Amerigroup Medicare |
$12.07
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$26.52
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4.73
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$12.07
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$12.07
|
| Rate for Payer: Banner University Family Care Medicaid |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$46.24
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$18.46
|
| Rate for Payer: Cigna All Products |
$46.15
|
| Rate for Payer: Copperpoint |
$19.92
|
| Rate for Payer: HealthNet Commercial |
$42.60
|
| Rate for Payer: HealthNet Medicare |
$19.88
|
| Rate for Payer: Humana Medicare |
$12.07
|
| Rate for Payer: Mercy Care Medicaid |
$4.73
|
| Rate for Payer: SELF PAY |
$56.80
|
| Rate for Payer: Veterans (Triwest) |
$12.07
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$41.39
|
| Rate for Payer: United Healthcare Medicare |
$12.78
|
|
|
Potassium 24 hr urine
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633618
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$63.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$12.07
|
| Rate for Payer: Amerigroup Medicare |
$12.07
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$12.07
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$46.24
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$18.46
|
| Rate for Payer: Copperpoint |
$19.92
|
| Rate for Payer: Humana Medicare |
$12.07
|
| Rate for Payer: SELF PAY |
$56.80
|
| Rate for Payer: Veterans (Triwest) |
$12.07
|
|
|
Potassium Level
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
633616
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$67.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$12.75
|
| Rate for Payer: Amerigroup Medicare |
$12.75
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$12.75
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$12.75
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$19.50
|
| Rate for Payer: Copperpoint |
$21.04
|
| Rate for Payer: Humana Medicare |
$12.75
|
| Rate for Payer: SELF PAY |
$60.00
|
| Rate for Payer: Veterans (Triwest) |
$12.75
|
|
|
Potassium Level
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
633616
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$67.50
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: AHCCCS Medicaid |
$4.76
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.76
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$12.75
|
| Rate for Payer: Amerigroup Medicare |
$12.75
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$28.01
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4.76
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$12.75
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$12.75
|
| Rate for Payer: Banner University Family Care Medicaid |
$4.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$19.50
|
| Rate for Payer: Cigna All Products |
$48.75
|
| Rate for Payer: Copperpoint |
$21.04
|
| Rate for Payer: HealthNet Commercial |
$45.00
|
| Rate for Payer: HealthNet Medicare |
$21.00
|
| Rate for Payer: Humana Medicare |
$12.75
|
| Rate for Payer: Mercy Care Medicaid |
$4.76
|
| Rate for Payer: SELF PAY |
$60.00
|
| Rate for Payer: Veterans (Triwest) |
$12.75
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$43.72
|
| Rate for Payer: United Healthcare Medicare |
$13.50
|
|
|
Powerpoint SLIM IMPLANTABLE PORT
|
Facility
IP
|
$1,571.25
|
|
| Hospital Charge Code |
24325294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$267.11 |
| Max. Negotiated Rate |
$1,414.12 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,414.12
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$267.11
|
| Rate for Payer: Amerigroup Medicare |
$267.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$267.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$267.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$408.53
|
| Rate for Payer: Copperpoint |
$440.74
|
| Rate for Payer: Humana Medicare |
$267.11
|
| Rate for Payer: SELF PAY |
$1,257.00
|
| Rate for Payer: Veterans (Triwest) |
$267.11
|
|
|
Powerpoint SLIM IMPLANTABLE PORT
|
Facility
OP
|
$1,571.25
|
|
| Hospital Charge Code |
24325294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$267.11 |
| Max. Negotiated Rate |
$1,414.12 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,414.12
|
| Rate for Payer: Aetna Medicare |
$439.95
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$267.11
|
| Rate for Payer: Amerigroup Medicare |
$267.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$586.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$267.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$267.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$408.53
|
| Rate for Payer: Cigna All Products |
$1,099.88
|
| Rate for Payer: Copperpoint |
$440.74
|
| Rate for Payer: HealthNet Commercial |
$942.75
|
| Rate for Payer: HealthNet Medicare |
$439.95
|
| Rate for Payer: Humana Medicare |
$267.11
|
| Rate for Payer: SELF PAY |
$1,257.00
|
| Rate for Payer: Veterans (Triwest) |
$267.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$916.04
|
| Rate for Payer: United Healthcare Medicare |
$282.82
|
|
|
Prealbumin LC
|
Facility
IP
|
$214.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
1905830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$192.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$36.38
|
| Rate for Payer: Amerigroup Medicare |
$36.38
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$36.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$36.38
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$55.64
|
| Rate for Payer: Copperpoint |
$60.03
|
| Rate for Payer: Humana Medicare |
$36.38
|
| Rate for Payer: SELF PAY |
$171.20
|
| Rate for Payer: Veterans (Triwest) |
$36.38
|
|
|
Prealbumin LC
|
Facility
OP
|
$214.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
1905830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$192.60
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: AHCCCS Medicaid |
$14.59
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$14.59
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$36.38
|
| Rate for Payer: Amerigroup Medicare |
$36.38
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$79.93
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$14.59
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$36.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$36.38
|
| Rate for Payer: Banner University Family Care Medicaid |
$14.59
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$55.64
|
| Rate for Payer: Cigna All Products |
$139.10
|
| Rate for Payer: Copperpoint |
$60.03
|
| Rate for Payer: HealthNet Commercial |
$128.40
|
| Rate for Payer: HealthNet Medicare |
$59.92
|
| Rate for Payer: Humana Medicare |
$36.38
|
| Rate for Payer: Mercy Care Medicaid |
$14.59
|
| Rate for Payer: SELF PAY |
$171.20
|
| Rate for Payer: Veterans (Triwest) |
$36.38
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$124.76
|
| Rate for Payer: United Healthcare Medicare |
$38.52
|
|
|
PRE-ANES EXAM/EVAL
|
Facility
OP
|
$177.00
|
|
|
Service Code
|
CPT 99231 QZ
|
| Hospital Charge Code |
22789175
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$159.30
|
| Rate for Payer: Aetna Medicare |
$49.56
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$30.09
|
| Rate for Payer: Amerigroup Medicare |
$30.09
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$66.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$30.09
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$30.09
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$46.02
|
| Rate for Payer: Cigna All Products |
$115.05
|
| Rate for Payer: Copperpoint |
$49.65
|
| Rate for Payer: HealthNet Commercial |
$106.20
|
| Rate for Payer: HealthNet Medicare |
$49.56
|
| Rate for Payer: Humana Medicare |
$30.09
|
| Rate for Payer: SELF PAY |
$141.60
|
| Rate for Payer: Veterans (Triwest) |
$30.09
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$103.19
|
| Rate for Payer: United Healthcare Medicare |
$31.86
|
|
|
PRE-ANES EXAM/EVAL
|
Facility
IP
|
$177.00
|
|
|
Service Code
|
CPT 99231 QZ
|
| Hospital Charge Code |
22789175
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$159.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$30.09
|
| Rate for Payer: Amerigroup Medicare |
$30.09
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$30.09
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$30.09
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$46.02
|
| Rate for Payer: Copperpoint |
$49.65
|
| Rate for Payer: Humana Medicare |
$30.09
|
| Rate for Payer: SELF PAY |
$141.60
|
| Rate for Payer: Veterans (Triwest) |
$30.09
|
|
|
PRECISION THIN 7.0 X .38 X 18.5MM
|
Facility
OP
|
$137.00
|
|
| Hospital Charge Code |
24135537
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: SELF PAY |
$109.60
|
| Rate for Payer: Aetna POS, PPO, HMO |
$123.30
|
| Rate for Payer: Aetna Medicare |
$38.36
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$23.29
|
| Rate for Payer: Amerigroup Medicare |
$23.29
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$51.17
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.29
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.29
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$35.62
|
| Rate for Payer: Cigna All Products |
$95.90
|
| Rate for Payer: Copperpoint |
$38.43
|
| Rate for Payer: HealthNet Commercial |
$82.20
|
| Rate for Payer: HealthNet Medicare |
$38.36
|
| Rate for Payer: Humana Medicare |
$23.29
|
| Rate for Payer: Veterans (Triwest) |
$23.29
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$79.87
|
| Rate for Payer: United Healthcare Medicare |
$24.66
|
|
|
PRECISION THIN 7.0 X .38 X 18.5MM
|
Facility
IP
|
$137.00
|
|
| Hospital Charge Code |
24135537
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$123.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$23.29
|
| Rate for Payer: Amerigroup Medicare |
$23.29
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.29
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.29
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$35.62
|
| Rate for Payer: Copperpoint |
$38.43
|
| Rate for Payer: Humana Medicare |
$23.29
|
| Rate for Payer: SELF PAY |
$109.60
|
| Rate for Payer: Veterans (Triwest) |
$23.29
|
|
|
PRECISION THIN 9.0 X .38 X .25.0MM
|
Facility
OP
|
$135.00
|
|
| Hospital Charge Code |
24185370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$121.50
|
| Rate for Payer: Aetna Medicare |
$37.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$22.95
|
| Rate for Payer: Amerigroup Medicare |
$22.95
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$50.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$22.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$22.95
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$35.10
|
| Rate for Payer: Cigna All Products |
$94.50
|
| Rate for Payer: Copperpoint |
$37.87
|
| Rate for Payer: HealthNet Commercial |
$81.00
|
| Rate for Payer: HealthNet Medicare |
$37.80
|
| Rate for Payer: Humana Medicare |
$22.95
|
| Rate for Payer: SELF PAY |
$108.00
|
| Rate for Payer: Veterans (Triwest) |
$22.95
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$78.70
|
| Rate for Payer: United Healthcare Medicare |
$24.30
|
|
|
PRECISION THIN 9.0 X .38 X .25.0MM
|
Facility
IP
|
$135.00
|
|
| Hospital Charge Code |
24185370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$121.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$22.95
|
| Rate for Payer: Amerigroup Medicare |
$22.95
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$22.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$22.95
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$35.10
|
| Rate for Payer: Copperpoint |
$37.87
|
| Rate for Payer: Humana Medicare |
$22.95
|
| Rate for Payer: SELF PAY |
$108.00
|
| Rate for Payer: Veterans (Triwest) |
$22.95
|
|
|
PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
23294372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$98.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.53
|
| Rate for Payer: Amerigroup Medicare |
$18.53
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$28.34
|
| Rate for Payer: Copperpoint |
$30.57
|
| Rate for Payer: Humana Medicare |
$18.53
|
| Rate for Payer: SELF PAY |
$87.20
|
| Rate for Payer: Veterans (Triwest) |
$18.53
|
|
|
PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
23294372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Copperpoint |
$30.57
|
| Rate for Payer: Aetna POS, PPO, HMO |
$98.10
|
| Rate for Payer: Aetna Medicare |
$30.52
|
| Rate for Payer: AHCCCS Medicaid |
$15.05
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$15.05
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.53
|
| Rate for Payer: Amerigroup Medicare |
$18.53
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$40.71
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$15.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.53
|
| Rate for Payer: Banner University Family Care Medicaid |
$15.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$28.34
|
| Rate for Payer: Cigna All Products |
$70.85
|
| Rate for Payer: HealthNet Commercial |
$65.40
|
| Rate for Payer: HealthNet Medicare |
$30.52
|
| Rate for Payer: Humana Medicare |
$18.53
|
| Rate for Payer: Mercy Care Medicaid |
$15.05
|
| Rate for Payer: SELF PAY |
$87.20
|
| Rate for Payer: Veterans (Triwest) |
$18.53
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$63.55
|
| Rate for Payer: United Healthcare Medicare |
$19.62
|
|
|
PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
23296930
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$98.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.53
|
| Rate for Payer: Amerigroup Medicare |
$18.53
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$28.34
|
| Rate for Payer: Copperpoint |
$30.57
|
| Rate for Payer: Humana Medicare |
$18.53
|
| Rate for Payer: SELF PAY |
$87.20
|
| Rate for Payer: Veterans (Triwest) |
$18.53
|
|
|
PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
23296930
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$98.10
|
| Rate for Payer: Aetna Medicare |
$30.52
|
| Rate for Payer: AHCCCS Medicaid |
$15.05
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$15.05
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.53
|
| Rate for Payer: Amerigroup Medicare |
$18.53
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$40.71
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$15.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.53
|
| Rate for Payer: Banner University Family Care Medicaid |
$15.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$28.34
|
| Rate for Payer: Cigna All Products |
$70.85
|
| Rate for Payer: Copperpoint |
$30.57
|
| Rate for Payer: HealthNet Commercial |
$65.40
|
| Rate for Payer: HealthNet Medicare |
$30.52
|
| Rate for Payer: Humana Medicare |
$18.53
|
| Rate for Payer: Mercy Care Medicaid |
$15.05
|
| Rate for Payer: SELF PAY |
$87.20
|
| Rate for Payer: Veterans (Triwest) |
$18.53
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$63.55
|
| Rate for Payer: United Healthcare Medicare |
$19.62
|
|
|
Pregnancy Test Serum 1
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
9579719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$190.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$36.04
|
| Rate for Payer: Amerigroup Medicare |
$36.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$36.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$36.04
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$137.36
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$55.12
|
| Rate for Payer: Copperpoint |
$59.47
|
| Rate for Payer: Humana Medicare |
$36.04
|
| Rate for Payer: SELF PAY |
$169.60
|
| Rate for Payer: Veterans (Triwest) |
$36.04
|
|
|
Pregnancy Test Serum 1
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
9579719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna Medicare |
$59.36
|
| Rate for Payer: Aetna POS, PPO, HMO |
$190.80
|
| Rate for Payer: AHCCCS Medicaid |
$7.52
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$7.52
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$36.04
|
| Rate for Payer: Amerigroup Medicare |
$36.04
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$79.18
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$7.52
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$36.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$36.04
|
| Rate for Payer: Banner University Family Care Medicaid |
$7.52
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$137.36
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$55.12
|
| Rate for Payer: Cigna All Products |
$137.80
|
| Rate for Payer: Copperpoint |
$59.47
|
| Rate for Payer: HealthNet Commercial |
$127.20
|
| Rate for Payer: HealthNet Medicare |
$59.36
|
| Rate for Payer: Humana Medicare |
$36.04
|
| Rate for Payer: Mercy Care Medicaid |
$7.52
|
| Rate for Payer: SELF PAY |
$169.60
|
| Rate for Payer: Veterans (Triwest) |
$36.04
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$123.60
|
| Rate for Payer: United Healthcare Medicare |
$38.16
|
|