|
Pregnancy Test Urine 1
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
9579720
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$143.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$27.03
|
| Rate for Payer: Amerigroup Medicare |
$27.03
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$27.03
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$27.03
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$103.01
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$41.34
|
| Rate for Payer: Copperpoint |
$44.60
|
| Rate for Payer: Humana Medicare |
$27.03
|
| Rate for Payer: SELF PAY |
$127.20
|
| Rate for Payer: Veterans (Triwest) |
$27.03
|
|
|
Pregnancy Test Urine 1
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
9579720
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$143.10
|
| Rate for Payer: Aetna Medicare |
$44.52
|
| Rate for Payer: AHCCCS Medicaid |
$8.61
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$8.61
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$27.03
|
| Rate for Payer: Amerigroup Medicare |
$27.03
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$59.39
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$8.61
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$27.03
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$27.03
|
| Rate for Payer: Banner University Family Care Medicaid |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$103.01
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$41.34
|
| Rate for Payer: Cigna All Products |
$103.35
|
| Rate for Payer: Copperpoint |
$44.60
|
| Rate for Payer: HealthNet Commercial |
$95.40
|
| Rate for Payer: HealthNet Medicare |
$44.52
|
| Rate for Payer: Humana Medicare |
$27.03
|
| Rate for Payer: Mercy Care Medicaid |
$8.61
|
| Rate for Payer: SELF PAY |
$127.20
|
| Rate for Payer: Veterans (Triwest) |
$27.03
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$92.70
|
| Rate for Payer: United Healthcare Medicare |
$28.62
|
|
|
PRESS PATCH
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
22355154
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$32.40
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.12
|
| Rate for Payer: Amerigroup Medicare |
$6.12
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$13.45
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.12
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$9.36
|
| Rate for Payer: Cigna All Products |
$25.20
|
| Rate for Payer: Copperpoint |
$10.10
|
| Rate for Payer: HealthNet Commercial |
$21.60
|
| Rate for Payer: HealthNet Medicare |
$10.08
|
| Rate for Payer: Humana Medicare |
$6.12
|
| Rate for Payer: SELF PAY |
$28.80
|
| Rate for Payer: Veterans (Triwest) |
$6.12
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$20.99
|
| Rate for Payer: United Healthcare Medicare |
$6.48
|
|
|
PRESS PATCH
|
Facility
IP
|
$36.00
|
|
| Hospital Charge Code |
22355154
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$32.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.12
|
| Rate for Payer: Amerigroup Medicare |
$6.12
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.12
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$9.36
|
| Rate for Payer: Copperpoint |
$10.10
|
| Rate for Payer: Humana Medicare |
$6.12
|
| Rate for Payer: SELF PAY |
$28.80
|
| Rate for Payer: Veterans (Triwest) |
$6.12
|
|
|
Primidone (Mysoline), Serum LC
|
Facility
OP
|
$319.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
1285610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.59 |
| Max. Negotiated Rate |
$287.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$287.10
|
| Rate for Payer: Aetna Medicare |
$89.32
|
| Rate for Payer: AHCCCS Medicaid |
$16.59
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$16.59
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$54.23
|
| Rate for Payer: Amerigroup Medicare |
$54.23
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$119.15
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$16.59
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$54.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$54.23
|
| Rate for Payer: Banner University Family Care Medicaid |
$16.59
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$82.94
|
| Rate for Payer: Cigna All Products |
$207.35
|
| Rate for Payer: Copperpoint |
$89.48
|
| Rate for Payer: HealthNet Commercial |
$191.40
|
| Rate for Payer: HealthNet Medicare |
$89.32
|
| Rate for Payer: Humana Medicare |
$54.23
|
| Rate for Payer: Mercy Care Medicaid |
$16.59
|
| Rate for Payer: SELF PAY |
$255.20
|
| Rate for Payer: Veterans (Triwest) |
$54.23
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$185.98
|
| Rate for Payer: United Healthcare Medicare |
$57.42
|
|
|
Primidone (Mysoline), Serum LC
|
Facility
IP
|
$319.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
1285610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$287.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$287.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$54.23
|
| Rate for Payer: Amerigroup Medicare |
$54.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$54.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$54.23
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$82.94
|
| Rate for Payer: Copperpoint |
$89.48
|
| Rate for Payer: Humana Medicare |
$54.23
|
| Rate for Payer: SELF PAY |
$255.20
|
| Rate for Payer: Veterans (Triwest) |
$54.23
|
|
|
PROBE PULSE OX PED/ADULT NOVAMETRIX
|
Facility
OP
|
$101.00
|
|
| Hospital Charge Code |
22355401
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$90.90
|
| Rate for Payer: Aetna Medicare |
$28.28
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.17
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$37.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.17
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$26.26
|
| Rate for Payer: Cigna All Products |
$70.70
|
| Rate for Payer: Copperpoint |
$28.33
|
| Rate for Payer: HealthNet Commercial |
$60.60
|
| Rate for Payer: HealthNet Medicare |
$28.28
|
| Rate for Payer: Humana Medicare |
$17.17
|
| Rate for Payer: SELF PAY |
$80.80
|
| Rate for Payer: Veterans (Triwest) |
$17.17
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$58.88
|
| Rate for Payer: United Healthcare Medicare |
$18.18
|
|
|
PROBE PULSE OX PED/ADULT NOVAMETRIX
|
Facility
IP
|
$101.00
|
|
| Hospital Charge Code |
22355401
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$90.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.17
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.17
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$26.26
|
| Rate for Payer: Copperpoint |
$28.33
|
| Rate for Payer: Humana Medicare |
$17.17
|
| Rate for Payer: SELF PAY |
$80.80
|
| Rate for Payer: Veterans (Triwest) |
$17.17
|
|
|
Procedures For Obesity
|
Facility
IP
|
$7,285.44
|
|
|
Service Code
|
APRDRG 4031
|
| Hospital Charge Code |
APRDRG4031
|
| Min. Negotiated Rate |
$7,285.44 |
| Max. Negotiated Rate |
$7,285.44 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$7,285.44
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$7,285.44
|
| Rate for Payer: Banner University Family Care Medicaid |
$7,285.44
|
| Rate for Payer: Mercy Care Medicaid |
$7,285.44
|
|
|
Procedures For Obesity
|
Facility
IP
|
$29,636.25
|
|
|
Service Code
|
APRDRG 4034
|
| Hospital Charge Code |
APRDRG4034
|
| Min. Negotiated Rate |
$29,636.25 |
| Max. Negotiated Rate |
$29,636.25 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$29,636.25
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$29,636.25
|
| Rate for Payer: Banner University Family Care Medicaid |
$29,636.25
|
| Rate for Payer: Mercy Care Medicaid |
$29,636.25
|
|
|
Procedures For Obesity
|
Facility
IP
|
$8,425.22
|
|
|
Service Code
|
APRDRG 4032
|
| Hospital Charge Code |
APRDRG4032
|
| Min. Negotiated Rate |
$8,425.22 |
| Max. Negotiated Rate |
$8,425.22 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$8,425.22
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$8,425.22
|
| Rate for Payer: Banner University Family Care Medicaid |
$8,425.22
|
| Rate for Payer: Mercy Care Medicaid |
$8,425.22
|
|
|
Procedures For Obesity
|
Facility
IP
|
$13,512.47
|
|
|
Service Code
|
APRDRG 4033
|
| Hospital Charge Code |
APRDRG4033
|
| Min. Negotiated Rate |
$13,512.47 |
| Max. Negotiated Rate |
$13,512.47 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13,512.47
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13,512.47
|
| Rate for Payer: Banner University Family Care Medicaid |
$13,512.47
|
| Rate for Payer: Mercy Care Medicaid |
$13,512.47
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
IP
|
$15,397.83
|
|
|
Service Code
|
APRDRG 8502
|
| Hospital Charge Code |
APRDRG8502
|
| Min. Negotiated Rate |
$15,397.83 |
| Max. Negotiated Rate |
$15,397.83 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$15,397.83
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$15,397.83
|
| Rate for Payer: Banner University Family Care Medicaid |
$15,397.83
|
| Rate for Payer: Mercy Care Medicaid |
$15,397.83
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
IP
|
$19,903.63
|
|
|
Service Code
|
APRDRG 8503
|
| Hospital Charge Code |
APRDRG8503
|
| Min. Negotiated Rate |
$19,903.63 |
| Max. Negotiated Rate |
$19,903.63 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$19,903.63
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$19,903.63
|
| Rate for Payer: Banner University Family Care Medicaid |
$19,903.63
|
| Rate for Payer: Mercy Care Medicaid |
$19,903.63
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
IP
|
$44,695.31
|
|
|
Service Code
|
APRDRG 8504
|
| Hospital Charge Code |
APRDRG8504
|
| Min. Negotiated Rate |
$44,695.31 |
| Max. Negotiated Rate |
$44,695.31 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$44,695.31
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$44,695.31
|
| Rate for Payer: Banner University Family Care Medicaid |
$44,695.31
|
| Rate for Payer: Mercy Care Medicaid |
$44,695.31
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
IP
|
$11,244.14
|
|
|
Service Code
|
APRDRG 8501
|
| Hospital Charge Code |
APRDRG8501
|
| Min. Negotiated Rate |
$11,244.14 |
| Max. Negotiated Rate |
$11,244.14 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$11,244.14
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$11,244.14
|
| Rate for Payer: Banner University Family Care Medicaid |
$11,244.14
|
| Rate for Payer: Mercy Care Medicaid |
$11,244.14
|
|
|
Progesterone LC
|
Facility
OP
|
$546.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
1909537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$491.40
|
| Rate for Payer: Aetna Medicare |
$152.88
|
| Rate for Payer: AHCCCS Medicaid |
$20.86
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$20.86
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$92.82
|
| Rate for Payer: Amerigroup Medicare |
$92.82
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$203.93
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$20.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$92.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$92.82
|
| Rate for Payer: Banner University Family Care Medicaid |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$357.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$141.96
|
| Rate for Payer: Cigna All Products |
$354.90
|
| Rate for Payer: Copperpoint |
$153.15
|
| Rate for Payer: HealthNet Commercial |
$327.60
|
| Rate for Payer: HealthNet Medicare |
$152.88
|
| Rate for Payer: Humana Medicare |
$92.82
|
| Rate for Payer: Mercy Care Medicaid |
$20.86
|
| Rate for Payer: SELF PAY |
$436.80
|
| Rate for Payer: Veterans (Triwest) |
$92.82
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$318.32
|
| Rate for Payer: United Healthcare Medicare |
$98.28
|
|
|
Progesterone LC
|
Facility
IP
|
$546.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
1909537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$491.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$92.82
|
| Rate for Payer: Amerigroup Medicare |
$92.82
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$92.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$92.82
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$357.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$141.96
|
| Rate for Payer: Copperpoint |
$153.15
|
| Rate for Payer: Humana Medicare |
$92.82
|
| Rate for Payer: SELF PAY |
$436.80
|
| Rate for Payer: Veterans (Triwest) |
$92.82
|
|
|
Programming State II
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
27281906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$189.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$35.70
|
| Rate for Payer: Amerigroup Medicare |
$35.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$35.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$35.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$54.60
|
| Rate for Payer: Copperpoint |
$58.91
|
| Rate for Payer: Humana Medicare |
$35.70
|
| Rate for Payer: SELF PAY |
$168.00
|
| Rate for Payer: Veterans (Triwest) |
$35.70
|
|
|
Programming State II
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
27281906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$189.00
|
| Rate for Payer: Aetna Medicare |
$58.80
|
| Rate for Payer: AHCCCS Medicaid |
$145.44
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$145.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$35.70
|
| Rate for Payer: Amerigroup Medicare |
$35.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$78.44
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$145.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$35.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$35.70
|
| Rate for Payer: Banner University Family Care Medicaid |
$145.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$54.60
|
| Rate for Payer: Cigna All Products |
$105.00
|
| Rate for Payer: Copperpoint |
$58.91
|
| Rate for Payer: HealthNet Commercial |
$126.00
|
| Rate for Payer: HealthNet Medicare |
$58.80
|
| Rate for Payer: Humana Medicare |
$35.70
|
| Rate for Payer: Mercy Care Medicaid |
$145.44
|
| Rate for Payer: SELF PAY |
$168.00
|
| Rate for Payer: Veterans (Triwest) |
$35.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$122.43
|
| Rate for Payer: United Healthcare Medicare |
$37.80
|
|
|
PROINSULIN
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
22576579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$107.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$20.23
|
| Rate for Payer: Amerigroup Medicare |
$20.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$20.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$20.23
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$30.94
|
| Rate for Payer: Copperpoint |
$33.38
|
| Rate for Payer: Humana Medicare |
$20.23
|
| Rate for Payer: SELF PAY |
$95.20
|
| Rate for Payer: Veterans (Triwest) |
$20.23
|
|
|
PROINSULIN
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
22576579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$107.10
|
| Rate for Payer: Aetna Medicare |
$33.32
|
| Rate for Payer: AHCCCS Medicaid |
$26.69
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$26.69
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$20.23
|
| Rate for Payer: Amerigroup Medicare |
$20.23
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$44.45
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$26.69
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$20.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$20.23
|
| Rate for Payer: Banner University Family Care Medicaid |
$26.69
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$30.94
|
| Rate for Payer: Cigna All Products |
$77.35
|
| Rate for Payer: Copperpoint |
$33.38
|
| Rate for Payer: HealthNet Commercial |
$71.40
|
| Rate for Payer: HealthNet Medicare |
$33.32
|
| Rate for Payer: Humana Medicare |
$20.23
|
| Rate for Payer: Mercy Care Medicaid |
$26.69
|
| Rate for Payer: SELF PAY |
$95.20
|
| Rate for Payer: Veterans (Triwest) |
$20.23
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$69.38
|
| Rate for Payer: United Healthcare Medicare |
$21.42
|
|
|
Prolactin LC
|
Facility
OP
|
$241.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
1285574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$216.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$216.90
|
| Rate for Payer: Aetna Medicare |
$67.48
|
| Rate for Payer: AHCCCS Medicaid |
$19.38
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$19.38
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.97
|
| Rate for Payer: Amerigroup Medicare |
$40.97
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$90.01
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$19.38
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.97
|
| Rate for Payer: Banner University Family Care Medicaid |
$19.38
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$151.64
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$62.66
|
| Rate for Payer: Cigna All Products |
$156.65
|
| Rate for Payer: Copperpoint |
$67.60
|
| Rate for Payer: HealthNet Commercial |
$144.60
|
| Rate for Payer: HealthNet Medicare |
$67.48
|
| Rate for Payer: Humana Medicare |
$40.97
|
| Rate for Payer: Mercy Care Medicaid |
$19.38
|
| Rate for Payer: SELF PAY |
$192.80
|
| Rate for Payer: Veterans (Triwest) |
$40.97
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$140.50
|
| Rate for Payer: United Healthcare Medicare |
$43.38
|
|
|
Prolactin LC
|
Facility
IP
|
$241.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
1285574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.97 |
| Max. Negotiated Rate |
$216.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$216.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.97
|
| Rate for Payer: Amerigroup Medicare |
$40.97
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.97
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$151.64
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$62.66
|
| Rate for Payer: Copperpoint |
$67.60
|
| Rate for Payer: Humana Medicare |
$40.97
|
| Rate for Payer: SELF PAY |
$192.80
|
| Rate for Payer: Veterans (Triwest) |
$40.97
|
|
|
PROLENE 4 0 SH BLUE
|
Facility
OP
|
$99.00
|
|
| Hospital Charge Code |
23770584
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$89.10
|
| Rate for Payer: Aetna Medicare |
$27.72
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.83
|
| Rate for Payer: Amerigroup Medicare |
$16.83
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$36.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.83
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.83
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$25.74
|
| Rate for Payer: Cigna All Products |
$69.30
|
| Rate for Payer: Copperpoint |
$27.77
|
| Rate for Payer: HealthNet Commercial |
$59.40
|
| Rate for Payer: HealthNet Medicare |
$27.72
|
| Rate for Payer: Humana Medicare |
$16.83
|
| Rate for Payer: SELF PAY |
$79.20
|
| Rate for Payer: Veterans (Triwest) |
$16.83
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$57.72
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
|