|
PROLENE 4 0 SH BLUE
|
Facility
IP
|
$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: Allwell from Arizona Complete Health Medicare Advantage |
$16.83
|
| Rate for Payer: Amerigroup Medicare |
$16.83
|
| 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: Copperpoint |
$27.77
|
| Rate for Payer: Humana Medicare |
$16.83
|
| Rate for Payer: SELF PAY |
$79.20
|
| Rate for Payer: Veterans (Triwest) |
$16.83
|
|
|
Protein 24 Hour Urine
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633811
|
|
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
|
|
|
Protein 24 Hour Urine
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633811
|
|
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
|
|
|
Protein C Activity (Chrom) LC
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
6781142
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: AHCCCS Medicaid |
$13.84
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13.84
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$64.24
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13.84
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: Banner University Family Care Medicaid |
$13.84
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Cigna All Products |
$111.80
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: HealthNet Commercial |
$103.20
|
| Rate for Payer: HealthNet Medicare |
$48.16
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: Mercy Care Medicaid |
$13.84
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$30.96
|
|
|
Protein C Activity (Chrom) LC
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
6781142
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
|
|
Protein C Deficiency Profile LC
|
Facility
OP
|
$427.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
2087638
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$384.30
|
| Rate for Payer: Aetna Medicare |
$119.56
|
| Rate for Payer: AHCCCS Medicaid |
$12.01
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$12.01
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$72.59
|
| Rate for Payer: Amerigroup Medicare |
$72.59
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$159.48
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$12.01
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$72.59
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$72.59
|
| Rate for Payer: Banner University Family Care Medicaid |
$12.01
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$111.02
|
| Rate for Payer: Cigna All Products |
$277.55
|
| Rate for Payer: Copperpoint |
$119.77
|
| Rate for Payer: HealthNet Commercial |
$256.20
|
| Rate for Payer: HealthNet Medicare |
$119.56
|
| Rate for Payer: Humana Medicare |
$72.59
|
| Rate for Payer: Mercy Care Medicaid |
$12.01
|
| Rate for Payer: SELF PAY |
$341.60
|
| Rate for Payer: Veterans (Triwest) |
$72.59
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$248.94
|
| Rate for Payer: United Healthcare Medicare |
$76.86
|
|
|
Protein C Deficiency Profile LC
|
Facility
IP
|
$427.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
2087638
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.59 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$384.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$72.59
|
| Rate for Payer: Amerigroup Medicare |
$72.59
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$72.59
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$72.59
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$111.02
|
| Rate for Payer: Copperpoint |
$119.77
|
| Rate for Payer: Humana Medicare |
$72.59
|
| Rate for Payer: SELF PAY |
$341.60
|
| Rate for Payer: Veterans (Triwest) |
$72.59
|
|
|
Protein Electro, 24-Hour Urine LC
|
Facility
OP
|
$808.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
1285721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$727.20
|
| Rate for Payer: Aetna Medicare |
$226.24
|
| Rate for Payer: AHCCCS Medicaid |
$17.83
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$17.83
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$137.36
|
| Rate for Payer: Amerigroup Medicare |
$137.36
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$301.79
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$17.83
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$137.36
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$137.36
|
| Rate for Payer: Banner University Family Care Medicaid |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$88.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$210.08
|
| Rate for Payer: Cigna All Products |
$525.20
|
| Rate for Payer: Copperpoint |
$226.64
|
| Rate for Payer: HealthNet Commercial |
$484.80
|
| Rate for Payer: HealthNet Medicare |
$226.24
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Mercy Care Medicaid |
$17.83
|
| Rate for Payer: SELF PAY |
$646.40
|
| Rate for Payer: Veterans (Triwest) |
$137.36
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$471.06
|
| Rate for Payer: United Healthcare Medicare |
$145.44
|
|
|
Protein Electro, 24-Hour Urine LC
|
Facility
IP
|
$808.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
1285721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$727.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$137.36
|
| Rate for Payer: Amerigroup Medicare |
$137.36
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$137.36
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$137.36
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$88.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$210.08
|
| Rate for Payer: Copperpoint |
$226.64
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: SELF PAY |
$646.40
|
| Rate for Payer: Veterans (Triwest) |
$137.36
|
|
|
Protein Electro, Random Urine LC
|
Facility
OP
|
$808.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
2087639
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$727.20
|
| Rate for Payer: Aetna Medicare |
$226.24
|
| Rate for Payer: AHCCCS Medicaid |
$17.83
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$17.83
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$137.36
|
| Rate for Payer: Amerigroup Medicare |
$137.36
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$301.79
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$17.83
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$137.36
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$137.36
|
| Rate for Payer: Banner University Family Care Medicaid |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$88.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$210.08
|
| Rate for Payer: Cigna All Products |
$525.20
|
| Rate for Payer: Copperpoint |
$226.64
|
| Rate for Payer: HealthNet Commercial |
$484.80
|
| Rate for Payer: HealthNet Medicare |
$226.24
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Mercy Care Medicaid |
$17.83
|
| Rate for Payer: SELF PAY |
$646.40
|
| Rate for Payer: Veterans (Triwest) |
$137.36
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$471.06
|
| Rate for Payer: United Healthcare Medicare |
$145.44
|
|
|
Protein Electro, Random Urine LC
|
Facility
IP
|
$808.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
2087639
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$727.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$137.36
|
| Rate for Payer: Amerigroup Medicare |
$137.36
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$137.36
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$137.36
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$88.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$210.08
|
| Rate for Payer: Copperpoint |
$226.64
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: SELF PAY |
$646.40
|
| Rate for Payer: Veterans (Triwest) |
$137.36
|
|
|
Protein Electro Serum LC
|
Facility
OP
|
$717.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
1285802
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$645.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$645.30
|
| Rate for Payer: Aetna Medicare |
$200.76
|
| Rate for Payer: AHCCCS Medicaid |
$10.74
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$10.74
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$121.89
|
| Rate for Payer: Amerigroup Medicare |
$121.89
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$267.80
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$10.74
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$121.89
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$121.89
|
| Rate for Payer: Banner University Family Care Medicaid |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$94.52
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$186.42
|
| Rate for Payer: Cigna All Products |
$466.05
|
| Rate for Payer: Copperpoint |
$201.12
|
| Rate for Payer: HealthNet Commercial |
$430.20
|
| Rate for Payer: HealthNet Medicare |
$200.76
|
| Rate for Payer: Humana Medicare |
$121.89
|
| Rate for Payer: Mercy Care Medicaid |
$10.74
|
| Rate for Payer: SELF PAY |
$573.60
|
| Rate for Payer: Veterans (Triwest) |
$121.89
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$418.01
|
| Rate for Payer: United Healthcare Medicare |
$129.06
|
|
|
Protein Electro Serum LC
|
Facility
IP
|
$717.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
1285802
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$645.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$645.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$121.89
|
| Rate for Payer: Amerigroup Medicare |
$121.89
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$121.89
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$121.89
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$94.52
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$186.42
|
| Rate for Payer: Copperpoint |
$201.12
|
| Rate for Payer: Humana Medicare |
$121.89
|
| Rate for Payer: SELF PAY |
$573.60
|
| Rate for Payer: Veterans (Triwest) |
$121.89
|
|
|
Protein Level Urine
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
12253376
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$90.00
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: AHCCCS Medicaid |
$3.67
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3.67
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.00
|
| Rate for Payer: Amerigroup Medicare |
$17.00
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$37.35
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3.67
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.00
|
| Rate for Payer: Banner University Family Care Medicaid |
$3.67
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$26.00
|
| Rate for Payer: Cigna All Products |
$65.00
|
| Rate for Payer: Copperpoint |
$28.05
|
| Rate for Payer: HealthNet Commercial |
$60.00
|
| Rate for Payer: HealthNet Medicare |
$28.00
|
| Rate for Payer: Humana Medicare |
$17.00
|
| Rate for Payer: Mercy Care Medicaid |
$3.67
|
| Rate for Payer: SELF PAY |
$80.00
|
| Rate for Payer: Veterans (Triwest) |
$17.00
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$58.30
|
| Rate for Payer: United Healthcare Medicare |
$18.00
|
|
|
Protein Level Urine
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
12253376
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$90.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.00
|
| Rate for Payer: Amerigroup Medicare |
$17.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$26.00
|
| Rate for Payer: Copperpoint |
$28.05
|
| Rate for Payer: Humana Medicare |
$17.00
|
| Rate for Payer: SELF PAY |
$80.00
|
| Rate for Payer: Veterans (Triwest) |
$17.00
|
|
|
Protein S-Functional LC
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2087641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$170.10
|
| Rate for Payer: Aetna Medicare |
$52.92
|
| Rate for Payer: AHCCCS Medicaid |
$15.32
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$15.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$32.13
|
| Rate for Payer: Amerigroup Medicare |
$32.13
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$70.59
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$15.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$32.13
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$32.13
|
| Rate for Payer: Banner University Family Care Medicaid |
$15.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$49.14
|
| Rate for Payer: Cigna All Products |
$122.85
|
| Rate for Payer: Copperpoint |
$53.01
|
| Rate for Payer: HealthNet Commercial |
$113.40
|
| Rate for Payer: HealthNet Medicare |
$52.92
|
| Rate for Payer: Humana Medicare |
$32.13
|
| Rate for Payer: Mercy Care Medicaid |
$15.32
|
| Rate for Payer: SELF PAY |
$151.20
|
| Rate for Payer: Veterans (Triwest) |
$32.13
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$110.19
|
| Rate for Payer: United Healthcare Medicare |
$34.02
|
|
|
Protein S-Functional LC
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2087641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$170.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$32.13
|
| Rate for Payer: Amerigroup Medicare |
$32.13
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$32.13
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$32.13
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$49.14
|
| Rate for Payer: Copperpoint |
$53.01
|
| Rate for Payer: Humana Medicare |
$32.13
|
| Rate for Payer: SELF PAY |
$151.20
|
| Rate for Payer: Veterans (Triwest) |
$32.13
|
|
|
Protein S Panel LC
|
Facility
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2087640
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$191.93 |
| Max. Negotiated Rate |
$1,016.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,016.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$191.93
|
| Rate for Payer: Amerigroup Medicare |
$191.93
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$191.93
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$191.93
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$293.54
|
| Rate for Payer: Copperpoint |
$316.68
|
| Rate for Payer: Humana Medicare |
$191.93
|
| Rate for Payer: SELF PAY |
$903.20
|
| Rate for Payer: Veterans (Triwest) |
$191.93
|
|
|
Protein S Panel LC
|
Facility
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2087640
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$1,016.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,016.10
|
| Rate for Payer: Aetna Medicare |
$316.12
|
| Rate for Payer: AHCCCS Medicaid |
$15.32
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$15.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$191.93
|
| Rate for Payer: Amerigroup Medicare |
$191.93
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$421.68
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$15.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$191.93
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$191.93
|
| Rate for Payer: Banner University Family Care Medicaid |
$15.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$293.54
|
| Rate for Payer: Cigna All Products |
$733.85
|
| Rate for Payer: Copperpoint |
$316.68
|
| Rate for Payer: HealthNet Commercial |
$677.40
|
| Rate for Payer: HealthNet Medicare |
$316.12
|
| Rate for Payer: Humana Medicare |
$191.93
|
| Rate for Payer: Mercy Care Medicaid |
$15.32
|
| Rate for Payer: SELF PAY |
$903.20
|
| Rate for Payer: Veterans (Triwest) |
$191.93
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$658.21
|
| Rate for Payer: United Healthcare Medicare |
$203.22
|
|
|
Protein Total
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
|
|
Protein Total
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$74.70
|
| Rate for Payer: Aetna Medicare |
$23.24
|
| Rate for Payer: AHCCCS Medicaid |
$3.67
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3.67
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$31.00
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3.67
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$14.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$14.11
|
| Rate for Payer: Banner University Family Care Medicaid |
$3.67
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$21.58
|
| Rate for Payer: Cigna All Products |
$53.95
|
| Rate for Payer: Copperpoint |
$23.28
|
| Rate for Payer: HealthNet Commercial |
$49.80
|
| Rate for Payer: HealthNet Medicare |
$23.24
|
| Rate for Payer: Humana Medicare |
$14.11
|
| Rate for Payer: Mercy Care Medicaid |
$3.67
|
| Rate for Payer: SELF PAY |
$66.40
|
| Rate for Payer: Veterans (Triwest) |
$14.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$48.39
|
| Rate for Payer: United Healthcare Medicare |
$14.94
|
|
|
Protein total CSF
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
633813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$81.90
|
| Rate for Payer: Aetna Medicare |
$25.48
|
| Rate for Payer: AHCCCS Medicaid |
$4.00
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.47
|
| Rate for Payer: Amerigroup Medicare |
$15.47
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$33.99
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.47
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.47
|
| Rate for Payer: Banner University Family Care Medicaid |
$4.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.66
|
| Rate for Payer: Cigna All Products |
$59.15
|
| Rate for Payer: Copperpoint |
$25.53
|
| Rate for Payer: HealthNet Commercial |
$54.60
|
| Rate for Payer: HealthNet Medicare |
$25.48
|
| Rate for Payer: Humana Medicare |
$15.47
|
| Rate for Payer: Mercy Care Medicaid |
$4.00
|
| Rate for Payer: SELF PAY |
$72.80
|
| Rate for Payer: Veterans (Triwest) |
$15.47
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$53.05
|
| Rate for Payer: United Healthcare Medicare |
$16.38
|
|
|
Protein total CSF
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
633813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$81.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.47
|
| Rate for Payer: Amerigroup Medicare |
$15.47
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.47
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.47
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.66
|
| Rate for Payer: Copperpoint |
$25.53
|
| Rate for Payer: Humana Medicare |
$15.47
|
| Rate for Payer: SELF PAY |
$72.80
|
| Rate for Payer: Veterans (Triwest) |
$15.47
|
|
|
PROT EL 24 HR
|
Facility
IP
|
$808.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
22481495
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$727.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$137.36
|
| Rate for Payer: Amerigroup Medicare |
$137.36
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$137.36
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$137.36
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$88.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$210.08
|
| Rate for Payer: Copperpoint |
$226.64
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: SELF PAY |
$646.40
|
| Rate for Payer: Veterans (Triwest) |
$137.36
|
|
|
PROT EL 24 HR
|
Facility
OP
|
$808.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
22481495
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$727.20
|
| Rate for Payer: Aetna Medicare |
$226.24
|
| Rate for Payer: AHCCCS Medicaid |
$17.83
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$17.83
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$137.36
|
| Rate for Payer: Amerigroup Medicare |
$137.36
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$301.79
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$17.83
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$137.36
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$137.36
|
| Rate for Payer: Banner University Family Care Medicaid |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$88.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$210.08
|
| Rate for Payer: Cigna All Products |
$525.20
|
| Rate for Payer: Copperpoint |
$226.64
|
| Rate for Payer: HealthNet Commercial |
$484.80
|
| Rate for Payer: HealthNet Medicare |
$226.24
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Mercy Care Medicaid |
$17.83
|
| Rate for Payer: SELF PAY |
$646.40
|
| Rate for Payer: Veterans (Triwest) |
$137.36
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$471.06
|
| Rate for Payer: United Healthcare Medicare |
$145.44
|
|