|
PROT EL R UR
|
Facility
OP
|
$808.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
22481496
|
|
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
|
|
|
PROT EL R UR
|
Facility
IP
|
$808.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
22481496
|
|
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
|
|
|
Prothrombin/INR POC
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 85610 QW
|
| Hospital Charge Code |
714167
|
|
Hospital Revenue Code
|
305
|
| 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 |
$44.93
|
| 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
|
|
|
Prothrombin/INR POC
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 85610 QW
|
| Hospital Charge Code |
714167
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| 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 |
$4.29
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.29
|
| 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 |
$4.29
|
| 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 |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$44.93
|
| 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 |
$4.29
|
| 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
|
|
|
Prothrombin Time
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
305
|
| 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 |
$44.93
|
| 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
|
|
|
Prothrombin Time
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| 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 |
$4.29
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.29
|
| 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 |
$4.29
|
| 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 |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$44.93
|
| 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 |
$4.29
|
| 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
|
|
|
PROTIME
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
22481498
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| 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 |
$4.29
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.29
|
| 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 |
$4.29
|
| 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 |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$44.93
|
| 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 |
$4.29
|
| 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
|
|
|
PROTIME
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
22481498
|
|
Hospital Revenue Code
|
305
|
| 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 |
$44.93
|
| 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
|
|
|
Protime/PTT
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
898512
|
|
Hospital Revenue Code
|
305
|
| 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 |
$44.93
|
| 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
|
|
|
Protime/PTT
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
898512
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| 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 |
$4.29
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.29
|
| 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 |
$4.29
|
| 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 |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$44.93
|
| 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 |
$4.29
|
| 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
|
|
|
PSA Diagnostic
|
Facility
OP
|
$214.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
1019536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| 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 |
$18.39
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$18.39
|
| 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 |
$18.39
|
| 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 |
$18.39
|
| 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 |
$18.39
|
| 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
|
|
|
PSA Diagnostic
|
Facility
IP
|
$214.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
1019536
|
|
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
|
|
|
PSA Diagnostic.
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
13095387
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$201.60
|
| Rate for Payer: Aetna Medicare |
$62.72
|
| Rate for Payer: AHCCCS Medicaid |
$18.39
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$18.39
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.08
|
| Rate for Payer: Amerigroup Medicare |
$38.08
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$83.66
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$18.39
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.08
|
| Rate for Payer: Banner University Family Care Medicaid |
$18.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$58.24
|
| Rate for Payer: Cigna All Products |
$145.60
|
| Rate for Payer: Copperpoint |
$62.83
|
| Rate for Payer: HealthNet Commercial |
$134.40
|
| Rate for Payer: HealthNet Medicare |
$62.72
|
| Rate for Payer: Humana Medicare |
$38.08
|
| Rate for Payer: Mercy Care Medicaid |
$18.39
|
| Rate for Payer: SELF PAY |
$179.20
|
| Rate for Payer: Veterans (Triwest) |
$38.08
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$130.59
|
| Rate for Payer: United Healthcare Medicare |
$40.32
|
|
|
PSA Diagnostic.
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
13095387
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$201.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.08
|
| Rate for Payer: Amerigroup Medicare |
$38.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$58.24
|
| Rate for Payer: Copperpoint |
$62.83
|
| Rate for Payer: Humana Medicare |
$38.08
|
| Rate for Payer: SELF PAY |
$179.20
|
| Rate for Payer: Veterans (Triwest) |
$38.08
|
|
|
PSA Screen
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
1019535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$201.60
|
| Rate for Payer: Aetna Medicare |
$62.72
|
| Rate for Payer: AHCCCS Medicaid |
$38.62
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$38.62
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.08
|
| Rate for Payer: Amerigroup Medicare |
$38.08
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$83.66
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$38.62
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.08
|
| Rate for Payer: Banner University Family Care Medicaid |
$38.62
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$143.61
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$58.24
|
| Rate for Payer: Cigna All Products |
$145.60
|
| Rate for Payer: Copperpoint |
$62.83
|
| Rate for Payer: HealthNet Commercial |
$134.40
|
| Rate for Payer: HealthNet Medicare |
$62.72
|
| Rate for Payer: Humana Medicare |
$38.08
|
| Rate for Payer: Mercy Care Medicaid |
$38.62
|
| Rate for Payer: SELF PAY |
$179.20
|
| Rate for Payer: Veterans (Triwest) |
$38.08
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$130.59
|
| Rate for Payer: United Healthcare Medicare |
$40.32
|
|
|
PSA Screen
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
1019535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$201.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.08
|
| Rate for Payer: Amerigroup Medicare |
$38.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.08
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$143.61
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$58.24
|
| Rate for Payer: Copperpoint |
$62.83
|
| Rate for Payer: Humana Medicare |
$38.08
|
| Rate for Payer: SELF PAY |
$179.20
|
| Rate for Payer: Veterans (Triwest) |
$38.08
|
|
|
PSA Total+% Free (Serial) LC
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
1909550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Copperpoint |
$75.74
|
| Rate for Payer: Aetna POS, PPO, HMO |
$243.00
|
| Rate for Payer: Aetna Medicare |
$75.60
|
| Rate for Payer: AHCCCS Medicaid |
$18.39
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$18.39
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$45.90
|
| Rate for Payer: Amerigroup Medicare |
$45.90
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$100.84
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$18.39
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$45.90
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$45.90
|
| Rate for Payer: Banner University Family Care Medicaid |
$18.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$70.20
|
| Rate for Payer: Cigna All Products |
$175.50
|
| Rate for Payer: HealthNet Commercial |
$162.00
|
| Rate for Payer: HealthNet Medicare |
$75.60
|
| Rate for Payer: Humana Medicare |
$45.90
|
| Rate for Payer: Mercy Care Medicaid |
$18.39
|
| Rate for Payer: SELF PAY |
$216.00
|
| Rate for Payer: Veterans (Triwest) |
$45.90
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$157.41
|
| Rate for Payer: United Healthcare Medicare |
$48.60
|
|
|
PSA Total+% Free (Serial) LC
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
1909550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$243.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$45.90
|
| Rate for Payer: Amerigroup Medicare |
$45.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$45.90
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$45.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$70.20
|
| Rate for Payer: Copperpoint |
$75.74
|
| Rate for Payer: Humana Medicare |
$45.90
|
| Rate for Payer: SELF PAY |
$216.00
|
| Rate for Payer: Veterans (Triwest) |
$45.90
|
|
|
PSA Ultra. W/Serial Monitor LC
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
22311204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.71 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Humana Medicare |
$44.71
|
| Rate for Payer: SELF PAY |
$210.40
|
| Rate for Payer: Veterans (Triwest) |
$44.71
|
| Rate for Payer: Aetna POS, PPO, HMO |
$236.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$44.71
|
| Rate for Payer: Amerigroup Medicare |
$44.71
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$44.71
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$44.71
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$68.38
|
| Rate for Payer: Copperpoint |
$73.77
|
|
|
PSA Ultra. W/Serial Monitor LC
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
22311204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Aetna Medicare |
$73.64
|
| Rate for Payer: Aetna POS, PPO, HMO |
$236.70
|
| Rate for Payer: AHCCCS Medicaid |
$18.39
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$18.39
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$44.71
|
| Rate for Payer: Amerigroup Medicare |
$44.71
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$98.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$18.39
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$44.71
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$44.71
|
| Rate for Payer: Banner University Family Care Medicaid |
$18.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$68.38
|
| Rate for Payer: Cigna All Products |
$170.95
|
| Rate for Payer: Copperpoint |
$73.77
|
| Rate for Payer: HealthNet Commercial |
$157.80
|
| Rate for Payer: HealthNet Medicare |
$73.64
|
| Rate for Payer: Humana Medicare |
$44.71
|
| Rate for Payer: Mercy Care Medicaid |
$18.39
|
| Rate for Payer: SELF PAY |
$210.40
|
| Rate for Payer: Veterans (Triwest) |
$44.71
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$153.33
|
| Rate for Payer: United Healthcare Medicare |
$47.34
|
|
|
PT CANALITH REPOSITIONING
|
Facility
IP
|
$193.00
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
4836205
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$173.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$32.81
|
| Rate for Payer: Amerigroup Medicare |
$32.81
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$32.81
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$32.81
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$125.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$50.18
|
| Rate for Payer: Copperpoint |
$54.14
|
| Rate for Payer: Humana Medicare |
$32.81
|
| Rate for Payer: SELF PAY |
$154.40
|
| Rate for Payer: Veterans (Triwest) |
$32.81
|
|
|
PT CANALITH REPOSITIONING
|
Facility
OP
|
$193.00
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
4836205
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$173.70
|
| Rate for Payer: Aetna Medicare |
$54.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$32.81
|
| Rate for Payer: Amerigroup Medicare |
$32.81
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$72.09
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$32.81
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$32.81
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$125.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$50.18
|
| Rate for Payer: Cigna All Products |
$135.10
|
| Rate for Payer: Copperpoint |
$54.14
|
| Rate for Payer: HealthNet Commercial |
$115.80
|
| Rate for Payer: HealthNet Medicare |
$54.04
|
| Rate for Payer: Humana Medicare |
$32.81
|
| Rate for Payer: SELF PAY |
$154.40
|
| Rate for Payer: Veterans (Triwest) |
$32.81
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$112.52
|
| Rate for Payer: United Healthcare Medicare |
$34.74
|
|
|
PT Community/Work Reintegration Charge
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
22408476
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Aetna Medicare |
$48.16
|
| 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 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: Cigna All Products |
$120.40
|
| 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: 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
|
|
|
PT Community/Work Reintegration Charge
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
22408476
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PT CONTRAST BATH @ 15 MIN
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97034 GP
|
| Hospital Charge Code |
8865467
|
|
Hospital Revenue Code
|
420
|
| 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
|
|