|
QuantiFERON Client Incubated LC
|
Facility
IP
|
$770.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
6781827
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.48 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$693.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$130.90
|
| Rate for Payer: Amerigroup Medicare |
$130.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$130.90
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$58.48
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$200.20
|
| Rate for Payer: Copperpoint |
$215.99
|
| Rate for Payer: Humana Medicare |
$130.90
|
| Rate for Payer: SELF PAY |
$616.00
|
| Rate for Payer: Veterans (Triwest) |
$130.90
|
|
|
QuantiFERON Client Incubated LC
|
Facility
OP
|
$770.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
6781827
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.48 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$693.00
|
| Rate for Payer: Aetna Medicare |
$215.60
|
| Rate for Payer: AHCCCS Medicaid |
$61.98
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$61.98
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$130.90
|
| Rate for Payer: Amerigroup Medicare |
$130.90
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$287.60
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$61.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$130.90
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$130.90
|
| Rate for Payer: Banner University Family Care Medicaid |
$61.98
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$58.48
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$200.20
|
| Rate for Payer: Cigna All Products |
$500.50
|
| Rate for Payer: Copperpoint |
$215.99
|
| Rate for Payer: HealthNet Commercial |
$462.00
|
| Rate for Payer: HealthNet Medicare |
$215.60
|
| Rate for Payer: Humana Medicare |
$130.90
|
| Rate for Payer: Mercy Care Medicaid |
$61.98
|
| Rate for Payer: SELF PAY |
$616.00
|
| Rate for Payer: Veterans (Triwest) |
$130.90
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$448.91
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
|
|
QuantiFERON TB Gold (In Tube) LC
|
Facility
IP
|
$145.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
2087648
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$130.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$24.65
|
| Rate for Payer: Amerigroup Medicare |
$24.65
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$24.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$24.65
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$58.48
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$37.70
|
| Rate for Payer: Copperpoint |
$40.67
|
| Rate for Payer: Humana Medicare |
$24.65
|
| Rate for Payer: SELF PAY |
$116.00
|
| Rate for Payer: Veterans (Triwest) |
$24.65
|
|
|
QuantiFERON TB Gold (In Tube) LC
|
Facility
OP
|
$145.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
2087648
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$130.50
|
| Rate for Payer: Aetna Medicare |
$40.60
|
| Rate for Payer: AHCCCS Medicaid |
$61.98
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$61.98
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$24.65
|
| Rate for Payer: Amerigroup Medicare |
$24.65
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$54.16
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$61.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$24.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$24.65
|
| Rate for Payer: Banner University Family Care Medicaid |
$61.98
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$58.48
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$37.70
|
| Rate for Payer: Cigna All Products |
$94.25
|
| Rate for Payer: Copperpoint |
$40.67
|
| Rate for Payer: HealthNet Commercial |
$87.00
|
| Rate for Payer: HealthNet Medicare |
$40.60
|
| Rate for Payer: Humana Medicare |
$24.65
|
| Rate for Payer: Mercy Care Medicaid |
$61.98
|
| Rate for Payer: SELF PAY |
$116.00
|
| Rate for Payer: Veterans (Triwest) |
$24.65
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$84.53
|
| Rate for Payer: United Healthcare Medicare |
$26.10
|
|
|
QUANT LIPOPR
|
Facility
IP
|
$426.00
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
22481501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$383.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$383.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$72.42
|
| Rate for Payer: Amerigroup Medicare |
$72.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$72.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$72.42
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$135.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$110.76
|
| Rate for Payer: Copperpoint |
$119.49
|
| Rate for Payer: Humana Medicare |
$72.42
|
| Rate for Payer: SELF PAY |
$340.80
|
| Rate for Payer: Veterans (Triwest) |
$72.42
|
|
|
QUANT LIPOPR
|
Facility
OP
|
$426.00
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
22481501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$383.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$383.40
|
| Rate for Payer: Aetna Medicare |
$119.28
|
| Rate for Payer: AHCCCS Medicaid |
$34.19
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$34.19
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$72.42
|
| Rate for Payer: Amerigroup Medicare |
$72.42
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$159.11
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$34.19
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$72.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$72.42
|
| Rate for Payer: Banner University Family Care Medicaid |
$34.19
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$135.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$110.76
|
| Rate for Payer: Cigna All Products |
$276.90
|
| Rate for Payer: Copperpoint |
$119.49
|
| Rate for Payer: HealthNet Commercial |
$255.60
|
| Rate for Payer: HealthNet Medicare |
$119.28
|
| Rate for Payer: Humana Medicare |
$72.42
|
| Rate for Payer: Mercy Care Medicaid |
$34.19
|
| Rate for Payer: SELF PAY |
$340.80
|
| Rate for Payer: Veterans (Triwest) |
$72.42
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$248.36
|
| Rate for Payer: United Healthcare Medicare |
$76.68
|
|
|
QUICK CARE URINALYSIS DIPSTICK
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22422559
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: SELF PAY |
$20.80
|
| Rate for Payer: Humana Medicare |
$4.42
|
| Rate for Payer: Aetna POS, PPO, HMO |
$23.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$4.42
|
| Rate for Payer: Amerigroup Medicare |
$4.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$4.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$4.42
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$16.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$6.76
|
| Rate for Payer: Copperpoint |
$7.29
|
| Rate for Payer: Veterans (Triwest) |
$4.42
|
|
|
QUICK CARE URINALYSIS DIPSTICK
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22422559
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$23.40
|
| Rate for Payer: Aetna Medicare |
$7.28
|
| Rate for Payer: AHCCCS Medicaid |
$3.48
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3.48
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$4.42
|
| Rate for Payer: Amerigroup Medicare |
$4.42
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$9.71
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3.48
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$4.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$4.42
|
| Rate for Payer: Banner University Family Care Medicaid |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$16.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$6.76
|
| Rate for Payer: Cigna All Products |
$16.90
|
| Rate for Payer: Copperpoint |
$7.29
|
| Rate for Payer: HealthNet Commercial |
$15.60
|
| Rate for Payer: HealthNet Medicare |
$7.28
|
| Rate for Payer: Humana Medicare |
$4.42
|
| Rate for Payer: Mercy Care Medicaid |
$3.48
|
| Rate for Payer: SELF PAY |
$20.80
|
| Rate for Payer: Veterans (Triwest) |
$4.42
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$15.16
|
| Rate for Payer: United Healthcare Medicare |
$4.68
|
|
|
QUICKCLIP PRO 230XM
|
Facility
IP
|
$643.48
|
|
| Hospital Charge Code |
27443862
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.39 |
| Max. Negotiated Rate |
$579.13 |
| Rate for Payer: Aetna POS, PPO, HMO |
$579.13
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$109.39
|
| Rate for Payer: Amerigroup Medicare |
$109.39
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$109.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$109.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$167.30
|
| Rate for Payer: Copperpoint |
$180.50
|
| Rate for Payer: Humana Medicare |
$109.39
|
| Rate for Payer: SELF PAY |
$514.78
|
| Rate for Payer: Veterans (Triwest) |
$109.39
|
|
|
QUICKCLIP PRO 230XM
|
Facility
OP
|
$643.48
|
|
| Hospital Charge Code |
27443862
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.39 |
| Max. Negotiated Rate |
$579.13 |
| Rate for Payer: Aetna POS, PPO, HMO |
$579.13
|
| Rate for Payer: Aetna Medicare |
$180.17
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$109.39
|
| Rate for Payer: Amerigroup Medicare |
$109.39
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$240.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$109.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$109.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$167.30
|
| Rate for Payer: Cigna All Products |
$450.44
|
| Rate for Payer: Copperpoint |
$180.50
|
| Rate for Payer: HealthNet Commercial |
$386.09
|
| Rate for Payer: HealthNet Medicare |
$180.17
|
| Rate for Payer: Humana Medicare |
$109.39
|
| Rate for Payer: SELF PAY |
$514.78
|
| Rate for Payer: Veterans (Triwest) |
$109.39
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$375.15
|
| Rate for Payer: United Healthcare Medicare |
$115.83
|
|
|
QUICKSNAP 2MM X8MM SCREW
|
Facility
IP
|
$2,888.00
|
|
| Hospital Charge Code |
27555211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$490.96 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,599.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$490.96
|
| Rate for Payer: Amerigroup Medicare |
$490.96
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$490.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$490.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$750.88
|
| Rate for Payer: Copperpoint |
$810.08
|
| Rate for Payer: Humana Medicare |
$490.96
|
| Rate for Payer: SELF PAY |
$2,310.40
|
| Rate for Payer: Veterans (Triwest) |
$490.96
|
|
|
QUICKSNAP 2MM X8MM SCREW
|
Facility
OP
|
$2,888.00
|
|
| Hospital Charge Code |
27555211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$490.96 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,599.20
|
| Rate for Payer: Aetna Medicare |
$808.64
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$490.96
|
| Rate for Payer: Amerigroup Medicare |
$490.96
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,078.67
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$490.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$490.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$750.88
|
| Rate for Payer: Cigna All Products |
$2,021.60
|
| Rate for Payer: Copperpoint |
$810.08
|
| Rate for Payer: HealthNet Commercial |
$1,732.80
|
| Rate for Payer: HealthNet Medicare |
$808.64
|
| Rate for Payer: Humana Medicare |
$490.96
|
| Rate for Payer: SELF PAY |
$2,310.40
|
| Rate for Payer: Veterans (Triwest) |
$490.96
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,683.70
|
| Rate for Payer: United Healthcare Medicare |
$519.84
|
|
|
QWIX DRILL AO 2IN SIA 2MM X L65MM
|
Facility
IP
|
$890.04
|
|
| Hospital Charge Code |
27341817
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.31 |
| Max. Negotiated Rate |
$801.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$801.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$151.31
|
| Rate for Payer: Amerigroup Medicare |
$151.31
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$151.31
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$151.31
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$231.41
|
| Rate for Payer: Copperpoint |
$249.66
|
| Rate for Payer: Humana Medicare |
$151.31
|
| Rate for Payer: SELF PAY |
$712.03
|
| Rate for Payer: Veterans (Triwest) |
$151.31
|
|
|
QWIX DRILL AO 2IN SIA 2MM X L65MM
|
Facility
OP
|
$890.04
|
|
| Hospital Charge Code |
27341817
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.31 |
| Max. Negotiated Rate |
$801.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$801.04
|
| Rate for Payer: Aetna Medicare |
$249.21
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$151.31
|
| Rate for Payer: Amerigroup Medicare |
$151.31
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$332.43
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$151.31
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$151.31
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$231.41
|
| Rate for Payer: Cigna All Products |
$623.03
|
| Rate for Payer: Copperpoint |
$249.66
|
| Rate for Payer: HealthNet Commercial |
$534.02
|
| Rate for Payer: HealthNet Medicare |
$249.21
|
| Rate for Payer: Humana Medicare |
$151.31
|
| Rate for Payer: SELF PAY |
$712.03
|
| Rate for Payer: Veterans (Triwest) |
$151.31
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$518.89
|
| Rate for Payer: United Healthcare Medicare |
$160.21
|
|
|
Rabies Neut. Abs Titrat. (RFFIT) LC
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
22617332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$93.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.68
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.68
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.68
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.04
|
| Rate for Payer: Copperpoint |
$29.17
|
| Rate for Payer: Humana Medicare |
$17.68
|
| Rate for Payer: SELF PAY |
$83.20
|
| Rate for Payer: Veterans (Triwest) |
$17.68
|
|
|
Rabies Neut. Abs Titrat. (RFFIT) LC
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
22617332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$93.60
|
| Rate for Payer: Aetna Medicare |
$29.12
|
| Rate for Payer: AHCCCS Medicaid |
$16.91
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$16.91
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.68
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$38.84
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$16.91
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.68
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.68
|
| Rate for Payer: Banner University Family Care Medicaid |
$16.91
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.04
|
| Rate for Payer: Cigna All Products |
$67.60
|
| Rate for Payer: Copperpoint |
$29.17
|
| Rate for Payer: HealthNet Commercial |
$62.40
|
| Rate for Payer: HealthNet Medicare |
$29.12
|
| Rate for Payer: Humana Medicare |
$17.68
|
| Rate for Payer: Mercy Care Medicaid |
$16.91
|
| Rate for Payer: SELF PAY |
$83.20
|
| Rate for Payer: Veterans (Triwest) |
$17.68
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$60.63
|
| Rate for Payer: United Healthcare Medicare |
$18.72
|
|
|
Radiology Misc
|
Facility
OP
|
$821.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
22828024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$139.57 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$738.90
|
| Rate for Payer: Aetna Medicare |
$229.88
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$139.57
|
| Rate for Payer: Amerigroup Medicare |
$139.57
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$306.64
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$139.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$139.57
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$536.52
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$213.46
|
| Rate for Payer: Cigna All Products |
$574.70
|
| Rate for Payer: Copperpoint |
$230.29
|
| Rate for Payer: HealthNet Commercial |
$492.60
|
| Rate for Payer: HealthNet Medicare |
$229.88
|
| Rate for Payer: Humana Medicare |
$139.57
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$656.80
|
| Rate for Payer: Veterans (Triwest) |
$139.57
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$478.64
|
| Rate for Payer: United Healthcare Medicare |
$147.78
|
|
|
Radiology Misc
|
Facility
IP
|
$821.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
22828024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$139.57 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$738.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$139.57
|
| Rate for Payer: Amerigroup Medicare |
$139.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$139.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$139.57
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$536.52
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$213.46
|
| Rate for Payer: Copperpoint |
$230.29
|
| Rate for Payer: Humana Medicare |
$139.57
|
| Rate for Payer: SELF PAY |
$656.80
|
| Rate for Payer: Veterans (Triwest) |
$139.57
|
|
|
Radiotherapy
|
Facility
IP
|
$16,027.69
|
|
|
Service Code
|
APRDRG 6923
|
| Hospital Charge Code |
APRDRG6923
|
| Min. Negotiated Rate |
$16,027.69 |
| Max. Negotiated Rate |
$16,027.69 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$16,027.69
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$16,027.69
|
| Rate for Payer: Banner University Family Care Medicaid |
$16,027.69
|
| Rate for Payer: Mercy Care Medicaid |
$16,027.69
|
|
|
Radiotherapy
|
Facility
IP
|
$25,806.61
|
|
|
Service Code
|
APRDRG 6924
|
| Hospital Charge Code |
APRDRG6924
|
| Min. Negotiated Rate |
$25,806.61 |
| Max. Negotiated Rate |
$25,806.61 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$25,806.61
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$25,806.61
|
| Rate for Payer: Banner University Family Care Medicaid |
$25,806.61
|
| Rate for Payer: Mercy Care Medicaid |
$25,806.61
|
|
|
Radiotherapy
|
Facility
IP
|
$9,793.65
|
|
|
Service Code
|
APRDRG 6922
|
| Hospital Charge Code |
APRDRG6922
|
| Min. Negotiated Rate |
$9,793.65 |
| Max. Negotiated Rate |
$9,793.65 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$9,793.65
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$9,793.65
|
| Rate for Payer: Banner University Family Care Medicaid |
$9,793.65
|
| Rate for Payer: Mercy Care Medicaid |
$9,793.65
|
|
|
Radiotherapy
|
Facility
IP
|
$5,319.42
|
|
|
Service Code
|
APRDRG 6921
|
| Hospital Charge Code |
APRDRG6921
|
| Min. Negotiated Rate |
$5,319.42 |
| Max. Negotiated Rate |
$5,319.42 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$5,319.42
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$5,319.42
|
| Rate for Payer: Banner University Family Care Medicaid |
$5,319.42
|
| Rate for Payer: Mercy Care Medicaid |
$5,319.42
|
|
|
RAM NASAL OXYGEN CANNULA INFANT
|
Facility
OP
|
$90.28
|
|
| Hospital Charge Code |
27554771
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna POS, PPO, HMO |
$81.25
|
| Rate for Payer: Aetna Medicare |
$25.28
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.35
|
| Rate for Payer: Amerigroup Medicare |
$15.35
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$33.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.47
|
| Rate for Payer: Cigna All Products |
$63.20
|
| Rate for Payer: Copperpoint |
$25.32
|
| Rate for Payer: HealthNet Commercial |
$54.17
|
| Rate for Payer: HealthNet Medicare |
$25.28
|
| Rate for Payer: Humana Medicare |
$15.35
|
| Rate for Payer: SELF PAY |
$72.22
|
| Rate for Payer: Veterans (Triwest) |
$15.35
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$52.63
|
| Rate for Payer: United Healthcare Medicare |
$16.25
|
|
|
RAM NASAL OXYGEN CANNULA INFANT
|
Facility
IP
|
$90.28
|
|
| Hospital Charge Code |
27554771
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna POS, PPO, HMO |
$81.25
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.35
|
| Rate for Payer: Amerigroup Medicare |
$15.35
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.47
|
| Rate for Payer: Copperpoint |
$25.32
|
| Rate for Payer: Humana Medicare |
$15.35
|
| Rate for Payer: SELF PAY |
$72.22
|
| Rate for Payer: Veterans (Triwest) |
$15.35
|
|
|
RAM NASAL OXYGEN CANNULA NEWBORN
|
Facility
IP
|
$90.23
|
|
| Hospital Charge Code |
27554772
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$81.21 |
| Rate for Payer: Aetna POS, PPO, HMO |
$81.21
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.34
|
| Rate for Payer: Amerigroup Medicare |
$15.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.34
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.46
|
| Rate for Payer: Copperpoint |
$25.31
|
| Rate for Payer: Humana Medicare |
$15.34
|
| Rate for Payer: SELF PAY |
$72.18
|
| Rate for Payer: Veterans (Triwest) |
$15.34
|
|