|
Rectovaginal Fistula closure vaginal
|
Facility
IP
|
$3,130.00
|
|
|
Service Code
|
CPT 57300
|
| Hospital Charge Code |
27291796
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$532.10 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,817.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$532.10
|
| Rate for Payer: Amerigroup Medicare |
$532.10
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$532.10
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$532.10
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$813.80
|
| Rate for Payer: Copperpoint |
$877.97
|
| Rate for Payer: Humana Medicare |
$532.10
|
| Rate for Payer: SELF PAY |
$2,504.00
|
| Rate for Payer: Veterans (Triwest) |
$532.10
|
|
|
Rectovaginal Fistula closure vaginal
|
Facility
OP
|
$3,130.00
|
|
|
Service Code
|
CPT 57300
|
| Hospital Charge Code |
27291796
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$532.10 |
| Max. Negotiated Rate |
$3,803.66 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,817.00
|
| Rate for Payer: Aetna Medicare |
$876.40
|
| Rate for Payer: AHCCCS Medicaid |
$3,803.66
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3,803.66
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$532.10
|
| Rate for Payer: Amerigroup Medicare |
$532.10
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,169.06
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3,803.66
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$532.10
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$532.10
|
| Rate for Payer: Banner University Family Care Medicaid |
$3,803.66
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$813.80
|
| Rate for Payer: Cigna All Products |
$1,565.00
|
| Rate for Payer: Copperpoint |
$877.97
|
| Rate for Payer: HealthNet Commercial |
$1,878.00
|
| Rate for Payer: HealthNet Medicare |
$876.40
|
| Rate for Payer: Humana Medicare |
$532.10
|
| Rate for Payer: Mercy Care Medicaid |
$3,803.66
|
| Rate for Payer: SELF PAY |
$2,504.00
|
| Rate for Payer: Veterans (Triwest) |
$532.10
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,824.79
|
| Rate for Payer: United Healthcare Medicare |
$563.40
|
|
|
Rectovaginal Fistula with colostomy
|
Facility
IP
|
$5,535.00
|
|
|
Service Code
|
CPT 57307
|
| Hospital Charge Code |
27267821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$940.95 |
| Max. Negotiated Rate |
$4,981.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4,981.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$940.95
|
| Rate for Payer: Amerigroup Medicare |
$940.95
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$940.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$940.95
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,439.10
|
| Rate for Payer: Copperpoint |
$1,552.57
|
| Rate for Payer: Humana Medicare |
$940.95
|
| Rate for Payer: SELF PAY |
$4,428.00
|
| Rate for Payer: Veterans (Triwest) |
$940.95
|
|
|
Rectovaginal Fistula with colostomy
|
Facility
OP
|
$5,535.00
|
|
|
Service Code
|
CPT 57307
|
| Hospital Charge Code |
27267821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$940.95 |
| Max. Negotiated Rate |
$4,981.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4,981.50
|
| Rate for Payer: Aetna Medicare |
$1,549.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$940.95
|
| Rate for Payer: Amerigroup Medicare |
$940.95
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$2,067.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$940.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$940.95
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,439.10
|
| Rate for Payer: Cigna All Products |
$2,767.50
|
| Rate for Payer: Copperpoint |
$1,552.57
|
| Rate for Payer: HealthNet Commercial |
$3,321.00
|
| Rate for Payer: HealthNet Medicare |
$1,549.80
|
| Rate for Payer: Humana Medicare |
$940.95
|
| Rate for Payer: SELF PAY |
$4,428.00
|
| Rate for Payer: Veterans (Triwest) |
$940.95
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$3,226.90
|
| Rate for Payer: United Healthcare Medicare |
$996.30
|
|
|
REF Ab Titer
|
Facility
OP
|
$107.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
22248796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$96.30
|
| Rate for Payer: Aetna Medicare |
$29.96
|
| Rate for Payer: AHCCCS Medicaid |
$5.18
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$5.18
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.19
|
| Rate for Payer: Amerigroup Medicare |
$18.19
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$39.96
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$5.18
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.19
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.19
|
| Rate for Payer: Banner University Family Care Medicaid |
$5.18
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.82
|
| Rate for Payer: Cigna All Products |
$69.55
|
| Rate for Payer: Copperpoint |
$30.01
|
| Rate for Payer: HealthNet Commercial |
$64.20
|
| Rate for Payer: HealthNet Medicare |
$29.96
|
| Rate for Payer: Humana Medicare |
$18.19
|
| Rate for Payer: Mercy Care Medicaid |
$5.18
|
| Rate for Payer: SELF PAY |
$85.60
|
| Rate for Payer: Veterans (Triwest) |
$18.19
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$62.38
|
| Rate for Payer: United Healthcare Medicare |
$19.26
|
|
|
REF Ab Titer
|
Facility
IP
|
$107.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
22248796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$96.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.19
|
| Rate for Payer: Amerigroup Medicare |
$18.19
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.19
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.19
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.82
|
| Rate for Payer: Copperpoint |
$30.01
|
| Rate for Payer: Humana Medicare |
$18.19
|
| Rate for Payer: SELF PAY |
$85.60
|
| Rate for Payer: Veterans (Triwest) |
$18.19
|
|
|
REF BB ANTIBODY ID ADDT'L AB
|
Facility
OP
|
$237.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
22373731
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.29 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$213.30
|
| Rate for Payer: Aetna Medicare |
$66.36
|
| Rate for Payer: AHCCCS Medicaid |
$211.16
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$211.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.29
|
| Rate for Payer: Amerigroup Medicare |
$40.29
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$88.52
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$211.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.29
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.29
|
| Rate for Payer: Banner University Family Care Medicaid |
$211.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.62
|
| Rate for Payer: Cigna All Products |
$154.05
|
| Rate for Payer: Copperpoint |
$66.48
|
| Rate for Payer: HealthNet Commercial |
$142.20
|
| Rate for Payer: HealthNet Medicare |
$66.36
|
| Rate for Payer: Humana Medicare |
$40.29
|
| Rate for Payer: Mercy Care Medicaid |
$211.16
|
| Rate for Payer: SELF PAY |
$189.60
|
| Rate for Payer: Veterans (Triwest) |
$40.29
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$138.17
|
| Rate for Payer: United Healthcare Medicare |
$42.66
|
|
|
REF BB ANTIBODY ID ADDT'L AB
|
Facility
IP
|
$237.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
22373731
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.29 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$213.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.29
|
| Rate for Payer: Amerigroup Medicare |
$40.29
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.29
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.29
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.62
|
| Rate for Payer: Copperpoint |
$66.48
|
| Rate for Payer: Humana Medicare |
$40.29
|
| Rate for Payer: SELF PAY |
$189.60
|
| Rate for Payer: Veterans (Triwest) |
$40.29
|
|
|
REF DAT
|
Facility
IP
|
$237.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
5562972
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.29 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$213.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.29
|
| Rate for Payer: Amerigroup Medicare |
$40.29
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.29
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.29
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.62
|
| Rate for Payer: Copperpoint |
$66.48
|
| Rate for Payer: Humana Medicare |
$40.29
|
| Rate for Payer: SELF PAY |
$189.60
|
| Rate for Payer: Veterans (Triwest) |
$40.29
|
|
|
REF DAT
|
Facility
OP
|
$237.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
5562972
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$213.30
|
| Rate for Payer: Aetna Medicare |
$66.36
|
| Rate for Payer: AHCCCS Medicaid |
$5.39
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$5.39
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.29
|
| Rate for Payer: Amerigroup Medicare |
$40.29
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$88.52
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$5.39
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.29
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.29
|
| Rate for Payer: Banner University Family Care Medicaid |
$5.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.62
|
| Rate for Payer: Cigna All Products |
$154.05
|
| Rate for Payer: Copperpoint |
$66.48
|
| Rate for Payer: HealthNet Commercial |
$142.20
|
| Rate for Payer: HealthNet Medicare |
$66.36
|
| Rate for Payer: Humana Medicare |
$40.29
|
| Rate for Payer: Mercy Care Medicaid |
$5.39
|
| Rate for Payer: SELF PAY |
$189.60
|
| Rate for Payer: Veterans (Triwest) |
$40.29
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$138.17
|
| Rate for Payer: United Healthcare Medicare |
$42.66
|
|
|
Reference ABID
|
Facility
OP
|
$761.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
1165545
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Aetna Medicare |
$213.08
|
| Rate for Payer: AHCCCS Medicaid |
$211.16
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$211.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$284.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$211.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: Banner University Family Care Medicaid |
$211.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Cigna All Products |
$494.65
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: HealthNet Commercial |
$456.60
|
| Rate for Payer: HealthNet Medicare |
$213.08
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: Mercy Care Medicaid |
$211.16
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$443.66
|
| Rate for Payer: United Healthcare Medicare |
$136.98
|
|
|
Reference ABID
|
Facility
IP
|
$761.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
1165545
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$684.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$129.37
|
| Rate for Payer: Amerigroup Medicare |
$129.37
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$129.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$129.37
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.86
|
| Rate for Payer: Copperpoint |
$213.46
|
| Rate for Payer: Humana Medicare |
$129.37
|
| Rate for Payer: SELF PAY |
$608.80
|
| Rate for Payer: Veterans (Triwest) |
$129.37
|
|
|
Reference Elution
|
Facility
IP
|
$107.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
2192233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$96.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.19
|
| Rate for Payer: Amerigroup Medicare |
$18.19
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.19
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.19
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.82
|
| Rate for Payer: Copperpoint |
$30.01
|
| Rate for Payer: Humana Medicare |
$18.19
|
| Rate for Payer: SELF PAY |
$85.60
|
| Rate for Payer: Veterans (Triwest) |
$18.19
|
|
|
Reference Elution
|
Facility
OP
|
$107.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
1165547
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$96.30
|
| Rate for Payer: Aetna Medicare |
$29.96
|
| Rate for Payer: AHCCCS Medicaid |
$17.89
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$17.89
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.19
|
| Rate for Payer: Amerigroup Medicare |
$18.19
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$39.96
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$17.89
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.19
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.19
|
| Rate for Payer: Banner University Family Care Medicaid |
$17.89
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.82
|
| Rate for Payer: Cigna All Products |
$69.55
|
| Rate for Payer: Copperpoint |
$30.01
|
| Rate for Payer: HealthNet Commercial |
$64.20
|
| Rate for Payer: HealthNet Medicare |
$29.96
|
| Rate for Payer: Humana Medicare |
$18.19
|
| Rate for Payer: Mercy Care Medicaid |
$17.89
|
| Rate for Payer: SELF PAY |
$85.60
|
| Rate for Payer: Veterans (Triwest) |
$18.19
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$62.38
|
| Rate for Payer: United Healthcare Medicare |
$19.26
|
|
|
Reference Elution
|
Facility
OP
|
$107.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
2192233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$96.30
|
| Rate for Payer: Aetna Medicare |
$29.96
|
| Rate for Payer: AHCCCS Medicaid |
$17.89
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$17.89
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.19
|
| Rate for Payer: Amerigroup Medicare |
$18.19
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$39.96
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$17.89
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.19
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.19
|
| Rate for Payer: Banner University Family Care Medicaid |
$17.89
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.82
|
| Rate for Payer: Cigna All Products |
$69.55
|
| Rate for Payer: Copperpoint |
$30.01
|
| Rate for Payer: HealthNet Commercial |
$64.20
|
| Rate for Payer: HealthNet Medicare |
$29.96
|
| Rate for Payer: Humana Medicare |
$18.19
|
| Rate for Payer: Mercy Care Medicaid |
$17.89
|
| Rate for Payer: SELF PAY |
$85.60
|
| Rate for Payer: Veterans (Triwest) |
$18.19
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$62.38
|
| Rate for Payer: United Healthcare Medicare |
$19.26
|
|
|
Reference Elution
|
Facility
IP
|
$107.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
1165547
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$96.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.19
|
| Rate for Payer: Amerigroup Medicare |
$18.19
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.19
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.19
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.82
|
| Rate for Payer: Copperpoint |
$30.01
|
| Rate for Payer: Humana Medicare |
$18.19
|
| Rate for Payer: SELF PAY |
$85.60
|
| Rate for Payer: Veterans (Triwest) |
$18.19
|
|
|
.Reflex to GenoSure(R) MG LC
|
Facility
IP
|
$1,502.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
22311165
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$255.34 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,351.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$255.34
|
| Rate for Payer: Amerigroup Medicare |
$255.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$255.34
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$255.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$390.52
|
| Rate for Payer: Copperpoint |
$421.31
|
| Rate for Payer: Humana Medicare |
$255.34
|
| Rate for Payer: SELF PAY |
$1,201.60
|
| Rate for Payer: Veterans (Triwest) |
$255.34
|
|
|
.Reflex to GenoSure(R) MG LC
|
Facility
OP
|
$1,502.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
22311165
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$255.34 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,351.80
|
| Rate for Payer: Aetna Medicare |
$420.56
|
| Rate for Payer: AHCCCS Medicaid |
$257.45
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$257.45
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$255.34
|
| Rate for Payer: Amerigroup Medicare |
$255.34
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$561.00
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$257.45
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$255.34
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$255.34
|
| Rate for Payer: Banner University Family Care Medicaid |
$257.45
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$390.52
|
| Rate for Payer: Cigna All Products |
$976.30
|
| Rate for Payer: Copperpoint |
$421.31
|
| Rate for Payer: HealthNet Commercial |
$901.20
|
| Rate for Payer: HealthNet Medicare |
$420.56
|
| Rate for Payer: Humana Medicare |
$255.34
|
| Rate for Payer: Mercy Care Medicaid |
$257.45
|
| Rate for Payer: SELF PAY |
$1,201.60
|
| Rate for Payer: Veterans (Triwest) |
$255.34
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$875.67
|
| Rate for Payer: United Healthcare Medicare |
$270.36
|
|
|
REF RBC OTHER THAN ABO
|
Facility
OP
|
$237.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
22373722
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$213.30
|
| Rate for Payer: Aetna Medicare |
$66.36
|
| Rate for Payer: AHCCCS Medicaid |
$3.83
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3.83
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.29
|
| Rate for Payer: Amerigroup Medicare |
$40.29
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$88.52
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3.83
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.29
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.29
|
| Rate for Payer: Banner University Family Care Medicaid |
$3.83
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.62
|
| Rate for Payer: Cigna All Products |
$154.05
|
| Rate for Payer: Copperpoint |
$66.48
|
| Rate for Payer: HealthNet Commercial |
$142.20
|
| Rate for Payer: HealthNet Medicare |
$66.36
|
| Rate for Payer: Humana Medicare |
$40.29
|
| Rate for Payer: Mercy Care Medicaid |
$3.83
|
| Rate for Payer: SELF PAY |
$189.60
|
| Rate for Payer: Veterans (Triwest) |
$40.29
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$138.17
|
| Rate for Payer: United Healthcare Medicare |
$42.66
|
|
|
REF RBC OTHER THAN ABO
|
Facility
IP
|
$237.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
22373722
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.29 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$213.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.29
|
| Rate for Payer: Amerigroup Medicare |
$40.29
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.29
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.29
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.62
|
| Rate for Payer: Copperpoint |
$66.48
|
| Rate for Payer: Humana Medicare |
$40.29
|
| Rate for Payer: SELF PAY |
$189.60
|
| Rate for Payer: Veterans (Triwest) |
$40.29
|
|
|
REF RBC PHENOTYPING
|
Facility
IP
|
$237.00
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
1676008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.29 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$213.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.29
|
| Rate for Payer: Amerigroup Medicare |
$40.29
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.29
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.29
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.62
|
| Rate for Payer: Copperpoint |
$66.48
|
| Rate for Payer: Humana Medicare |
$40.29
|
| Rate for Payer: SELF PAY |
$189.60
|
| Rate for Payer: Veterans (Triwest) |
$40.29
|
|
|
REF RBC PHENOTYPING
|
Facility
OP
|
$237.00
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
1676008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$213.30
|
| Rate for Payer: Aetna Medicare |
$66.36
|
| Rate for Payer: AHCCCS Medicaid |
$7.75
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$7.75
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.29
|
| Rate for Payer: Amerigroup Medicare |
$40.29
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$88.52
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$7.75
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.29
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.29
|
| Rate for Payer: Banner University Family Care Medicaid |
$7.75
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.62
|
| Rate for Payer: Cigna All Products |
$154.05
|
| Rate for Payer: Copperpoint |
$66.48
|
| Rate for Payer: HealthNet Commercial |
$142.20
|
| Rate for Payer: HealthNet Medicare |
$66.36
|
| Rate for Payer: Humana Medicare |
$40.29
|
| Rate for Payer: Mercy Care Medicaid |
$7.75
|
| Rate for Payer: SELF PAY |
$189.60
|
| Rate for Payer: Veterans (Triwest) |
$40.29
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$138.17
|
| Rate for Payer: United Healthcare Medicare |
$42.66
|
|
|
Rehabilitation
|
Facility
IP
|
$12,529.81
|
|
|
Service Code
|
APRDRG 8603
|
| Hospital Charge Code |
APRDRG8603
|
| Min. Negotiated Rate |
$12,529.81 |
| Max. Negotiated Rate |
$12,529.81 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$12,529.81
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$12,529.81
|
| Rate for Payer: Banner University Family Care Medicaid |
$12,529.81
|
| Rate for Payer: Mercy Care Medicaid |
$12,529.81
|
|
|
Rehabilitation
|
Facility
IP
|
$15,792.02
|
|
|
Service Code
|
APRDRG 8604
|
| Hospital Charge Code |
APRDRG8604
|
| Min. Negotiated Rate |
$15,792.02 |
| Max. Negotiated Rate |
$15,792.02 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$15,792.02
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$15,792.02
|
| Rate for Payer: Banner University Family Care Medicaid |
$15,792.02
|
| Rate for Payer: Mercy Care Medicaid |
$15,792.02
|
|
|
Rehabilitation
|
Facility
IP
|
$9,792.25
|
|
|
Service Code
|
APRDRG 8602
|
| Hospital Charge Code |
APRDRG8602
|
| Min. Negotiated Rate |
$9,792.25 |
| Max. Negotiated Rate |
$9,792.25 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$9,792.25
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$9,792.25
|
| Rate for Payer: Banner University Family Care Medicaid |
$9,792.25
|
| Rate for Payer: Mercy Care Medicaid |
$9,792.25
|
|