|
RETRIEVAL TISSUE SYSTEM ANCHOR
|
Facility
OP
|
$368.00
|
|
| Hospital Charge Code |
22354821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.56 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: SELF PAY |
$294.40
|
| Rate for Payer: Aetna POS, PPO, HMO |
$331.20
|
| Rate for Payer: Aetna Medicare |
$103.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$62.56
|
| Rate for Payer: Amerigroup Medicare |
$62.56
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$137.45
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$62.56
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$62.56
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$95.68
|
| Rate for Payer: Cigna All Products |
$257.60
|
| Rate for Payer: Copperpoint |
$103.22
|
| Rate for Payer: HealthNet Commercial |
$220.80
|
| Rate for Payer: HealthNet Medicare |
$103.04
|
| Rate for Payer: Humana Medicare |
$62.56
|
| Rate for Payer: Veterans (Triwest) |
$62.56
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$214.54
|
| Rate for Payer: United Healthcare Medicare |
$66.24
|
|
|
RETRIEVAL TISSUE SYSTEM ANCHOR
|
Facility
IP
|
$368.00
|
|
| Hospital Charge Code |
22354821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.56 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$331.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$62.56
|
| Rate for Payer: Amerigroup Medicare |
$62.56
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$62.56
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$62.56
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$95.68
|
| Rate for Payer: Copperpoint |
$103.22
|
| Rate for Payer: Humana Medicare |
$62.56
|
| Rate for Payer: SELF PAY |
$294.40
|
| Rate for Payer: Veterans (Triwest) |
$62.56
|
|
|
Reverse T3 LC
|
Facility
OP
|
$378.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
2087649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Mercy Care Medicaid |
$15.76
|
| Rate for Payer: SELF PAY |
$302.40
|
| Rate for Payer: Humana Medicare |
$64.26
|
| Rate for Payer: Aetna POS, PPO, HMO |
$340.20
|
| Rate for Payer: Aetna Medicare |
$105.84
|
| Rate for Payer: AHCCCS Medicaid |
$15.76
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$15.76
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$64.26
|
| Rate for Payer: Amerigroup Medicare |
$64.26
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$141.18
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$15.76
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$64.26
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$64.26
|
| Rate for Payer: Banner University Family Care Medicaid |
$15.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$98.28
|
| Rate for Payer: Cigna All Products |
$245.70
|
| Rate for Payer: Copperpoint |
$106.03
|
| Rate for Payer: HealthNet Commercial |
$226.80
|
| Rate for Payer: HealthNet Medicare |
$105.84
|
| Rate for Payer: Veterans (Triwest) |
$64.26
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$220.37
|
| Rate for Payer: United Healthcare Medicare |
$68.04
|
|
|
Reverse T3 LC
|
Facility
IP
|
$378.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
2087649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$340.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$64.26
|
| Rate for Payer: Amerigroup Medicare |
$64.26
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$64.26
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$64.26
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$98.28
|
| Rate for Payer: Copperpoint |
$106.03
|
| Rate for Payer: Humana Medicare |
$64.26
|
| Rate for Payer: SELF PAY |
$302.40
|
| Rate for Payer: Veterans (Triwest) |
$64.26
|
|
|
RF Qualitative
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
1051519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$121.50
|
| Rate for Payer: Aetna Medicare |
$37.80
|
| Rate for Payer: AHCCCS Medicaid |
$6.14
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$6.14
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$22.95
|
| Rate for Payer: Amerigroup Medicare |
$22.95
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$50.42
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$6.14
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$22.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$22.95
|
| Rate for Payer: Banner University Family Care Medicaid |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$86.93
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$35.10
|
| Rate for Payer: Cigna All Products |
$87.75
|
| Rate for Payer: Copperpoint |
$37.87
|
| Rate for Payer: HealthNet Commercial |
$81.00
|
| Rate for Payer: HealthNet Medicare |
$37.80
|
| Rate for Payer: Humana Medicare |
$22.95
|
| Rate for Payer: Mercy Care Medicaid |
$6.14
|
| Rate for Payer: SELF PAY |
$108.00
|
| Rate for Payer: Veterans (Triwest) |
$22.95
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$78.70
|
| Rate for Payer: United Healthcare Medicare |
$24.30
|
|
|
RF Qualitative
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
1051519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$121.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$22.95
|
| Rate for Payer: Amerigroup Medicare |
$22.95
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$22.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$86.93
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$35.10
|
| Rate for Payer: Copperpoint |
$37.87
|
| Rate for Payer: Humana Medicare |
$22.95
|
| Rate for Payer: SELF PAY |
$108.00
|
| Rate for Payer: Veterans (Triwest) |
$22.95
|
|
|
Rh
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
22308645
|
|
Hospital Revenue Code
|
302
|
| 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: Blue Cross Blue Shield AZ PPO |
$64.60
|
| 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
|
|
|
Rh
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
22308645
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$89.10
|
| Rate for Payer: Aetna Medicare |
$27.72
|
| Rate for Payer: AHCCCS Medicaid |
$2.99
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2.99
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.83
|
| Rate for Payer: Amerigroup Medicare |
$16.83
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$36.98
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2.99
|
| 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: Banner University Family Care Medicaid |
$2.99
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$64.60
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$25.74
|
| Rate for Payer: Cigna All Products |
$64.35
|
| Rate for Payer: Copperpoint |
$27.77
|
| Rate for Payer: HealthNet Commercial |
$59.40
|
| Rate for Payer: HealthNet Medicare |
$27.72
|
| Rate for Payer: Humana Medicare |
$16.83
|
| Rate for Payer: Mercy Care Medicaid |
$2.99
|
| Rate for Payer: SELF PAY |
$79.20
|
| Rate for Payer: Veterans (Triwest) |
$16.83
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$57.72
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
|
|
Rheumatoid Arthritis Factor LC
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
1285583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$121.50
|
| Rate for Payer: Aetna Medicare |
$37.80
|
| Rate for Payer: AHCCCS Medicaid |
$6.14
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$6.14
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$22.95
|
| Rate for Payer: Amerigroup Medicare |
$22.95
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$50.42
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$6.14
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$22.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$22.95
|
| Rate for Payer: Banner University Family Care Medicaid |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$86.93
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$35.10
|
| Rate for Payer: Cigna All Products |
$87.75
|
| Rate for Payer: Copperpoint |
$37.87
|
| Rate for Payer: HealthNet Commercial |
$81.00
|
| Rate for Payer: HealthNet Medicare |
$37.80
|
| Rate for Payer: Humana Medicare |
$22.95
|
| Rate for Payer: Mercy Care Medicaid |
$6.14
|
| Rate for Payer: SELF PAY |
$108.00
|
| Rate for Payer: Veterans (Triwest) |
$22.95
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$78.70
|
| Rate for Payer: United Healthcare Medicare |
$24.30
|
|
|
Rheumatoid Arthritis Factor LC
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
1285583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$121.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$22.95
|
| Rate for Payer: Amerigroup Medicare |
$22.95
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$22.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$86.93
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$35.10
|
| Rate for Payer: Copperpoint |
$37.87
|
| Rate for Payer: Humana Medicare |
$22.95
|
| Rate for Payer: SELF PAY |
$108.00
|
| Rate for Payer: Veterans (Triwest) |
$22.95
|
|
|
RHEUMATOID FACTOR; QUANTITATIVE
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
23603252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$35.10
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: AHCCCS Medicaid |
$5.67
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$5.67
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.63
|
| Rate for Payer: Amerigroup Medicare |
$6.63
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$14.57
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$5.67
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.63
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.63
|
| Rate for Payer: Banner University Family Care Medicaid |
$5.67
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.14
|
| Rate for Payer: Cigna All Products |
$25.35
|
| Rate for Payer: Copperpoint |
$10.94
|
| Rate for Payer: HealthNet Commercial |
$23.40
|
| Rate for Payer: HealthNet Medicare |
$10.92
|
| Rate for Payer: Humana Medicare |
$6.63
|
| Rate for Payer: Mercy Care Medicaid |
$5.67
|
| Rate for Payer: SELF PAY |
$31.20
|
| Rate for Payer: Veterans (Triwest) |
$6.63
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$22.74
|
| Rate for Payer: United Healthcare Medicare |
$7.02
|
|
|
RHEUMATOID FACTOR; QUANTITATIVE
|
Facility
IP
|
$39.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
23603252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: SELF PAY |
$31.20
|
| Rate for Payer: Humana Medicare |
$6.63
|
| Rate for Payer: Aetna POS, PPO, HMO |
$35.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.63
|
| Rate for Payer: Amerigroup Medicare |
$6.63
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.63
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.63
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.14
|
| Rate for Payer: Copperpoint |
$10.94
|
| Rate for Payer: Veterans (Triwest) |
$6.63
|
|
|
.RMSF, IgG, IFA LC
|
Facility
IP
|
$238.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1285666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Humana Medicare |
$40.46
|
| Rate for Payer: SELF PAY |
$190.40
|
| Rate for Payer: Aetna POS, PPO, HMO |
$214.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.46
|
| Rate for Payer: Amerigroup Medicare |
$40.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.46
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.88
|
| Rate for Payer: Copperpoint |
$66.76
|
| Rate for Payer: Veterans (Triwest) |
$40.46
|
|
|
.RMSF, IgG, IFA LC
|
Facility
OP
|
$238.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1285666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$214.20
|
| Rate for Payer: Aetna Medicare |
$66.64
|
| Rate for Payer: AHCCCS Medicaid |
$19.35
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$19.35
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.46
|
| Rate for Payer: Amerigroup Medicare |
$40.46
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$88.89
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$19.35
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.46
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.46
|
| Rate for Payer: Banner University Family Care Medicaid |
$19.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.88
|
| Rate for Payer: Cigna All Products |
$154.70
|
| Rate for Payer: Copperpoint |
$66.76
|
| Rate for Payer: HealthNet Commercial |
$142.80
|
| Rate for Payer: HealthNet Medicare |
$66.64
|
| Rate for Payer: Humana Medicare |
$40.46
|
| Rate for Payer: Mercy Care Medicaid |
$19.35
|
| Rate for Payer: SELF PAY |
$190.40
|
| Rate for Payer: Veterans (Triwest) |
$40.46
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$138.75
|
| Rate for Payer: United Healthcare Medicare |
$42.84
|
|
|
RNA, PCR (NonGraph) rfx/Geno LC
|
Facility
IP
|
$685.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
22311205
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$116.45 |
| Max. Negotiated Rate |
$616.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$616.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$116.45
|
| Rate for Payer: Amerigroup Medicare |
$116.45
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$116.45
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$116.45
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$457.64
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$178.10
|
| Rate for Payer: Copperpoint |
$192.14
|
| Rate for Payer: Humana Medicare |
$116.45
|
| Rate for Payer: SELF PAY |
$548.00
|
| Rate for Payer: Veterans (Triwest) |
$116.45
|
|
|
RNA, PCR (NonGraph) rfx/Geno LC
|
Facility
OP
|
$685.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
22311205
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$616.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$616.50
|
| Rate for Payer: Aetna Medicare |
$191.80
|
| Rate for Payer: AHCCCS Medicaid |
$42.84
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$42.84
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$116.45
|
| Rate for Payer: Amerigroup Medicare |
$116.45
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$255.85
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$42.84
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$116.45
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$116.45
|
| Rate for Payer: Banner University Family Care Medicaid |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$457.64
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$178.10
|
| Rate for Payer: Cigna All Products |
$445.25
|
| Rate for Payer: Copperpoint |
$192.14
|
| Rate for Payer: HealthNet Commercial |
$411.00
|
| Rate for Payer: HealthNet Medicare |
$191.80
|
| Rate for Payer: Humana Medicare |
$116.45
|
| Rate for Payer: Mercy Care Medicaid |
$42.84
|
| Rate for Payer: SELF PAY |
$548.00
|
| Rate for Payer: Veterans (Triwest) |
$116.45
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$399.35
|
| Rate for Payer: United Healthcare Medicare |
$123.30
|
|
|
RNA Real Time PCR (Non-Graph) LC
|
Facility
OP
|
$1,058.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
6781926
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$952.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$952.20
|
| Rate for Payer: Aetna Medicare |
$296.24
|
| Rate for Payer: AHCCCS Medicaid |
$85.10
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$85.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$179.86
|
| Rate for Payer: Amerigroup Medicare |
$179.86
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$395.16
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$85.10
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$179.86
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$179.86
|
| Rate for Payer: Banner University Family Care Medicaid |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$615.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$275.08
|
| Rate for Payer: Cigna All Products |
$687.70
|
| Rate for Payer: Copperpoint |
$296.77
|
| Rate for Payer: HealthNet Commercial |
$634.80
|
| Rate for Payer: HealthNet Medicare |
$296.24
|
| Rate for Payer: Humana Medicare |
$179.86
|
| Rate for Payer: Mercy Care Medicaid |
$85.10
|
| Rate for Payer: SELF PAY |
$846.40
|
| Rate for Payer: Veterans (Triwest) |
$179.86
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$616.81
|
| Rate for Payer: United Healthcare Medicare |
$190.44
|
|
|
RNA Real Time PCR (Non-Graph) LC
|
Facility
IP
|
$1,058.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
6781926
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$179.86 |
| Max. Negotiated Rate |
$952.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$952.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$179.86
|
| Rate for Payer: Amerigroup Medicare |
$179.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$179.86
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$179.86
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$615.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$275.08
|
| Rate for Payer: Copperpoint |
$296.77
|
| Rate for Payer: Humana Medicare |
$179.86
|
| Rate for Payer: SELF PAY |
$846.40
|
| Rate for Payer: Veterans (Triwest) |
$179.86
|
|
|
Robotic colpopexy
|
Facility
OP
|
$5,050.00
|
|
|
Service Code
|
CPT 57425
|
| Hospital Charge Code |
27281899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$858.50 |
| Max. Negotiated Rate |
$12,916.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4,545.00
|
| Rate for Payer: Aetna Medicare |
$1,414.00
|
| Rate for Payer: AHCCCS Medicaid |
$12,916.10
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$12,916.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$858.50
|
| Rate for Payer: Amerigroup Medicare |
$858.50
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,886.17
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$12,916.10
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$858.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$858.50
|
| Rate for Payer: Banner University Family Care Medicaid |
$12,916.10
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,313.00
|
| Rate for Payer: Cigna All Products |
$2,525.00
|
| Rate for Payer: Copperpoint |
$1,416.53
|
| Rate for Payer: HealthNet Commercial |
$3,030.00
|
| Rate for Payer: HealthNet Medicare |
$1,414.00
|
| Rate for Payer: Humana Medicare |
$858.50
|
| Rate for Payer: Mercy Care Medicaid |
$12,916.10
|
| Rate for Payer: SELF PAY |
$4,040.00
|
| Rate for Payer: Veterans (Triwest) |
$858.50
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2,944.15
|
| Rate for Payer: United Healthcare Medicare |
$909.00
|
|
|
Robotic colpopexy
|
Facility
IP
|
$5,050.00
|
|
|
Service Code
|
CPT 57425
|
| Hospital Charge Code |
27281899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$858.50 |
| Max. Negotiated Rate |
$4,545.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4,545.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$858.50
|
| Rate for Payer: Amerigroup Medicare |
$858.50
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$858.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$858.50
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,313.00
|
| Rate for Payer: Copperpoint |
$1,416.53
|
| Rate for Payer: Humana Medicare |
$858.50
|
| Rate for Payer: SELF PAY |
$4,040.00
|
| Rate for Payer: Veterans (Triwest) |
$858.50
|
|
|
Rocky Mtn Spotted Fever, IgM LC
|
Facility
IP
|
$238.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1285661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$214.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.46
|
| Rate for Payer: Amerigroup Medicare |
$40.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.46
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.88
|
| Rate for Payer: Copperpoint |
$66.76
|
| Rate for Payer: Humana Medicare |
$40.46
|
| Rate for Payer: SELF PAY |
$190.40
|
| Rate for Payer: Veterans (Triwest) |
$40.46
|
|
|
Rocky Mtn Spotted Fever, IgM LC
|
Facility
OP
|
$238.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1285661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$214.20
|
| Rate for Payer: Aetna Medicare |
$66.64
|
| Rate for Payer: AHCCCS Medicaid |
$19.35
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$19.35
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.46
|
| Rate for Payer: Amerigroup Medicare |
$40.46
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$88.89
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$19.35
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.46
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.46
|
| Rate for Payer: Banner University Family Care Medicaid |
$19.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.88
|
| Rate for Payer: Cigna All Products |
$154.70
|
| Rate for Payer: Copperpoint |
$66.76
|
| Rate for Payer: HealthNet Commercial |
$142.80
|
| Rate for Payer: HealthNet Medicare |
$66.64
|
| Rate for Payer: Humana Medicare |
$40.46
|
| Rate for Payer: Mercy Care Medicaid |
$19.35
|
| Rate for Payer: SELF PAY |
$190.40
|
| Rate for Payer: Veterans (Triwest) |
$40.46
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$138.75
|
| Rate for Payer: United Healthcare Medicare |
$42.84
|
|
|
Rocky Mtn Spotted Fev, IgG, Qn LC
|
Facility
OP
|
$238.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1285665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$214.20
|
| Rate for Payer: Aetna Medicare |
$66.64
|
| Rate for Payer: AHCCCS Medicaid |
$19.35
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$19.35
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.46
|
| Rate for Payer: Amerigroup Medicare |
$40.46
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$88.89
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$19.35
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.46
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.46
|
| Rate for Payer: Banner University Family Care Medicaid |
$19.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.88
|
| Rate for Payer: Cigna All Products |
$154.70
|
| Rate for Payer: Copperpoint |
$66.76
|
| Rate for Payer: HealthNet Commercial |
$142.80
|
| Rate for Payer: HealthNet Medicare |
$66.64
|
| Rate for Payer: Humana Medicare |
$40.46
|
| Rate for Payer: Mercy Care Medicaid |
$19.35
|
| Rate for Payer: SELF PAY |
$190.40
|
| Rate for Payer: Veterans (Triwest) |
$40.46
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$138.75
|
| Rate for Payer: United Healthcare Medicare |
$42.84
|
|
|
Rocky Mtn Spotted Fev, IgG, Qn LC
|
Facility
IP
|
$238.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1285665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$214.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.46
|
| Rate for Payer: Amerigroup Medicare |
$40.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.46
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.88
|
| Rate for Payer: Copperpoint |
$66.76
|
| Rate for Payer: Humana Medicare |
$40.46
|
| Rate for Payer: SELF PAY |
$190.40
|
| Rate for Payer: Veterans (Triwest) |
$40.46
|
|
|
ROOM/BED: Extended Recovery
|
Facility
IP
|
$50.00
|
|
| Hospital Charge Code |
2091602
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$45.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$8.50
|
| Rate for Payer: Amerigroup Medicare |
$8.50
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$8.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$8.50
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$13.00
|
| Rate for Payer: Copperpoint |
$14.03
|
| Rate for Payer: Humana Medicare |
$8.50
|
| Rate for Payer: SELF PAY |
$40.00
|
| Rate for Payer: Veterans (Triwest) |
$8.50
|
|