|
43239 BIOPSY OF THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL B
|
Facility
|
OP
|
$3,325.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
23599032
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$498.75 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Aetna of AZ Commercial |
$2,992.50
|
| Rate for Payer: Aetna of AZ Medicare |
$931.00
|
| Rate for Payer: AHCCCS Medicaid |
$1,173.92
|
| Rate for Payer: Allwell Medicaid |
$1,173.92
|
| Rate for Payer: Allwell Medicare |
$498.75
|
| Rate for Payer: Amerigroup Medicare |
$498.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,241.89
|
| Rate for Payer: AZCH Complete Medicaid |
$1,173.92
|
| Rate for Payer: AZCH Complete Medicare |
$498.75
|
| Rate for Payer: Banner UC Health Medicaid |
$1,173.92
|
| Rate for Payer: Banner UC Health Medicare |
$498.75
|
| Rate for Payer: Bisbee Police All Plans |
$864.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,261.00
|
| Rate for Payer: Cash Price |
$2,660.00
|
| Rate for Payer: Cash Price |
$2,660.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,327.50
|
| Rate for Payer: Copperpoint Commercial |
$822.94
|
| Rate for Payer: Health Net of AZ Commercial |
$1,995.00
|
| Rate for Payer: Health Net of AZ Medicare |
$931.00
|
| Rate for Payer: Humana of AZ Medicare |
$498.75
|
| Rate for Payer: Mercy Care Medicaid |
$1,173.92
|
| Rate for Payer: Self Pay Self Pay |
$2,660.00
|
| Rate for Payer: TriWest Medicare |
$498.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$598.50
|
|
|
43239 BIOPSY OF THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL B
|
Facility
|
IP
|
$3,325.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
23599032
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$864.50 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Aetna of AZ Commercial |
$2,992.50
|
| Rate for Payer: Bisbee Police All Plans |
$864.50
|
| Rate for Payer: Cash Price |
$2,660.00
|
| Rate for Payer: Self Pay Self Pay |
$2,660.00
|
|
|
43760 GASTRO TUBE REPLACEMENT
|
Facility
|
OP
|
$2,159.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
22282918
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$323.85 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,943.10
|
| Rate for Payer: Aetna of AZ Medicare |
$604.52
|
| Rate for Payer: AHCCCS Medicaid |
$385.90
|
| Rate for Payer: Allwell Medicaid |
$385.90
|
| Rate for Payer: Allwell Medicare |
$323.85
|
| Rate for Payer: Amerigroup Medicare |
$323.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$806.39
|
| Rate for Payer: AZCH Complete Medicaid |
$385.90
|
| Rate for Payer: AZCH Complete Medicare |
$323.85
|
| Rate for Payer: Banner UC Health Medicaid |
$385.90
|
| Rate for Payer: Banner UC Health Medicare |
$323.85
|
| Rate for Payer: Bisbee Police All Plans |
$561.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,468.12
|
| Rate for Payer: Cash Price |
$1,727.20
|
| Rate for Payer: Cash Price |
$1,727.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,511.30
|
| Rate for Payer: Copperpoint Commercial |
$534.35
|
| Rate for Payer: Health Net of AZ Commercial |
$1,295.40
|
| Rate for Payer: Health Net of AZ Medicare |
$604.52
|
| Rate for Payer: Humana of AZ Medicare |
$323.85
|
| Rate for Payer: Mercy Care Medicaid |
$385.90
|
| Rate for Payer: Self Pay Self Pay |
$1,727.20
|
| Rate for Payer: TriWest Medicare |
$323.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$388.62
|
|
|
43760 GASTRO TUBE REPLACEMENT
|
Facility
|
IP
|
$2,159.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
22282918
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$561.34 |
| Max. Negotiated Rate |
$1,943.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,943.10
|
| Rate for Payer: Bisbee Police All Plans |
$561.34
|
| Rate for Payer: Cash Price |
$1,727.20
|
| Rate for Payer: Self Pay Self Pay |
$1,727.20
|
|
|
45378 PROF DIAGNOSTIC COLONSCOP
|
Facility
|
OP
|
$3,684.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
22389269
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$552.60 |
| Max. Negotiated Rate |
$3,315.60 |
| Rate for Payer: Aetna of AZ Commercial |
$3,315.60
|
| Rate for Payer: Aetna of AZ Medicare |
$1,031.52
|
| Rate for Payer: AHCCCS Medicaid |
$1,150.80
|
| Rate for Payer: Allwell Medicaid |
$1,150.80
|
| Rate for Payer: Allwell Medicare |
$552.60
|
| Rate for Payer: Amerigroup Medicare |
$552.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,375.97
|
| Rate for Payer: AZCH Complete Medicaid |
$1,150.80
|
| Rate for Payer: AZCH Complete Medicare |
$552.60
|
| Rate for Payer: Banner UC Health Medicaid |
$1,150.80
|
| Rate for Payer: Banner UC Health Medicare |
$552.60
|
| Rate for Payer: Bisbee Police All Plans |
$957.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,505.12
|
| Rate for Payer: Cash Price |
$2,947.20
|
| Rate for Payer: Cash Price |
$2,947.20
|
| Rate for Payer: Cigna of AZ Commercial |
$2,578.80
|
| Rate for Payer: Copperpoint Commercial |
$911.79
|
| Rate for Payer: Health Net of AZ Commercial |
$2,210.40
|
| Rate for Payer: Health Net of AZ Medicare |
$1,031.52
|
| Rate for Payer: Humana of AZ Medicare |
$552.60
|
| Rate for Payer: Mercy Care Medicaid |
$1,150.80
|
| Rate for Payer: Self Pay Self Pay |
$2,947.20
|
| Rate for Payer: TriWest Medicare |
$552.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$663.12
|
|
|
45378 PROF DIAGNOSTIC COLONSCOP
|
Facility
|
IP
|
$3,684.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
22389269
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$957.84 |
| Max. Negotiated Rate |
$3,315.60 |
| Rate for Payer: Aetna of AZ Commercial |
$3,315.60
|
| Rate for Payer: Bisbee Police All Plans |
$957.84
|
| Rate for Payer: Cash Price |
$2,947.20
|
| Rate for Payer: Self Pay Self Pay |
$2,947.20
|
|
|
49082 ABDOMINAL PARACENTESIS
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
22282919
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$796.50
|
| Rate for Payer: Aetna of AZ Medicare |
$247.80
|
| Rate for Payer: AHCCCS Medicaid |
$1,173.92
|
| Rate for Payer: Allwell Medicaid |
$1,173.92
|
| Rate for Payer: Allwell Medicare |
$132.75
|
| Rate for Payer: Amerigroup Medicare |
$132.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$330.55
|
| Rate for Payer: AZCH Complete Medicaid |
$1,173.92
|
| Rate for Payer: AZCH Complete Medicare |
$132.75
|
| Rate for Payer: Banner UC Health Medicaid |
$1,173.92
|
| Rate for Payer: Banner UC Health Medicare |
$132.75
|
| Rate for Payer: Bisbee Police All Plans |
$230.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$601.80
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna of AZ Commercial |
$575.25
|
| Rate for Payer: Copperpoint Commercial |
$219.04
|
| Rate for Payer: Health Net of AZ Commercial |
$531.00
|
| Rate for Payer: Health Net of AZ Medicare |
$247.80
|
| Rate for Payer: Humana of AZ Medicare |
$132.75
|
| Rate for Payer: Mercy Care Medicaid |
$1,173.92
|
| Rate for Payer: Self Pay Self Pay |
$708.00
|
| Rate for Payer: TriWest Medicare |
$132.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$159.30
|
|
|
49082 ABDOMINAL PARACENTESIS
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
22282919
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$796.50 |
| Rate for Payer: Aetna of AZ Commercial |
$796.50
|
| Rate for Payer: Bisbee Police All Plans |
$230.10
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Self Pay Self Pay |
$708.00
|
|
|
4MM OVAL CARBIDE BUR
|
Facility
|
OP
|
$166.00
|
|
| Hospital Charge Code |
27433626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna of AZ Commercial |
$149.40
|
| Rate for Payer: Aetna of AZ Medicare |
$46.48
|
| Rate for Payer: Allwell Medicare |
$24.90
|
| Rate for Payer: Amerigroup Medicare |
$24.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$62.00
|
| Rate for Payer: AZCH Complete Medicare |
$24.90
|
| Rate for Payer: Banner UC Health Medicare |
$24.90
|
| Rate for Payer: Bisbee Police All Plans |
$43.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$112.88
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cigna of AZ Commercial |
$116.20
|
| Rate for Payer: Copperpoint Commercial |
$41.08
|
| Rate for Payer: Health Net of AZ Commercial |
$99.60
|
| Rate for Payer: Health Net of AZ Medicare |
$46.48
|
| Rate for Payer: Humana of AZ Medicare |
$24.90
|
| Rate for Payer: Self Pay Self Pay |
$132.80
|
| Rate for Payer: TriWest Medicare |
$24.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$96.78
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$29.88
|
|
|
4MM OVAL CARBIDE BUR
|
Facility
|
IP
|
$166.00
|
|
| Hospital Charge Code |
27433626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna of AZ Commercial |
$149.40
|
| Rate for Payer: Bisbee Police All Plans |
$43.16
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Self Pay Self Pay |
$132.80
|
|
|
5-0 Polysorb P-13 Violet Braided
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
22926431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Bisbee Police All Plans |
$20.28
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
|
|
5-0 Polysorb P-13 Violet Braided
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
22926431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Aetna of AZ Medicare |
$21.84
|
| Rate for Payer: Allwell Medicare |
$11.70
|
| Rate for Payer: Amerigroup Medicare |
$11.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$29.13
|
| Rate for Payer: AZCH Complete Medicare |
$11.70
|
| Rate for Payer: Banner UC Health Medicare |
$11.70
|
| Rate for Payer: Bisbee Police All Plans |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$53.04
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna of AZ Commercial |
$54.60
|
| Rate for Payer: Copperpoint Commercial |
$19.30
|
| Rate for Payer: Health Net of AZ Commercial |
$46.80
|
| Rate for Payer: Health Net of AZ Medicare |
$21.84
|
| Rate for Payer: Humana of AZ Medicare |
$11.70
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
| Rate for Payer: TriWest Medicare |
$11.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$45.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.04
|
|
|
5-0 Prolene FS-2
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
22926433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of AZ Commercial |
$50.40
|
| Rate for Payer: Bisbee Police All Plans |
$14.56
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Self Pay Self Pay |
$44.80
|
|
|
5-0 Prolene FS-2
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
22926433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of AZ Commercial |
$50.40
|
| Rate for Payer: Aetna of AZ Medicare |
$15.68
|
| Rate for Payer: Allwell Medicare |
$8.40
|
| Rate for Payer: Amerigroup Medicare |
$8.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$20.92
|
| Rate for Payer: AZCH Complete Medicare |
$8.40
|
| Rate for Payer: Banner UC Health Medicare |
$8.40
|
| Rate for Payer: Bisbee Police All Plans |
$14.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$38.08
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cigna of AZ Commercial |
$39.20
|
| Rate for Payer: Copperpoint Commercial |
$13.86
|
| Rate for Payer: Health Net of AZ Commercial |
$33.60
|
| Rate for Payer: Health Net of AZ Medicare |
$15.68
|
| Rate for Payer: Humana of AZ Medicare |
$8.40
|
| Rate for Payer: Self Pay Self Pay |
$44.80
|
| Rate for Payer: TriWest Medicare |
$8.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$32.65
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.08
|
|
|
5-0 Vicryl Plus P-3 Undyed Braided
|
Facility
|
IP
|
$17.00
|
|
| Hospital Charge Code |
22926430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of AZ Commercial |
$15.30
|
| Rate for Payer: Bisbee Police All Plans |
$4.42
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Self Pay Self Pay |
$13.60
|
|
|
5-0 Vicryl Plus P-3 Undyed Braided
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
22926430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of AZ Commercial |
$15.30
|
| Rate for Payer: Aetna of AZ Medicare |
$4.76
|
| Rate for Payer: Allwell Medicare |
$2.55
|
| Rate for Payer: Amerigroup Medicare |
$2.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$6.35
|
| Rate for Payer: AZCH Complete Medicare |
$2.55
|
| Rate for Payer: Banner UC Health Medicare |
$2.55
|
| Rate for Payer: Bisbee Police All Plans |
$4.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$11.56
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cigna of AZ Commercial |
$11.90
|
| Rate for Payer: Copperpoint Commercial |
$4.21
|
| Rate for Payer: Health Net of AZ Commercial |
$10.20
|
| Rate for Payer: Health Net of AZ Medicare |
$4.76
|
| Rate for Payer: Humana of AZ Medicare |
$2.55
|
| Rate for Payer: Self Pay Self Pay |
$13.60
|
| Rate for Payer: TriWest Medicare |
$2.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$9.91
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.06
|
|
|
51010 SUPRAPUBIC CATH INSERTIO
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
CPT 51010
|
| Hospital Charge Code |
22282920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$448.20 |
| Rate for Payer: Aetna of AZ Commercial |
$448.20
|
| Rate for Payer: Bisbee Police All Plans |
$129.48
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Self Pay Self Pay |
$398.40
|
|
|
51010 SUPRAPUBIC CATH INSERTIO
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
CPT 51010
|
| Hospital Charge Code |
22282920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$448.20 |
| Rate for Payer: Aetna of AZ Commercial |
$448.20
|
| Rate for Payer: Aetna of AZ Medicare |
$139.44
|
| Rate for Payer: Allwell Medicare |
$74.70
|
| Rate for Payer: Amerigroup Medicare |
$74.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$186.00
|
| Rate for Payer: AZCH Complete Medicare |
$74.70
|
| Rate for Payer: Banner UC Health Medicare |
$74.70
|
| Rate for Payer: Bisbee Police All Plans |
$129.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$338.64
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cigna of AZ Commercial |
$348.60
|
| Rate for Payer: Copperpoint Commercial |
$123.26
|
| Rate for Payer: Health Net of AZ Commercial |
$298.80
|
| Rate for Payer: Health Net of AZ Medicare |
$139.44
|
| Rate for Payer: Humana of AZ Medicare |
$74.70
|
| Rate for Payer: Self Pay Self Pay |
$398.40
|
| Rate for Payer: TriWest Medicare |
$74.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$290.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$89.64
|
|
|
51701 CATH URETHRA SIMPLE
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
22282921
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.16 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of AZ Commercial |
$194.40
|
| Rate for Payer: Bisbee Police All Plans |
$56.16
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Self Pay Self Pay |
$172.80
|
|
|
51701 CATH URETHRA SIMPLE
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
22282921
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$194.40
|
| Rate for Payer: Aetna of AZ Medicare |
$60.48
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$32.40
|
| Rate for Payer: Amerigroup Medicare |
$32.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$80.68
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$32.40
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$32.40
|
| Rate for Payer: Bisbee Police All Plans |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$146.88
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna of AZ Commercial |
$151.20
|
| Rate for Payer: Copperpoint Commercial |
$53.46
|
| Rate for Payer: Health Net of AZ Commercial |
$129.60
|
| Rate for Payer: Health Net of AZ Medicare |
$60.48
|
| Rate for Payer: Humana of AZ Medicare |
$32.40
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$172.80
|
| Rate for Payer: TriWest Medicare |
$32.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.88
|
|
|
51703 CATH URETHRA COMPLEX
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
22282922
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of AZ Commercial |
$461.70
|
| Rate for Payer: Bisbee Police All Plans |
$133.38
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Self Pay Self Pay |
$410.40
|
|
|
51703 CATH URETHRA COMPLEX
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
22282922
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$461.70
|
| Rate for Payer: Aetna of AZ Medicare |
$143.64
|
| Rate for Payer: AHCCCS Medicaid |
$202.34
|
| Rate for Payer: Allwell Medicaid |
$202.34
|
| Rate for Payer: Allwell Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicare |
$76.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$191.61
|
| Rate for Payer: AZCH Complete Medicaid |
$202.34
|
| Rate for Payer: AZCH Complete Medicare |
$76.95
|
| Rate for Payer: Banner UC Health Medicaid |
$202.34
|
| Rate for Payer: Banner UC Health Medicare |
$76.95
|
| Rate for Payer: Bisbee Police All Plans |
$133.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$348.84
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cigna of AZ Commercial |
$359.10
|
| Rate for Payer: Copperpoint Commercial |
$126.97
|
| Rate for Payer: Health Net of AZ Commercial |
$307.80
|
| Rate for Payer: Health Net of AZ Medicare |
$143.64
|
| Rate for Payer: Humana of AZ Medicare |
$76.95
|
| Rate for Payer: Mercy Care Medicaid |
$202.34
|
| Rate for Payer: Self Pay Self Pay |
$410.40
|
| Rate for Payer: TriWest Medicare |
$76.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$92.34
|
|
|
551781 HIV-1 Genosure Archive
|
Facility
|
IP
|
$1,244.00
|
|
| Hospital Charge Code |
23173814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$323.44 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,119.60
|
| Rate for Payer: Bisbee Police All Plans |
$323.44
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Self Pay Self Pay |
$995.20
|
|
|
551781 HIV-1 Genosure Archive
|
Facility
|
OP
|
$1,244.00
|
|
| Hospital Charge Code |
23173814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$186.60 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,119.60
|
| Rate for Payer: Aetna of AZ Medicare |
$348.32
|
| Rate for Payer: Allwell Medicare |
$186.60
|
| Rate for Payer: Amerigroup Medicare |
$186.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$464.63
|
| Rate for Payer: AZCH Complete Medicare |
$186.60
|
| Rate for Payer: Banner UC Health Medicare |
$186.60
|
| Rate for Payer: Bisbee Police All Plans |
$323.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$845.92
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cigna of AZ Commercial |
$808.60
|
| Rate for Payer: Copperpoint Commercial |
$307.89
|
| Rate for Payer: Health Net of AZ Commercial |
$746.40
|
| Rate for Payer: Health Net of AZ Medicare |
$348.32
|
| Rate for Payer: Humana of AZ Medicare |
$186.60
|
| Rate for Payer: Self Pay Self Pay |
$995.20
|
| Rate for Payer: TriWest Medicare |
$186.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$725.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$223.92
|
|
|
56420 INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSCESS
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
23008151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.10 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$624.60
|
| Rate for Payer: Aetna of AZ Medicare |
$194.32
|
| Rate for Payer: AHCCCS Medicaid |
$246.96
|
| Rate for Payer: Allwell Medicaid |
$246.96
|
| Rate for Payer: Allwell Medicare |
$104.10
|
| Rate for Payer: Amerigroup Medicare |
$104.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$259.21
|
| Rate for Payer: AZCH Complete Medicaid |
$246.96
|
| Rate for Payer: AZCH Complete Medicare |
$104.10
|
| Rate for Payer: Banner UC Health Medicaid |
$246.96
|
| Rate for Payer: Banner UC Health Medicare |
$104.10
|
| Rate for Payer: Bisbee Police All Plans |
$180.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$471.92
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cigna of AZ Commercial |
$485.80
|
| Rate for Payer: Copperpoint Commercial |
$171.76
|
| Rate for Payer: Health Net of AZ Commercial |
$416.40
|
| Rate for Payer: Health Net of AZ Medicare |
$194.32
|
| Rate for Payer: Humana of AZ Medicare |
$104.10
|
| Rate for Payer: Mercy Care Medicaid |
$246.96
|
| Rate for Payer: Self Pay Self Pay |
$555.20
|
| Rate for Payer: TriWest Medicare |
$104.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$124.92
|
|
