|
4.0 x 28MM POLY SCREW
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354175
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$484.90 |
| Max. Negotiated Rate |
$1,678.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,678.50
|
| Rate for Payer: Bisbee Police All Plans |
$484.90
|
| Rate for Payer: Cash Price |
$1,492.00
|
| Rate for Payer: Self Pay Self Pay |
$1,492.00
|
|
|
4.0 x 28MM POLY SCREW
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354175
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$1,678.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,678.50
|
| Rate for Payer: Aetna of AZ Medicare |
$522.20
|
| Rate for Payer: Allwell Medicare |
$298.40
|
| Rate for Payer: Amerigroup Medicare |
$298.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$696.58
|
| Rate for Payer: AZCH Complete Medicare |
$298.40
|
| Rate for Payer: Banner UC Health Medicare |
$298.40
|
| Rate for Payer: Bisbee Police All Plans |
$484.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,268.20
|
| Rate for Payer: Cash Price |
$1,492.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,305.50
|
| Rate for Payer: Copperpoint Commercial |
$461.59
|
| Rate for Payer: Health Net of AZ Commercial |
$1,119.00
|
| Rate for Payer: Health Net of AZ Medicare |
$522.20
|
| Rate for Payer: Humana of AZ Medicare |
$298.40
|
| Rate for Payer: Self Pay Self Pay |
$1,492.00
|
| Rate for Payer: TriWest Medicare |
$298.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,087.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$335.70
|
|
|
4.0 X 32MM POLY CANN SCREW
|
Facility
|
OP
|
$1,976.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354198
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$316.16 |
| Max. Negotiated Rate |
$1,778.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,778.40
|
| Rate for Payer: Aetna of AZ Medicare |
$553.28
|
| Rate for Payer: Allwell Medicare |
$316.16
|
| Rate for Payer: Amerigroup Medicare |
$316.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$738.04
|
| Rate for Payer: AZCH Complete Medicare |
$316.16
|
| Rate for Payer: Banner UC Health Medicare |
$316.16
|
| Rate for Payer: Bisbee Police All Plans |
$513.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,343.68
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,383.20
|
| Rate for Payer: Copperpoint Commercial |
$489.06
|
| Rate for Payer: Health Net of AZ Commercial |
$1,185.60
|
| Rate for Payer: Health Net of AZ Medicare |
$553.28
|
| Rate for Payer: Humana of AZ Medicare |
$316.16
|
| Rate for Payer: Self Pay Self Pay |
$1,580.80
|
| Rate for Payer: TriWest Medicare |
$316.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,152.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$355.68
|
|
|
4.0 X 32MM POLY CANN SCREW
|
Facility
|
IP
|
$1,976.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354198
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$513.76 |
| Max. Negotiated Rate |
$1,778.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,778.40
|
| Rate for Payer: Bisbee Police All Plans |
$513.76
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Self Pay Self Pay |
$1,580.80
|
|
|
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 |
$532.00 |
| 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 |
$586.96
|
| Rate for Payer: Allwell Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicare |
$532.00
|
| Rate for Payer: Amerigroup Medicare |
$532.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,241.89
|
| Rate for Payer: AZCH Complete Medicaid |
$586.96
|
| Rate for Payer: AZCH Complete Medicare |
$532.00
|
| Rate for Payer: Banner UC Health Medicaid |
$586.96
|
| Rate for Payer: Banner UC Health Medicare |
$532.00
|
| 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 |
$532.00
|
| Rate for Payer: Mercy Care Medicaid |
$586.96
|
| Rate for Payer: Self Pay Self Pay |
$2,660.00
|
| Rate for Payer: TriWest Medicare |
$532.00
|
| 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
|
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
|
|
|
43760 GASTRO TUBE REPLACEMENT
|
Facility
|
OP
|
$2,159.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
22282918
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$192.95 |
| 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 |
$192.95
|
| Rate for Payer: Allwell Medicaid |
$192.95
|
| Rate for Payer: Allwell Medicare |
$345.44
|
| Rate for Payer: Amerigroup Medicare |
$345.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$806.39
|
| Rate for Payer: AZCH Complete Medicaid |
$192.95
|
| Rate for Payer: AZCH Complete Medicare |
$345.44
|
| Rate for Payer: Banner UC Health Medicaid |
$192.95
|
| Rate for Payer: Banner UC Health Medicare |
$345.44
|
| 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 |
$345.44
|
| Rate for Payer: Mercy Care Medicaid |
$192.95
|
| Rate for Payer: Self Pay Self Pay |
$1,727.20
|
| Rate for Payer: TriWest Medicare |
$345.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$388.62
|
|
|
45378 PROF DIAGNOSTIC COLONSCOP
|
Facility
|
OP
|
$3,684.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
22389269
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$575.40 |
| 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 |
$575.40
|
| Rate for Payer: Allwell Medicaid |
$575.40
|
| Rate for Payer: Allwell Medicare |
$589.44
|
| Rate for Payer: Amerigroup Medicare |
$589.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,375.97
|
| Rate for Payer: AZCH Complete Medicaid |
$575.40
|
| Rate for Payer: AZCH Complete Medicare |
$589.44
|
| Rate for Payer: Banner UC Health Medicaid |
$575.40
|
| Rate for Payer: Banner UC Health Medicare |
$589.44
|
| 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 |
$589.44
|
| Rate for Payer: Mercy Care Medicaid |
$575.40
|
| Rate for Payer: Self Pay Self Pay |
$2,947.20
|
| Rate for Payer: TriWest Medicare |
$589.44
|
| 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 |
$141.60 |
| 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 |
$586.96
|
| Rate for Payer: Allwell Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicare |
$141.60
|
| Rate for Payer: Amerigroup Medicare |
$141.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$330.55
|
| Rate for Payer: AZCH Complete Medicaid |
$586.96
|
| Rate for Payer: AZCH Complete Medicare |
$141.60
|
| Rate for Payer: Banner UC Health Medicaid |
$586.96
|
| Rate for Payer: Banner UC Health Medicare |
$141.60
|
| 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 |
$141.60
|
| Rate for Payer: Mercy Care Medicaid |
$586.96
|
| Rate for Payer: Self Pay Self Pay |
$708.00
|
| Rate for Payer: TriWest Medicare |
$141.60
|
| 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
|
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
|
|
|
4MM OVAL CARBIDE BUR
|
Facility
|
OP
|
$166.00
|
|
| Hospital Charge Code |
27433626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.56 |
| 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 |
$26.56
|
| Rate for Payer: Amerigroup Medicare |
$26.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$62.00
|
| Rate for Payer: AZCH Complete Medicare |
$26.56
|
| Rate for Payer: Banner UC Health Medicare |
$26.56
|
| 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 |
$41.09
|
| 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 |
$26.56
|
| Rate for Payer: Self Pay Self Pay |
$132.80
|
| Rate for Payer: TriWest Medicare |
$26.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$96.78
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$29.88
|
|
|
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 |
$12.48 |
| 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 |
$12.48
|
| Rate for Payer: Amerigroup Medicare |
$12.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$29.13
|
| Rate for Payer: AZCH Complete Medicare |
$12.48
|
| Rate for Payer: Banner UC Health Medicare |
$12.48
|
| 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 |
$12.48
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
| Rate for Payer: TriWest Medicare |
$12.48
|
| 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
|
OP
|
$56.00
|
|
| Hospital Charge Code |
22926433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.96 |
| 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 |
$8.96
|
| Rate for Payer: Amerigroup Medicare |
$8.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$20.92
|
| Rate for Payer: AZCH Complete Medicare |
$8.96
|
| Rate for Payer: Banner UC Health Medicare |
$8.96
|
| 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 |
$8.96
|
| Rate for Payer: Self Pay Self Pay |
$44.80
|
| Rate for Payer: TriWest Medicare |
$8.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$32.65
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.08
|
|
|
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 Vicryl Plus P-3 Undyed Braided
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
22926430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.72 |
| 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 |
$2.72
|
| Rate for Payer: Amerigroup Medicare |
$2.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$6.35
|
| Rate for Payer: AZCH Complete Medicare |
$2.72
|
| Rate for Payer: Banner UC Health Medicare |
$2.72
|
| 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 |
$2.72
|
| Rate for Payer: Self Pay Self Pay |
$13.60
|
| Rate for Payer: TriWest Medicare |
$2.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$9.91
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.06
|
|
|
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
|
|
|
51010 SUPRAPUBIC CATH INSERTIO
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 51010
|
| Hospital Charge Code |
22282920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.68 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: Aetna of AZ Commercial |
$425.70
|
| Rate for Payer: Aetna of AZ Medicare |
$132.44
|
| Rate for Payer: Allwell Medicare |
$75.68
|
| Rate for Payer: Amerigroup Medicare |
$75.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$176.67
|
| Rate for Payer: AZCH Complete Medicare |
$75.68
|
| Rate for Payer: Banner UC Health Medicare |
$75.68
|
| Rate for Payer: Bisbee Police All Plans |
$122.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$321.64
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cigna of AZ Commercial |
$331.10
|
| Rate for Payer: Copperpoint Commercial |
$117.07
|
| Rate for Payer: Health Net of AZ Commercial |
$283.80
|
| Rate for Payer: Health Net of AZ Medicare |
$132.44
|
| Rate for Payer: Humana of AZ Medicare |
$75.68
|
| Rate for Payer: Self Pay Self Pay |
$378.40
|
| Rate for Payer: TriWest Medicare |
$75.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$275.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$85.14
|
|
|
51010 SUPRAPUBIC CATH INSERTIO
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 51010
|
| Hospital Charge Code |
22282920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: Aetna of AZ Commercial |
$425.70
|
| Rate for Payer: Bisbee Police All Plans |
$122.98
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Self Pay Self Pay |
$378.40
|
|
|
51701 CATH URETHRA SIMPLE
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
22282921
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna of AZ Commercial |
$262.80
|
| Rate for Payer: Bisbee Police All Plans |
$75.92
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Self Pay Self Pay |
$233.60
|
|
|
51701 CATH URETHRA SIMPLE
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
22282921
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$262.80
|
| Rate for Payer: Aetna of AZ Medicare |
$81.76
|
| Rate for Payer: Allwell Medicare |
$46.72
|
| Rate for Payer: Amerigroup Medicare |
$46.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$109.06
|
| Rate for Payer: AZCH Complete Medicare |
$46.72
|
| Rate for Payer: Banner UC Health Medicare |
$46.72
|
| Rate for Payer: Bisbee Police All Plans |
$75.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$198.56
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cigna of AZ Commercial |
$204.40
|
| Rate for Payer: Copperpoint Commercial |
$72.27
|
| Rate for Payer: Health Net of AZ Commercial |
$175.20
|
| Rate for Payer: Health Net of AZ Medicare |
$81.76
|
| Rate for Payer: Humana of AZ Medicare |
$46.72
|
| Rate for Payer: Self Pay Self Pay |
$233.60
|
| Rate for Payer: TriWest Medicare |
$46.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$52.56
|
|
|
51703 CATH URETHRA COMPLEX
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
22282922
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$382.50
|
| Rate for Payer: Aetna of AZ Medicare |
$119.00
|
| Rate for Payer: AHCCCS Medicaid |
$101.17
|
| Rate for Payer: Allwell Medicaid |
$101.17
|
| Rate for Payer: Allwell Medicare |
$68.00
|
| Rate for Payer: Amerigroup Medicare |
$68.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$158.74
|
| Rate for Payer: AZCH Complete Medicaid |
$101.17
|
| Rate for Payer: AZCH Complete Medicare |
$68.00
|
| Rate for Payer: Banner UC Health Medicaid |
$101.17
|
| Rate for Payer: Banner UC Health Medicare |
$68.00
|
| Rate for Payer: Bisbee Police All Plans |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$289.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna of AZ Commercial |
$297.50
|
| Rate for Payer: Copperpoint Commercial |
$105.19
|
| Rate for Payer: Health Net of AZ Commercial |
$255.00
|
| Rate for Payer: Health Net of AZ Medicare |
$119.00
|
| Rate for Payer: Humana of AZ Medicare |
$68.00
|
| Rate for Payer: Mercy Care Medicaid |
$101.17
|
| Rate for Payer: Self Pay Self Pay |
$340.00
|
| Rate for Payer: TriWest Medicare |
$68.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$76.50
|
|
