LAPLPLASTY
|
Facility
|
IP
|
$32,550.00
|
|
Hospital Charge Code |
24358101
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$8,463.00 |
Max. Negotiated Rate |
$29,295.00 |
Rate for Payer: Aetna of AZ Commercial |
$29,295.00
|
Rate for Payer: Bisbee Police All Plans |
$8,463.00
|
Rate for Payer: Cash Price |
$26,040.00
|
Rate for Payer: Self Pay Self Pay |
$26,040.00
|
|
LAPLPLASTY
|
Facility
|
OP
|
$32,550.00
|
|
Hospital Charge Code |
24358101
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4,882.50 |
Max. Negotiated Rate |
$29,295.00 |
Rate for Payer: Aetna of AZ Commercial |
$29,295.00
|
Rate for Payer: Aetna of AZ Medicare |
$9,114.00
|
Rate for Payer: Allwell Medicare |
$4,882.50
|
Rate for Payer: Amerigroup Medicare |
$4,882.50
|
Rate for Payer: APIPA Medicare/Medicaid |
$12,157.42
|
Rate for Payer: AZCH Complete Medicare |
$4,882.50
|
Rate for Payer: Banner UC Health Medicare |
$4,882.50
|
Rate for Payer: Bisbee Police All Plans |
$8,463.00
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$22,134.00
|
Rate for Payer: Cash Price |
$26,040.00
|
Rate for Payer: Cigna of AZ Commercial |
$22,785.00
|
Rate for Payer: Copperpoint Commercial |
$8,056.12
|
Rate for Payer: Health Net of AZ Commercial |
$19,530.00
|
Rate for Payer: Health Net of AZ Medicare |
$9,114.00
|
Rate for Payer: Humana of AZ Medicare |
$4,882.50
|
Rate for Payer: Self Pay Self Pay |
$26,040.00
|
Rate for Payer: TriWest Medicare |
$4,882.50
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$18,976.65
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$5,859.00
|
|
LAPLPLASTY SAW BLADE 40MMX11MM STRYKER
|
Facility
|
OP
|
$788.00
|
|
Hospital Charge Code |
24358103
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$118.20 |
Max. Negotiated Rate |
$709.20 |
Rate for Payer: Aetna of AZ Commercial |
$709.20
|
Rate for Payer: Aetna of AZ Medicare |
$220.64
|
Rate for Payer: Allwell Medicare |
$118.20
|
Rate for Payer: Amerigroup Medicare |
$118.20
|
Rate for Payer: APIPA Medicare/Medicaid |
$294.32
|
Rate for Payer: AZCH Complete Medicare |
$118.20
|
Rate for Payer: Banner UC Health Medicare |
$118.20
|
Rate for Payer: Bisbee Police All Plans |
$204.88
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$535.84
|
Rate for Payer: Cash Price |
$630.40
|
Rate for Payer: Cigna of AZ Commercial |
$551.60
|
Rate for Payer: Copperpoint Commercial |
$195.03
|
Rate for Payer: Health Net of AZ Commercial |
$472.80
|
Rate for Payer: Health Net of AZ Medicare |
$220.64
|
Rate for Payer: Humana of AZ Medicare |
$118.20
|
Rate for Payer: Self Pay Self Pay |
$630.40
|
Rate for Payer: TriWest Medicare |
$118.20
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$459.40
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$141.84
|
|
LAPLPLASTY SAW BLADE 40MMX11MM STRYKER
|
Facility
|
IP
|
$788.00
|
|
Hospital Charge Code |
24358103
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$204.88 |
Max. Negotiated Rate |
$709.20 |
Rate for Payer: Aetna of AZ Commercial |
$709.20
|
Rate for Payer: Bisbee Police All Plans |
$204.88
|
Rate for Payer: Cash Price |
$630.40
|
Rate for Payer: Self Pay Self Pay |
$630.40
|
|
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); DIAGNOSTIC
|
Facility
|
OP
|
$698.00
|
|
Service Code
|
CPT 31505
|
Hospital Charge Code |
22209502
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$104.70 |
Max. Negotiated Rate |
$2,161.00 |
Rate for Payer: Aetna of AZ Commercial |
$628.20
|
Rate for Payer: Aetna of AZ Medicare |
$195.44
|
Rate for Payer: AHCCCS Medicaid |
$238.36
|
Rate for Payer: Allwell Medicaid |
$238.36
|
Rate for Payer: Allwell Medicare |
$104.70
|
Rate for Payer: Amerigroup Medicare |
$104.70
|
Rate for Payer: APIPA Medicare/Medicaid |
$260.70
|
Rate for Payer: AZCH Complete Medicaid |
$238.36
|
Rate for Payer: AZCH Complete Medicare |
$104.70
|
Rate for Payer: Banner UC Health Medicaid |
$238.36
|
Rate for Payer: Banner UC Health Medicare |
$104.70
|
Rate for Payer: Bisbee Police All Plans |
$181.48
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$474.64
|
Rate for Payer: Cash Price |
$558.40
|
Rate for Payer: Cash Price |
$558.40
|
Rate for Payer: Cigna of AZ Commercial |
$488.60
|
Rate for Payer: Copperpoint Commercial |
$172.76
|
Rate for Payer: Health Net of AZ Commercial |
$418.80
|
Rate for Payer: Health Net of AZ Medicare |
$195.44
|
Rate for Payer: Humana of AZ Medicare |
$104.70
|
Rate for Payer: Mercy Care Medicaid |
$238.36
|
Rate for Payer: Self Pay Self Pay |
$558.40
|
Rate for Payer: TriWest Medicare |
$104.70
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$125.64
|
|
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); DIAGNOSTIC
|
Facility
|
IP
|
$698.00
|
|
Service Code
|
CPT 31505
|
Hospital Charge Code |
22209502
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$181.48 |
Max. Negotiated Rate |
$628.20 |
Rate for Payer: Aetna of AZ Commercial |
$628.20
|
Rate for Payer: Bisbee Police All Plans |
$181.48
|
Rate for Payer: Cash Price |
$558.40
|
Rate for Payer: Self Pay Self Pay |
$558.40
|
|
latanoprost Ophth 0.005% Sol [CQCH]
|
Facility
|
OP
|
$2.20
|
|
Service Code
|
NDC 17478062512
|
Hospital Charge Code |
105927842
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.33 |
Max. Negotiated Rate |
$1.98 |
Rate for Payer: Aetna of AZ Commercial |
$1.98
|
Rate for Payer: Aetna of AZ Medicare |
$0.62
|
Rate for Payer: Allwell Medicare |
$0.33
|
Rate for Payer: Amerigroup Medicare |
$0.33
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.82
|
Rate for Payer: AZCH Complete Medicare |
$0.33
|
Rate for Payer: Banner UC Health Medicare |
$0.33
|
Rate for Payer: Bisbee Police All Plans |
$0.57
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.50
|
Rate for Payer: Cash Price |
$1.76
|
Rate for Payer: Cigna of AZ Commercial |
$1.43
|
Rate for Payer: Copperpoint Commercial |
$0.54
|
Rate for Payer: Health Net of AZ Commercial |
$1.32
|
Rate for Payer: Health Net of AZ Medicare |
$0.62
|
Rate for Payer: Humana of AZ Medicare |
$0.33
|
Rate for Payer: Self Pay Self Pay |
$1.76
|
Rate for Payer: TriWest Medicare |
$0.33
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.28
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.40
|
|
latanoprost Ophth 0.005% Sol [CQCH]
|
Facility
|
IP
|
$2.20
|
|
Service Code
|
NDC 17478062512
|
Hospital Charge Code |
105927842
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$1.98 |
Rate for Payer: Aetna of AZ Commercial |
$1.98
|
Rate for Payer: Bisbee Police All Plans |
$0.57
|
Rate for Payer: Cash Price |
$1.76
|
Rate for Payer: Self Pay Self Pay |
$1.76
|
|
.LDL Size Comment LC
|
Facility
|
IP
|
$158.00
|
|
Service Code
|
CPT 83721
|
Hospital Charge Code |
22311155
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$41.08 |
Max. Negotiated Rate |
$142.20 |
Rate for Payer: Aetna of AZ Commercial |
$142.20
|
Rate for Payer: Bisbee Police All Plans |
$41.08
|
Rate for Payer: Cash Price |
$126.40
|
Rate for Payer: Self Pay Self Pay |
$126.40
|
|
.LDL Size Comment LC
|
Facility
|
OP
|
$158.00
|
|
Service Code
|
CPT 83721
|
Hospital Charge Code |
22311155
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$10.50 |
Max. Negotiated Rate |
$142.20 |
Rate for Payer: Aetna of AZ Commercial |
$142.20
|
Rate for Payer: Aetna of AZ Medicare |
$44.24
|
Rate for Payer: AHCCCS Medicaid |
$10.50
|
Rate for Payer: Allwell Medicaid |
$10.50
|
Rate for Payer: Allwell Medicare |
$23.70
|
Rate for Payer: Amerigroup Medicare |
$23.70
|
Rate for Payer: APIPA Medicare/Medicaid |
$59.01
|
Rate for Payer: AZCH Complete Medicaid |
$10.50
|
Rate for Payer: AZCH Complete Medicare |
$23.70
|
Rate for Payer: Banner UC Health Medicaid |
$10.50
|
Rate for Payer: Banner UC Health Medicare |
$23.70
|
Rate for Payer: Bisbee Police All Plans |
$41.08
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$107.44
|
Rate for Payer: Cash Price |
$126.40
|
Rate for Payer: Cash Price |
$126.40
|
Rate for Payer: Cigna of AZ Commercial |
$102.70
|
Rate for Payer: Copperpoint Commercial |
$39.10
|
Rate for Payer: Health Net of AZ Commercial |
$94.80
|
Rate for Payer: Health Net of AZ Medicare |
$44.24
|
Rate for Payer: Humana of AZ Medicare |
$23.70
|
Rate for Payer: Mercy Care Medicaid |
$10.50
|
Rate for Payer: Self Pay Self Pay |
$126.40
|
Rate for Payer: TriWest Medicare |
$23.70
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$92.11
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.44
|
|
LEAD
|
Facility
|
OP
|
$19,029.00
|
|
Service Code
|
CPT C1778
|
Hospital Charge Code |
22354567
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$17,126.10 |
Rate for Payer: Aetna of AZ Commercial |
$17,126.10
|
Rate for Payer: Aetna of AZ Medicare |
$5,328.12
|
Rate for Payer: AHCCCS Medicaid |
$0.13
|
Rate for Payer: Allwell Medicaid |
$0.13
|
Rate for Payer: Allwell Medicare |
$2,854.35
|
Rate for Payer: Amerigroup Medicare |
$2,854.35
|
Rate for Payer: APIPA Medicare/Medicaid |
$7,107.33
|
Rate for Payer: AZCH Complete Medicaid |
$0.13
|
Rate for Payer: AZCH Complete Medicare |
$2,854.35
|
Rate for Payer: Banner UC Health Medicaid |
$0.13
|
Rate for Payer: Banner UC Health Medicare |
$2,854.35
|
Rate for Payer: Bisbee Police All Plans |
$4,947.54
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$12,939.72
|
Rate for Payer: Cash Price |
$15,223.20
|
Rate for Payer: Cash Price |
$15,223.20
|
Rate for Payer: Cigna of AZ Commercial |
$13,320.30
|
Rate for Payer: Copperpoint Commercial |
$4,709.68
|
Rate for Payer: Health Net of AZ Commercial |
$11,417.40
|
Rate for Payer: Health Net of AZ Medicare |
$5,328.12
|
Rate for Payer: Humana of AZ Medicare |
$2,854.35
|
Rate for Payer: Mercy Care Medicaid |
$0.13
|
Rate for Payer: Self Pay Self Pay |
$15,223.20
|
Rate for Payer: TriWest Medicare |
$2,854.35
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$11,093.91
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$3,425.22
|
|
LEAD
|
Facility
|
IP
|
$19,029.00
|
|
Service Code
|
CPT C1778
|
Hospital Charge Code |
22354567
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4,947.54 |
Max. Negotiated Rate |
$17,126.10 |
Rate for Payer: Aetna of AZ Commercial |
$17,126.10
|
Rate for Payer: Bisbee Police All Plans |
$4,947.54
|
Rate for Payer: Cash Price |
$15,223.20
|
Rate for Payer: Self Pay Self Pay |
$15,223.20
|
|
LEAD ADULT
|
Facility
|
OP
|
$296.00
|
|
Service Code
|
CPT 83655
|
Hospital Charge Code |
22481489
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$12.11 |
Max. Negotiated Rate |
$266.40 |
Rate for Payer: Aetna of AZ Commercial |
$266.40
|
Rate for Payer: Aetna of AZ Medicare |
$82.88
|
Rate for Payer: AHCCCS Medicaid |
$12.11
|
Rate for Payer: Allwell Medicaid |
$12.11
|
Rate for Payer: Allwell Medicare |
$44.40
|
Rate for Payer: Amerigroup Medicare |
$44.40
|
Rate for Payer: APIPA Medicare/Medicaid |
$110.56
|
Rate for Payer: AZCH Complete Medicaid |
$12.11
|
Rate for Payer: AZCH Complete Medicare |
$44.40
|
Rate for Payer: Banner UC Health Medicaid |
$12.11
|
Rate for Payer: Banner UC Health Medicare |
$44.40
|
Rate for Payer: Bisbee Police All Plans |
$76.96
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$201.28
|
Rate for Payer: Cash Price |
$236.80
|
Rate for Payer: Cash Price |
$236.80
|
Rate for Payer: Cigna of AZ Commercial |
$192.40
|
Rate for Payer: Copperpoint Commercial |
$73.26
|
Rate for Payer: Health Net of AZ Commercial |
$177.60
|
Rate for Payer: Health Net of AZ Medicare |
$82.88
|
Rate for Payer: Humana of AZ Medicare |
$44.40
|
Rate for Payer: Mercy Care Medicaid |
$12.11
|
Rate for Payer: Self Pay Self Pay |
$236.80
|
Rate for Payer: TriWest Medicare |
$44.40
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$172.57
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$53.28
|
|
LEAD ADULT
|
Facility
|
IP
|
$296.00
|
|
Service Code
|
CPT 83655
|
Hospital Charge Code |
22481489
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$76.96 |
Max. Negotiated Rate |
$266.40 |
Rate for Payer: Aetna of AZ Commercial |
$266.40
|
Rate for Payer: Bisbee Police All Plans |
$76.96
|
Rate for Payer: Cash Price |
$236.80
|
Rate for Payer: Self Pay Self Pay |
$236.80
|
|
Lead, Blood (Adult) LC
|
Facility
|
IP
|
$282.00
|
|
Service Code
|
CPT 83655
|
Hospital Charge Code |
1285614
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$73.32 |
Max. Negotiated Rate |
$253.80 |
Rate for Payer: Aetna of AZ Commercial |
$253.80
|
Rate for Payer: Bisbee Police All Plans |
$73.32
|
Rate for Payer: Cash Price |
$225.60
|
Rate for Payer: Self Pay Self Pay |
$225.60
|
|
Lead, Blood (Adult) LC
|
Facility
|
OP
|
$282.00
|
|
Service Code
|
CPT 83655
|
Hospital Charge Code |
1285614
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$12.11 |
Max. Negotiated Rate |
$253.80 |
Rate for Payer: Aetna of AZ Commercial |
$253.80
|
Rate for Payer: Aetna of AZ Medicare |
$78.96
|
Rate for Payer: AHCCCS Medicaid |
$12.11
|
Rate for Payer: Allwell Medicaid |
$12.11
|
Rate for Payer: Allwell Medicare |
$42.30
|
Rate for Payer: Amerigroup Medicare |
$42.30
|
Rate for Payer: APIPA Medicare/Medicaid |
$105.33
|
Rate for Payer: AZCH Complete Medicaid |
$12.11
|
Rate for Payer: AZCH Complete Medicare |
$42.30
|
Rate for Payer: Banner UC Health Medicaid |
$12.11
|
Rate for Payer: Banner UC Health Medicare |
$42.30
|
Rate for Payer: Bisbee Police All Plans |
$73.32
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$191.76
|
Rate for Payer: Cash Price |
$225.60
|
Rate for Payer: Cash Price |
$225.60
|
Rate for Payer: Cigna of AZ Commercial |
$183.30
|
Rate for Payer: Copperpoint Commercial |
$69.80
|
Rate for Payer: Health Net of AZ Commercial |
$169.20
|
Rate for Payer: Health Net of AZ Medicare |
$78.96
|
Rate for Payer: Humana of AZ Medicare |
$42.30
|
Rate for Payer: Mercy Care Medicaid |
$12.11
|
Rate for Payer: Self Pay Self Pay |
$225.60
|
Rate for Payer: TriWest Medicare |
$42.30
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$164.41
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$50.76
|
|
Lead, Blood (Pediatric) LC
|
Facility
|
OP
|
$282.00
|
|
Service Code
|
CPT 83655
|
Hospital Charge Code |
1285615
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$12.11 |
Max. Negotiated Rate |
$253.80 |
Rate for Payer: Aetna of AZ Commercial |
$253.80
|
Rate for Payer: Aetna of AZ Medicare |
$78.96
|
Rate for Payer: AHCCCS Medicaid |
$12.11
|
Rate for Payer: Allwell Medicaid |
$12.11
|
Rate for Payer: Allwell Medicare |
$42.30
|
Rate for Payer: Amerigroup Medicare |
$42.30
|
Rate for Payer: APIPA Medicare/Medicaid |
$105.33
|
Rate for Payer: AZCH Complete Medicaid |
$12.11
|
Rate for Payer: AZCH Complete Medicare |
$42.30
|
Rate for Payer: Banner UC Health Medicaid |
$12.11
|
Rate for Payer: Banner UC Health Medicare |
$42.30
|
Rate for Payer: Bisbee Police All Plans |
$73.32
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$191.76
|
Rate for Payer: Cash Price |
$225.60
|
Rate for Payer: Cash Price |
$225.60
|
Rate for Payer: Cigna of AZ Commercial |
$183.30
|
Rate for Payer: Copperpoint Commercial |
$69.80
|
Rate for Payer: Health Net of AZ Commercial |
$169.20
|
Rate for Payer: Health Net of AZ Medicare |
$78.96
|
Rate for Payer: Humana of AZ Medicare |
$42.30
|
Rate for Payer: Mercy Care Medicaid |
$12.11
|
Rate for Payer: Self Pay Self Pay |
$225.60
|
Rate for Payer: TriWest Medicare |
$42.30
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$164.41
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$50.76
|
|
Lead, Blood (Pediatric) LC
|
Facility
|
IP
|
$282.00
|
|
Service Code
|
CPT 83655
|
Hospital Charge Code |
1285615
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$73.32 |
Max. Negotiated Rate |
$253.80 |
Rate for Payer: Aetna of AZ Commercial |
$253.80
|
Rate for Payer: Bisbee Police All Plans |
$73.32
|
Rate for Payer: Cash Price |
$225.60
|
Rate for Payer: Self Pay Self Pay |
$225.60
|
|
LEAD INTRODUCER
|
Facility
|
OP
|
$1,605.00
|
|
Service Code
|
CPT C1894
|
Hospital Charge Code |
22354566
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$1,444.50 |
Rate for Payer: Aetna of AZ Commercial |
$1,444.50
|
Rate for Payer: Aetna of AZ Medicare |
$449.40
|
Rate for Payer: AHCCCS Medicaid |
$0.13
|
Rate for Payer: Allwell Medicaid |
$0.13
|
Rate for Payer: Allwell Medicare |
$240.75
|
Rate for Payer: Amerigroup Medicare |
$240.75
|
Rate for Payer: APIPA Medicare/Medicaid |
$599.47
|
Rate for Payer: AZCH Complete Medicaid |
$0.13
|
Rate for Payer: AZCH Complete Medicare |
$240.75
|
Rate for Payer: Banner UC Health Medicaid |
$0.13
|
Rate for Payer: Banner UC Health Medicare |
$240.75
|
Rate for Payer: Bisbee Police All Plans |
$417.30
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,091.40
|
Rate for Payer: Cash Price |
$1,284.00
|
Rate for Payer: Cash Price |
$1,284.00
|
Rate for Payer: Cigna of AZ Commercial |
$1,123.50
|
Rate for Payer: Copperpoint Commercial |
$397.24
|
Rate for Payer: Health Net of AZ Commercial |
$963.00
|
Rate for Payer: Health Net of AZ Medicare |
$449.40
|
Rate for Payer: Humana of AZ Medicare |
$240.75
|
Rate for Payer: Mercy Care Medicaid |
$0.13
|
Rate for Payer: Self Pay Self Pay |
$1,284.00
|
Rate for Payer: TriWest Medicare |
$240.75
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$935.72
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$288.90
|
|
LEAD INTRODUCER
|
Facility
|
IP
|
$1,605.00
|
|
Service Code
|
CPT C1894
|
Hospital Charge Code |
22354566
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$417.30 |
Max. Negotiated Rate |
$1,444.50 |
Rate for Payer: Aetna of AZ Commercial |
$1,444.50
|
Rate for Payer: Bisbee Police All Plans |
$417.30
|
Rate for Payer: Cash Price |
$1,284.00
|
Rate for Payer: Self Pay Self Pay |
$1,284.00
|
|
Legal Draw Fee
|
Facility
|
OP
|
$48.00
|
|
Hospital Charge Code |
2240047
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$7.20 |
Max. Negotiated Rate |
$43.20 |
Rate for Payer: Aetna of AZ Commercial |
$43.20
|
Rate for Payer: Aetna of AZ Medicare |
$13.44
|
Rate for Payer: Allwell Medicare |
$7.20
|
Rate for Payer: Amerigroup Medicare |
$7.20
|
Rate for Payer: APIPA Medicare/Medicaid |
$17.93
|
Rate for Payer: AZCH Complete Medicare |
$7.20
|
Rate for Payer: Banner UC Health Medicare |
$7.20
|
Rate for Payer: Bisbee Police All Plans |
$12.48
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$32.64
|
Rate for Payer: Cash Price |
$38.40
|
Rate for Payer: Cigna of AZ Commercial |
$31.20
|
Rate for Payer: Copperpoint Commercial |
$11.88
|
Rate for Payer: Health Net of AZ Commercial |
$28.80
|
Rate for Payer: Health Net of AZ Medicare |
$13.44
|
Rate for Payer: Humana of AZ Medicare |
$7.20
|
Rate for Payer: Self Pay Self Pay |
$38.40
|
Rate for Payer: TriWest Medicare |
$7.20
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$27.98
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.64
|
|
Legal Draw Fee
|
Facility
|
IP
|
$48.00
|
|
Hospital Charge Code |
2240047
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$12.48 |
Max. Negotiated Rate |
$43.20 |
Rate for Payer: Aetna of AZ Commercial |
$43.20
|
Rate for Payer: Bisbee Police All Plans |
$12.48
|
Rate for Payer: Cash Price |
$38.40
|
Rate for Payer: Self Pay Self Pay |
$38.40
|
|
Legionella pneumophila Abs. LC
|
Facility
|
OP
|
$91.00
|
|
Service Code
|
CPT 86713
|
Hospital Charge Code |
22201718
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$13.65 |
Max. Negotiated Rate |
$81.90 |
Rate for Payer: Aetna of AZ Commercial |
$81.90
|
Rate for Payer: Aetna of AZ Medicare |
$25.48
|
Rate for Payer: AHCCCS Medicaid |
$15.30
|
Rate for Payer: Allwell Medicaid |
$15.30
|
Rate for Payer: Allwell Medicare |
$13.65
|
Rate for Payer: Amerigroup Medicare |
$13.65
|
Rate for Payer: APIPA Medicare/Medicaid |
$33.99
|
Rate for Payer: AZCH Complete Medicaid |
$15.30
|
Rate for Payer: AZCH Complete Medicare |
$13.65
|
Rate for Payer: Banner UC Health Medicaid |
$15.30
|
Rate for Payer: Banner UC Health Medicare |
$13.65
|
Rate for Payer: Bisbee Police All Plans |
$23.66
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$61.88
|
Rate for Payer: Cash Price |
$72.80
|
Rate for Payer: Cash Price |
$72.80
|
Rate for Payer: Cigna of AZ Commercial |
$59.15
|
Rate for Payer: Copperpoint Commercial |
$22.52
|
Rate for Payer: Health Net of AZ Commercial |
$54.60
|
Rate for Payer: Health Net of AZ Medicare |
$25.48
|
Rate for Payer: Humana of AZ Medicare |
$13.65
|
Rate for Payer: Mercy Care Medicaid |
$15.30
|
Rate for Payer: Self Pay Self Pay |
$72.80
|
Rate for Payer: TriWest Medicare |
$13.65
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$53.05
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$16.38
|
|
Legionella pneumophila Abs. LC
|
Facility
|
IP
|
$91.00
|
|
Service Code
|
CPT 86713
|
Hospital Charge Code |
22201718
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$23.66 |
Max. Negotiated Rate |
$81.90 |
Rate for Payer: Aetna of AZ Commercial |
$81.90
|
Rate for Payer: Bisbee Police All Plans |
$23.66
|
Rate for Payer: Cash Price |
$72.80
|
Rate for Payer: Self Pay Self Pay |
$72.80
|
|
LEOS 01.6MM SMOOTH K WIRE
|
Facility
|
IP
|
$630.00
|
|
Hospital Charge Code |
27595625
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$163.80 |
Max. Negotiated Rate |
$567.00 |
Rate for Payer: Aetna of AZ Commercial |
$567.00
|
Rate for Payer: Bisbee Police All Plans |
$163.80
|
Rate for Payer: Cash Price |
$504.00
|
Rate for Payer: Self Pay Self Pay |
$504.00
|
|