|
69210 REMOVE IMPACTED CERUMEN
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
22282928
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of AZ Commercial |
$153.00
|
| Rate for Payer: Bisbee Police All Plans |
$44.20
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Self Pay Self Pay |
$136.00
|
|
|
69210 REMOVE IMPACTED CERUMEN
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
22282928
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$153.00
|
| Rate for Payer: Aetna of AZ Medicare |
$47.60
|
| Rate for Payer: AHCCCS Medicaid |
$80.70
|
| Rate for Payer: Allwell Medicaid |
$80.70
|
| Rate for Payer: Allwell Medicare |
$25.50
|
| Rate for Payer: Amerigroup Medicare |
$25.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$63.50
|
| Rate for Payer: AZCH Complete Medicaid |
$80.70
|
| Rate for Payer: AZCH Complete Medicare |
$25.50
|
| Rate for Payer: Banner UC Health Medicaid |
$80.70
|
| Rate for Payer: Banner UC Health Medicare |
$25.50
|
| Rate for Payer: Bisbee Police All Plans |
$44.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$115.60
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna of AZ Commercial |
$119.00
|
| Rate for Payer: Copperpoint Commercial |
$42.08
|
| Rate for Payer: Health Net of AZ Commercial |
$102.00
|
| Rate for Payer: Health Net of AZ Medicare |
$47.60
|
| Rate for Payer: Humana of AZ Medicare |
$25.50
|
| Rate for Payer: Mercy Care Medicaid |
$80.70
|
| Rate for Payer: Self Pay Self Pay |
$136.00
|
| Rate for Payer: TriWest Medicare |
$25.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.60
|
|
|
81050 Urine Volume Measure
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
22525241
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of AZ Commercial |
$42.30
|
| Rate for Payer: Aetna of AZ Medicare |
$13.16
|
| Rate for Payer: AHCCCS Medicaid |
$3.64
|
| Rate for Payer: Allwell Medicaid |
$3.64
|
| Rate for Payer: Allwell Medicare |
$7.05
|
| Rate for Payer: Amerigroup Medicare |
$7.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$17.55
|
| Rate for Payer: AZCH Complete Medicaid |
$3.64
|
| Rate for Payer: AZCH Complete Medicare |
$7.05
|
| Rate for Payer: Banner UC Health Medicaid |
$3.64
|
| Rate for Payer: Banner UC Health Medicare |
$7.05
|
| Rate for Payer: Bisbee Police All Plans |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$31.96
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cigna of AZ Commercial |
$30.55
|
| Rate for Payer: Copperpoint Commercial |
$11.63
|
| Rate for Payer: Health Net of AZ Commercial |
$28.20
|
| Rate for Payer: Health Net of AZ Medicare |
$13.16
|
| Rate for Payer: Humana of AZ Medicare |
$7.05
|
| Rate for Payer: Mercy Care Medicaid |
$3.64
|
| Rate for Payer: Self Pay Self Pay |
$37.60
|
| Rate for Payer: TriWest Medicare |
$7.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$27.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.46
|
|
|
81050 Urine Volume Measure
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
22525241
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of AZ Commercial |
$42.30
|
| Rate for Payer: Bisbee Police All Plans |
$12.22
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Self Pay Self Pay |
$37.60
|
|
|
82107 HEPATOCELLULAR
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
23294379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Banner UC Health Medicare |
$33.90
|
| Rate for Payer: Aetna of AZ Commercial |
$203.40
|
| Rate for Payer: Aetna of AZ Medicare |
$63.28
|
| Rate for Payer: AHCCCS Medicaid |
$64.41
|
| Rate for Payer: Allwell Medicaid |
$64.41
|
| Rate for Payer: Allwell Medicare |
$33.90
|
| Rate for Payer: Amerigroup Medicare |
$33.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$84.41
|
| Rate for Payer: AZCH Complete Medicaid |
$64.41
|
| Rate for Payer: AZCH Complete Medicare |
$33.90
|
| Rate for Payer: Banner UC Health Medicaid |
$64.41
|
| Rate for Payer: Bisbee Police All Plans |
$58.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$153.68
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cigna of AZ Commercial |
$146.90
|
| Rate for Payer: Copperpoint Commercial |
$55.94
|
| Rate for Payer: Health Net of AZ Commercial |
$135.60
|
| Rate for Payer: Health Net of AZ Medicare |
$63.28
|
| Rate for Payer: Humana of AZ Medicare |
$33.90
|
| Rate for Payer: Mercy Care Medicaid |
$64.41
|
| Rate for Payer: Self Pay Self Pay |
$180.80
|
| Rate for Payer: TriWest Medicare |
$33.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$131.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.68
|
|
|
82107 HEPATOCELLULAR
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
23294379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna of AZ Commercial |
$203.40
|
| Rate for Payer: Bisbee Police All Plans |
$58.76
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Self Pay Self Pay |
$180.80
|
|
|
83735 LC#LC
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
23173801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Aetna of AZ Medicare |
$23.52
|
| Rate for Payer: AHCCCS Medicaid |
$6.70
|
| Rate for Payer: Allwell Medicaid |
$6.70
|
| Rate for Payer: Allwell Medicare |
$12.60
|
| Rate for Payer: Amerigroup Medicare |
$12.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$31.37
|
| Rate for Payer: AZCH Complete Medicaid |
$6.70
|
| Rate for Payer: AZCH Complete Medicare |
$12.60
|
| Rate for Payer: Banner UC Health Medicaid |
$6.70
|
| Rate for Payer: Banner UC Health Medicare |
$12.60
|
| Rate for Payer: Bisbee Police All Plans |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$57.12
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna of AZ Commercial |
$54.60
|
| Rate for Payer: Copperpoint Commercial |
$20.79
|
| Rate for Payer: Health Net of AZ Commercial |
$50.40
|
| Rate for Payer: Health Net of AZ Medicare |
$23.52
|
| Rate for Payer: Humana of AZ Medicare |
$12.60
|
| Rate for Payer: Mercy Care Medicaid |
$6.70
|
| Rate for Payer: Self Pay Self Pay |
$67.20
|
| Rate for Payer: TriWest Medicare |
$12.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$48.97
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.12
|
|
|
83735 LC#LC
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
23173801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Bisbee Police All Plans |
$21.84
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Self Pay Self Pay |
$67.20
|
|
|
83951 DCP
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
23187087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$286.20 |
| Rate for Payer: Aetna of AZ Commercial |
$286.20
|
| Rate for Payer: Bisbee Police All Plans |
$82.68
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Self Pay Self Pay |
$254.40
|
|
|
83951 DCP
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
23187087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$286.20 |
| Rate for Payer: Aetna of AZ Commercial |
$286.20
|
| Rate for Payer: Aetna of AZ Medicare |
$89.04
|
| Rate for Payer: AHCCCS Medicaid |
$64.41
|
| Rate for Payer: Allwell Medicaid |
$64.41
|
| Rate for Payer: Allwell Medicare |
$47.70
|
| Rate for Payer: Amerigroup Medicare |
$47.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$118.77
|
| Rate for Payer: AZCH Complete Medicaid |
$64.41
|
| Rate for Payer: AZCH Complete Medicare |
$47.70
|
| Rate for Payer: Banner UC Health Medicaid |
$64.41
|
| Rate for Payer: Banner UC Health Medicare |
$47.70
|
| Rate for Payer: Bisbee Police All Plans |
$82.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$216.24
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna of AZ Commercial |
$206.70
|
| Rate for Payer: Copperpoint Commercial |
$78.70
|
| Rate for Payer: Health Net of AZ Commercial |
$190.80
|
| Rate for Payer: Health Net of AZ Medicare |
$89.04
|
| Rate for Payer: Humana of AZ Medicare |
$47.70
|
| Rate for Payer: Mercy Care Medicaid |
$64.41
|
| Rate for Payer: Self Pay Self Pay |
$254.40
|
| Rate for Payer: TriWest Medicare |
$47.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$185.39
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$57.24
|
|
|
84702 FIRST TRIMESTER SCREEN
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
23294406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of AZ Commercial |
$193.50
|
| Rate for Payer: Aetna of AZ Medicare |
$60.20
|
| Rate for Payer: AHCCCS Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicare |
$32.25
|
| Rate for Payer: Amerigroup Medicare |
$32.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$80.30
|
| Rate for Payer: AZCH Complete Medicaid |
$15.05
|
| Rate for Payer: AZCH Complete Medicare |
$32.25
|
| Rate for Payer: Banner UC Health Medicaid |
$15.05
|
| Rate for Payer: Banner UC Health Medicare |
$32.25
|
| Rate for Payer: Bisbee Police All Plans |
$55.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$146.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna of AZ Commercial |
$139.75
|
| Rate for Payer: Copperpoint Commercial |
$53.21
|
| Rate for Payer: Health Net of AZ Commercial |
$129.00
|
| Rate for Payer: Health Net of AZ Medicare |
$60.20
|
| Rate for Payer: Humana of AZ Medicare |
$32.25
|
| Rate for Payer: Mercy Care Medicaid |
$15.05
|
| Rate for Payer: Self Pay Self Pay |
$172.00
|
| Rate for Payer: TriWest Medicare |
$32.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$125.34
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.70
|
|
|
84702 FIRST TRIMESTER SCREEN
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
23294406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of AZ Commercial |
$193.50
|
| Rate for Payer: Bisbee Police All Plans |
$55.90
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Self Pay Self Pay |
$172.00
|
|
|
86331 HYPERSENSITIVITY PNEUMONITIS PANEL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
23298045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of AZ Commercial |
$84.60
|
| Rate for Payer: Bisbee Police All Plans |
$24.44
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Self Pay Self Pay |
$75.20
|
|
|
86331 HYPERSENSITIVITY PNEUMONITIS PANEL
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
23298039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of AZ Commercial |
$135.90
|
| Rate for Payer: Bisbee Police All Plans |
$39.26
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Self Pay Self Pay |
$120.80
|
|
|
86331 HYPERSENSITIVITY PNEUMONITIS PANEL
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
23298039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of AZ Commercial |
$135.90
|
| Rate for Payer: Aetna of AZ Medicare |
$42.28
|
| Rate for Payer: AHCCCS Medicaid |
$12.25
|
| Rate for Payer: Allwell Medicaid |
$12.25
|
| Rate for Payer: Allwell Medicare |
$22.65
|
| Rate for Payer: Amerigroup Medicare |
$22.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$56.40
|
| Rate for Payer: AZCH Complete Medicaid |
$12.25
|
| Rate for Payer: AZCH Complete Medicare |
$22.65
|
| Rate for Payer: Banner UC Health Medicaid |
$12.25
|
| Rate for Payer: Banner UC Health Medicare |
$22.65
|
| Rate for Payer: Bisbee Police All Plans |
$39.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$102.68
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cigna of AZ Commercial |
$98.15
|
| Rate for Payer: Copperpoint Commercial |
$37.37
|
| Rate for Payer: Health Net of AZ Commercial |
$90.60
|
| Rate for Payer: Health Net of AZ Medicare |
$42.28
|
| Rate for Payer: Humana of AZ Medicare |
$22.65
|
| Rate for Payer: Mercy Care Medicaid |
$12.25
|
| Rate for Payer: Self Pay Self Pay |
$120.80
|
| Rate for Payer: TriWest Medicare |
$22.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$88.03
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$27.18
|
|
|
86331 HYPERSENSITIVITY PNEUMONITIS PANEL
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
23298045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of AZ Commercial |
$84.60
|
| Rate for Payer: Aetna of AZ Medicare |
$26.32
|
| Rate for Payer: AHCCCS Medicaid |
$11.98
|
| Rate for Payer: Allwell Medicaid |
$11.98
|
| Rate for Payer: Allwell Medicare |
$14.10
|
| Rate for Payer: Amerigroup Medicare |
$14.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$35.11
|
| Rate for Payer: AZCH Complete Medicaid |
$11.98
|
| Rate for Payer: AZCH Complete Medicare |
$14.10
|
| Rate for Payer: Banner UC Health Medicaid |
$11.98
|
| Rate for Payer: Banner UC Health Medicare |
$14.10
|
| Rate for Payer: Bisbee Police All Plans |
$24.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$63.92
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cigna of AZ Commercial |
$61.10
|
| Rate for Payer: Copperpoint Commercial |
$23.26
|
| Rate for Payer: Health Net of AZ Commercial |
$56.40
|
| Rate for Payer: Health Net of AZ Medicare |
$26.32
|
| Rate for Payer: Humana of AZ Medicare |
$14.10
|
| Rate for Payer: Mercy Care Medicaid |
$11.98
|
| Rate for Payer: Self Pay Self Pay |
$75.20
|
| Rate for Payer: TriWest Medicare |
$14.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$54.80
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$16.92
|
|
|
86356 MONONUCLEAR CELL ANTIGEN
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
23568452
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of AZ Commercial |
$124.20
|
| Rate for Payer: Aetna of AZ Medicare |
$38.64
|
| Rate for Payer: AHCCCS Medicaid |
$26.78
|
| Rate for Payer: Allwell Medicaid |
$26.78
|
| Rate for Payer: Allwell Medicare |
$20.70
|
| Rate for Payer: Amerigroup Medicare |
$20.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$51.54
|
| Rate for Payer: AZCH Complete Medicaid |
$26.78
|
| Rate for Payer: AZCH Complete Medicare |
$20.70
|
| Rate for Payer: Banner UC Health Medicaid |
$26.78
|
| Rate for Payer: Banner UC Health Medicare |
$20.70
|
| Rate for Payer: Bisbee Police All Plans |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$93.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna of AZ Commercial |
$89.70
|
| Rate for Payer: Copperpoint Commercial |
$34.16
|
| Rate for Payer: Health Net of AZ Commercial |
$82.80
|
| Rate for Payer: Health Net of AZ Medicare |
$38.64
|
| Rate for Payer: Humana of AZ Medicare |
$20.70
|
| Rate for Payer: Mercy Care Medicaid |
$26.78
|
| Rate for Payer: Self Pay Self Pay |
$110.40
|
| Rate for Payer: TriWest Medicare |
$20.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$80.45
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$24.84
|
|
|
86356 MONONUCLEAR CELL ANTIGEN
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
23568452
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of AZ Commercial |
$124.20
|
| Rate for Payer: Bisbee Police All Plans |
$35.88
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Self Pay Self Pay |
$110.40
|
|
|
86357 NATURAL KILLER CELL SURFACE AG
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
23568453
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of AZ Commercial |
$326.70
|
| Rate for Payer: Aetna of AZ Medicare |
$101.64
|
| Rate for Payer: AHCCCS Medicaid |
$37.73
|
| Rate for Payer: Allwell Medicaid |
$37.73
|
| Rate for Payer: Allwell Medicare |
$54.45
|
| Rate for Payer: Amerigroup Medicare |
$54.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$135.58
|
| Rate for Payer: AZCH Complete Medicaid |
$37.73
|
| Rate for Payer: AZCH Complete Medicare |
$54.45
|
| Rate for Payer: Banner UC Health Medicaid |
$37.73
|
| Rate for Payer: Banner UC Health Medicare |
$54.45
|
| Rate for Payer: Bisbee Police All Plans |
$94.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$246.84
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna of AZ Commercial |
$235.95
|
| Rate for Payer: Copperpoint Commercial |
$89.84
|
| Rate for Payer: Health Net of AZ Commercial |
$217.80
|
| Rate for Payer: Health Net of AZ Medicare |
$101.64
|
| Rate for Payer: Humana of AZ Medicare |
$54.45
|
| Rate for Payer: Mercy Care Medicaid |
$37.73
|
| Rate for Payer: Self Pay Self Pay |
$290.40
|
| Rate for Payer: TriWest Medicare |
$54.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$211.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$65.34
|
|
|
86357 NATURAL KILLER CELL SURFACE AG
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
23568453
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.38 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of AZ Commercial |
$326.70
|
| Rate for Payer: Bisbee Police All Plans |
$94.38
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Self Pay Self Pay |
$290.40
|
|
|
86359 T LYMPH CD3 CELLS
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
23568454
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna of AZ Commercial |
$297.90
|
| Rate for Payer: Aetna of AZ Medicare |
$92.68
|
| Rate for Payer: AHCCCS Medicaid |
$37.73
|
| Rate for Payer: Allwell Medicaid |
$37.73
|
| Rate for Payer: Allwell Medicare |
$49.65
|
| Rate for Payer: Amerigroup Medicare |
$49.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$123.63
|
| Rate for Payer: AZCH Complete Medicaid |
$37.73
|
| Rate for Payer: AZCH Complete Medicare |
$49.65
|
| Rate for Payer: Banner UC Health Medicaid |
$37.73
|
| Rate for Payer: Banner UC Health Medicare |
$49.65
|
| Rate for Payer: Bisbee Police All Plans |
$86.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$225.08
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cigna of AZ Commercial |
$215.15
|
| Rate for Payer: Copperpoint Commercial |
$81.92
|
| Rate for Payer: Health Net of AZ Commercial |
$198.60
|
| Rate for Payer: Health Net of AZ Medicare |
$92.68
|
| Rate for Payer: Humana of AZ Medicare |
$49.65
|
| Rate for Payer: Mercy Care Medicaid |
$37.73
|
| Rate for Payer: Self Pay Self Pay |
$264.80
|
| Rate for Payer: TriWest Medicare |
$49.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$192.97
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$59.58
|
|
|
86359 T LYMPH CD3 CELLS
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
23568454
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna of AZ Commercial |
$297.90
|
| Rate for Payer: Bisbee Police All Plans |
$86.06
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Self Pay Self Pay |
$264.80
|
|
|
86628 CANDIDA AB
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
23294423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Aetna of AZ Medicare |
$71.40
|
| Rate for Payer: AHCCCS Medicaid |
$12.01
|
| Rate for Payer: Allwell Medicaid |
$12.01
|
| Rate for Payer: Allwell Medicare |
$38.25
|
| Rate for Payer: Amerigroup Medicare |
$38.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$95.24
|
| Rate for Payer: AZCH Complete Medicaid |
$12.01
|
| Rate for Payer: AZCH Complete Medicare |
$38.25
|
| Rate for Payer: Banner UC Health Medicaid |
$12.01
|
| Rate for Payer: Banner UC Health Medicare |
$38.25
|
| Rate for Payer: Bisbee Police All Plans |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna of AZ Commercial |
$165.75
|
| Rate for Payer: Copperpoint Commercial |
$63.11
|
| Rate for Payer: Health Net of AZ Commercial |
$153.00
|
| Rate for Payer: Health Net of AZ Medicare |
$71.40
|
| Rate for Payer: Humana of AZ Medicare |
$38.25
|
| Rate for Payer: Mercy Care Medicaid |
$12.01
|
| Rate for Payer: Self Pay Self Pay |
$204.00
|
| Rate for Payer: TriWest Medicare |
$38.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$148.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$45.90
|
|
|
86628 CANDIDA AB
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
23294423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Bisbee Police All Plans |
$66.30
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Self Pay Self Pay |
$204.00
|
|
|
86628 LC#LC
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
23173802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Bisbee Police All Plans |
$66.30
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Self Pay Self Pay |
$204.00
|
|
