|
64455 INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO NERV
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
22986169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.04 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna of AZ Commercial |
$993.60
|
| Rate for Payer: Bisbee Police All Plans |
$287.04
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Self Pay Self Pay |
$883.20
|
|
|
64455 INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO NERV
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
22986169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.64 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$993.60
|
| Rate for Payer: Aetna of AZ Medicare |
$309.12
|
| Rate for Payer: AHCCCS Medicaid |
$189.35
|
| Rate for Payer: Allwell Medicaid |
$189.35
|
| Rate for Payer: Allwell Medicare |
$176.64
|
| Rate for Payer: Amerigroup Medicare |
$176.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$412.34
|
| Rate for Payer: AZCH Complete Medicaid |
$189.35
|
| Rate for Payer: AZCH Complete Medicare |
$176.64
|
| Rate for Payer: Banner UC Health Medicaid |
$189.35
|
| Rate for Payer: Banner UC Health Medicare |
$176.64
|
| Rate for Payer: Bisbee Police All Plans |
$287.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$750.72
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna of AZ Commercial |
$772.80
|
| Rate for Payer: Copperpoint Commercial |
$273.24
|
| Rate for Payer: Health Net of AZ Commercial |
$662.40
|
| Rate for Payer: Health Net of AZ Medicare |
$309.12
|
| Rate for Payer: Humana of AZ Medicare |
$176.64
|
| Rate for Payer: Mercy Care Medicaid |
$189.35
|
| Rate for Payer: Self Pay Self Pay |
$883.20
|
| Rate for Payer: TriWest Medicare |
$176.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$198.72
|
|
|
64566 POSTERIOR TIBIAL NEUROSTIMULATION, PERCUTANEOUS NEEDLE
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
27414132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$151.20
|
| Rate for Payer: Aetna of AZ Medicare |
$47.04
|
| Rate for Payer: AHCCCS Medicaid |
$189.35
|
| Rate for Payer: Allwell Medicaid |
$189.35
|
| Rate for Payer: Allwell Medicare |
$26.88
|
| Rate for Payer: Amerigroup Medicare |
$26.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$62.75
|
| Rate for Payer: AZCH Complete Medicaid |
$189.35
|
| Rate for Payer: AZCH Complete Medicare |
$26.88
|
| Rate for Payer: Banner UC Health Medicaid |
$189.35
|
| Rate for Payer: Banner UC Health Medicare |
$26.88
|
| Rate for Payer: Bisbee Police All Plans |
$43.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$114.24
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna of AZ Commercial |
$84.00
|
| Rate for Payer: Copperpoint Commercial |
$41.58
|
| Rate for Payer: Health Net of AZ Commercial |
$100.80
|
| Rate for Payer: Health Net of AZ Medicare |
$47.04
|
| Rate for Payer: Humana of AZ Medicare |
$26.88
|
| Rate for Payer: Mercy Care Medicaid |
$189.35
|
| Rate for Payer: Self Pay Self Pay |
$134.40
|
| Rate for Payer: TriWest Medicare |
$26.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.24
|
|
|
64566 POSTERIOR TIBIAL NEUROSTIMULATION, PERCUTANEOUS NEEDLE
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
27414132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna of AZ Commercial |
$151.20
|
| Rate for Payer: Bisbee Police All Plans |
$43.68
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Self Pay Self Pay |
$134.40
|
|
|
65205 REMOVE FB EXT EYE SUPERT
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
22282924
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$181.80
|
| Rate for Payer: Aetna of AZ Medicare |
$56.56
|
| Rate for Payer: AHCCCS Medicaid |
$81.16
|
| Rate for Payer: Allwell Medicaid |
$81.16
|
| Rate for Payer: Allwell Medicare |
$32.32
|
| Rate for Payer: Amerigroup Medicare |
$32.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$75.45
|
| Rate for Payer: AZCH Complete Medicaid |
$81.16
|
| Rate for Payer: AZCH Complete Medicare |
$32.32
|
| Rate for Payer: Banner UC Health Medicaid |
$81.16
|
| Rate for Payer: Banner UC Health Medicare |
$32.32
|
| Rate for Payer: Bisbee Police All Plans |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cigna of AZ Commercial |
$141.40
|
| Rate for Payer: Copperpoint Commercial |
$49.99
|
| Rate for Payer: Health Net of AZ Commercial |
$121.20
|
| Rate for Payer: Health Net of AZ Medicare |
$56.56
|
| Rate for Payer: Humana of AZ Medicare |
$32.32
|
| Rate for Payer: Mercy Care Medicaid |
$81.16
|
| Rate for Payer: Self Pay Self Pay |
$161.60
|
| Rate for Payer: TriWest Medicare |
$32.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$36.36
|
|
|
65205 REMOVE FB EXT EYE SUPERT
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
22282924
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.52 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of AZ Commercial |
$181.80
|
| Rate for Payer: Bisbee Police All Plans |
$52.52
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Self Pay Self Pay |
$161.60
|
|
|
65210 REMOVE FB EXT EYE ENBEDD
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
22282925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$209.70
|
| Rate for Payer: Aetna of AZ Medicare |
$65.24
|
| Rate for Payer: AHCCCS Medicaid |
$195.91
|
| Rate for Payer: Allwell Medicaid |
$195.91
|
| Rate for Payer: Allwell Medicare |
$37.28
|
| Rate for Payer: Amerigroup Medicare |
$37.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$87.03
|
| Rate for Payer: AZCH Complete Medicaid |
$195.91
|
| Rate for Payer: AZCH Complete Medicare |
$37.28
|
| Rate for Payer: Banner UC Health Medicaid |
$195.91
|
| Rate for Payer: Banner UC Health Medicare |
$37.28
|
| Rate for Payer: Bisbee Police All Plans |
$60.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$158.44
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cigna of AZ Commercial |
$163.10
|
| Rate for Payer: Copperpoint Commercial |
$57.67
|
| Rate for Payer: Health Net of AZ Commercial |
$139.80
|
| Rate for Payer: Health Net of AZ Medicare |
$65.24
|
| Rate for Payer: Humana of AZ Medicare |
$37.28
|
| Rate for Payer: Mercy Care Medicaid |
$195.91
|
| Rate for Payer: Self Pay Self Pay |
$186.40
|
| Rate for Payer: TriWest Medicare |
$37.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.94
|
|
|
65210 REMOVE FB EXT EYE ENBEDD
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
22282925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$209.70 |
| Rate for Payer: Aetna of AZ Commercial |
$209.70
|
| Rate for Payer: Bisbee Police All Plans |
$60.58
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Self Pay Self Pay |
$186.40
|
|
|
65235 REMOVE FB INTRAOCULAR
|
Facility
|
OP
|
$2,337.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
22282926
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.92 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,103.30
|
| Rate for Payer: Aetna of AZ Medicare |
$654.36
|
| Rate for Payer: AHCCCS Medicaid |
$1,507.39
|
| Rate for Payer: Allwell Medicaid |
$1,507.39
|
| Rate for Payer: Allwell Medicare |
$373.92
|
| Rate for Payer: Amerigroup Medicare |
$373.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$872.87
|
| Rate for Payer: AZCH Complete Medicaid |
$1,507.39
|
| Rate for Payer: AZCH Complete Medicare |
$373.92
|
| Rate for Payer: Banner UC Health Medicaid |
$1,507.39
|
| Rate for Payer: Banner UC Health Medicare |
$373.92
|
| Rate for Payer: Bisbee Police All Plans |
$607.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,589.16
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,635.90
|
| Rate for Payer: Copperpoint Commercial |
$578.41
|
| Rate for Payer: Health Net of AZ Commercial |
$1,402.20
|
| Rate for Payer: Health Net of AZ Medicare |
$654.36
|
| Rate for Payer: Humana of AZ Medicare |
$373.92
|
| Rate for Payer: Mercy Care Medicaid |
$1,507.39
|
| Rate for Payer: Self Pay Self Pay |
$1,869.60
|
| Rate for Payer: TriWest Medicare |
$373.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$420.66
|
|
|
65235 REMOVE FB INTRAOCULAR
|
Facility
|
IP
|
$2,337.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
22282926
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$607.62 |
| Max. Negotiated Rate |
$2,103.30 |
| Rate for Payer: Aetna of AZ Commercial |
$2,103.30
|
| Rate for Payer: Bisbee Police All Plans |
$607.62
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Self Pay Self Pay |
$1,869.60
|
|
|
6.6 POST REAMER
|
Facility
|
OP
|
$964.00
|
|
| Hospital Charge Code |
22354197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.24 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Aetna of AZ Commercial |
$867.60
|
| Rate for Payer: Aetna of AZ Medicare |
$269.92
|
| Rate for Payer: Allwell Medicare |
$154.24
|
| Rate for Payer: Amerigroup Medicare |
$154.24
|
| Rate for Payer: APIPA Medicare/Medicaid |
$360.05
|
| Rate for Payer: AZCH Complete Medicare |
$154.24
|
| Rate for Payer: Banner UC Health Medicare |
$154.24
|
| Rate for Payer: Bisbee Police All Plans |
$250.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$655.52
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cigna of AZ Commercial |
$674.80
|
| Rate for Payer: Copperpoint Commercial |
$238.59
|
| Rate for Payer: Health Net of AZ Commercial |
$578.40
|
| Rate for Payer: Health Net of AZ Medicare |
$269.92
|
| Rate for Payer: Humana of AZ Medicare |
$154.24
|
| Rate for Payer: Self Pay Self Pay |
$771.20
|
| Rate for Payer: TriWest Medicare |
$154.24
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$562.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$173.52
|
|
|
6.6 POST REAMER
|
Facility
|
IP
|
$964.00
|
|
| Hospital Charge Code |
22354197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$250.64 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Aetna of AZ Commercial |
$867.60
|
| Rate for Payer: Bisbee Police All Plans |
$250.64
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Self Pay Self Pay |
$771.20
|
|
|
6.6 x 20MM POST
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$608.00 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,420.00
|
| Rate for Payer: Aetna of AZ Medicare |
$1,064.00
|
| Rate for Payer: Allwell Medicare |
$608.00
|
| Rate for Payer: Amerigroup Medicare |
$608.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,419.30
|
| Rate for Payer: AZCH Complete Medicare |
$608.00
|
| Rate for Payer: Banner UC Health Medicare |
$608.00
|
| Rate for Payer: Bisbee Police All Plans |
$988.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,584.00
|
| Rate for Payer: Cash Price |
$3,040.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,660.00
|
| Rate for Payer: Copperpoint Commercial |
$940.50
|
| Rate for Payer: Health Net of AZ Commercial |
$2,280.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,064.00
|
| Rate for Payer: Humana of AZ Medicare |
$608.00
|
| Rate for Payer: Self Pay Self Pay |
$3,040.00
|
| Rate for Payer: TriWest Medicare |
$608.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,215.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$684.00
|
|
|
6.6 x 20MM POST
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$988.00 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,420.00
|
| Rate for Payer: Bisbee Police All Plans |
$988.00
|
| Rate for Payer: Cash Price |
$3,040.00
|
| Rate for Payer: Self Pay Self Pay |
$3,040.00
|
|
|
69200 REMOVE FB EXT EAR
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
22282927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.44 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of AZ Commercial |
$309.60
|
| Rate for Payer: Bisbee Police All Plans |
$89.44
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Self Pay Self Pay |
$275.20
|
|
|
69200 REMOVE FB EXT EAR
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
22282927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$309.60
|
| Rate for Payer: Aetna of AZ Medicare |
$96.32
|
| Rate for Payer: Allwell Medicare |
$55.04
|
| Rate for Payer: Amerigroup Medicare |
$55.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$128.48
|
| Rate for Payer: AZCH Complete Medicare |
$55.04
|
| Rate for Payer: Banner UC Health Medicare |
$55.04
|
| Rate for Payer: Bisbee Police All Plans |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$233.92
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cigna of AZ Commercial |
$240.80
|
| Rate for Payer: Copperpoint Commercial |
$85.14
|
| Rate for Payer: Health Net of AZ Commercial |
$206.40
|
| Rate for Payer: Health Net of AZ Medicare |
$96.32
|
| Rate for Payer: Humana of AZ Medicare |
$55.04
|
| Rate for Payer: Self Pay Self Pay |
$275.20
|
| Rate for Payer: TriWest Medicare |
$55.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$61.92
|
|
|
69210 REMOVE IMPACTED CERUMEN
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
22282928
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of AZ Commercial |
$207.00
|
| Rate for Payer: Bisbee Police All Plans |
$59.80
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Self Pay Self Pay |
$184.00
|
|
|
69210 REMOVE IMPACTED CERUMEN
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
22282928
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$207.00
|
| Rate for Payer: Aetna of AZ Medicare |
$64.40
|
| Rate for Payer: Allwell Medicare |
$36.80
|
| Rate for Payer: Amerigroup Medicare |
$36.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$85.91
|
| Rate for Payer: AZCH Complete Medicare |
$36.80
|
| Rate for Payer: Banner UC Health Medicare |
$36.80
|
| Rate for Payer: Bisbee Police All Plans |
$59.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$156.40
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna of AZ Commercial |
$161.00
|
| Rate for Payer: Copperpoint Commercial |
$56.92
|
| Rate for Payer: Health Net of AZ Commercial |
$138.00
|
| Rate for Payer: Health Net of AZ Medicare |
$64.40
|
| Rate for Payer: Humana of AZ Medicare |
$36.80
|
| Rate for Payer: Self Pay Self Pay |
$184.00
|
| Rate for Payer: TriWest Medicare |
$36.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.40
|
|
|
7.5FR ULTRA SLIM SINGLE USE URETEROSCOPE
|
Facility
|
OP
|
$3,725.00
|
|
| Hospital Charge Code |
27887273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$596.00 |
| Max. Negotiated Rate |
$3,352.50 |
| Rate for Payer: Aetna of AZ Commercial |
$3,352.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1,043.00
|
| Rate for Payer: Allwell Medicare |
$596.00
|
| Rate for Payer: Amerigroup Medicare |
$596.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,391.29
|
| Rate for Payer: AZCH Complete Medicare |
$596.00
|
| Rate for Payer: Banner UC Health Medicare |
$596.00
|
| Rate for Payer: Bisbee Police All Plans |
$968.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,533.00
|
| Rate for Payer: Cash Price |
$2,980.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,607.50
|
| Rate for Payer: Copperpoint Commercial |
$921.94
|
| Rate for Payer: Health Net of AZ Commercial |
$2,235.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,043.00
|
| Rate for Payer: Humana of AZ Medicare |
$596.00
|
| Rate for Payer: Self Pay Self Pay |
$2,980.00
|
| Rate for Payer: TriWest Medicare |
$596.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,171.68
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$670.50
|
|
|
7.5FR ULTRA SLIM SINGLE USE URETEROSCOPE
|
Facility
|
IP
|
$3,725.00
|
|
| Hospital Charge Code |
27887273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$968.50 |
| Max. Negotiated Rate |
$3,352.50 |
| Rate for Payer: Aetna of AZ Commercial |
$3,352.50
|
| Rate for Payer: Bisbee Police All Plans |
$968.50
|
| Rate for Payer: Cash Price |
$2,980.00
|
| Rate for Payer: Self Pay Self Pay |
$2,980.00
|
|
|
80307 - Drug test(s), presumptive, any number of drug classe
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
23090951
|
|
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
|
|
|
80307 - Drug test(s), presumptive, any number of drug classe
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
23090951
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.12 |
| 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: Allwell Medicare |
$45.12
|
| Rate for Payer: Amerigroup Medicare |
$45.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$105.33
|
| Rate for Payer: AZCH Complete Medicare |
$45.12
|
| Rate for Payer: Banner UC Health Medicare |
$45.12
|
| 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: 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 |
$45.12
|
| Rate for Payer: Self Pay Self Pay |
$225.60
|
| Rate for Payer: TriWest Medicare |
$45.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$164.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$50.76
|
|
|
80326 Drug Analysis Profile, Comprehensive, Ur LC
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 80326
|
| Hospital Charge Code |
28077245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.96 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna of AZ Commercial |
$252.90
|
| Rate for Payer: Aetna of AZ Medicare |
$78.68
|
| Rate for Payer: Allwell Medicare |
$44.96
|
| Rate for Payer: Amerigroup Medicare |
$44.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$104.95
|
| Rate for Payer: AZCH Complete Medicare |
$44.96
|
| Rate for Payer: Banner UC Health Medicare |
$44.96
|
| Rate for Payer: Bisbee Police All Plans |
$73.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$191.08
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cigna of AZ Commercial |
$182.65
|
| Rate for Payer: Copperpoint Commercial |
$69.55
|
| Rate for Payer: Health Net of AZ Commercial |
$168.60
|
| Rate for Payer: Health Net of AZ Medicare |
$78.68
|
| Rate for Payer: Humana of AZ Medicare |
$44.96
|
| Rate for Payer: Self Pay Self Pay |
$224.80
|
| Rate for Payer: TriWest Medicare |
$44.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$163.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$50.58
|
|
|
80326 Drug Analysis Profile, Comprehensive, Ur LC
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 80326
|
| Hospital Charge Code |
28077245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna of AZ Commercial |
$252.90
|
| Rate for Payer: Bisbee Police All Plans |
$73.06
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Self Pay Self Pay |
$224.80
|
|
|
80331 Drug Analysis Profile, Comprehensive, Ur LC
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 80331
|
| Hospital Charge Code |
28077246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna of AZ Commercial |
$252.90
|
| Rate for Payer: Bisbee Police All Plans |
$73.06
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Self Pay Self Pay |
$224.80
|
|
