LINEAR CUTTER ENDOSCOPIC 45MM
|
Facility
|
OP
|
$945.00
|
|
Hospital Charge Code |
22951123
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$141.75 |
Max. Negotiated Rate |
$850.50 |
Rate for Payer: Aetna of AZ Commercial |
$850.50
|
Rate for Payer: Aetna of AZ Medicare |
$264.60
|
Rate for Payer: Allwell Medicare |
$141.75
|
Rate for Payer: Amerigroup Medicare |
$141.75
|
Rate for Payer: APIPA Medicare/Medicaid |
$352.96
|
Rate for Payer: AZCH Complete Medicare |
$141.75
|
Rate for Payer: Banner UC Health Medicare |
$141.75
|
Rate for Payer: Bisbee Police All Plans |
$245.70
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$642.60
|
Rate for Payer: Cash Price |
$756.00
|
Rate for Payer: Cigna of AZ Commercial |
$661.50
|
Rate for Payer: Copperpoint Commercial |
$233.89
|
Rate for Payer: Health Net of AZ Commercial |
$567.00
|
Rate for Payer: Health Net of AZ Medicare |
$264.60
|
Rate for Payer: Humana of AZ Medicare |
$141.75
|
Rate for Payer: Self Pay Self Pay |
$756.00
|
Rate for Payer: TriWest Medicare |
$141.75
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$550.94
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$170.10
|
|
Lipase Level
|
Facility
|
IP
|
$184.00
|
|
Service Code
|
CPT 83690
|
Hospital Charge Code |
633776
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$47.84 |
Max. Negotiated Rate |
$165.60 |
Rate for Payer: Aetna of AZ Commercial |
$165.60
|
Rate for Payer: Bisbee Police All Plans |
$47.84
|
Rate for Payer: Cash Price |
$147.20
|
Rate for Payer: Self Pay Self Pay |
$147.20
|
|
Lipase Level
|
Facility
|
OP
|
$184.00
|
|
Service Code
|
CPT 83690
|
Hospital Charge Code |
633776
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$6.89 |
Max. Negotiated Rate |
$165.60 |
Rate for Payer: Aetna of AZ Commercial |
$165.60
|
Rate for Payer: Aetna of AZ Medicare |
$51.52
|
Rate for Payer: AHCCCS Medicaid |
$6.89
|
Rate for Payer: Allwell Medicaid |
$6.89
|
Rate for Payer: Allwell Medicare |
$27.60
|
Rate for Payer: Amerigroup Medicare |
$27.60
|
Rate for Payer: APIPA Medicare/Medicaid |
$68.72
|
Rate for Payer: AZCH Complete Medicaid |
$6.89
|
Rate for Payer: AZCH Complete Medicare |
$27.60
|
Rate for Payer: Banner UC Health Medicaid |
$6.89
|
Rate for Payer: Banner UC Health Medicare |
$27.60
|
Rate for Payer: Bisbee Police All Plans |
$47.84
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$125.12
|
Rate for Payer: Cash Price |
$147.20
|
Rate for Payer: Cash Price |
$147.20
|
Rate for Payer: Cigna of AZ Commercial |
$119.60
|
Rate for Payer: Copperpoint Commercial |
$45.54
|
Rate for Payer: Health Net of AZ Commercial |
$110.40
|
Rate for Payer: Health Net of AZ Medicare |
$51.52
|
Rate for Payer: Humana of AZ Medicare |
$27.60
|
Rate for Payer: Mercy Care Medicaid |
$6.89
|
Rate for Payer: Self Pay Self Pay |
$147.20
|
Rate for Payer: TriWest Medicare |
$27.60
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$107.27
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$33.12
|
|
Lipid Panel Standard
|
Facility
|
IP
|
$207.00
|
|
Service Code
|
CPT 80061
|
Hospital Charge Code |
22141051
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$53.82 |
Max. Negotiated Rate |
$186.30 |
Rate for Payer: Aetna of AZ Commercial |
$186.30
|
Rate for Payer: Bisbee Police All Plans |
$53.82
|
Rate for Payer: Cash Price |
$165.60
|
Rate for Payer: Self Pay Self Pay |
$165.60
|
|
Lipid Panel Standard
|
Facility
|
OP
|
$207.00
|
|
Service Code
|
CPT 80061
|
Hospital Charge Code |
22141051
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$13.39 |
Max. Negotiated Rate |
$186.30 |
Rate for Payer: Aetna of AZ Commercial |
$186.30
|
Rate for Payer: Aetna of AZ Medicare |
$57.96
|
Rate for Payer: AHCCCS Medicaid |
$13.39
|
Rate for Payer: Allwell Medicaid |
$13.39
|
Rate for Payer: Allwell Medicare |
$31.05
|
Rate for Payer: Amerigroup Medicare |
$31.05
|
Rate for Payer: APIPA Medicare/Medicaid |
$77.31
|
Rate for Payer: AZCH Complete Medicaid |
$13.39
|
Rate for Payer: AZCH Complete Medicare |
$31.05
|
Rate for Payer: Banner UC Health Medicaid |
$13.39
|
Rate for Payer: Banner UC Health Medicare |
$31.05
|
Rate for Payer: Bisbee Police All Plans |
$53.82
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$140.76
|
Rate for Payer: Cash Price |
$165.60
|
Rate for Payer: Cash Price |
$165.60
|
Rate for Payer: Cigna of AZ Commercial |
$134.55
|
Rate for Payer: Copperpoint Commercial |
$51.23
|
Rate for Payer: Health Net of AZ Commercial |
$124.20
|
Rate for Payer: Health Net of AZ Medicare |
$57.96
|
Rate for Payer: Humana of AZ Medicare |
$31.05
|
Rate for Payer: Mercy Care Medicaid |
$13.39
|
Rate for Payer: Self Pay Self Pay |
$165.60
|
Rate for Payer: TriWest Medicare |
$31.05
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$120.68
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$37.26
|
|
.LIPO FRAC
|
Facility
|
IP
|
$458.00
|
|
Service Code
|
CPT 83701
|
Hospital Charge Code |
22481447
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$119.08 |
Max. Negotiated Rate |
$412.20 |
Rate for Payer: Aetna of AZ Commercial |
$412.20
|
Rate for Payer: Bisbee Police All Plans |
$119.08
|
Rate for Payer: Cash Price |
$366.40
|
Rate for Payer: Self Pay Self Pay |
$366.40
|
|
.LIPO FRAC
|
Facility
|
OP
|
$458.00
|
|
Service Code
|
CPT 83701
|
Hospital Charge Code |
22481447
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$33.86 |
Max. Negotiated Rate |
$412.20 |
Rate for Payer: Aetna of AZ Commercial |
$412.20
|
Rate for Payer: Aetna of AZ Medicare |
$128.24
|
Rate for Payer: AHCCCS Medicaid |
$33.86
|
Rate for Payer: Allwell Medicaid |
$33.86
|
Rate for Payer: Allwell Medicare |
$68.70
|
Rate for Payer: Amerigroup Medicare |
$68.70
|
Rate for Payer: APIPA Medicare/Medicaid |
$171.06
|
Rate for Payer: AZCH Complete Medicaid |
$33.86
|
Rate for Payer: AZCH Complete Medicare |
$68.70
|
Rate for Payer: Banner UC Health Medicaid |
$33.86
|
Rate for Payer: Banner UC Health Medicare |
$68.70
|
Rate for Payer: Bisbee Police All Plans |
$119.08
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$311.44
|
Rate for Payer: Cash Price |
$366.40
|
Rate for Payer: Cash Price |
$366.40
|
Rate for Payer: Cigna of AZ Commercial |
$297.70
|
Rate for Payer: Copperpoint Commercial |
$113.36
|
Rate for Payer: Health Net of AZ Commercial |
$274.80
|
Rate for Payer: Health Net of AZ Medicare |
$128.24
|
Rate for Payer: Humana of AZ Medicare |
$68.70
|
Rate for Payer: Mercy Care Medicaid |
$33.86
|
Rate for Payer: Self Pay Self Pay |
$366.40
|
Rate for Payer: TriWest Medicare |
$68.70
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$267.01
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$82.44
|
|
Lipoprotein (A) LC
|
Facility
|
IP
|
$295.00
|
|
Service Code
|
CPT 83695
|
Hospital Charge Code |
4711245
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$76.70 |
Max. Negotiated Rate |
$265.50 |
Rate for Payer: Aetna of AZ Commercial |
$265.50
|
Rate for Payer: Bisbee Police All Plans |
$76.70
|
Rate for Payer: Cash Price |
$236.00
|
Rate for Payer: Self Pay Self Pay |
$236.00
|
|
Lipoprotein (A) LC
|
Facility
|
OP
|
$295.00
|
|
Service Code
|
CPT 83695
|
Hospital Charge Code |
4711245
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$14.32 |
Max. Negotiated Rate |
$265.50 |
Rate for Payer: Aetna of AZ Commercial |
$265.50
|
Rate for Payer: Aetna of AZ Medicare |
$82.60
|
Rate for Payer: AHCCCS Medicaid |
$14.32
|
Rate for Payer: Allwell Medicaid |
$14.32
|
Rate for Payer: Allwell Medicare |
$44.25
|
Rate for Payer: Amerigroup Medicare |
$44.25
|
Rate for Payer: APIPA Medicare/Medicaid |
$110.18
|
Rate for Payer: AZCH Complete Medicaid |
$14.32
|
Rate for Payer: AZCH Complete Medicare |
$44.25
|
Rate for Payer: Banner UC Health Medicaid |
$14.32
|
Rate for Payer: Banner UC Health Medicare |
$44.25
|
Rate for Payer: Bisbee Police All Plans |
$76.70
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$200.60
|
Rate for Payer: Cash Price |
$236.00
|
Rate for Payer: Cash Price |
$236.00
|
Rate for Payer: Cigna of AZ Commercial |
$191.75
|
Rate for Payer: Copperpoint Commercial |
$73.01
|
Rate for Payer: Health Net of AZ Commercial |
$177.00
|
Rate for Payer: Health Net of AZ Medicare |
$82.60
|
Rate for Payer: Humana of AZ Medicare |
$44.25
|
Rate for Payer: Mercy Care Medicaid |
$14.32
|
Rate for Payer: Self Pay Self Pay |
$236.00
|
Rate for Payer: TriWest Medicare |
$44.25
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$171.98
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$53.10
|
|
lisinopril 10 mg Tab [CQCH]
|
Facility
|
OP
|
$0.05
|
|
Service Code
|
NDC 904679861
|
Hospital Charge Code |
105929476
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Aetna of AZ Commercial |
$0.05
|
Rate for Payer: Aetna of AZ Medicare |
$0.01
|
Rate for Payer: Allwell Medicare |
$0.01
|
Rate for Payer: Amerigroup Medicare |
$0.01
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.02
|
Rate for Payer: AZCH Complete Medicare |
$0.01
|
Rate for Payer: Banner UC Health Medicare |
$0.01
|
Rate for Payer: Bisbee Police All Plans |
$0.01
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.03
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Cigna of AZ Commercial |
$0.03
|
Rate for Payer: Copperpoint Commercial |
$0.01
|
Rate for Payer: Health Net of AZ Commercial |
$0.03
|
Rate for Payer: Health Net of AZ Medicare |
$0.01
|
Rate for Payer: Humana of AZ Medicare |
$0.01
|
Rate for Payer: Self Pay Self Pay |
$0.04
|
Rate for Payer: TriWest Medicare |
$0.01
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.03
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
lisinopril 10 mg Tab [CQCH]
|
Facility
|
IP
|
$0.05
|
|
Service Code
|
NDC 904679861
|
Hospital Charge Code |
105929476
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Aetna of AZ Commercial |
$0.05
|
Rate for Payer: Bisbee Police All Plans |
$0.01
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Self Pay Self Pay |
$0.04
|
|
lisinopril 20 mg Tab [CQCH]
|
Facility
|
IP
|
$0.07
|
|
Service Code
|
NDC 904679961
|
Hospital Charge Code |
105929344
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Aetna of AZ Commercial |
$0.06
|
Rate for Payer: Bisbee Police All Plans |
$0.02
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Self Pay Self Pay |
$0.06
|
|
lisinopril 20 mg Tab [CQCH]
|
Facility
|
OP
|
$0.07
|
|
Service Code
|
NDC 904679961
|
Hospital Charge Code |
105929344
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Aetna of AZ Commercial |
$0.06
|
Rate for Payer: Aetna of AZ Medicare |
$0.02
|
Rate for Payer: Allwell Medicare |
$0.01
|
Rate for Payer: Amerigroup Medicare |
$0.01
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.03
|
Rate for Payer: AZCH Complete Medicare |
$0.01
|
Rate for Payer: Banner UC Health Medicare |
$0.01
|
Rate for Payer: Bisbee Police All Plans |
$0.02
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.05
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of AZ Commercial |
$0.05
|
Rate for Payer: Copperpoint Commercial |
$0.02
|
Rate for Payer: Health Net of AZ Commercial |
$0.04
|
Rate for Payer: Health Net of AZ Medicare |
$0.02
|
Rate for Payer: Humana of AZ Medicare |
$0.01
|
Rate for Payer: Self Pay Self Pay |
$0.06
|
Rate for Payer: TriWest Medicare |
$0.01
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.04
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
lisinopril 2.5 mg Tab [CQCH]
|
Facility
|
IP
|
$0.44
|
|
Service Code
|
NDC 68084076525
|
Hospital Charge Code |
105929411
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.40 |
Rate for Payer: Aetna of AZ Commercial |
$0.40
|
Rate for Payer: Bisbee Police All Plans |
$0.11
|
Rate for Payer: Cash Price |
$0.35
|
Rate for Payer: Self Pay Self Pay |
$0.35
|
|
lisinopril 2.5 mg Tab [CQCH]
|
Facility
|
OP
|
$0.44
|
|
Service Code
|
NDC 68084076525
|
Hospital Charge Code |
105929411
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.40 |
Rate for Payer: Aetna of AZ Commercial |
$0.40
|
Rate for Payer: Aetna of AZ Medicare |
$0.12
|
Rate for Payer: Allwell Medicare |
$0.07
|
Rate for Payer: Amerigroup Medicare |
$0.07
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.16
|
Rate for Payer: AZCH Complete Medicare |
$0.07
|
Rate for Payer: Banner UC Health Medicare |
$0.07
|
Rate for Payer: Bisbee Police All Plans |
$0.11
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.30
|
Rate for Payer: Cash Price |
$0.35
|
Rate for Payer: Cigna of AZ Commercial |
$0.29
|
Rate for Payer: Copperpoint Commercial |
$0.11
|
Rate for Payer: Health Net of AZ Commercial |
$0.26
|
Rate for Payer: Health Net of AZ Medicare |
$0.12
|
Rate for Payer: Humana of AZ Medicare |
$0.07
|
Rate for Payer: Self Pay Self Pay |
$0.35
|
Rate for Payer: TriWest Medicare |
$0.07
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.26
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.08
|
|
lisinopril 5 mg Tab [CQCH]
|
Facility
|
OP
|
$0.05
|
|
Service Code
|
NDC 904679761
|
Hospital Charge Code |
105929279
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Aetna of AZ Commercial |
$0.05
|
Rate for Payer: Aetna of AZ Medicare |
$0.01
|
Rate for Payer: Allwell Medicare |
$0.01
|
Rate for Payer: Amerigroup Medicare |
$0.01
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.02
|
Rate for Payer: AZCH Complete Medicare |
$0.01
|
Rate for Payer: Banner UC Health Medicare |
$0.01
|
Rate for Payer: Bisbee Police All Plans |
$0.01
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.03
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Cigna of AZ Commercial |
$0.03
|
Rate for Payer: Copperpoint Commercial |
$0.01
|
Rate for Payer: Health Net of AZ Commercial |
$0.03
|
Rate for Payer: Health Net of AZ Medicare |
$0.01
|
Rate for Payer: Humana of AZ Medicare |
$0.01
|
Rate for Payer: Self Pay Self Pay |
$0.04
|
Rate for Payer: TriWest Medicare |
$0.01
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.03
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
lisinopril 5 mg Tab [CQCH]
|
Facility
|
IP
|
$0.05
|
|
Service Code
|
NDC 904679761
|
Hospital Charge Code |
105929279
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Aetna of AZ Commercial |
$0.05
|
Rate for Payer: Bisbee Police All Plans |
$0.01
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Self Pay Self Pay |
$0.04
|
|
lithium 300 mg Cap [CQCH]
|
Facility
|
IP
|
$0.03
|
|
Service Code
|
NDC 54252725
|
Hospital Charge Code |
105929541
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.03 |
Rate for Payer: Aetna of AZ Commercial |
$0.03
|
Rate for Payer: Bisbee Police All Plans |
$0.01
|
Rate for Payer: Cash Price |
$0.02
|
Rate for Payer: Self Pay Self Pay |
$0.02
|
|
lithium 300 mg Cap [CQCH]
|
Facility
|
OP
|
$0.03
|
|
Service Code
|
NDC 54252725
|
Hospital Charge Code |
105929541
|
Hospital Revenue Code
|
251
|
Max. Negotiated Rate |
$0.03 |
Rate for Payer: Aetna of AZ Commercial |
$0.03
|
Rate for Payer: Aetna of AZ Medicare |
$0.01
|
Rate for Payer: Allwell Medicare |
$0.00
|
Rate for Payer: Amerigroup Medicare |
$0.00
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.01
|
Rate for Payer: AZCH Complete Medicare |
$0.00
|
Rate for Payer: Banner UC Health Medicare |
$0.00
|
Rate for Payer: Bisbee Police All Plans |
$0.01
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.02
|
Rate for Payer: Cash Price |
$0.02
|
Rate for Payer: Cigna of AZ Commercial |
$0.02
|
Rate for Payer: Copperpoint Commercial |
$0.01
|
Rate for Payer: Health Net of AZ Commercial |
$0.02
|
Rate for Payer: Health Net of AZ Medicare |
$0.01
|
Rate for Payer: Humana of AZ Medicare |
$0.00
|
Rate for Payer: Self Pay Self Pay |
$0.02
|
Rate for Payer: TriWest Medicare |
$0.00
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.02
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
Lithium (Eskalith), Serum LC
|
Facility
|
OP
|
$128.00
|
|
Service Code
|
CPT 80178
|
Hospital Charge Code |
1905523
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$6.61 |
Max. Negotiated Rate |
$115.20 |
Rate for Payer: Aetna of AZ Commercial |
$115.20
|
Rate for Payer: Aetna of AZ Medicare |
$35.84
|
Rate for Payer: AHCCCS Medicaid |
$6.61
|
Rate for Payer: Allwell Medicaid |
$6.61
|
Rate for Payer: Allwell Medicare |
$19.20
|
Rate for Payer: Amerigroup Medicare |
$19.20
|
Rate for Payer: APIPA Medicare/Medicaid |
$47.81
|
Rate for Payer: AZCH Complete Medicaid |
$6.61
|
Rate for Payer: AZCH Complete Medicare |
$19.20
|
Rate for Payer: Banner UC Health Medicaid |
$6.61
|
Rate for Payer: Banner UC Health Medicare |
$19.20
|
Rate for Payer: Bisbee Police All Plans |
$33.28
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$87.04
|
Rate for Payer: Cash Price |
$102.40
|
Rate for Payer: Cash Price |
$102.40
|
Rate for Payer: Cigna of AZ Commercial |
$83.20
|
Rate for Payer: Copperpoint Commercial |
$31.68
|
Rate for Payer: Health Net of AZ Commercial |
$76.80
|
Rate for Payer: Health Net of AZ Medicare |
$35.84
|
Rate for Payer: Humana of AZ Medicare |
$19.20
|
Rate for Payer: Mercy Care Medicaid |
$6.61
|
Rate for Payer: Self Pay Self Pay |
$102.40
|
Rate for Payer: TriWest Medicare |
$19.20
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$74.62
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$23.04
|
|
Lithium (Eskalith), Serum LC
|
Facility
|
IP
|
$128.00
|
|
Service Code
|
CPT 80178
|
Hospital Charge Code |
1905523
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$33.28 |
Max. Negotiated Rate |
$115.20 |
Rate for Payer: Aetna of AZ Commercial |
$115.20
|
Rate for Payer: Bisbee Police All Plans |
$33.28
|
Rate for Payer: Cash Price |
$102.40
|
Rate for Payer: Self Pay Self Pay |
$102.40
|
|
Liver elastography
|
Facility
|
IP
|
$166.00
|
|
Service Code
|
CPT 91200
|
Hospital Charge Code |
22282825
|
Hospital Revenue Code
|
400
|
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
|
|
Liver elastography
|
Facility
|
OP
|
$166.00
|
|
Service Code
|
CPT 91200
|
Hospital Charge Code |
22282825
|
Hospital Revenue Code
|
400
|
Min. Negotiated Rate |
$24.90 |
Max. Negotiated Rate |
$202.34 |
Rate for Payer: Aetna of AZ Commercial |
$149.40
|
Rate for Payer: Aetna of AZ Medicare |
$46.48
|
Rate for Payer: AHCCCS Medicaid |
$202.34
|
Rate for Payer: Allwell Medicaid |
$202.34
|
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 Medicaid |
$202.34
|
Rate for Payer: AZCH Complete Medicare |
$24.90
|
Rate for Payer: Banner UC Health Medicaid |
$202.34
|
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: 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: Mercy Care Medicaid |
$202.34
|
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
|
|
Liver-Kidney Microsomal Ab LC
|
Facility
|
OP
|
$181.00
|
|
Service Code
|
CPT 86376
|
Hospital Charge Code |
22011788
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$14.55 |
Max. Negotiated Rate |
$162.90 |
Rate for Payer: Aetna of AZ Commercial |
$162.90
|
Rate for Payer: Aetna of AZ Medicare |
$50.68
|
Rate for Payer: AHCCCS Medicaid |
$14.55
|
Rate for Payer: Allwell Medicaid |
$14.55
|
Rate for Payer: Allwell Medicare |
$27.15
|
Rate for Payer: Amerigroup Medicare |
$27.15
|
Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
Rate for Payer: AZCH Complete Medicaid |
$14.55
|
Rate for Payer: AZCH Complete Medicare |
$27.15
|
Rate for Payer: Banner UC Health Medicaid |
$14.55
|
Rate for Payer: Banner UC Health Medicare |
$27.15
|
Rate for Payer: Bisbee Police All Plans |
$47.06
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$123.08
|
Rate for Payer: Cash Price |
$144.80
|
Rate for Payer: Cash Price |
$144.80
|
Rate for Payer: Cigna of AZ Commercial |
$117.65
|
Rate for Payer: Copperpoint Commercial |
$44.80
|
Rate for Payer: Health Net of AZ Commercial |
$108.60
|
Rate for Payer: Health Net of AZ Medicare |
$50.68
|
Rate for Payer: Humana of AZ Medicare |
$27.15
|
Rate for Payer: Mercy Care Medicaid |
$14.55
|
Rate for Payer: Self Pay Self Pay |
$144.80
|
Rate for Payer: TriWest Medicare |
$27.15
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
Liver-Kidney Microsomal Ab LC
|
Facility
|
IP
|
$181.00
|
|
Service Code
|
CPT 86376
|
Hospital Charge Code |
22011788
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$47.06 |
Max. Negotiated Rate |
$162.90 |
Rate for Payer: Aetna of AZ Commercial |
$162.90
|
Rate for Payer: Bisbee Police All Plans |
$47.06
|
Rate for Payer: Cash Price |
$144.80
|
Rate for Payer: Self Pay Self Pay |
$144.80
|
|