|
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
|
|
|
87328 Giardia lamblia
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
23173791
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna of AZ Commercial |
$244.80
|
| Rate for Payer: Aetna of AZ Medicare |
$76.16
|
| Rate for Payer: AHCCCS Medicaid |
$13.82
|
| Rate for Payer: Allwell Medicaid |
$13.82
|
| Rate for Payer: Allwell Medicare |
$40.80
|
| Rate for Payer: Amerigroup Medicare |
$40.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$101.59
|
| Rate for Payer: AZCH Complete Medicaid |
$13.82
|
| Rate for Payer: AZCH Complete Medicare |
$40.80
|
| Rate for Payer: Banner UC Health Medicaid |
$13.82
|
| Rate for Payer: Banner UC Health Medicare |
$40.80
|
| Rate for Payer: Bisbee Police All Plans |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$184.96
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cigna of AZ Commercial |
$176.80
|
| Rate for Payer: Copperpoint Commercial |
$67.32
|
| Rate for Payer: Health Net of AZ Commercial |
$163.20
|
| Rate for Payer: Health Net of AZ Medicare |
$76.16
|
| Rate for Payer: Humana of AZ Medicare |
$40.80
|
| Rate for Payer: Mercy Care Medicaid |
$13.82
|
| Rate for Payer: Self Pay Self Pay |
$217.60
|
| Rate for Payer: TriWest Medicare |
$40.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$158.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.96
|
|
|
87328 Giardia lamblia
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
23173791
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna of AZ Commercial |
$244.80
|
| Rate for Payer: Bisbee Police All Plans |
$70.72
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Self Pay Self Pay |
$217.60
|
|
|
87329 Giardia lamblia
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
23173792
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna of AZ Commercial |
$205.20
|
| Rate for Payer: Bisbee Police All Plans |
$59.28
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Self Pay Self Pay |
$182.40
|
|
|
87329 Giardia lamblia
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
23173792
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna of AZ Commercial |
$205.20
|
| Rate for Payer: Aetna of AZ Medicare |
$63.84
|
| Rate for Payer: AHCCCS Medicaid |
$11.98
|
| Rate for Payer: Allwell Medicaid |
$11.98
|
| Rate for Payer: Allwell Medicare |
$34.20
|
| Rate for Payer: Amerigroup Medicare |
$34.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$85.16
|
| Rate for Payer: AZCH Complete Medicaid |
$11.98
|
| Rate for Payer: AZCH Complete Medicare |
$34.20
|
| Rate for Payer: Banner UC Health Medicaid |
$11.98
|
| Rate for Payer: Banner UC Health Medicare |
$34.20
|
| Rate for Payer: Bisbee Police All Plans |
$59.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$155.04
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cigna of AZ Commercial |
$148.20
|
| Rate for Payer: Copperpoint Commercial |
$56.43
|
| Rate for Payer: Health Net of AZ Commercial |
$136.80
|
| Rate for Payer: Health Net of AZ Medicare |
$63.84
|
| Rate for Payer: Humana of AZ Medicare |
$34.20
|
| Rate for Payer: Mercy Care Medicaid |
$11.98
|
| Rate for Payer: Self Pay Self Pay |
$182.40
|
| Rate for Payer: TriWest Medicare |
$34.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$132.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.04
|
|
|
87900 HIV-1 Quant PCR
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
23173798
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$130.35 |
| Max. Negotiated Rate |
$899.10 |
| Rate for Payer: Aetna of AZ Commercial |
$899.10
|
| Rate for Payer: Aetna of AZ Medicare |
$279.72
|
| Rate for Payer: AHCCCS Medicaid |
$130.35
|
| Rate for Payer: Allwell Medicaid |
$130.35
|
| Rate for Payer: Allwell Medicare |
$149.85
|
| Rate for Payer: Amerigroup Medicare |
$149.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$373.13
|
| Rate for Payer: AZCH Complete Medicaid |
$130.35
|
| Rate for Payer: AZCH Complete Medicare |
$149.85
|
| Rate for Payer: Banner UC Health Medicaid |
$130.35
|
| Rate for Payer: Banner UC Health Medicare |
$149.85
|
| Rate for Payer: Bisbee Police All Plans |
$259.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$679.32
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna of AZ Commercial |
$649.35
|
| Rate for Payer: Copperpoint Commercial |
$247.25
|
| Rate for Payer: Health Net of AZ Commercial |
$599.40
|
| Rate for Payer: Health Net of AZ Medicare |
$279.72
|
| Rate for Payer: Humana of AZ Medicare |
$149.85
|
| Rate for Payer: Mercy Care Medicaid |
$130.35
|
| Rate for Payer: Self Pay Self Pay |
$799.20
|
| Rate for Payer: TriWest Medicare |
$149.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$582.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$179.82
|
|
|
87900 HIV-1 Quant PCR
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
23173798
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$259.74 |
| Max. Negotiated Rate |
$899.10 |
| Rate for Payer: Aetna of AZ Commercial |
$899.10
|
| Rate for Payer: Bisbee Police All Plans |
$259.74
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Self Pay Self Pay |
$799.20
|
|
|
87901 HIV-1 Quant PCR
|
Facility
|
OP
|
$1,502.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
23173796
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$225.30 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,351.80
|
| Rate for Payer: Aetna of AZ Medicare |
$420.56
|
| Rate for Payer: AHCCCS Medicaid |
$257.45
|
| Rate for Payer: Allwell Medicaid |
$257.45
|
| Rate for Payer: Allwell Medicare |
$225.30
|
| Rate for Payer: Amerigroup Medicare |
$225.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$561.00
|
| Rate for Payer: AZCH Complete Medicaid |
$257.45
|
| Rate for Payer: AZCH Complete Medicare |
$225.30
|
| Rate for Payer: Banner UC Health Medicaid |
$257.45
|
| Rate for Payer: Banner UC Health Medicare |
$225.30
|
| Rate for Payer: Bisbee Police All Plans |
$390.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,021.36
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Cigna of AZ Commercial |
$976.30
|
| Rate for Payer: Copperpoint Commercial |
$371.74
|
| Rate for Payer: Health Net of AZ Commercial |
$901.20
|
| Rate for Payer: Health Net of AZ Medicare |
$420.56
|
| Rate for Payer: Humana of AZ Medicare |
$225.30
|
| Rate for Payer: Mercy Care Medicaid |
$257.45
|
| Rate for Payer: Self Pay Self Pay |
$1,201.60
|
| Rate for Payer: TriWest Medicare |
$225.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$875.67
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$270.36
|
|
|
87901 HIV-1 Quant PCR
|
Facility
|
IP
|
$1,502.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
23173796
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$390.52 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,351.80
|
| Rate for Payer: Bisbee Police All Plans |
$390.52
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Self Pay Self Pay |
$1,201.60
|
|
|
87906 HIV-1 Genosure Archive
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
23173794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Aetna of AZ Commercial |
$495.90
|
| Rate for Payer: Bisbee Police All Plans |
$143.26
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Self Pay Self Pay |
$440.80
|
|
|
87906 HIV-1 Genosure Archive
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
23173794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Aetna of AZ Commercial |
$495.90
|
| Rate for Payer: Aetna of AZ Medicare |
$154.28
|
| Rate for Payer: AHCCCS Medicaid |
$128.73
|
| Rate for Payer: Allwell Medicaid |
$128.73
|
| Rate for Payer: Allwell Medicare |
$82.65
|
| Rate for Payer: Amerigroup Medicare |
$82.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$205.80
|
| Rate for Payer: AZCH Complete Medicaid |
$128.73
|
| Rate for Payer: AZCH Complete Medicare |
$82.65
|
| Rate for Payer: Banner UC Health Medicaid |
$128.73
|
| Rate for Payer: Banner UC Health Medicare |
$82.65
|
| Rate for Payer: Bisbee Police All Plans |
$143.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$374.68
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cigna of AZ Commercial |
$358.15
|
| Rate for Payer: Copperpoint Commercial |
$136.37
|
| Rate for Payer: Health Net of AZ Commercial |
$330.60
|
| Rate for Payer: Health Net of AZ Medicare |
$154.28
|
| Rate for Payer: Humana of AZ Medicare |
$82.65
|
| Rate for Payer: Mercy Care Medicaid |
$128.73
|
| Rate for Payer: Self Pay Self Pay |
$440.80
|
| Rate for Payer: TriWest Medicare |
$82.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$321.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$99.18
|
|
|
87906 HIV-1 Quant PCR
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
23173797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Aetna of AZ Commercial |
$495.90
|
| Rate for Payer: Aetna of AZ Medicare |
$154.28
|
| Rate for Payer: AHCCCS Medicaid |
$128.73
|
| Rate for Payer: Allwell Medicaid |
$128.73
|
| Rate for Payer: Allwell Medicare |
$82.65
|
| Rate for Payer: Amerigroup Medicare |
$82.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$205.80
|
| Rate for Payer: AZCH Complete Medicaid |
$128.73
|
| Rate for Payer: AZCH Complete Medicare |
$82.65
|
| Rate for Payer: Banner UC Health Medicaid |
$128.73
|
| Rate for Payer: Banner UC Health Medicare |
$82.65
|
| Rate for Payer: Bisbee Police All Plans |
$143.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$374.68
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cigna of AZ Commercial |
$358.15
|
| Rate for Payer: Copperpoint Commercial |
$136.37
|
| Rate for Payer: Health Net of AZ Commercial |
$330.60
|
| Rate for Payer: Health Net of AZ Medicare |
$154.28
|
| Rate for Payer: Humana of AZ Medicare |
$82.65
|
| Rate for Payer: Mercy Care Medicaid |
$128.73
|
| Rate for Payer: Self Pay Self Pay |
$440.80
|
| Rate for Payer: TriWest Medicare |
$82.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$321.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$99.18
|
|
|
87906 HIV-1 Quant PCR
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
23173797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Aetna of AZ Commercial |
$495.90
|
| Rate for Payer: Bisbee Police All Plans |
$143.26
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Self Pay Self Pay |
$440.80
|
|
|
88184 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR
|
Facility
|
IP
|
$4,281.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
23568455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1,113.06 |
| Max. Negotiated Rate |
$3,852.90 |
| Rate for Payer: Aetna of AZ Commercial |
$3,852.90
|
| Rate for Payer: Bisbee Police All Plans |
$1,113.06
|
| Rate for Payer: Cash Price |
$3,424.80
|
| Rate for Payer: Self Pay Self Pay |
$3,424.80
|
|
|
88184 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR
|
Facility
|
OP
|
$4,281.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
23568455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$211.16 |
| Max. Negotiated Rate |
$3,852.90 |
| Rate for Payer: Aetna of AZ Commercial |
$3,852.90
|
| Rate for Payer: Aetna of AZ Medicare |
$1,198.68
|
| Rate for Payer: AHCCCS Medicaid |
$211.16
|
| Rate for Payer: Allwell Medicaid |
$211.16
|
| Rate for Payer: Allwell Medicare |
$642.15
|
| Rate for Payer: Amerigroup Medicare |
$642.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,598.95
|
| Rate for Payer: AZCH Complete Medicaid |
$211.16
|
| Rate for Payer: AZCH Complete Medicare |
$642.15
|
| Rate for Payer: Banner UC Health Medicaid |
$211.16
|
| Rate for Payer: Banner UC Health Medicare |
$642.15
|
| Rate for Payer: Bisbee Police All Plans |
$1,113.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,911.08
|
| Rate for Payer: Cash Price |
$3,424.80
|
| Rate for Payer: Cash Price |
$3,424.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,782.65
|
| Rate for Payer: Copperpoint Commercial |
$1,059.55
|
| Rate for Payer: Health Net of AZ Commercial |
$2,568.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,198.68
|
| Rate for Payer: Humana of AZ Medicare |
$642.15
|
| Rate for Payer: Mercy Care Medicaid |
$211.16
|
| Rate for Payer: Self Pay Self Pay |
$3,424.80
|
| Rate for Payer: TriWest Medicare |
$642.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,495.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$770.58
|
|
|
88185 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
23568456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of AZ Commercial |
$61.20
|
| Rate for Payer: Bisbee Police All Plans |
$17.68
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Self Pay Self Pay |
$54.40
|
|
|
88185 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
23568456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of AZ Commercial |
$61.20
|
| Rate for Payer: Aetna of AZ Medicare |
$19.04
|
| Rate for Payer: AHCCCS Medicaid |
$12.26
|
| Rate for Payer: Allwell Medicaid |
$12.26
|
| Rate for Payer: Allwell Medicare |
$10.20
|
| Rate for Payer: Amerigroup Medicare |
$10.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$25.40
|
| Rate for Payer: AZCH Complete Medicaid |
$12.26
|
| Rate for Payer: AZCH Complete Medicare |
$10.20
|
| Rate for Payer: Banner UC Health Medicaid |
$12.26
|
| Rate for Payer: Banner UC Health Medicare |
$10.20
|
| Rate for Payer: Bisbee Police All Plans |
$17.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$46.24
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cigna of AZ Commercial |
$44.20
|
| Rate for Payer: Copperpoint Commercial |
$16.83
|
| Rate for Payer: Health Net of AZ Commercial |
$40.80
|
| Rate for Payer: Health Net of AZ Medicare |
$19.04
|
| Rate for Payer: Humana of AZ Medicare |
$10.20
|
| Rate for Payer: Mercy Care Medicaid |
$12.26
|
| Rate for Payer: Self Pay Self Pay |
$54.40
|
| Rate for Payer: TriWest Medicare |
$10.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$39.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.24
|
|
|
88189 FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88189
|
| Hospital Charge Code |
23568457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of AZ Commercial |
$180.00
|
| Rate for Payer: Bisbee Police All Plans |
$52.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Self Pay Self Pay |
$160.00
|
|
|
88189 FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 88189
|
| Hospital Charge Code |
23568457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of AZ Commercial |
$180.00
|
| Rate for Payer: Aetna of AZ Medicare |
$56.00
|
| Rate for Payer: AHCCCS Medicaid |
$34.50
|
| Rate for Payer: Allwell Medicaid |
$34.50
|
| Rate for Payer: Allwell Medicare |
$30.00
|
| Rate for Payer: Amerigroup Medicare |
$30.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$74.70
|
| Rate for Payer: AZCH Complete Medicaid |
$34.50
|
| Rate for Payer: AZCH Complete Medicare |
$30.00
|
| Rate for Payer: Banner UC Health Medicaid |
$34.50
|
| Rate for Payer: Banner UC Health Medicare |
$30.00
|
| Rate for Payer: Bisbee Police All Plans |
$52.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$136.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna of AZ Commercial |
$130.00
|
| Rate for Payer: Copperpoint Commercial |
$49.50
|
| Rate for Payer: Health Net of AZ Commercial |
$120.00
|
| Rate for Payer: Health Net of AZ Medicare |
$56.00
|
| Rate for Payer: Humana of AZ Medicare |
$30.00
|
| Rate for Payer: Mercy Care Medicaid |
$34.50
|
| Rate for Payer: Self Pay Self Pay |
$160.00
|
| Rate for Payer: TriWest Medicare |
$30.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$116.60
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$36.00
|
|
|
90783 INTRA ARTERIAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 90783
|
| Hospital Charge Code |
22282929
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of AZ Commercial |
$88.20
|
| Rate for Payer: Bisbee Police All Plans |
$25.48
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Self Pay Self Pay |
$78.40
|
|
|
90783 INTRA ARTERIAL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 90783
|
| Hospital Charge Code |
22282929
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of AZ Commercial |
$88.20
|
| Rate for Payer: Aetna of AZ Medicare |
$27.44
|
| Rate for Payer: Allwell Medicare |
$14.70
|
| Rate for Payer: Amerigroup Medicare |
$14.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$36.60
|
| Rate for Payer: AZCH Complete Medicare |
$14.70
|
| Rate for Payer: Banner UC Health Medicare |
$14.70
|
| Rate for Payer: Bisbee Police All Plans |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$66.64
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cigna of AZ Commercial |
$68.60
|
| Rate for Payer: Copperpoint Commercial |
$24.26
|
| Rate for Payer: Health Net of AZ Commercial |
$58.80
|
| Rate for Payer: Health Net of AZ Medicare |
$27.44
|
| Rate for Payer: Humana of AZ Medicare |
$14.70
|
| Rate for Payer: Self Pay Self Pay |
$78.40
|
| Rate for Payer: TriWest Medicare |
$14.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$57.13
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$17.64
|
|
|
91034 ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CA
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
23599031
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$1,708.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,708.20
|
| Rate for Payer: Aetna of AZ Medicare |
$531.44
|
| Rate for Payer: AHCCCS Medicaid |
$707.28
|
| Rate for Payer: Allwell Medicaid |
$707.28
|
| Rate for Payer: Allwell Medicare |
$284.70
|
| Rate for Payer: Amerigroup Medicare |
$284.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$708.90
|
| Rate for Payer: AZCH Complete Medicaid |
$707.28
|
| Rate for Payer: AZCH Complete Medicare |
$284.70
|
| Rate for Payer: Banner UC Health Medicaid |
$707.28
|
| Rate for Payer: Banner UC Health Medicare |
$284.70
|
| Rate for Payer: Bisbee Police All Plans |
$493.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,290.64
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,328.60
|
| Rate for Payer: Copperpoint Commercial |
$469.76
|
| Rate for Payer: Health Net of AZ Commercial |
$1,138.80
|
| Rate for Payer: Health Net of AZ Medicare |
$531.44
|
| Rate for Payer: Humana of AZ Medicare |
$284.70
|
| Rate for Payer: Mercy Care Medicaid |
$707.28
|
| Rate for Payer: Self Pay Self Pay |
$1,518.40
|
| Rate for Payer: TriWest Medicare |
$284.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,106.53
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$341.64
|
|
|
91034 ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CA
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
23599031
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$493.48 |
| Max. Negotiated Rate |
$1,708.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,708.20
|
| Rate for Payer: Bisbee Police All Plans |
$493.48
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Self Pay Self Pay |
$1,518.40
|
|
|
92507 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, A
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
27726434
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
92507 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, A
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
27726434
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| 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 |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| 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 |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$32.25
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| 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 |
$150.50
|
| 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 |
$0.13
|
| 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
|
|
