|
MRA Head w/o Contrast 70544
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
22986618
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$491.66 |
| Max. Negotiated Rate |
$1,701.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,701.90
|
| Rate for Payer: Bisbee Police All Plans |
$491.66
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Self Pay Self Pay |
$1,512.80
|
|
|
MRA Neck w/ Contrast
|
Facility
|
OP
|
$5,028.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
1005378
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$533.78 |
| Max. Negotiated Rate |
$4,525.20 |
| Rate for Payer: Aetna of AZ Commercial |
$4,525.20
|
| Rate for Payer: Aetna of AZ Medicare |
$1,407.84
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$754.20
|
| Rate for Payer: Amerigroup Medicare |
$754.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,877.96
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$754.20
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$754.20
|
| Rate for Payer: Bisbee Police All Plans |
$1,307.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,419.04
|
| Rate for Payer: Cash Price |
$4,022.40
|
| Rate for Payer: Cash Price |
$4,022.40
|
| Rate for Payer: Cigna of AZ Commercial |
$3,519.60
|
| Rate for Payer: Copperpoint Commercial |
$1,244.43
|
| Rate for Payer: Health Net of AZ Commercial |
$3,016.80
|
| Rate for Payer: Health Net of AZ Medicare |
$1,407.84
|
| Rate for Payer: Humana of AZ Medicare |
$754.20
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$4,022.40
|
| Rate for Payer: TriWest Medicare |
$754.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,931.32
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$905.04
|
|
|
MRA Neck w/ Contrast
|
Facility
|
IP
|
$5,028.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
1005378
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,307.28 |
| Max. Negotiated Rate |
$4,525.20 |
| Rate for Payer: Aetna of AZ Commercial |
$4,525.20
|
| Rate for Payer: Bisbee Police All Plans |
$1,307.28
|
| Rate for Payer: Cash Price |
$4,022.40
|
| Rate for Payer: Self Pay Self Pay |
$4,022.40
|
|
|
MRA Neck w/ Contrast 70548
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
22986619
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$552.76 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,913.40
|
| Rate for Payer: Bisbee Police All Plans |
$552.76
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Self Pay Self Pay |
$1,700.80
|
|
|
MRA Neck w/ Contrast 70548
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
22986619
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$318.90 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,913.40
|
| Rate for Payer: Aetna of AZ Medicare |
$595.28
|
| Rate for Payer: AHCCCS Medicaid |
$483.64
|
| Rate for Payer: Allwell Medicaid |
$483.64
|
| Rate for Payer: Allwell Medicare |
$318.90
|
| Rate for Payer: Amerigroup Medicare |
$318.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$794.06
|
| Rate for Payer: AZCH Complete Medicaid |
$483.64
|
| Rate for Payer: AZCH Complete Medicare |
$318.90
|
| Rate for Payer: Banner UC Health Medicaid |
$483.64
|
| Rate for Payer: Banner UC Health Medicare |
$318.90
|
| Rate for Payer: Bisbee Police All Plans |
$552.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,445.68
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,488.20
|
| Rate for Payer: Copperpoint Commercial |
$526.18
|
| Rate for Payer: Health Net of AZ Commercial |
$1,275.60
|
| Rate for Payer: Health Net of AZ Medicare |
$595.28
|
| Rate for Payer: Humana of AZ Medicare |
$318.90
|
| Rate for Payer: Mercy Care Medicaid |
$483.64
|
| Rate for Payer: Self Pay Self Pay |
$1,700.80
|
| Rate for Payer: TriWest Medicare |
$318.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,239.46
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$382.68
|
|
|
MRA Neck w/o Contrast
|
Facility
|
IP
|
$3,253.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
821396
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$845.78 |
| Max. Negotiated Rate |
$2,927.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,927.70
|
| Rate for Payer: Bisbee Police All Plans |
$845.78
|
| Rate for Payer: Cash Price |
$2,602.40
|
| Rate for Payer: Self Pay Self Pay |
$2,602.40
|
|
|
MRA Neck w/o Contrast
|
Facility
|
OP
|
$3,253.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
821396
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$333.68 |
| Max. Negotiated Rate |
$2,927.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,927.70
|
| Rate for Payer: Aetna of AZ Medicare |
$910.84
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$487.95
|
| Rate for Payer: Amerigroup Medicare |
$487.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,215.00
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$487.95
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$487.95
|
| Rate for Payer: Bisbee Police All Plans |
$845.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,212.04
|
| Rate for Payer: Cash Price |
$2,602.40
|
| Rate for Payer: Cash Price |
$2,602.40
|
| Rate for Payer: Cigna of AZ Commercial |
$2,277.10
|
| Rate for Payer: Copperpoint Commercial |
$805.12
|
| Rate for Payer: Health Net of AZ Commercial |
$1,951.80
|
| Rate for Payer: Health Net of AZ Medicare |
$910.84
|
| Rate for Payer: Humana of AZ Medicare |
$487.95
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$2,602.40
|
| Rate for Payer: TriWest Medicare |
$487.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,896.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$585.54
|
|
|
MRI Abdomen w/ Contrast
|
Facility
|
OP
|
$2,233.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
1005393
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$334.95 |
| Max. Negotiated Rate |
$2,009.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,009.70
|
| Rate for Payer: Aetna of AZ Medicare |
$625.24
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$334.95
|
| Rate for Payer: Amerigroup Medicare |
$334.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$834.03
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$334.95
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$334.95
|
| Rate for Payer: Bisbee Police All Plans |
$580.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,518.44
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,563.10
|
| Rate for Payer: Copperpoint Commercial |
$552.67
|
| Rate for Payer: Health Net of AZ Commercial |
$1,339.80
|
| Rate for Payer: Health Net of AZ Medicare |
$625.24
|
| Rate for Payer: Humana of AZ Medicare |
$334.95
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$1,786.40
|
| Rate for Payer: TriWest Medicare |
$334.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,301.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$401.94
|
|
|
MRI Abdomen w/ Contrast
|
Facility
|
IP
|
$2,233.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
1005393
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$580.58 |
| Max. Negotiated Rate |
$2,009.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,009.70
|
| Rate for Payer: Bisbee Police All Plans |
$580.58
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Self Pay Self Pay |
$1,786.40
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
IP
|
$3,069.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
1005395
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$797.94 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,762.10
|
| Rate for Payer: Bisbee Police All Plans |
$797.94
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Self Pay Self Pay |
$2,455.20
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
OP
|
$3,069.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
1005395
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$333.68 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,762.10
|
| Rate for Payer: Aetna of AZ Medicare |
$859.32
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$460.35
|
| Rate for Payer: Amerigroup Medicare |
$460.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,146.27
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$460.35
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$460.35
|
| Rate for Payer: Bisbee Police All Plans |
$797.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,086.92
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna of AZ Commercial |
$2,148.30
|
| Rate for Payer: Copperpoint Commercial |
$759.58
|
| Rate for Payer: Health Net of AZ Commercial |
$1,841.40
|
| Rate for Payer: Health Net of AZ Medicare |
$859.32
|
| Rate for Payer: Humana of AZ Medicare |
$460.35
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$2,455.20
|
| Rate for Payer: TriWest Medicare |
$460.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,789.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$552.42
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$5,124.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
1005391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$533.78 |
| Max. Negotiated Rate |
$4,611.60 |
| Rate for Payer: Aetna of AZ Commercial |
$4,611.60
|
| Rate for Payer: Aetna of AZ Medicare |
$1,434.72
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$768.60
|
| Rate for Payer: Amerigroup Medicare |
$768.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,913.81
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$768.60
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$768.60
|
| Rate for Payer: Bisbee Police All Plans |
$1,332.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,484.32
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Cigna of AZ Commercial |
$3,586.80
|
| Rate for Payer: Copperpoint Commercial |
$1,268.19
|
| Rate for Payer: Health Net of AZ Commercial |
$3,074.40
|
| Rate for Payer: Health Net of AZ Medicare |
$1,434.72
|
| Rate for Payer: Humana of AZ Medicare |
$768.60
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$4,099.20
|
| Rate for Payer: TriWest Medicare |
$768.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,987.29
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$922.32
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$5,124.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
1005391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,332.24 |
| Max. Negotiated Rate |
$4,611.60 |
| Rate for Payer: Aetna of AZ Commercial |
$4,611.60
|
| Rate for Payer: Bisbee Police All Plans |
$1,332.24
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Self Pay Self Pay |
$4,099.20
|
|
|
MRI Brain w/ Contrast
|
Facility
|
IP
|
$2,233.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
821400
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$580.58 |
| Max. Negotiated Rate |
$2,009.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,009.70
|
| Rate for Payer: Bisbee Police All Plans |
$580.58
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Self Pay Self Pay |
$1,786.40
|
|
|
MRI Brain w/ Contrast
|
Facility
|
OP
|
$2,233.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
821400
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$334.95 |
| Max. Negotiated Rate |
$2,009.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,009.70
|
| Rate for Payer: Aetna of AZ Medicare |
$625.24
|
| Rate for Payer: AHCCCS Medicaid |
$483.64
|
| Rate for Payer: Allwell Medicaid |
$483.64
|
| Rate for Payer: Allwell Medicare |
$334.95
|
| Rate for Payer: Amerigroup Medicare |
$334.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$834.03
|
| Rate for Payer: AZCH Complete Medicaid |
$483.64
|
| Rate for Payer: AZCH Complete Medicare |
$334.95
|
| Rate for Payer: Banner UC Health Medicaid |
$483.64
|
| Rate for Payer: Banner UC Health Medicare |
$334.95
|
| Rate for Payer: Bisbee Police All Plans |
$580.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,518.44
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,563.10
|
| Rate for Payer: Copperpoint Commercial |
$552.67
|
| Rate for Payer: Health Net of AZ Commercial |
$1,339.80
|
| Rate for Payer: Health Net of AZ Medicare |
$625.24
|
| Rate for Payer: Humana of AZ Medicare |
$334.95
|
| Rate for Payer: Mercy Care Medicaid |
$483.64
|
| Rate for Payer: Self Pay Self Pay |
$1,786.40
|
| Rate for Payer: TriWest Medicare |
$334.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,301.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$401.94
|
|
|
MRI Brain w/o Contrast
|
Facility
|
OP
|
$3,186.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
821402
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$333.68 |
| Max. Negotiated Rate |
$2,867.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,867.40
|
| Rate for Payer: Aetna of AZ Medicare |
$892.08
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$477.90
|
| Rate for Payer: Amerigroup Medicare |
$477.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,189.97
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$477.90
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$477.90
|
| Rate for Payer: Bisbee Police All Plans |
$828.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,166.48
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,230.20
|
| Rate for Payer: Copperpoint Commercial |
$788.54
|
| Rate for Payer: Health Net of AZ Commercial |
$1,911.60
|
| Rate for Payer: Health Net of AZ Medicare |
$892.08
|
| Rate for Payer: Humana of AZ Medicare |
$477.90
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$2,548.80
|
| Rate for Payer: TriWest Medicare |
$477.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,857.44
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$573.48
|
|
|
MRI Brain w/o Contrast
|
Facility
|
IP
|
$3,186.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
821402
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$828.36 |
| Max. Negotiated Rate |
$2,867.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,867.40
|
| Rate for Payer: Bisbee Police All Plans |
$828.36
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Self Pay Self Pay |
$2,548.80
|
|
|
MRI Brain w/ + w/o Contrast
|
Facility
|
OP
|
$5,035.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
821398
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$533.78 |
| Max. Negotiated Rate |
$4,531.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4,531.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1,409.80
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$755.25
|
| Rate for Payer: Amerigroup Medicare |
$755.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,880.57
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$755.25
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$755.25
|
| Rate for Payer: Bisbee Police All Plans |
$1,309.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,423.80
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3,524.50
|
| Rate for Payer: Copperpoint Commercial |
$1,246.16
|
| Rate for Payer: Health Net of AZ Commercial |
$3,021.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,409.80
|
| Rate for Payer: Humana of AZ Medicare |
$755.25
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$4,028.00
|
| Rate for Payer: TriWest Medicare |
$755.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,935.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$906.30
|
|
|
MRI Brain w/ + w/o Contrast
|
Facility
|
IP
|
$5,035.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
821398
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,309.10 |
| Max. Negotiated Rate |
$4,531.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4,531.50
|
| Rate for Payer: Bisbee Police All Plans |
$1,309.10
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Self Pay Self Pay |
$4,028.00
|
|
|
MRI Chest w/o Contrast
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
1005415
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$283.65 |
| Max. Negotiated Rate |
$1,701.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,701.90
|
| Rate for Payer: Aetna of AZ Medicare |
$529.48
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$283.65
|
| Rate for Payer: Amerigroup Medicare |
$283.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$706.29
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$283.65
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$283.65
|
| Rate for Payer: Bisbee Police All Plans |
$491.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,285.88
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,323.70
|
| Rate for Payer: Copperpoint Commercial |
$468.02
|
| Rate for Payer: Health Net of AZ Commercial |
$1,134.60
|
| Rate for Payer: Health Net of AZ Medicare |
$529.48
|
| Rate for Payer: Humana of AZ Medicare |
$283.65
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$1,512.80
|
| Rate for Payer: TriWest Medicare |
$283.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,102.45
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$340.38
|
|
|
MRI Chest w/o Contrast
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
1005415
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$491.66 |
| Max. Negotiated Rate |
$1,701.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,701.90
|
| Rate for Payer: Bisbee Police All Plans |
$491.66
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Self Pay Self Pay |
$1,512.80
|
|
|
MRI Chest w/ + w/o Contrast
|
Facility
|
OP
|
$2,363.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
821404
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$354.45 |
| Max. Negotiated Rate |
$2,126.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,126.70
|
| Rate for Payer: Aetna of AZ Medicare |
$661.64
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$354.45
|
| Rate for Payer: Amerigroup Medicare |
$354.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$882.58
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$354.45
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$354.45
|
| Rate for Payer: Bisbee Police All Plans |
$614.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,606.84
|
| Rate for Payer: Cash Price |
$1,890.40
|
| Rate for Payer: Cash Price |
$1,890.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,654.10
|
| Rate for Payer: Copperpoint Commercial |
$584.84
|
| Rate for Payer: Health Net of AZ Commercial |
$1,417.80
|
| Rate for Payer: Health Net of AZ Medicare |
$661.64
|
| Rate for Payer: Humana of AZ Medicare |
$354.45
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$1,890.40
|
| Rate for Payer: TriWest Medicare |
$354.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,377.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$425.34
|
|
|
MRI Chest w/ + w/o Contrast
|
Facility
|
IP
|
$2,363.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
821404
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$614.38 |
| Max. Negotiated Rate |
$2,126.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,126.70
|
| Rate for Payer: Bisbee Police All Plans |
$614.38
|
| Rate for Payer: Cash Price |
$1,890.40
|
| Rate for Payer: Self Pay Self Pay |
$1,890.40
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Facility
|
OP
|
$2,233.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
821408
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$334.95 |
| Max. Negotiated Rate |
$2,009.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,009.70
|
| Rate for Payer: Aetna of AZ Medicare |
$625.24
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$334.95
|
| Rate for Payer: Amerigroup Medicare |
$334.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$834.03
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$334.95
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$334.95
|
| Rate for Payer: Bisbee Police All Plans |
$580.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,518.44
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,563.10
|
| Rate for Payer: Copperpoint Commercial |
$552.67
|
| Rate for Payer: Health Net of AZ Commercial |
$1,339.80
|
| Rate for Payer: Health Net of AZ Medicare |
$625.24
|
| Rate for Payer: Humana of AZ Medicare |
$334.95
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$1,786.40
|
| Rate for Payer: TriWest Medicare |
$334.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,301.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$401.94
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Facility
|
IP
|
$2,233.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
821408
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$580.58 |
| Max. Negotiated Rate |
$2,009.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,009.70
|
| Rate for Payer: Bisbee Police All Plans |
$580.58
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Self Pay Self Pay |
$1,786.40
|
|
