|
MRI Sinus w/ + w/o Contrast
|
Facility
|
IP
|
$2,481.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
1779809
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$645.06 |
| Max. Negotiated Rate |
$2,232.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,232.90
|
| Rate for Payer: Bisbee Police All Plans |
$645.06
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Self Pay Self Pay |
$1,984.80
|
|
|
MRI Sinus w/ + w/o Contrast
|
Facility
|
OP
|
$2,481.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
1779809
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$372.15 |
| Max. Negotiated Rate |
$2,232.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,232.90
|
| Rate for Payer: Aetna of AZ Medicare |
$694.68
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$372.15
|
| Rate for Payer: Amerigroup Medicare |
$372.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$926.65
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$372.15
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$372.15
|
| Rate for Payer: Bisbee Police All Plans |
$645.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,687.08
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,736.70
|
| Rate for Payer: Copperpoint Commercial |
$614.05
|
| Rate for Payer: Health Net of AZ Commercial |
$1,488.60
|
| Rate for Payer: Health Net of AZ Medicare |
$694.68
|
| Rate for Payer: Humana of AZ Medicare |
$372.15
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$1,984.80
|
| Rate for Payer: TriWest Medicare |
$372.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,446.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$446.58
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
IP
|
$3,143.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
821441
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$817.18 |
| Max. Negotiated Rate |
$2,828.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,828.70
|
| Rate for Payer: Bisbee Police All Plans |
$817.18
|
| Rate for Payer: Cash Price |
$2,514.40
|
| Rate for Payer: Self Pay Self Pay |
$2,514.40
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
OP
|
$3,143.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
821441
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$333.68 |
| Max. Negotiated Rate |
$2,828.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,828.70
|
| Rate for Payer: Aetna of AZ Medicare |
$880.04
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$471.45
|
| Rate for Payer: Amerigroup Medicare |
$471.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,173.91
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$471.45
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$471.45
|
| Rate for Payer: Bisbee Police All Plans |
$817.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,137.24
|
| Rate for Payer: Cash Price |
$2,514.40
|
| Rate for Payer: Cash Price |
$2,514.40
|
| Rate for Payer: Cigna of AZ Commercial |
$2,200.10
|
| Rate for Payer: Copperpoint Commercial |
$777.89
|
| Rate for Payer: Health Net of AZ Commercial |
$1,885.80
|
| Rate for Payer: Health Net of AZ Medicare |
$880.04
|
| Rate for Payer: Humana of AZ Medicare |
$471.45
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$2,514.40
|
| Rate for Payer: TriWest Medicare |
$471.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,832.37
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$565.74
|
|
|
MRI Spine Cervical w/ + w/o Contrast
|
Facility
|
IP
|
$4,808.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
1005501
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,250.08 |
| Max. Negotiated Rate |
$4,327.20 |
| Rate for Payer: Aetna of AZ Commercial |
$4,327.20
|
| Rate for Payer: Bisbee Police All Plans |
$1,250.08
|
| Rate for Payer: Cash Price |
$3,846.40
|
| Rate for Payer: Self Pay Self Pay |
$3,846.40
|
|
|
MRI Spine Cervical w/ + w/o Contrast
|
Facility
|
OP
|
$4,808.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
1005501
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$533.78 |
| Max. Negotiated Rate |
$4,327.20 |
| Rate for Payer: Aetna of AZ Commercial |
$4,327.20
|
| Rate for Payer: Aetna of AZ Medicare |
$1,346.24
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$721.20
|
| Rate for Payer: Amerigroup Medicare |
$721.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,795.79
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$721.20
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$721.20
|
| Rate for Payer: Bisbee Police All Plans |
$1,250.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,269.44
|
| Rate for Payer: Cash Price |
$3,846.40
|
| Rate for Payer: Cash Price |
$3,846.40
|
| Rate for Payer: Cigna of AZ Commercial |
$3,365.60
|
| Rate for Payer: Copperpoint Commercial |
$1,189.98
|
| Rate for Payer: Health Net of AZ Commercial |
$2,884.80
|
| Rate for Payer: Health Net of AZ Medicare |
$1,346.24
|
| Rate for Payer: Humana of AZ Medicare |
$721.20
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$3,846.40
|
| Rate for Payer: TriWest Medicare |
$721.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,803.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$865.44
|
|
|
MRI Spine Lumbar w/ Contrast
|
Facility
|
IP
|
$2,233.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
821443
|
|
Hospital Revenue Code
|
612
|
| 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 Spine Lumbar w/ Contrast
|
Facility
|
OP
|
$2,233.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
821443
|
|
Hospital Revenue Code
|
612
|
| 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 Spine Lumbar w/o Contrast
|
Facility
|
IP
|
$3,146.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
821445
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$817.96 |
| Max. Negotiated Rate |
$2,831.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,831.40
|
| Rate for Payer: Bisbee Police All Plans |
$817.96
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Self Pay Self Pay |
$2,516.80
|
|
|
MRI Spine Lumbar w/o Contrast
|
Facility
|
OP
|
$3,146.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
821445
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$333.68 |
| Max. Negotiated Rate |
$2,831.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,831.40
|
| Rate for Payer: Aetna of AZ Medicare |
$880.88
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$471.90
|
| Rate for Payer: Amerigroup Medicare |
$471.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,175.03
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$471.90
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$471.90
|
| Rate for Payer: Bisbee Police All Plans |
$817.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,139.28
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,202.20
|
| Rate for Payer: Copperpoint Commercial |
$778.64
|
| Rate for Payer: Health Net of AZ Commercial |
$1,887.60
|
| Rate for Payer: Health Net of AZ Medicare |
$880.88
|
| Rate for Payer: Humana of AZ Medicare |
$471.90
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$2,516.80
|
| Rate for Payer: TriWest Medicare |
$471.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,834.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$566.28
|
|
|
MRI Spine Lumbar w/ + w/o Contrast
|
Facility
|
IP
|
$4,799.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
1005503
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,247.74 |
| Max. Negotiated Rate |
$4,319.10 |
| Rate for Payer: Aetna of AZ Commercial |
$4,319.10
|
| Rate for Payer: Bisbee Police All Plans |
$1,247.74
|
| Rate for Payer: Cash Price |
$3,839.20
|
| Rate for Payer: Self Pay Self Pay |
$3,839.20
|
|
|
MRI Spine Lumbar w/ + w/o Contrast
|
Facility
|
OP
|
$4,799.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
1005503
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$533.78 |
| Max. Negotiated Rate |
$4,319.10 |
| Rate for Payer: Aetna of AZ Commercial |
$4,319.10
|
| Rate for Payer: Aetna of AZ Medicare |
$1,343.72
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$719.85
|
| Rate for Payer: Amerigroup Medicare |
$719.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,792.43
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$719.85
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$719.85
|
| Rate for Payer: Bisbee Police All Plans |
$1,247.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,263.32
|
| Rate for Payer: Cash Price |
$3,839.20
|
| Rate for Payer: Cash Price |
$3,839.20
|
| Rate for Payer: Cigna of AZ Commercial |
$3,359.30
|
| Rate for Payer: Copperpoint Commercial |
$1,187.75
|
| Rate for Payer: Health Net of AZ Commercial |
$2,879.40
|
| Rate for Payer: Health Net of AZ Medicare |
$1,343.72
|
| Rate for Payer: Humana of AZ Medicare |
$719.85
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$3,839.20
|
| Rate for Payer: TriWest Medicare |
$719.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,797.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$863.82
|
|
|
MRI Spine Thoracic w/ Contrast
|
Facility
|
OP
|
$2,481.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
821447
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$372.15 |
| Max. Negotiated Rate |
$2,232.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,232.90
|
| Rate for Payer: Aetna of AZ Medicare |
$694.68
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$372.15
|
| Rate for Payer: Amerigroup Medicare |
$372.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$926.65
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$372.15
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$372.15
|
| Rate for Payer: Bisbee Police All Plans |
$645.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,687.08
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,736.70
|
| Rate for Payer: Copperpoint Commercial |
$614.05
|
| Rate for Payer: Health Net of AZ Commercial |
$1,488.60
|
| Rate for Payer: Health Net of AZ Medicare |
$694.68
|
| Rate for Payer: Humana of AZ Medicare |
$372.15
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$1,984.80
|
| Rate for Payer: TriWest Medicare |
$372.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,446.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$446.58
|
|
|
MRI Spine Thoracic w/ Contrast
|
Facility
|
IP
|
$2,481.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
821447
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$645.06 |
| Max. Negotiated Rate |
$2,232.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,232.90
|
| Rate for Payer: Bisbee Police All Plans |
$645.06
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Self Pay Self Pay |
$1,984.80
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
IP
|
$3,140.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
821449
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$816.40 |
| Max. Negotiated Rate |
$2,826.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,826.00
|
| Rate for Payer: Bisbee Police All Plans |
$816.40
|
| Rate for Payer: Cash Price |
$2,512.00
|
| Rate for Payer: Self Pay Self Pay |
$2,512.00
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
OP
|
$3,140.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
821449
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$333.68 |
| Max. Negotiated Rate |
$2,826.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,826.00
|
| Rate for Payer: Aetna of AZ Medicare |
$879.20
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$471.00
|
| Rate for Payer: Amerigroup Medicare |
$471.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,172.79
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$471.00
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$471.00
|
| Rate for Payer: Bisbee Police All Plans |
$816.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,135.20
|
| Rate for Payer: Cash Price |
$2,512.00
|
| Rate for Payer: Cash Price |
$2,512.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,198.00
|
| Rate for Payer: Copperpoint Commercial |
$777.15
|
| Rate for Payer: Health Net of AZ Commercial |
$1,884.00
|
| Rate for Payer: Health Net of AZ Medicare |
$879.20
|
| Rate for Payer: Humana of AZ Medicare |
$471.00
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$2,512.00
|
| Rate for Payer: TriWest Medicare |
$471.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,830.62
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$565.20
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
1005505
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$533.78 |
| Max. Negotiated Rate |
$4,329.90 |
| Rate for Payer: Aetna of AZ Commercial |
$4,329.90
|
| Rate for Payer: Aetna of AZ Medicare |
$1,347.08
|
| Rate for Payer: AHCCCS Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicaid |
$533.78
|
| Rate for Payer: Allwell Medicare |
$721.65
|
| Rate for Payer: Amerigroup Medicare |
$721.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,796.91
|
| Rate for Payer: AZCH Complete Medicaid |
$533.78
|
| Rate for Payer: AZCH Complete Medicare |
$721.65
|
| Rate for Payer: Banner UC Health Medicaid |
$533.78
|
| Rate for Payer: Banner UC Health Medicare |
$721.65
|
| Rate for Payer: Bisbee Police All Plans |
$1,250.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,271.48
|
| Rate for Payer: Cash Price |
$3,848.80
|
| Rate for Payer: Cash Price |
$3,848.80
|
| Rate for Payer: Cigna of AZ Commercial |
$3,367.70
|
| Rate for Payer: Copperpoint Commercial |
$1,190.72
|
| Rate for Payer: Health Net of AZ Commercial |
$2,886.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,347.08
|
| Rate for Payer: Humana of AZ Medicare |
$721.65
|
| Rate for Payer: Mercy Care Medicaid |
$533.78
|
| Rate for Payer: Self Pay Self Pay |
$3,848.80
|
| Rate for Payer: TriWest Medicare |
$721.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,804.81
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$865.98
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
1005505
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,250.86 |
| Max. Negotiated Rate |
$4,329.90 |
| Rate for Payer: Aetna of AZ Commercial |
$4,329.90
|
| Rate for Payer: Bisbee Police All Plans |
$1,250.86
|
| Rate for Payer: Cash Price |
$3,848.80
|
| Rate for Payer: Self Pay Self Pay |
$3,848.80
|
|
|
MRI TMJ
|
Facility
|
OP
|
$1,985.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
1005507
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$297.75 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,786.50
|
| Rate for Payer: Aetna of AZ Medicare |
$555.80
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$297.75
|
| Rate for Payer: Amerigroup Medicare |
$297.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$741.40
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$297.75
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$297.75
|
| Rate for Payer: Bisbee Police All Plans |
$516.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,349.80
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,389.50
|
| Rate for Payer: Copperpoint Commercial |
$491.29
|
| Rate for Payer: Health Net of AZ Commercial |
$1,191.00
|
| Rate for Payer: Health Net of AZ Medicare |
$555.80
|
| Rate for Payer: Humana of AZ Medicare |
$297.75
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$1,588.00
|
| Rate for Payer: TriWest Medicare |
$297.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,157.26
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$357.30
|
|
|
MRI TMJ
|
Facility
|
IP
|
$1,985.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
1005507
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$516.10 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,786.50
|
| Rate for Payer: Bisbee Police All Plans |
$516.10
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Self Pay Self Pay |
$1,588.00
|
|
|
MRI UE Joint w/ Contrast Bilateral
|
Facility
|
OP
|
$2,481.00
|
|
|
Service Code
|
CPT 73222 50
|
| Hospital Charge Code |
1007513
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$372.15 |
| Max. Negotiated Rate |
$2,232.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,232.90
|
| Rate for Payer: Aetna of AZ Medicare |
$694.68
|
| Rate for Payer: Allwell Medicare |
$372.15
|
| Rate for Payer: Amerigroup Medicare |
$372.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$926.65
|
| Rate for Payer: AZCH Complete Medicare |
$372.15
|
| Rate for Payer: Banner UC Health Medicare |
$372.15
|
| Rate for Payer: Bisbee Police All Plans |
$645.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,687.08
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,736.70
|
| Rate for Payer: Copperpoint Commercial |
$614.05
|
| Rate for Payer: Health Net of AZ Commercial |
$1,488.60
|
| Rate for Payer: Health Net of AZ Medicare |
$694.68
|
| Rate for Payer: Humana of AZ Medicare |
$372.15
|
| Rate for Payer: Self Pay Self Pay |
$1,984.80
|
| Rate for Payer: TriWest Medicare |
$372.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,446.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$446.58
|
|
|
MRI UE Joint w/ Contrast Bilateral
|
Facility
|
IP
|
$2,481.00
|
|
|
Service Code
|
CPT 73222 50
|
| Hospital Charge Code |
1007513
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$645.06 |
| Max. Negotiated Rate |
$2,232.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,232.90
|
| Rate for Payer: Bisbee Police All Plans |
$645.06
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Self Pay Self Pay |
$1,984.80
|
|
|
MRI UE Joint w/ Contrast Left
|
Facility
|
OP
|
$2,233.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
1007515
|
|
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: Allwell Medicare |
$334.95
|
| Rate for Payer: Amerigroup Medicare |
$334.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$834.03
|
| Rate for Payer: AZCH Complete Medicare |
$334.95
|
| 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: 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: 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 UE Joint w/ Contrast Left
|
Facility
|
IP
|
$2,233.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
1007515
|
|
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 UE Joint w/ Contrast Right
|
Facility
|
IP
|
$2,233.00
|
|
|
Service Code
|
CPT 73222 RT
|
| Hospital Charge Code |
1007517
|
|
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
|
|
