|
XR Scapula Left
|
Facility
IP
|
$465.00
|
|
|
Service Code
|
CPT 73010 LT
|
| Hospital Charge Code |
823619
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$418.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.05
|
| Rate for Payer: Amerigroup Medicare |
$79.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$120.90
|
| Rate for Payer: Copperpoint |
$130.43
|
| Rate for Payer: Humana Medicare |
$79.05
|
| Rate for Payer: SELF PAY |
$372.00
|
| Rate for Payer: Veterans (Triwest) |
$79.05
|
|
|
XR Scapula Left
|
Facility
OP
|
$465.00
|
|
|
Service Code
|
CPT 73010 LT
|
| Hospital Charge Code |
823619
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$418.50
|
| Rate for Payer: Aetna Medicare |
$130.20
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.05
|
| Rate for Payer: Amerigroup Medicare |
$79.05
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$173.68
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.05
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$120.90
|
| Rate for Payer: Cigna All Products |
$302.25
|
| Rate for Payer: Copperpoint |
$130.43
|
| Rate for Payer: HealthNet Commercial |
$279.00
|
| Rate for Payer: HealthNet Medicare |
$130.20
|
| Rate for Payer: Humana Medicare |
$79.05
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$372.00
|
| Rate for Payer: Veterans (Triwest) |
$79.05
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$271.09
|
| Rate for Payer: United Healthcare Medicare |
$83.70
|
|
|
XR Scapula Right
|
Facility
IP
|
$465.00
|
|
|
Service Code
|
CPT 73010 RT
|
| Hospital Charge Code |
823621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Humana Medicare |
$79.05
|
| Rate for Payer: SELF PAY |
$372.00
|
| Rate for Payer: Veterans (Triwest) |
$79.05
|
| Rate for Payer: Aetna POS, PPO, HMO |
$418.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.05
|
| Rate for Payer: Amerigroup Medicare |
$79.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$120.90
|
| Rate for Payer: Copperpoint |
$130.43
|
|
|
XR Scapula Right
|
Facility
OP
|
$465.00
|
|
|
Service Code
|
CPT 73010 RT
|
| Hospital Charge Code |
823621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna Medicare |
$130.20
|
| Rate for Payer: Aetna POS, PPO, HMO |
$418.50
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.05
|
| Rate for Payer: Amerigroup Medicare |
$79.05
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$173.68
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.05
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$120.90
|
| Rate for Payer: Cigna All Products |
$302.25
|
| Rate for Payer: Copperpoint |
$130.43
|
| Rate for Payer: HealthNet Commercial |
$279.00
|
| Rate for Payer: HealthNet Medicare |
$130.20
|
| Rate for Payer: Humana Medicare |
$79.05
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$372.00
|
| Rate for Payer: Veterans (Triwest) |
$79.05
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$271.09
|
| Rate for Payer: United Healthcare Medicare |
$83.70
|
|
|
XR Sella Turcica
|
Facility
OP
|
$335.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
1008063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$301.50
|
| Rate for Payer: Aetna Medicare |
$93.80
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$56.95
|
| Rate for Payer: Amerigroup Medicare |
$56.95
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$125.12
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$56.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$56.95
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$87.10
|
| Rate for Payer: Cigna All Products |
$217.75
|
| Rate for Payer: Copperpoint |
$93.97
|
| Rate for Payer: HealthNet Commercial |
$201.00
|
| Rate for Payer: HealthNet Medicare |
$93.80
|
| Rate for Payer: Humana Medicare |
$56.95
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$268.00
|
| Rate for Payer: Veterans (Triwest) |
$56.95
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$195.30
|
| Rate for Payer: United Healthcare Medicare |
$60.30
|
|
|
XR Sella Turcica
|
Facility
IP
|
$335.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
1008063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$301.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$56.95
|
| Rate for Payer: Amerigroup Medicare |
$56.95
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$56.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$56.95
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$87.10
|
| Rate for Payer: Copperpoint |
$93.97
|
| Rate for Payer: Humana Medicare |
$56.95
|
| Rate for Payer: SELF PAY |
$268.00
|
| Rate for Payer: Veterans (Triwest) |
$56.95
|
|
|
XR Shoulder 2 Views Left
|
Facility
IP
|
$446.00
|
|
|
Service Code
|
CPT 73020 LT
|
| Hospital Charge Code |
1284694
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$401.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$75.82
|
| Rate for Payer: Amerigroup Medicare |
$75.82
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$75.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$75.82
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$115.96
|
| Rate for Payer: Copperpoint |
$125.10
|
| Rate for Payer: Humana Medicare |
$75.82
|
| Rate for Payer: SELF PAY |
$356.80
|
| Rate for Payer: Veterans (Triwest) |
$75.82
|
|
|
XR Shoulder 2 Views Left
|
Facility
OP
|
$446.00
|
|
|
Service Code
|
CPT 73020 LT
|
| Hospital Charge Code |
1284694
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$401.40
|
| Rate for Payer: Aetna Medicare |
$124.88
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$75.82
|
| Rate for Payer: Amerigroup Medicare |
$75.82
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$166.58
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$75.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$75.82
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$115.96
|
| Rate for Payer: Cigna All Products |
$289.90
|
| Rate for Payer: Copperpoint |
$125.10
|
| Rate for Payer: HealthNet Commercial |
$267.60
|
| Rate for Payer: HealthNet Medicare |
$124.88
|
| Rate for Payer: Humana Medicare |
$75.82
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$356.80
|
| Rate for Payer: Veterans (Triwest) |
$75.82
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$260.02
|
| Rate for Payer: United Healthcare Medicare |
$80.28
|
|
|
XR Shoulder 2 Views Right
|
Facility
OP
|
$446.00
|
|
|
Service Code
|
CPT 73020 RT
|
| Hospital Charge Code |
1284697
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$75.82
|
| Rate for Payer: Aetna POS, PPO, HMO |
$401.40
|
| Rate for Payer: Aetna Medicare |
$124.88
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$75.82
|
| Rate for Payer: Amerigroup Medicare |
$75.82
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$166.58
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$75.82
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$115.96
|
| Rate for Payer: Cigna All Products |
$289.90
|
| Rate for Payer: Copperpoint |
$125.10
|
| Rate for Payer: HealthNet Commercial |
$267.60
|
| Rate for Payer: HealthNet Medicare |
$124.88
|
| Rate for Payer: Humana Medicare |
$75.82
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$356.80
|
| Rate for Payer: Veterans (Triwest) |
$75.82
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$260.02
|
| Rate for Payer: United Healthcare Medicare |
$80.28
|
|
|
XR Shoulder 2 Views Right
|
Facility
IP
|
$446.00
|
|
|
Service Code
|
CPT 73020 RT
|
| Hospital Charge Code |
1284697
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$401.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$75.82
|
| Rate for Payer: Amerigroup Medicare |
$75.82
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$75.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$75.82
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$115.96
|
| Rate for Payer: Copperpoint |
$125.10
|
| Rate for Payer: Humana Medicare |
$75.82
|
| Rate for Payer: SELF PAY |
$356.80
|
| Rate for Payer: Veterans (Triwest) |
$75.82
|
|
|
XR Shoulder Complete Left
|
Facility
OP
|
$556.00
|
|
|
Service Code
|
CPT 73030 LT
|
| Hospital Charge Code |
823627
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$500.40
|
| Rate for Payer: Aetna Medicare |
$155.68
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$94.52
|
| Rate for Payer: Amerigroup Medicare |
$94.52
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$207.67
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$94.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$94.52
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$360.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$144.56
|
| Rate for Payer: Cigna All Products |
$361.40
|
| Rate for Payer: Copperpoint |
$155.96
|
| Rate for Payer: HealthNet Commercial |
$333.60
|
| Rate for Payer: HealthNet Medicare |
$155.68
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$444.80
|
| Rate for Payer: Veterans (Triwest) |
$94.52
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$324.15
|
| Rate for Payer: United Healthcare Medicare |
$100.08
|
|
|
XR Shoulder Complete Left
|
Facility
IP
|
$556.00
|
|
|
Service Code
|
CPT 73030 LT
|
| Hospital Charge Code |
823627
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$500.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$94.52
|
| Rate for Payer: Amerigroup Medicare |
$94.52
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$94.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$94.52
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$360.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$144.56
|
| Rate for Payer: Copperpoint |
$155.96
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: SELF PAY |
$444.80
|
| Rate for Payer: Veterans (Triwest) |
$94.52
|
|
|
XR Shoulder Complete Right
|
Facility
IP
|
$556.00
|
|
|
Service Code
|
CPT 73030 RT
|
| Hospital Charge Code |
823629
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$500.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$94.52
|
| Rate for Payer: Amerigroup Medicare |
$94.52
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$94.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$94.52
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$360.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$144.56
|
| Rate for Payer: Copperpoint |
$155.96
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: SELF PAY |
$444.80
|
| Rate for Payer: Veterans (Triwest) |
$94.52
|
|
|
XR Shoulder Complete Right
|
Facility
OP
|
$556.00
|
|
|
Service Code
|
CPT 73030 RT
|
| Hospital Charge Code |
823629
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$500.40
|
| Rate for Payer: Aetna Medicare |
$155.68
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$94.52
|
| Rate for Payer: Amerigroup Medicare |
$94.52
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$207.67
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$94.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$94.52
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$360.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$144.56
|
| Rate for Payer: Cigna All Products |
$361.40
|
| Rate for Payer: Copperpoint |
$155.96
|
| Rate for Payer: HealthNet Commercial |
$333.60
|
| Rate for Payer: HealthNet Medicare |
$155.68
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$444.80
|
| Rate for Payer: Veterans (Triwest) |
$94.52
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$324.15
|
| Rate for Payer: United Healthcare Medicare |
$100.08
|
|
|
XR Sinuses Paranasal < 3 Views
|
Facility
OP
|
$466.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
1008070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$419.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$419.40
|
| Rate for Payer: Aetna Medicare |
$130.48
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.22
|
| Rate for Payer: Amerigroup Medicare |
$79.22
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$174.05
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.22
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.22
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$121.16
|
| Rate for Payer: Cigna All Products |
$302.90
|
| Rate for Payer: Copperpoint |
$130.71
|
| Rate for Payer: HealthNet Commercial |
$279.60
|
| Rate for Payer: HealthNet Medicare |
$130.48
|
| Rate for Payer: Humana Medicare |
$79.22
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$372.80
|
| Rate for Payer: Veterans (Triwest) |
$79.22
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$271.68
|
| Rate for Payer: United Healthcare Medicare |
$83.88
|
|
|
XR Sinuses Paranasal < 3 Views
|
Facility
IP
|
$466.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
1008070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$419.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$419.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.22
|
| Rate for Payer: Amerigroup Medicare |
$79.22
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.22
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.22
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$121.16
|
| Rate for Payer: Copperpoint |
$130.71
|
| Rate for Payer: Humana Medicare |
$79.22
|
| Rate for Payer: SELF PAY |
$372.80
|
| Rate for Payer: Veterans (Triwest) |
$79.22
|
|
|
XR Sinuses Paranasal Complete
|
Facility
IP
|
$926.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
823631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.42 |
| Max. Negotiated Rate |
$833.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$833.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$157.42
|
| Rate for Payer: Amerigroup Medicare |
$157.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$157.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$157.42
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$605.20
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$240.76
|
| Rate for Payer: Copperpoint |
$259.74
|
| Rate for Payer: Humana Medicare |
$157.42
|
| Rate for Payer: SELF PAY |
$740.80
|
| Rate for Payer: Veterans (Triwest) |
$157.42
|
|
|
XR Sinuses Paranasal Complete
|
Facility
OP
|
$926.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
823631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$833.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$833.40
|
| Rate for Payer: Aetna Medicare |
$259.28
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$157.42
|
| Rate for Payer: Amerigroup Medicare |
$157.42
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$345.86
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$157.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$157.42
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$605.20
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$240.76
|
| Rate for Payer: Cigna All Products |
$601.90
|
| Rate for Payer: Copperpoint |
$259.74
|
| Rate for Payer: HealthNet Commercial |
$555.60
|
| Rate for Payer: HealthNet Medicare |
$259.28
|
| Rate for Payer: Humana Medicare |
$157.42
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$740.80
|
| Rate for Payer: Veterans (Triwest) |
$157.42
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$539.86
|
| Rate for Payer: United Healthcare Medicare |
$166.68
|
|
|
XR Skull < 4 Views
|
Facility
IP
|
$465.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
823633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$418.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.05
|
| Rate for Payer: Amerigroup Medicare |
$79.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$120.90
|
| Rate for Payer: Copperpoint |
$130.43
|
| Rate for Payer: Humana Medicare |
$79.05
|
| Rate for Payer: SELF PAY |
$372.00
|
| Rate for Payer: Veterans (Triwest) |
$79.05
|
|
|
XR Skull < 4 Views
|
Facility
OP
|
$465.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
823633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$418.50
|
| Rate for Payer: Aetna Medicare |
$130.20
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.05
|
| Rate for Payer: Amerigroup Medicare |
$79.05
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$173.68
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.05
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$120.90
|
| Rate for Payer: Cigna All Products |
$302.25
|
| Rate for Payer: Copperpoint |
$130.43
|
| Rate for Payer: HealthNet Commercial |
$279.00
|
| Rate for Payer: HealthNet Medicare |
$130.20
|
| Rate for Payer: Humana Medicare |
$79.05
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$372.00
|
| Rate for Payer: Veterans (Triwest) |
$79.05
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$271.09
|
| Rate for Payer: United Healthcare Medicare |
$83.70
|
|
|
XR Skull Complete
|
Facility
IP
|
$1,110.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
1008072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.70 |
| Max. Negotiated Rate |
$999.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$999.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$188.70
|
| Rate for Payer: Amerigroup Medicare |
$188.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$188.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$188.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$288.60
|
| Rate for Payer: Copperpoint |
$311.36
|
| Rate for Payer: Humana Medicare |
$188.70
|
| Rate for Payer: SELF PAY |
$888.00
|
| Rate for Payer: Veterans (Triwest) |
$188.70
|
|
|
XR Skull Complete
|
Facility
OP
|
$1,110.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
1008072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$999.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$999.00
|
| Rate for Payer: Aetna Medicare |
$310.80
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$188.70
|
| Rate for Payer: Amerigroup Medicare |
$188.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$414.58
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$188.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$188.70
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$288.60
|
| Rate for Payer: Cigna All Products |
$721.50
|
| Rate for Payer: Copperpoint |
$311.36
|
| Rate for Payer: HealthNet Commercial |
$666.00
|
| Rate for Payer: HealthNet Medicare |
$310.80
|
| Rate for Payer: Humana Medicare |
$188.70
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$888.00
|
| Rate for Payer: Veterans (Triwest) |
$188.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$647.13
|
| Rate for Payer: United Healthcare Medicare |
$199.80
|
|
|
XR Spine Cervical 2 or 3 Views
|
Facility
OP
|
$556.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
823635
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$500.40
|
| Rate for Payer: Aetna Medicare |
$155.68
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$117.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$94.52
|
| Rate for Payer: Amerigroup Medicare |
$94.52
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$207.67
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$94.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$94.52
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$363.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$144.56
|
| Rate for Payer: Cigna All Products |
$361.40
|
| Rate for Payer: Copperpoint |
$155.96
|
| Rate for Payer: HealthNet Commercial |
$333.60
|
| Rate for Payer: HealthNet Medicare |
$155.68
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$444.80
|
| Rate for Payer: Veterans (Triwest) |
$94.52
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$324.15
|
| Rate for Payer: United Healthcare Medicare |
$100.08
|
|
|
XR Spine Cervical 2 or 3 Views
|
Facility
IP
|
$556.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
823635
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$500.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$500.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$94.52
|
| Rate for Payer: Amerigroup Medicare |
$94.52
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$94.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$94.52
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$363.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$144.56
|
| Rate for Payer: Copperpoint |
$155.96
|
| Rate for Payer: Humana Medicare |
$94.52
|
| Rate for Payer: SELF PAY |
$444.80
|
| Rate for Payer: Veterans (Triwest) |
$94.52
|
|
|
XR Spine Cervical 4 or 5 Views
|
Facility
OP
|
$1,110.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
4694460
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$999.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$999.00
|
| Rate for Payer: Aetna Medicare |
$310.80
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$158.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$188.70
|
| Rate for Payer: Amerigroup Medicare |
$188.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$414.58
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$188.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$188.70
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$697.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$288.60
|
| Rate for Payer: Cigna All Products |
$721.50
|
| Rate for Payer: Copperpoint |
$311.36
|
| Rate for Payer: HealthNet Commercial |
$666.00
|
| Rate for Payer: HealthNet Medicare |
$310.80
|
| Rate for Payer: Humana Medicare |
$188.70
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$888.00
|
| Rate for Payer: Veterans (Triwest) |
$188.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$647.13
|
| Rate for Payer: United Healthcare Medicare |
$199.80
|
|