|
XR Spine Cervical 4 or 5 Views
|
Facility
IP
|
$1,110.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
4694460
|
|
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: Blue Cross Blue Shield AZ PPO |
$697.40
|
| 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 Spine Cervical Comp w/ Flex/Ext
|
Facility
OP
|
$845.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
1008084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$760.50
|
| Rate for Payer: Aetna Medicare |
$236.60
|
| 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 |
$143.65
|
| Rate for Payer: Amerigroup Medicare |
$143.65
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$315.61
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$143.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$143.65
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$219.70
|
| Rate for Payer: Cigna All Products |
$549.25
|
| Rate for Payer: Copperpoint |
$237.02
|
| Rate for Payer: HealthNet Commercial |
$507.00
|
| Rate for Payer: HealthNet Medicare |
$236.60
|
| Rate for Payer: Humana Medicare |
$143.65
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$676.00
|
| Rate for Payer: Veterans (Triwest) |
$143.65
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$492.63
|
| Rate for Payer: United Healthcare Medicare |
$152.10
|
|
|
XR Spine Cervical Comp w/ Flex/Ext
|
Facility
IP
|
$845.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
1008084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$760.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$143.65
|
| Rate for Payer: Amerigroup Medicare |
$143.65
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$143.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$143.65
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$219.70
|
| Rate for Payer: Copperpoint |
$237.02
|
| Rate for Payer: Humana Medicare |
$143.65
|
| Rate for Payer: SELF PAY |
$676.00
|
| Rate for Payer: Veterans (Triwest) |
$143.65
|
|
|
XR Spine Entire 1 View
|
Facility
IP
|
$708.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
22200642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$637.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$637.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$120.36
|
| Rate for Payer: Amerigroup Medicare |
$120.36
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$120.36
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$120.36
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$184.08
|
| Rate for Payer: Copperpoint |
$198.59
|
| Rate for Payer: Humana Medicare |
$120.36
|
| Rate for Payer: SELF PAY |
$566.40
|
| Rate for Payer: Veterans (Triwest) |
$120.36
|
|
|
XR Spine Entire 1 View
|
Facility
OP
|
$708.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
22200642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$637.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$637.20
|
| Rate for Payer: Aetna Medicare |
$198.24
|
| 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 |
$120.36
|
| Rate for Payer: Amerigroup Medicare |
$120.36
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$264.44
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$120.36
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$120.36
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$184.08
|
| Rate for Payer: Cigna All Products |
$460.20
|
| Rate for Payer: Copperpoint |
$198.59
|
| Rate for Payer: HealthNet Commercial |
$424.80
|
| Rate for Payer: HealthNet Medicare |
$198.24
|
| Rate for Payer: Humana Medicare |
$120.36
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$566.40
|
| Rate for Payer: Veterans (Triwest) |
$120.36
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$412.76
|
| Rate for Payer: United Healthcare Medicare |
$127.44
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
IP
|
$926.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
823641
|
|
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 Spine Lumbosacral 2 or 3 Views
|
Facility
OP
|
$926.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
823641
|
|
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: Aetna Medicare |
$259.28
|
| 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 |
$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 |
$158.00
|
| 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 |
$158.00
|
| 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 |
$158.00
|
| 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 Spine Lumbosacral Bending Only
|
Facility
IP
|
$926.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
1163883
|
|
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: 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 Spine Lumbosacral Bending Only
|
Facility
OP
|
$926.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
1163883
|
|
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: Aetna Medicare |
$259.28
|
| 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 |
$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 |
$158.00
|
| 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 |
$158.00
|
| 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 |
$158.00
|
| 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 Spine Lumbosacral Complete w/ Bending
|
Facility
IP
|
$845.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
1008092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$760.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$143.65
|
| Rate for Payer: Amerigroup Medicare |
$143.65
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$143.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$143.65
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$552.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$219.70
|
| Rate for Payer: Copperpoint |
$237.02
|
| Rate for Payer: Humana Medicare |
$143.65
|
| Rate for Payer: SELF PAY |
$676.00
|
| Rate for Payer: Veterans (Triwest) |
$143.65
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Facility
OP
|
$845.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
1008092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$760.50
|
| Rate for Payer: Aetna Medicare |
$236.60
|
| 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 |
$143.65
|
| Rate for Payer: Amerigroup Medicare |
$143.65
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$315.61
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$143.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$143.65
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$552.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$219.70
|
| Rate for Payer: Cigna All Products |
$549.25
|
| Rate for Payer: Copperpoint |
$237.02
|
| Rate for Payer: HealthNet Commercial |
$507.00
|
| Rate for Payer: HealthNet Medicare |
$236.60
|
| Rate for Payer: Humana Medicare |
$143.65
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$676.00
|
| Rate for Payer: Veterans (Triwest) |
$143.65
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$492.63
|
| Rate for Payer: United Healthcare Medicare |
$152.10
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
OP
|
$845.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
823643
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$760.50
|
| Rate for Payer: Aetna Medicare |
$236.60
|
| 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 |
$143.65
|
| Rate for Payer: Amerigroup Medicare |
$143.65
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$315.61
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$143.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$143.65
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$542.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$219.70
|
| Rate for Payer: Cigna All Products |
$549.25
|
| Rate for Payer: Copperpoint |
$237.02
|
| Rate for Payer: HealthNet Commercial |
$507.00
|
| Rate for Payer: HealthNet Medicare |
$236.60
|
| Rate for Payer: Humana Medicare |
$143.65
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$676.00
|
| Rate for Payer: Veterans (Triwest) |
$143.65
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$492.63
|
| Rate for Payer: United Healthcare Medicare |
$152.10
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
IP
|
$845.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
823643
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$760.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$143.65
|
| Rate for Payer: Amerigroup Medicare |
$143.65
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$143.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$143.65
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$542.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$219.70
|
| Rate for Payer: Copperpoint |
$237.02
|
| Rate for Payer: Humana Medicare |
$143.65
|
| Rate for Payer: SELF PAY |
$676.00
|
| Rate for Payer: Veterans (Triwest) |
$143.65
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
OP
|
$741.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
823645
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.97 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$666.90
|
| Rate for Payer: Aetna Medicare |
$207.48
|
| 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 |
$125.97
|
| Rate for Payer: Amerigroup Medicare |
$125.97
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$276.76
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$158.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$125.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$125.97
|
| Rate for Payer: Banner University Family Care Medicaid |
$158.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$192.66
|
| Rate for Payer: Cigna All Products |
$481.65
|
| Rate for Payer: Copperpoint |
$207.85
|
| Rate for Payer: HealthNet Commercial |
$444.60
|
| Rate for Payer: HealthNet Medicare |
$207.48
|
| Rate for Payer: Humana Medicare |
$125.97
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: SELF PAY |
$592.80
|
| Rate for Payer: Veterans (Triwest) |
$125.97
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$432.00
|
| Rate for Payer: United Healthcare Medicare |
$133.38
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
IP
|
$741.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
823645
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.97 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$666.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$125.97
|
| Rate for Payer: Amerigroup Medicare |
$125.97
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$125.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$125.97
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$192.66
|
| Rate for Payer: Copperpoint |
$207.85
|
| Rate for Payer: Humana Medicare |
$125.97
|
| Rate for Payer: SELF PAY |
$592.80
|
| Rate for Payer: Veterans (Triwest) |
$125.97
|
|
|
XR Spine Thoracic 3 Views
|
Facility
OP
|
$465.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
823649
|
|
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: Blue Cross Blue Shield AZ PPO |
$303.96
|
| 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 Spine Thoracic 3 Views
|
Facility
IP
|
$465.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
823649
|
|
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: Blue Cross Blue Shield AZ PPO |
$303.96
|
| 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 Spine Thoracolumbar 2 Views
|
Facility
OP
|
$465.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
1008101
|
|
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 |
$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 |
$79.05
|
| 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 |
$117.30
|
| 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 |
$117.30
|
| 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 |
$117.30
|
| 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 Spine Thoracolumbar 2 Views
|
Facility
IP
|
$465.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
1008101
|
|
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 Sternoclavicular Joint(s)
|
Facility
IP
|
$426.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
823651
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$383.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$383.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$72.42
|
| Rate for Payer: Amerigroup Medicare |
$72.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$72.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$72.42
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$110.76
|
| Rate for Payer: Copperpoint |
$119.49
|
| Rate for Payer: Humana Medicare |
$72.42
|
| Rate for Payer: SELF PAY |
$340.80
|
| Rate for Payer: Veterans (Triwest) |
$72.42
|
|
|
XR Sternoclavicular Joint(s)
|
Facility
OP
|
$426.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
823651
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$383.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$383.40
|
| Rate for Payer: Aetna Medicare |
$119.28
|
| 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 |
$72.42
|
| Rate for Payer: Amerigroup Medicare |
$72.42
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$159.11
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$72.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$72.42
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$110.76
|
| Rate for Payer: Cigna All Products |
$276.90
|
| Rate for Payer: Copperpoint |
$119.49
|
| Rate for Payer: HealthNet Commercial |
$255.60
|
| Rate for Payer: HealthNet Medicare |
$119.28
|
| Rate for Payer: Humana Medicare |
$72.42
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$340.80
|
| Rate for Payer: Veterans (Triwest) |
$72.42
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$248.36
|
| Rate for Payer: United Healthcare Medicare |
$76.68
|
|
|
XR Sternum Minimum 2 Views
|
Facility
IP
|
$648.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
823653
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$583.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$110.16
|
| Rate for Payer: Amerigroup Medicare |
$110.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$110.16
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$110.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$168.48
|
| Rate for Payer: Copperpoint |
$181.76
|
| Rate for Payer: Humana Medicare |
$110.16
|
| Rate for Payer: SELF PAY |
$518.40
|
| Rate for Payer: Veterans (Triwest) |
$110.16
|
|
|
XR Sternum Minimum 2 Views
|
Facility
OP
|
$648.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
823653
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$583.20
|
| Rate for Payer: Aetna Medicare |
$181.44
|
| 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 |
$110.16
|
| Rate for Payer: Amerigroup Medicare |
$110.16
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$242.03
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$110.16
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$110.16
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$168.48
|
| Rate for Payer: Cigna All Products |
$421.20
|
| Rate for Payer: Copperpoint |
$181.76
|
| Rate for Payer: HealthNet Commercial |
$388.80
|
| Rate for Payer: HealthNet Medicare |
$181.44
|
| Rate for Payer: Humana Medicare |
$110.16
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$518.40
|
| Rate for Payer: Veterans (Triwest) |
$110.16
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$377.78
|
| Rate for Payer: United Healthcare Medicare |
$116.64
|
|
|
XR Temporomandibular Joints
|
Facility
IP
|
$741.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
1008107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.97 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$666.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$125.97
|
| Rate for Payer: Amerigroup Medicare |
$125.97
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$125.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$125.97
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$192.66
|
| Rate for Payer: Copperpoint |
$207.85
|
| Rate for Payer: Humana Medicare |
$125.97
|
| Rate for Payer: SELF PAY |
$592.80
|
| Rate for Payer: Veterans (Triwest) |
$125.97
|
|
|
XR Temporomandibular Joints
|
Facility
OP
|
$741.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
1008107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$666.90
|
| Rate for Payer: Aetna Medicare |
$207.48
|
| 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 |
$125.97
|
| Rate for Payer: Amerigroup Medicare |
$125.97
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$276.76
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$117.30
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$125.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$125.97
|
| Rate for Payer: Banner University Family Care Medicaid |
$117.30
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$192.66
|
| Rate for Payer: Cigna All Products |
$481.65
|
| Rate for Payer: Copperpoint |
$207.85
|
| Rate for Payer: HealthNet Commercial |
$444.60
|
| Rate for Payer: HealthNet Medicare |
$207.48
|
| Rate for Payer: Humana Medicare |
$125.97
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: SELF PAY |
$592.80
|
| Rate for Payer: Veterans (Triwest) |
$125.97
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$432.00
|
| Rate for Payer: United Healthcare Medicare |
$133.38
|
|