|
Placement of generator stage II
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 64590
|
| Hospital Charge Code |
27281905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$29,695.68 |
| Rate for Payer: Aetna of AZ Commercial |
$784.80
|
| Rate for Payer: Aetna of AZ Medicare |
$244.16
|
| Rate for Payer: AHCCCS Medicaid |
$29,695.68
|
| Rate for Payer: Allwell Medicaid |
$29,695.68
|
| Rate for Payer: Allwell Medicare |
$130.80
|
| Rate for Payer: Amerigroup Medicare |
$130.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$325.69
|
| Rate for Payer: AZCH Complete Medicaid |
$29,695.68
|
| Rate for Payer: AZCH Complete Medicare |
$130.80
|
| Rate for Payer: Banner UC Health Medicaid |
$29,695.68
|
| Rate for Payer: Banner UC Health Medicare |
$130.80
|
| Rate for Payer: Bisbee Police All Plans |
$226.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$592.96
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cigna of AZ Commercial |
$436.00
|
| Rate for Payer: Copperpoint Commercial |
$215.82
|
| Rate for Payer: Health Net of AZ Commercial |
$523.20
|
| Rate for Payer: Health Net of AZ Medicare |
$244.16
|
| Rate for Payer: Humana of AZ Medicare |
$130.80
|
| Rate for Payer: Mercy Care Medicaid |
$29,695.68
|
| Rate for Payer: Self Pay Self Pay |
$697.60
|
| Rate for Payer: TriWest Medicare |
$130.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$8,220.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$156.96
|
|
|
Placement of generator stage II
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
CPT 64590
|
| Hospital Charge Code |
27281905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.72 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Aetna of AZ Commercial |
$784.80
|
| Rate for Payer: Bisbee Police All Plans |
$226.72
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Self Pay Self Pay |
$697.60
|
|
|
Placement of lead Stage I
|
Facility
|
OP
|
$3,581.00
|
|
|
Service Code
|
CPT 64581
|
| Hospital Charge Code |
27291810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.15 |
| Max. Negotiated Rate |
$8,932.98 |
| Rate for Payer: Aetna of AZ Commercial |
$3,222.90
|
| Rate for Payer: Aetna of AZ Medicare |
$1,002.68
|
| Rate for Payer: AHCCCS Medicaid |
$8,932.98
|
| Rate for Payer: Allwell Medicaid |
$8,932.98
|
| Rate for Payer: Allwell Medicare |
$537.15
|
| Rate for Payer: Amerigroup Medicare |
$537.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,337.50
|
| Rate for Payer: AZCH Complete Medicaid |
$8,932.98
|
| Rate for Payer: AZCH Complete Medicare |
$537.15
|
| Rate for Payer: Banner UC Health Medicaid |
$8,932.98
|
| Rate for Payer: Banner UC Health Medicare |
$537.15
|
| Rate for Payer: Bisbee Police All Plans |
$931.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,435.08
|
| Rate for Payer: Cash Price |
$2,864.80
|
| Rate for Payer: Cash Price |
$2,864.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,790.50
|
| Rate for Payer: Copperpoint Commercial |
$886.30
|
| Rate for Payer: Health Net of AZ Commercial |
$2,148.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,002.68
|
| Rate for Payer: Humana of AZ Medicare |
$537.15
|
| Rate for Payer: Mercy Care Medicaid |
$8,932.98
|
| Rate for Payer: Self Pay Self Pay |
$2,864.80
|
| Rate for Payer: TriWest Medicare |
$537.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$6,109.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$644.58
|
|
|
Placement of lead Stage I
|
Facility
|
IP
|
$3,581.00
|
|
|
Service Code
|
CPT 64581
|
| Hospital Charge Code |
27291810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$931.06 |
| Max. Negotiated Rate |
$3,222.90 |
| Rate for Payer: Aetna of AZ Commercial |
$3,222.90
|
| Rate for Payer: Bisbee Police All Plans |
$931.06
|
| Rate for Payer: Cash Price |
$2,864.80
|
| Rate for Payer: Self Pay Self Pay |
$2,864.80
|
|
|
PLANTAR PYTHON 2 PLATE LEFT
|
Facility
|
IP
|
$8,663.00
|
|
| Hospital Charge Code |
24358102
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,252.38 |
| Max. Negotiated Rate |
$7,796.70 |
| Rate for Payer: Aetna of AZ Commercial |
$7,796.70
|
| Rate for Payer: Bisbee Police All Plans |
$2,252.38
|
| Rate for Payer: Cash Price |
$6,930.40
|
| Rate for Payer: Self Pay Self Pay |
$6,930.40
|
|
|
PLANTAR PYTHON 2 PLATE LEFT
|
Facility
|
OP
|
$8,663.00
|
|
| Hospital Charge Code |
24358102
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,299.45 |
| Max. Negotiated Rate |
$7,796.70 |
| Rate for Payer: Aetna of AZ Commercial |
$7,796.70
|
| Rate for Payer: Aetna of AZ Medicare |
$2,425.64
|
| Rate for Payer: Allwell Medicare |
$1,299.45
|
| Rate for Payer: Amerigroup Medicare |
$1,299.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3,235.63
|
| Rate for Payer: AZCH Complete Medicare |
$1,299.45
|
| Rate for Payer: Banner UC Health Medicare |
$1,299.45
|
| Rate for Payer: Bisbee Police All Plans |
$2,252.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5,890.84
|
| Rate for Payer: Cash Price |
$6,930.40
|
| Rate for Payer: Cigna of AZ Commercial |
$6,064.10
|
| Rate for Payer: Copperpoint Commercial |
$2,144.09
|
| Rate for Payer: Health Net of AZ Commercial |
$5,197.80
|
| Rate for Payer: Health Net of AZ Medicare |
$2,425.64
|
| Rate for Payer: Humana of AZ Medicare |
$1,299.45
|
| Rate for Payer: Self Pay Self Pay |
$6,930.40
|
| Rate for Payer: TriWest Medicare |
$1,299.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5,050.53
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,559.34
|
|
|
Plasma CPD Cryo Red
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
1221760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of AZ Commercial |
$453.60
|
| Rate for Payer: Bisbee Police All Plans |
$131.04
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Self Pay Self Pay |
$403.20
|
|
|
Plasma CPD Cryo Red
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
1221760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of AZ Commercial |
$453.60
|
| Rate for Payer: Aetna of AZ Medicare |
$141.12
|
| Rate for Payer: AHCCCS Medicaid |
$95.26
|
| Rate for Payer: Allwell Medicaid |
$95.26
|
| Rate for Payer: Allwell Medicare |
$75.60
|
| Rate for Payer: Amerigroup Medicare |
$75.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$188.24
|
| Rate for Payer: AZCH Complete Medicaid |
$95.26
|
| Rate for Payer: AZCH Complete Medicare |
$75.60
|
| Rate for Payer: Banner UC Health Medicaid |
$95.26
|
| Rate for Payer: Banner UC Health Medicare |
$75.60
|
| Rate for Payer: Bisbee Police All Plans |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$342.72
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna of AZ Commercial |
$327.60
|
| Rate for Payer: Copperpoint Commercial |
$124.74
|
| Rate for Payer: Health Net of AZ Commercial |
$302.40
|
| Rate for Payer: Health Net of AZ Medicare |
$141.12
|
| Rate for Payer: Humana of AZ Medicare |
$75.60
|
| Rate for Payer: Mercy Care Medicaid |
$95.26
|
| Rate for Payer: Self Pay Self Pay |
$403.20
|
| Rate for Payer: TriWest Medicare |
$75.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$293.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$90.72
|
|
|
Plasma CPD Cryo Red Thawed
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
1221768
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of AZ Commercial |
$453.60
|
| Rate for Payer: Bisbee Police All Plans |
$131.04
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Self Pay Self Pay |
$403.20
|
|
|
Plasma CPD Cryo Red Thawed
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
1221768
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of AZ Commercial |
$453.60
|
| Rate for Payer: Aetna of AZ Medicare |
$141.12
|
| Rate for Payer: AHCCCS Medicaid |
$95.26
|
| Rate for Payer: Allwell Medicaid |
$95.26
|
| Rate for Payer: Allwell Medicare |
$75.60
|
| Rate for Payer: Amerigroup Medicare |
$75.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$188.24
|
| Rate for Payer: AZCH Complete Medicaid |
$95.26
|
| Rate for Payer: AZCH Complete Medicare |
$75.60
|
| Rate for Payer: Banner UC Health Medicaid |
$95.26
|
| Rate for Payer: Banner UC Health Medicare |
$75.60
|
| Rate for Payer: Bisbee Police All Plans |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$342.72
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna of AZ Commercial |
$327.60
|
| Rate for Payer: Copperpoint Commercial |
$124.74
|
| Rate for Payer: Health Net of AZ Commercial |
$302.40
|
| Rate for Payer: Health Net of AZ Medicare |
$141.12
|
| Rate for Payer: Humana of AZ Medicare |
$75.60
|
| Rate for Payer: Mercy Care Medicaid |
$95.26
|
| Rate for Payer: Self Pay Self Pay |
$403.20
|
| Rate for Payer: TriWest Medicare |
$75.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$293.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$90.72
|
|
|
Plasma Thawed CPD
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
1757552
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Self Pay Self Pay |
$141.60
|
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Cash Price |
$141.60
|
|
|
Plasma Thawed CPD
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
1757552
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Aetna of AZ Medicare |
$49.56
|
| Rate for Payer: AHCCCS Medicaid |
$119.86
|
| Rate for Payer: Allwell Medicaid |
$119.86
|
| Rate for Payer: Allwell Medicare |
$26.55
|
| Rate for Payer: Amerigroup Medicare |
$26.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$66.11
|
| Rate for Payer: AZCH Complete Medicaid |
$119.86
|
| Rate for Payer: AZCH Complete Medicare |
$26.55
|
| Rate for Payer: Banner UC Health Medicaid |
$119.86
|
| Rate for Payer: Banner UC Health Medicare |
$26.55
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$120.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$115.05
|
| Rate for Payer: Copperpoint Commercial |
$43.81
|
| Rate for Payer: Health Net of AZ Commercial |
$106.20
|
| Rate for Payer: Health Net of AZ Medicare |
$49.56
|
| Rate for Payer: Humana of AZ Medicare |
$26.55
|
| Rate for Payer: Mercy Care Medicaid |
$119.86
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
| Rate for Payer: TriWest Medicare |
$26.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$103.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.86
|
|
|
Plastic repari of introitus
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
CPT 56800
|
| Hospital Charge Code |
27267829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$3,803.66 |
| Rate for Payer: Aetna of AZ Commercial |
$1,170.00
|
| Rate for Payer: Aetna of AZ Medicare |
$364.00
|
| Rate for Payer: AHCCCS Medicaid |
$3,803.66
|
| Rate for Payer: Allwell Medicaid |
$3,803.66
|
| Rate for Payer: Allwell Medicare |
$195.00
|
| Rate for Payer: Amerigroup Medicare |
$195.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$485.55
|
| Rate for Payer: AZCH Complete Medicaid |
$3,803.66
|
| Rate for Payer: AZCH Complete Medicare |
$195.00
|
| Rate for Payer: Banner UC Health Medicaid |
$3,803.66
|
| Rate for Payer: Banner UC Health Medicare |
$195.00
|
| Rate for Payer: Bisbee Police All Plans |
$338.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$884.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cigna of AZ Commercial |
$650.00
|
| Rate for Payer: Copperpoint Commercial |
$321.75
|
| Rate for Payer: Health Net of AZ Commercial |
$780.00
|
| Rate for Payer: Health Net of AZ Medicare |
$364.00
|
| Rate for Payer: Humana of AZ Medicare |
$195.00
|
| Rate for Payer: Mercy Care Medicaid |
$3,803.66
|
| Rate for Payer: Self Pay Self Pay |
$1,040.00
|
| Rate for Payer: TriWest Medicare |
$195.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$234.00
|
|
|
Plastic repari of introitus
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
CPT 56800
|
| Hospital Charge Code |
27267829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,170.00
|
| Rate for Payer: Bisbee Police All Plans |
$338.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Self Pay Self Pay |
$1,040.00
|
|
|
Platelet Antibody Profile LC
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
23018011
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna of AZ Commercial |
$367.20
|
| Rate for Payer: Aetna of AZ Medicare |
$114.24
|
| Rate for Payer: AHCCCS Medicaid |
$18.37
|
| Rate for Payer: Allwell Medicaid |
$18.37
|
| Rate for Payer: Allwell Medicare |
$61.20
|
| Rate for Payer: Amerigroup Medicare |
$61.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$152.39
|
| Rate for Payer: AZCH Complete Medicaid |
$18.37
|
| Rate for Payer: AZCH Complete Medicare |
$61.20
|
| Rate for Payer: Banner UC Health Medicaid |
$18.37
|
| Rate for Payer: Banner UC Health Medicare |
$61.20
|
| Rate for Payer: Bisbee Police All Plans |
$106.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$277.44
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna of AZ Commercial |
$265.20
|
| Rate for Payer: Copperpoint Commercial |
$100.98
|
| Rate for Payer: Health Net of AZ Commercial |
$244.80
|
| Rate for Payer: Health Net of AZ Medicare |
$114.24
|
| Rate for Payer: Humana of AZ Medicare |
$61.20
|
| Rate for Payer: Mercy Care Medicaid |
$18.37
|
| Rate for Payer: Self Pay Self Pay |
$326.40
|
| Rate for Payer: TriWest Medicare |
$61.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$237.86
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$73.44
|
|
|
Platelet Antibody Profile LC
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
23018011
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna of AZ Commercial |
$367.20
|
| Rate for Payer: Bisbee Police All Plans |
$106.08
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Self Pay Self Pay |
$326.40
|
|
|
Platelet Autoantibody Panel LC
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
22311202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna of AZ Commercial |
$367.20
|
| Rate for Payer: Aetna of AZ Medicare |
$114.24
|
| Rate for Payer: AHCCCS Medicaid |
$18.37
|
| Rate for Payer: Allwell Medicaid |
$18.37
|
| Rate for Payer: Allwell Medicare |
$61.20
|
| Rate for Payer: Amerigroup Medicare |
$61.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$152.39
|
| Rate for Payer: AZCH Complete Medicaid |
$18.37
|
| Rate for Payer: AZCH Complete Medicare |
$61.20
|
| Rate for Payer: Banner UC Health Medicaid |
$18.37
|
| Rate for Payer: Banner UC Health Medicare |
$61.20
|
| Rate for Payer: Bisbee Police All Plans |
$106.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$277.44
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna of AZ Commercial |
$265.20
|
| Rate for Payer: Copperpoint Commercial |
$100.98
|
| Rate for Payer: Health Net of AZ Commercial |
$244.80
|
| Rate for Payer: Health Net of AZ Medicare |
$114.24
|
| Rate for Payer: Humana of AZ Medicare |
$61.20
|
| Rate for Payer: Mercy Care Medicaid |
$18.37
|
| Rate for Payer: Self Pay Self Pay |
$326.40
|
| Rate for Payer: TriWest Medicare |
$61.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$237.86
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$73.44
|
|
|
Platelet Autoantibody Panel LC
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
22311202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna of AZ Commercial |
$367.20
|
| Rate for Payer: Bisbee Police All Plans |
$106.08
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Self Pay Self Pay |
$326.40
|
|
|
Platelet Count
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
633807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of AZ Commercial |
$84.60
|
| Rate for Payer: Bisbee Police All Plans |
$24.44
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Self Pay Self Pay |
$75.20
|
|
|
Platelet Count
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
633807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of AZ Commercial |
$84.60
|
| Rate for Payer: Aetna of AZ Medicare |
$26.32
|
| Rate for Payer: AHCCCS Medicaid |
$4.48
|
| Rate for Payer: Allwell Medicaid |
$4.48
|
| Rate for Payer: Allwell Medicare |
$14.10
|
| Rate for Payer: Amerigroup Medicare |
$14.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$35.11
|
| Rate for Payer: AZCH Complete Medicaid |
$4.48
|
| Rate for Payer: AZCH Complete Medicare |
$14.10
|
| Rate for Payer: Banner UC Health Medicaid |
$4.48
|
| Rate for Payer: Banner UC Health Medicare |
$14.10
|
| Rate for Payer: Bisbee Police All Plans |
$24.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$63.92
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cigna of AZ Commercial |
$61.10
|
| Rate for Payer: Copperpoint Commercial |
$23.26
|
| Rate for Payer: Health Net of AZ Commercial |
$56.40
|
| Rate for Payer: Health Net of AZ Medicare |
$26.32
|
| Rate for Payer: Humana of AZ Medicare |
$14.10
|
| Rate for Payer: Mercy Care Medicaid |
$4.48
|
| Rate for Payer: Self Pay Self Pay |
$75.20
|
| Rate for Payer: TriWest Medicare |
$14.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$54.80
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$16.92
|
|
|
PLETH TRACE
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
3230228
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$383.46 |
| Rate for Payer: Aetna of AZ Commercial |
$322.20
|
| Rate for Payer: Aetna of AZ Medicare |
$100.24
|
| Rate for Payer: AHCCCS Medicaid |
$383.46
|
| Rate for Payer: Allwell Medicaid |
$383.46
|
| Rate for Payer: Allwell Medicare |
$53.70
|
| Rate for Payer: Amerigroup Medicare |
$53.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$133.71
|
| Rate for Payer: AZCH Complete Medicaid |
$383.46
|
| Rate for Payer: AZCH Complete Medicare |
$53.70
|
| Rate for Payer: Banner UC Health Medicaid |
$383.46
|
| Rate for Payer: Banner UC Health Medicare |
$53.70
|
| Rate for Payer: Bisbee Police All Plans |
$93.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$243.44
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cigna of AZ Commercial |
$250.60
|
| Rate for Payer: Copperpoint Commercial |
$88.60
|
| Rate for Payer: Health Net of AZ Commercial |
$214.80
|
| Rate for Payer: Health Net of AZ Medicare |
$100.24
|
| Rate for Payer: Humana of AZ Medicare |
$53.70
|
| Rate for Payer: Mercy Care Medicaid |
$383.46
|
| Rate for Payer: Self Pay Self Pay |
$286.40
|
| Rate for Payer: TriWest Medicare |
$53.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$208.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$64.44
|
|
|
PLETH TRACE
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
3230228
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Aetna of AZ Commercial |
$322.20
|
| Rate for Payer: Bisbee Police All Plans |
$93.08
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Self Pay Self Pay |
$286.40
|
|
|
PLEUR EVAC CHEST DRAIN
|
Facility
|
OP
|
$166.00
|
|
| Hospital Charge Code |
22354500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna of AZ Commercial |
$149.40
|
| Rate for Payer: Aetna of AZ Medicare |
$46.48
|
| Rate for Payer: Allwell Medicare |
$24.90
|
| Rate for Payer: Amerigroup Medicare |
$24.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$62.00
|
| Rate for Payer: AZCH Complete Medicare |
$24.90
|
| Rate for Payer: Banner UC Health Medicare |
$24.90
|
| Rate for Payer: Bisbee Police All Plans |
$43.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$112.88
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cigna of AZ Commercial |
$116.20
|
| Rate for Payer: Copperpoint Commercial |
$41.08
|
| Rate for Payer: Health Net of AZ Commercial |
$99.60
|
| Rate for Payer: Health Net of AZ Medicare |
$46.48
|
| Rate for Payer: Humana of AZ Medicare |
$24.90
|
| Rate for Payer: Self Pay Self Pay |
$132.80
|
| Rate for Payer: TriWest Medicare |
$24.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$96.78
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$29.88
|
|
|
PLEUR EVAC CHEST DRAIN
|
Facility
|
IP
|
$166.00
|
|
| Hospital Charge Code |
22354500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna of AZ Commercial |
$149.40
|
| Rate for Payer: Bisbee Police All Plans |
$43.16
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Self Pay Self Pay |
$132.80
|
|
|
PLUG FISTULA .7 COOK
|
Facility
|
OP
|
$2,854.00
|
|
| Hospital Charge Code |
22955986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.10 |
| Max. Negotiated Rate |
$2,568.60 |
| Rate for Payer: Aetna of AZ Commercial |
$2,568.60
|
| Rate for Payer: Aetna of AZ Medicare |
$799.12
|
| Rate for Payer: Allwell Medicare |
$428.10
|
| Rate for Payer: Amerigroup Medicare |
$428.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,065.97
|
| Rate for Payer: AZCH Complete Medicare |
$428.10
|
| Rate for Payer: Banner UC Health Medicare |
$428.10
|
| Rate for Payer: Bisbee Police All Plans |
$742.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,940.72
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,997.80
|
| Rate for Payer: Copperpoint Commercial |
$706.36
|
| Rate for Payer: Health Net of AZ Commercial |
$1,712.40
|
| Rate for Payer: Health Net of AZ Medicare |
$799.12
|
| Rate for Payer: Humana of AZ Medicare |
$428.10
|
| Rate for Payer: Self Pay Self Pay |
$2,283.20
|
| Rate for Payer: TriWest Medicare |
$428.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,663.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$513.72
|
|
