PRE-ANES EXAM/EVAL
|
Facility
|
IP
|
$186.00
|
|
Service Code
|
CPT 99231 QZ
|
Hospital Charge Code |
22789175
|
Hospital Revenue Code
|
370
|
Min. Negotiated Rate |
$48.36 |
Max. Negotiated Rate |
$167.40 |
Rate for Payer: Aetna of AZ Commercial |
$167.40
|
Rate for Payer: Bisbee Police All Plans |
$48.36
|
Rate for Payer: Cash Price |
$148.80
|
Rate for Payer: Self Pay Self Pay |
$148.80
|
|
PRECISION THIN 7.0 X .38 X 18.5MM
|
Facility
|
IP
|
$144.00
|
|
Hospital Charge Code |
24135537
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$37.44 |
Max. Negotiated Rate |
$129.60 |
Rate for Payer: Aetna of AZ Commercial |
$129.60
|
Rate for Payer: Bisbee Police All Plans |
$37.44
|
Rate for Payer: Cash Price |
$115.20
|
Rate for Payer: Self Pay Self Pay |
$115.20
|
|
PRECISION THIN 7.0 X .38 X 18.5MM
|
Facility
|
OP
|
$144.00
|
|
Hospital Charge Code |
24135537
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$21.60 |
Max. Negotiated Rate |
$129.60 |
Rate for Payer: Aetna of AZ Commercial |
$129.60
|
Rate for Payer: Aetna of AZ Medicare |
$40.32
|
Rate for Payer: Allwell Medicare |
$21.60
|
Rate for Payer: Amerigroup Medicare |
$21.60
|
Rate for Payer: APIPA Medicare/Medicaid |
$53.78
|
Rate for Payer: AZCH Complete Medicare |
$21.60
|
Rate for Payer: Banner UC Health Medicare |
$21.60
|
Rate for Payer: Bisbee Police All Plans |
$37.44
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$97.92
|
Rate for Payer: Cash Price |
$115.20
|
Rate for Payer: Cigna of AZ Commercial |
$100.80
|
Rate for Payer: Copperpoint Commercial |
$35.64
|
Rate for Payer: Health Net of AZ Commercial |
$86.40
|
Rate for Payer: Health Net of AZ Medicare |
$40.32
|
Rate for Payer: Humana of AZ Medicare |
$21.60
|
Rate for Payer: Self Pay Self Pay |
$115.20
|
Rate for Payer: TriWest Medicare |
$21.60
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$83.95
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.92
|
|
prednisoLONE 15 mg/5 mL Oral Syrup UD [CQCH]
|
Facility
|
OP
|
$0.13
|
|
Service Code
|
HCPCS J7510
|
Hospital Charge Code |
105937577
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.44 |
Rate for Payer: Aetna of AZ Commercial |
$0.12
|
Rate for Payer: Aetna of AZ Medicare |
$0.04
|
Rate for Payer: AHCCCS Medicaid |
$0.44
|
Rate for Payer: Allwell Medicaid |
$0.44
|
Rate for Payer: Allwell Medicare |
$0.02
|
Rate for Payer: Amerigroup Medicare |
$0.02
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.05
|
Rate for Payer: AZCH Complete Medicaid |
$0.44
|
Rate for Payer: AZCH Complete Medicare |
$0.02
|
Rate for Payer: Banner UC Health Medicaid |
$0.44
|
Rate for Payer: Banner UC Health Medicare |
$0.02
|
Rate for Payer: Bisbee Police All Plans |
$0.03
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.09
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of AZ Commercial |
$0.08
|
Rate for Payer: Copperpoint Commercial |
$0.03
|
Rate for Payer: Health Net of AZ Commercial |
$0.08
|
Rate for Payer: Health Net of AZ Medicare |
$0.04
|
Rate for Payer: Humana of AZ Medicare |
$0.02
|
Rate for Payer: Mercy Care Medicaid |
$0.44
|
Rate for Payer: Self Pay Self Pay |
$0.10
|
Rate for Payer: TriWest Medicare |
$0.02
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.08
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
prednisoLONE 15 mg/5 mL Oral Syrup UD [CQCH]
|
Facility
|
IP
|
$0.13
|
|
Service Code
|
HCPCS J7510
|
Hospital Charge Code |
105937577
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.12 |
Rate for Payer: Aetna of AZ Commercial |
$0.12
|
Rate for Payer: Bisbee Police All Plans |
$0.03
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Self Pay Self Pay |
$0.10
|
|
prednisoLONE acetate 1% Ophth Susp [CQCH]
|
Facility
|
IP
|
$8.65
|
|
Service Code
|
NDC 61314063705
|
Hospital Charge Code |
105937654
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$2.25 |
Max. Negotiated Rate |
$7.78 |
Rate for Payer: Aetna of AZ Commercial |
$7.78
|
Rate for Payer: Bisbee Police All Plans |
$2.25
|
Rate for Payer: Cash Price |
$6.92
|
Rate for Payer: Self Pay Self Pay |
$6.92
|
|
prednisoLONE acetate 1% Ophth Susp [CQCH]
|
Facility
|
OP
|
$8.65
|
|
Service Code
|
NDC 61314063705
|
Hospital Charge Code |
105937654
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$1.30 |
Max. Negotiated Rate |
$7.78 |
Rate for Payer: Aetna of AZ Commercial |
$7.78
|
Rate for Payer: Aetna of AZ Medicare |
$2.42
|
Rate for Payer: Allwell Medicare |
$1.30
|
Rate for Payer: Amerigroup Medicare |
$1.30
|
Rate for Payer: APIPA Medicare/Medicaid |
$3.23
|
Rate for Payer: AZCH Complete Medicare |
$1.30
|
Rate for Payer: Banner UC Health Medicare |
$1.30
|
Rate for Payer: Bisbee Police All Plans |
$2.25
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5.88
|
Rate for Payer: Cash Price |
$6.92
|
Rate for Payer: Cigna of AZ Commercial |
$5.62
|
Rate for Payer: Copperpoint Commercial |
$2.14
|
Rate for Payer: Health Net of AZ Commercial |
$5.19
|
Rate for Payer: Health Net of AZ Medicare |
$2.42
|
Rate for Payer: Humana of AZ Medicare |
$1.30
|
Rate for Payer: Self Pay Self Pay |
$6.92
|
Rate for Payer: TriWest Medicare |
$1.30
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.04
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.56
|
|
predniSONE 10 mg Tab [CQCH]
|
Facility
|
IP
|
$0.15
|
|
Service Code
|
HCPCS J7510
|
Hospital Charge Code |
105937790
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of AZ Commercial |
$0.14
|
Rate for Payer: Bisbee Police All Plans |
$0.04
|
Rate for Payer: Cash Price |
$0.12
|
Rate for Payer: Self Pay Self Pay |
$0.12
|
|
predniSONE 10 mg Tab [CQCH]
|
Facility
|
OP
|
$0.15
|
|
Service Code
|
HCPCS J7510
|
Hospital Charge Code |
105937790
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.44 |
Rate for Payer: Aetna of AZ Commercial |
$0.14
|
Rate for Payer: Aetna of AZ Medicare |
$0.04
|
Rate for Payer: AHCCCS Medicaid |
$0.44
|
Rate for Payer: Allwell Medicaid |
$0.44
|
Rate for Payer: Allwell Medicare |
$0.02
|
Rate for Payer: Amerigroup Medicare |
$0.02
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.06
|
Rate for Payer: AZCH Complete Medicaid |
$0.44
|
Rate for Payer: AZCH Complete Medicare |
$0.02
|
Rate for Payer: Banner UC Health Medicaid |
$0.44
|
Rate for Payer: Banner UC Health Medicare |
$0.02
|
Rate for Payer: Bisbee Police All Plans |
$0.04
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.10
|
Rate for Payer: Cash Price |
$0.12
|
Rate for Payer: Cash Price |
$0.12
|
Rate for Payer: Cigna of AZ Commercial |
$0.10
|
Rate for Payer: Copperpoint Commercial |
$0.04
|
Rate for Payer: Health Net of AZ Commercial |
$0.09
|
Rate for Payer: Health Net of AZ Medicare |
$0.04
|
Rate for Payer: Humana of AZ Medicare |
$0.02
|
Rate for Payer: Mercy Care Medicaid |
$0.44
|
Rate for Payer: Self Pay Self Pay |
$0.12
|
Rate for Payer: TriWest Medicare |
$0.02
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.09
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
predniSONE 1 mg Tab [CQCH]
|
Facility
|
OP
|
$0.16
|
|
Service Code
|
HCPCS J7510
|
Hospital Charge Code |
105937861
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.44 |
Rate for Payer: Aetna of AZ Commercial |
$0.14
|
Rate for Payer: Aetna of AZ Medicare |
$0.04
|
Rate for Payer: AHCCCS Medicaid |
$0.44
|
Rate for Payer: Allwell Medicaid |
$0.44
|
Rate for Payer: Allwell Medicare |
$0.02
|
Rate for Payer: Amerigroup Medicare |
$0.02
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.06
|
Rate for Payer: AZCH Complete Medicaid |
$0.44
|
Rate for Payer: AZCH Complete Medicare |
$0.02
|
Rate for Payer: Banner UC Health Medicaid |
$0.44
|
Rate for Payer: Banner UC Health Medicare |
$0.02
|
Rate for Payer: Bisbee Police All Plans |
$0.04
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.11
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of AZ Commercial |
$0.10
|
Rate for Payer: Copperpoint Commercial |
$0.04
|
Rate for Payer: Health Net of AZ Commercial |
$0.10
|
Rate for Payer: Health Net of AZ Medicare |
$0.04
|
Rate for Payer: Humana of AZ Medicare |
$0.02
|
Rate for Payer: Mercy Care Medicaid |
$0.44
|
Rate for Payer: Self Pay Self Pay |
$0.13
|
Rate for Payer: TriWest Medicare |
$0.02
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.09
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
predniSONE 1 mg Tab [CQCH]
|
Facility
|
IP
|
$0.16
|
|
Service Code
|
HCPCS J7510
|
Hospital Charge Code |
105937861
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of AZ Commercial |
$0.14
|
Rate for Payer: Bisbee Police All Plans |
$0.04
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Self Pay Self Pay |
$0.13
|
|
predniSONE 20 mg Tab [CQCH]
|
Facility
|
IP
|
$0.13
|
|
Service Code
|
HCPCS J7510
|
Hospital Charge Code |
105937930
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.12 |
Rate for Payer: Aetna of AZ Commercial |
$0.12
|
Rate for Payer: Bisbee Police All Plans |
$0.03
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Self Pay Self Pay |
$0.10
|
|
predniSONE 20 mg Tab [CQCH]
|
Facility
|
OP
|
$0.13
|
|
Service Code
|
HCPCS J7510
|
Hospital Charge Code |
105937930
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.44 |
Rate for Payer: Aetna of AZ Commercial |
$0.12
|
Rate for Payer: Aetna of AZ Medicare |
$0.04
|
Rate for Payer: AHCCCS Medicaid |
$0.44
|
Rate for Payer: Allwell Medicaid |
$0.44
|
Rate for Payer: Allwell Medicare |
$0.02
|
Rate for Payer: Amerigroup Medicare |
$0.02
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.05
|
Rate for Payer: AZCH Complete Medicaid |
$0.44
|
Rate for Payer: AZCH Complete Medicare |
$0.02
|
Rate for Payer: Banner UC Health Medicaid |
$0.44
|
Rate for Payer: Banner UC Health Medicare |
$0.02
|
Rate for Payer: Bisbee Police All Plans |
$0.03
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.09
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of AZ Commercial |
$0.08
|
Rate for Payer: Copperpoint Commercial |
$0.03
|
Rate for Payer: Health Net of AZ Commercial |
$0.08
|
Rate for Payer: Health Net of AZ Medicare |
$0.04
|
Rate for Payer: Humana of AZ Medicare |
$0.02
|
Rate for Payer: Mercy Care Medicaid |
$0.44
|
Rate for Payer: Self Pay Self Pay |
$0.10
|
Rate for Payer: TriWest Medicare |
$0.02
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.08
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
predniSONE 5 mg Tab [CQCH]
|
Facility
|
IP
|
$0.14
|
|
Service Code
|
HCPCS J7510
|
Hospital Charge Code |
105937719
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.13 |
Rate for Payer: Aetna of AZ Commercial |
$0.13
|
Rate for Payer: Bisbee Police All Plans |
$0.04
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Self Pay Self Pay |
$0.11
|
|
predniSONE 5 mg Tab [CQCH]
|
Facility
|
OP
|
$0.14
|
|
Service Code
|
HCPCS J7510
|
Hospital Charge Code |
105937719
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.44 |
Rate for Payer: Aetna of AZ Commercial |
$0.13
|
Rate for Payer: Aetna of AZ Medicare |
$0.04
|
Rate for Payer: AHCCCS Medicaid |
$0.44
|
Rate for Payer: Allwell Medicaid |
$0.44
|
Rate for Payer: Allwell Medicare |
$0.02
|
Rate for Payer: Amerigroup Medicare |
$0.02
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.05
|
Rate for Payer: AZCH Complete Medicaid |
$0.44
|
Rate for Payer: AZCH Complete Medicare |
$0.02
|
Rate for Payer: Banner UC Health Medicaid |
$0.44
|
Rate for Payer: Banner UC Health Medicare |
$0.02
|
Rate for Payer: Bisbee Police All Plans |
$0.04
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.10
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cigna of AZ Commercial |
$0.09
|
Rate for Payer: Copperpoint Commercial |
$0.03
|
Rate for Payer: Health Net of AZ Commercial |
$0.08
|
Rate for Payer: Health Net of AZ Medicare |
$0.04
|
Rate for Payer: Humana of AZ Medicare |
$0.02
|
Rate for Payer: Mercy Care Medicaid |
$0.44
|
Rate for Payer: Self Pay Self Pay |
$0.11
|
Rate for Payer: TriWest Medicare |
$0.02
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.08
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
pregabalin 50 mg oral cap [CQCH]
|
Facility
|
IP
|
$0.41
|
|
Service Code
|
NDC 904699261
|
Hospital Charge Code |
105937999
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.37 |
Rate for Payer: Aetna of AZ Commercial |
$0.37
|
Rate for Payer: Bisbee Police All Plans |
$0.11
|
Rate for Payer: Cash Price |
$0.32
|
Rate for Payer: Self Pay Self Pay |
$0.33
|
|
pregabalin 50 mg oral cap [CQCH]
|
Facility
|
OP
|
$0.41
|
|
Service Code
|
NDC 904699261
|
Hospital Charge Code |
105937999
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.37 |
Rate for Payer: Aetna of AZ Commercial |
$0.37
|
Rate for Payer: Aetna of AZ Medicare |
$0.11
|
Rate for Payer: Allwell Medicare |
$0.06
|
Rate for Payer: Amerigroup Medicare |
$0.06
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.15
|
Rate for Payer: AZCH Complete Medicare |
$0.06
|
Rate for Payer: Banner UC Health Medicare |
$0.06
|
Rate for Payer: Bisbee Police All Plans |
$0.11
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.28
|
Rate for Payer: Cash Price |
$0.32
|
Rate for Payer: Cigna of AZ Commercial |
$0.27
|
Rate for Payer: Copperpoint Commercial |
$0.10
|
Rate for Payer: Health Net of AZ Commercial |
$0.25
|
Rate for Payer: Health Net of AZ Medicare |
$0.11
|
Rate for Payer: Humana of AZ Medicare |
$0.06
|
Rate for Payer: Self Pay Self Pay |
$0.33
|
Rate for Payer: TriWest Medicare |
$0.06
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.24
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.07
|
|
PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)
|
Facility
|
OP
|
$109.00
|
|
Service Code
|
CPT 84163
|
Hospital Charge Code |
23294372
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$15.05 |
Max. Negotiated Rate |
$98.10 |
Rate for Payer: Aetna of AZ Commercial |
$98.10
|
Rate for Payer: Aetna of AZ Medicare |
$30.52
|
Rate for Payer: AHCCCS Medicaid |
$15.05
|
Rate for Payer: Allwell Medicaid |
$15.05
|
Rate for Payer: Allwell Medicare |
$16.35
|
Rate for Payer: Amerigroup Medicare |
$16.35
|
Rate for Payer: APIPA Medicare/Medicaid |
$40.71
|
Rate for Payer: AZCH Complete Medicaid |
$15.05
|
Rate for Payer: AZCH Complete Medicare |
$16.35
|
Rate for Payer: Banner UC Health Medicaid |
$15.05
|
Rate for Payer: Banner UC Health Medicare |
$16.35
|
Rate for Payer: Bisbee Police All Plans |
$28.34
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$74.12
|
Rate for Payer: Cash Price |
$87.20
|
Rate for Payer: Cash Price |
$87.20
|
Rate for Payer: Cigna of AZ Commercial |
$70.85
|
Rate for Payer: Copperpoint Commercial |
$26.98
|
Rate for Payer: Health Net of AZ Commercial |
$65.40
|
Rate for Payer: Health Net of AZ Medicare |
$30.52
|
Rate for Payer: Humana of AZ Medicare |
$16.35
|
Rate for Payer: Mercy Care Medicaid |
$15.05
|
Rate for Payer: Self Pay Self Pay |
$87.20
|
Rate for Payer: TriWest Medicare |
$16.35
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$63.55
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.62
|
|
PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)
|
Facility
|
IP
|
$109.00
|
|
Service Code
|
CPT 84163
|
Hospital Charge Code |
23294372
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$28.34 |
Max. Negotiated Rate |
$98.10 |
Rate for Payer: Aetna of AZ Commercial |
$98.10
|
Rate for Payer: Bisbee Police All Plans |
$28.34
|
Rate for Payer: Cash Price |
$87.20
|
Rate for Payer: Self Pay Self Pay |
$87.20
|
|
PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)
|
Facility
|
OP
|
$114.00
|
|
Service Code
|
CPT 84163
|
Hospital Charge Code |
23296930
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$15.05 |
Max. Negotiated Rate |
$102.60 |
Rate for Payer: Aetna of AZ Commercial |
$102.60
|
Rate for Payer: Aetna of AZ Medicare |
$31.92
|
Rate for Payer: AHCCCS Medicaid |
$15.05
|
Rate for Payer: Allwell Medicaid |
$15.05
|
Rate for Payer: Allwell Medicare |
$17.10
|
Rate for Payer: Amerigroup Medicare |
$17.10
|
Rate for Payer: APIPA Medicare/Medicaid |
$42.58
|
Rate for Payer: AZCH Complete Medicaid |
$15.05
|
Rate for Payer: AZCH Complete Medicare |
$17.10
|
Rate for Payer: Banner UC Health Medicaid |
$15.05
|
Rate for Payer: Banner UC Health Medicare |
$17.10
|
Rate for Payer: Bisbee Police All Plans |
$29.64
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$77.52
|
Rate for Payer: Cash Price |
$91.20
|
Rate for Payer: Cash Price |
$91.20
|
Rate for Payer: Cigna of AZ Commercial |
$74.10
|
Rate for Payer: Copperpoint Commercial |
$28.22
|
Rate for Payer: Health Net of AZ Commercial |
$68.40
|
Rate for Payer: Health Net of AZ Medicare |
$31.92
|
Rate for Payer: Humana of AZ Medicare |
$17.10
|
Rate for Payer: Mercy Care Medicaid |
$15.05
|
Rate for Payer: Self Pay Self Pay |
$91.20
|
Rate for Payer: TriWest Medicare |
$17.10
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$66.46
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$20.52
|
|
PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)
|
Facility
|
IP
|
$114.00
|
|
Service Code
|
CPT 84163
|
Hospital Charge Code |
23296930
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$29.64 |
Max. Negotiated Rate |
$102.60 |
Rate for Payer: Aetna of AZ Commercial |
$102.60
|
Rate for Payer: Bisbee Police All Plans |
$29.64
|
Rate for Payer: Cash Price |
$91.20
|
Rate for Payer: Self Pay Self Pay |
$91.20
|
|
Pregnancy Test Serum 1
|
Facility
|
OP
|
$212.00
|
|
Service Code
|
CPT 84703
|
Hospital Charge Code |
9579719
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$7.52 |
Max. Negotiated Rate |
$190.80 |
Rate for Payer: Aetna of AZ Commercial |
$190.80
|
Rate for Payer: Aetna of AZ Medicare |
$59.36
|
Rate for Payer: AHCCCS Medicaid |
$7.52
|
Rate for Payer: Allwell Medicaid |
$7.52
|
Rate for Payer: Allwell Medicare |
$31.80
|
Rate for Payer: Amerigroup Medicare |
$31.80
|
Rate for Payer: APIPA Medicare/Medicaid |
$79.18
|
Rate for Payer: AZCH Complete Medicaid |
$7.52
|
Rate for Payer: AZCH Complete Medicare |
$31.80
|
Rate for Payer: Banner UC Health Medicaid |
$7.52
|
Rate for Payer: Banner UC Health Medicare |
$31.80
|
Rate for Payer: Bisbee Police All Plans |
$55.12
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$144.16
|
Rate for Payer: Cash Price |
$169.60
|
Rate for Payer: Cash Price |
$169.60
|
Rate for Payer: Cigna of AZ Commercial |
$137.80
|
Rate for Payer: Copperpoint Commercial |
$52.47
|
Rate for Payer: Health Net of AZ Commercial |
$127.20
|
Rate for Payer: Health Net of AZ Medicare |
$59.36
|
Rate for Payer: Humana of AZ Medicare |
$31.80
|
Rate for Payer: Mercy Care Medicaid |
$7.52
|
Rate for Payer: Self Pay Self Pay |
$169.60
|
Rate for Payer: TriWest Medicare |
$31.80
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$123.60
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.16
|
|
Pregnancy Test Serum 1
|
Facility
|
IP
|
$212.00
|
|
Service Code
|
CPT 84703
|
Hospital Charge Code |
9579719
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$55.12 |
Max. Negotiated Rate |
$190.80 |
Rate for Payer: Aetna of AZ Commercial |
$190.80
|
Rate for Payer: Bisbee Police All Plans |
$55.12
|
Rate for Payer: Cash Price |
$169.60
|
Rate for Payer: Self Pay Self Pay |
$169.60
|
|
Pregnancy Test Urine 1
|
Facility
|
OP
|
$159.00
|
|
Service Code
|
CPT 81025
|
Hospital Charge Code |
9579720
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$8.61 |
Max. Negotiated Rate |
$143.10 |
Rate for Payer: Aetna of AZ Commercial |
$143.10
|
Rate for Payer: Aetna of AZ Medicare |
$44.52
|
Rate for Payer: AHCCCS Medicaid |
$8.61
|
Rate for Payer: Allwell Medicaid |
$8.61
|
Rate for Payer: Allwell Medicare |
$23.85
|
Rate for Payer: Amerigroup Medicare |
$23.85
|
Rate for Payer: APIPA Medicare/Medicaid |
$59.39
|
Rate for Payer: AZCH Complete Medicaid |
$8.61
|
Rate for Payer: AZCH Complete Medicare |
$23.85
|
Rate for Payer: Banner UC Health Medicaid |
$8.61
|
Rate for Payer: Banner UC Health Medicare |
$23.85
|
Rate for Payer: Bisbee Police All Plans |
$41.34
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$108.12
|
Rate for Payer: Cash Price |
$127.20
|
Rate for Payer: Cash Price |
$127.20
|
Rate for Payer: Cigna of AZ Commercial |
$103.35
|
Rate for Payer: Copperpoint Commercial |
$39.35
|
Rate for Payer: Health Net of AZ Commercial |
$95.40
|
Rate for Payer: Health Net of AZ Medicare |
$44.52
|
Rate for Payer: Humana of AZ Medicare |
$23.85
|
Rate for Payer: Mercy Care Medicaid |
$8.61
|
Rate for Payer: Self Pay Self Pay |
$127.20
|
Rate for Payer: TriWest Medicare |
$23.85
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$92.70
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.62
|
|
Pregnancy Test Urine 1
|
Facility
|
IP
|
$159.00
|
|
Service Code
|
CPT 81025
|
Hospital Charge Code |
9579720
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$41.34 |
Max. Negotiated Rate |
$143.10 |
Rate for Payer: Aetna of AZ Commercial |
$143.10
|
Rate for Payer: Bisbee Police All Plans |
$41.34
|
Rate for Payer: Cash Price |
$127.20
|
Rate for Payer: Self Pay Self Pay |
$127.20
|
|