|
Testosterone, Serum LC
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
1285542
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of AZ Commercial |
$304.20
|
| Rate for Payer: Aetna of AZ Medicare |
$94.64
|
| Rate for Payer: AHCCCS Medicaid |
$25.81
|
| Rate for Payer: Allwell Medicaid |
$25.81
|
| Rate for Payer: Allwell Medicare |
$50.70
|
| Rate for Payer: Amerigroup Medicare |
$50.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$126.24
|
| Rate for Payer: AZCH Complete Medicaid |
$25.81
|
| Rate for Payer: AZCH Complete Medicare |
$50.70
|
| Rate for Payer: Banner UC Health Medicaid |
$25.81
|
| Rate for Payer: Banner UC Health Medicare |
$50.70
|
| Rate for Payer: Bisbee Police All Plans |
$87.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$229.84
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cigna of AZ Commercial |
$219.70
|
| Rate for Payer: Copperpoint Commercial |
$83.66
|
| Rate for Payer: Health Net of AZ Commercial |
$202.80
|
| Rate for Payer: Health Net of AZ Medicare |
$94.64
|
| Rate for Payer: Humana of AZ Medicare |
$50.70
|
| Rate for Payer: Mercy Care Medicaid |
$25.81
|
| Rate for Payer: Self Pay Self Pay |
$270.40
|
| Rate for Payer: TriWest Medicare |
$50.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$197.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$60.84
|
|
|
Test Stimulation Cable
|
Facility
|
IP
|
$219.00
|
|
| Hospital Charge Code |
22981864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna of AZ Commercial |
$197.10
|
| Rate for Payer: Bisbee Police All Plans |
$56.94
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Self Pay Self Pay |
$175.20
|
|
|
Test Stimulation Cable
|
Facility
|
OP
|
$219.00
|
|
| Hospital Charge Code |
22981864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna of AZ Commercial |
$197.10
|
| Rate for Payer: Aetna of AZ Medicare |
$61.32
|
| Rate for Payer: Allwell Medicare |
$32.85
|
| Rate for Payer: Amerigroup Medicare |
$32.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$81.80
|
| Rate for Payer: AZCH Complete Medicare |
$32.85
|
| Rate for Payer: Banner UC Health Medicare |
$32.85
|
| Rate for Payer: Bisbee Police All Plans |
$56.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$148.92
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna of AZ Commercial |
$153.30
|
| Rate for Payer: Copperpoint Commercial |
$54.20
|
| Rate for Payer: Health Net of AZ Commercial |
$131.40
|
| Rate for Payer: Health Net of AZ Medicare |
$61.32
|
| Rate for Payer: Humana of AZ Medicare |
$32.85
|
| Rate for Payer: Self Pay Self Pay |
$175.20
|
| Rate for Payer: TriWest Medicare |
$32.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$127.68
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$39.42
|
|
|
tetanus-diphtheria toxoids (Td)adult IM [CQCH]
|
Facility
|
IP
|
$45.44
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
105943587
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna of AZ Commercial |
$40.90
|
| Rate for Payer: Bisbee Police All Plans |
$11.81
|
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: Self Pay Self Pay |
$36.35
|
|
|
tetanus-diphtheria toxoids (Td)adult IM [CQCH]
|
Facility
|
OP
|
$45.44
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
105943587
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$52.78 |
| Rate for Payer: Aetna of AZ Commercial |
$40.90
|
| Rate for Payer: Aetna of AZ Medicare |
$12.72
|
| Rate for Payer: AHCCCS Medicaid |
$52.78
|
| Rate for Payer: Allwell Medicaid |
$52.78
|
| Rate for Payer: Allwell Medicare |
$6.82
|
| Rate for Payer: Amerigroup Medicare |
$6.82
|
| Rate for Payer: APIPA Medicare/Medicaid |
$16.97
|
| Rate for Payer: AZCH Complete Medicaid |
$52.78
|
| Rate for Payer: AZCH Complete Medicare |
$6.82
|
| Rate for Payer: Banner UC Health Medicaid |
$52.78
|
| Rate for Payer: Banner UC Health Medicare |
$6.82
|
| Rate for Payer: Bisbee Police All Plans |
$11.81
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$30.90
|
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: Cigna of AZ Commercial |
$29.54
|
| Rate for Payer: Copperpoint Commercial |
$11.25
|
| Rate for Payer: Health Net of AZ Commercial |
$27.26
|
| Rate for Payer: Health Net of AZ Medicare |
$12.72
|
| Rate for Payer: Humana of AZ Medicare |
$6.82
|
| Rate for Payer: Mercy Care Medicaid |
$52.78
|
| Rate for Payer: Self Pay Self Pay |
$36.35
|
| Rate for Payer: TriWest Medicare |
$6.82
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$26.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.18
|
|
|
tetanus/diphth/pertuss (ADACEL-Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL Sus [CQCH]
|
Facility
|
OP
|
$94.59
|
|
|
Service Code
|
NDC 49281040010
|
| Hospital Charge Code |
118000817
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$85.13 |
| Rate for Payer: Aetna of AZ Commercial |
$85.13
|
| Rate for Payer: Aetna of AZ Medicare |
$26.49
|
| Rate for Payer: Allwell Medicare |
$14.19
|
| Rate for Payer: Amerigroup Medicare |
$14.19
|
| Rate for Payer: APIPA Medicare/Medicaid |
$35.33
|
| Rate for Payer: AZCH Complete Medicare |
$14.19
|
| Rate for Payer: Banner UC Health Medicare |
$14.19
|
| Rate for Payer: Bisbee Police All Plans |
$24.59
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$64.32
|
| Rate for Payer: Cash Price |
$75.67
|
| Rate for Payer: Cigna of AZ Commercial |
$61.48
|
| Rate for Payer: Copperpoint Commercial |
$23.41
|
| Rate for Payer: Health Net of AZ Commercial |
$56.75
|
| Rate for Payer: Health Net of AZ Medicare |
$26.49
|
| Rate for Payer: Humana of AZ Medicare |
$14.19
|
| Rate for Payer: Self Pay Self Pay |
$75.67
|
| Rate for Payer: TriWest Medicare |
$14.19
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$55.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$17.03
|
|
|
tetanus/diphth/pertuss (ADACEL-Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL Sus [CQCH]
|
Facility
|
IP
|
$94.59
|
|
|
Service Code
|
NDC 49281040010
|
| Hospital Charge Code |
118000817
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.59 |
| Max. Negotiated Rate |
$85.13 |
| Rate for Payer: Aetna of AZ Commercial |
$85.13
|
| Rate for Payer: Bisbee Police All Plans |
$24.59
|
| Rate for Payer: Cash Price |
$75.67
|
| Rate for Payer: Self Pay Self Pay |
$75.67
|
|
|
tetanus immune globulin 250 units IM [CQCH]
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
105943449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$839.06 |
| Rate for Payer: Aetna of AZ Commercial |
$469.80
|
| Rate for Payer: Aetna of AZ Medicare |
$146.16
|
| Rate for Payer: AHCCCS Medicaid |
$839.06
|
| Rate for Payer: Allwell Medicaid |
$839.06
|
| Rate for Payer: Allwell Medicare |
$78.30
|
| Rate for Payer: Amerigroup Medicare |
$78.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$194.97
|
| Rate for Payer: AZCH Complete Medicaid |
$839.06
|
| Rate for Payer: AZCH Complete Medicare |
$78.30
|
| Rate for Payer: Banner UC Health Medicaid |
$839.06
|
| Rate for Payer: Banner UC Health Medicare |
$78.30
|
| Rate for Payer: Bisbee Police All Plans |
$135.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$354.96
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna of AZ Commercial |
$339.30
|
| Rate for Payer: Copperpoint Commercial |
$129.20
|
| Rate for Payer: Health Net of AZ Commercial |
$313.20
|
| Rate for Payer: Health Net of AZ Medicare |
$146.16
|
| Rate for Payer: Humana of AZ Medicare |
$78.30
|
| Rate for Payer: Mercy Care Medicaid |
$839.06
|
| Rate for Payer: Self Pay Self Pay |
$417.60
|
| Rate for Payer: TriWest Medicare |
$78.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$304.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$93.96
|
|
|
tetanus immune globulin 250 units IM [CQCH]
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
105943449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.72 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Aetna of AZ Commercial |
$469.80
|
| Rate for Payer: Bisbee Police All Plans |
$135.72
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Self Pay Self Pay |
$417.60
|
|
|
tetracaine ophth 0.5% Soln 15 mL [CQCH]
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
NDC 68682092064
|
| Hospital Charge Code |
111669704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna of AZ Commercial |
$3.67
|
| Rate for Payer: Bisbee Police All Plans |
$1.06
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Self Pay Self Pay |
$3.26
|
|
|
tetracaine ophth 0.5% Soln 15 mL [CQCH]
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
NDC 68682092064
|
| Hospital Charge Code |
111669704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna of AZ Commercial |
$3.67
|
| Rate for Payer: Aetna of AZ Medicare |
$1.14
|
| Rate for Payer: Allwell Medicare |
$0.61
|
| Rate for Payer: Amerigroup Medicare |
$0.61
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.52
|
| Rate for Payer: AZCH Complete Medicare |
$0.61
|
| Rate for Payer: Banner UC Health Medicare |
$0.61
|
| Rate for Payer: Bisbee Police All Plans |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cigna of AZ Commercial |
$2.65
|
| Rate for Payer: Copperpoint Commercial |
$1.01
|
| Rate for Payer: Health Net of AZ Commercial |
$2.45
|
| Rate for Payer: Health Net of AZ Medicare |
$1.14
|
| Rate for Payer: Humana of AZ Medicare |
$0.61
|
| Rate for Payer: Self Pay Self Pay |
$3.26
|
| Rate for Payer: TriWest Medicare |
$0.61
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.38
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.73
|
|
|
Thawed Aph FFP ACDA 200-400 ml
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316425
|
|
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
|
|
|
Thawed Aph FFP ACDA 200-400 ml
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316425
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| 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
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Thawed Cryo AHF
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
22191131
|
|
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
|
|
|
Thawed Cryo AHF
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
22191131
|
|
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
|
|
|
Thawed Plasma ACDA
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316439
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| 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
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Thawed Plasma ACDA
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316439
|
|
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
|
|
|
Thawed Plasma ACDA Irr
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316442
|
|
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
|
|
|
Thawed Plasma ACDA Irr
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316442
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| 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
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Thawed Plasma ACDB
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316434
|
|
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
|
|
|
Thawed Plasma ACDB
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316434
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| 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
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Thawed Plasma ACDB Irr
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316437
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| 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
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Thawed Plasma ACDB Irr
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316437
|
|
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
|
|
|
Thawed Plasma CP2D Irr
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316450
|
|
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
|
|
|
Thawed Plasma CP2D Irr
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
22316450
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| 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
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
