|
US Color Doppler
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
22427825
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$216.60 |
| Max. Negotiated Rate |
$1,299.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,299.60
|
| Rate for Payer: Aetna of AZ Medicare |
$404.32
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$216.60
|
| Rate for Payer: Amerigroup Medicare |
$216.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$539.33
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$216.60
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$216.60
|
| Rate for Payer: Bisbee Police All Plans |
$375.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$981.92
|
| Rate for Payer: Cash Price |
$1,155.20
|
| Rate for Payer: Cash Price |
$1,155.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,010.80
|
| Rate for Payer: Copperpoint Commercial |
$357.39
|
| Rate for Payer: Health Net of AZ Commercial |
$866.40
|
| Rate for Payer: Health Net of AZ Medicare |
$404.32
|
| Rate for Payer: Humana of AZ Medicare |
$216.60
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$1,155.20
|
| Rate for Payer: TriWest Medicare |
$216.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$841.85
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$259.92
|
|
|
US Echo 2D Limited
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
1883704
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$140.66 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Aetna of AZ Commercial |
$486.90
|
| Rate for Payer: Bisbee Police All Plans |
$140.66
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Self Pay Self Pay |
$432.80
|
|
|
US Echo 2D Limited
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
1883704
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Aetna of AZ Commercial |
$486.90
|
| Rate for Payer: Aetna of AZ Medicare |
$151.48
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$81.15
|
| Rate for Payer: Amerigroup Medicare |
$81.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$202.06
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$81.15
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$81.15
|
| Rate for Payer: Bisbee Police All Plans |
$140.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$367.88
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cigna of AZ Commercial |
$378.70
|
| Rate for Payer: Copperpoint Commercial |
$133.90
|
| Rate for Payer: Health Net of AZ Commercial |
$324.60
|
| Rate for Payer: Health Net of AZ Medicare |
$151.48
|
| Rate for Payer: Humana of AZ Medicare |
$81.15
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$432.80
|
| Rate for Payer: TriWest Medicare |
$81.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$315.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$97.38
|
|
|
US Echocardiogram Complete
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
1161150
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$227.76 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna of AZ Commercial |
$788.40
|
| Rate for Payer: Bisbee Police All Plans |
$227.76
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Self Pay Self Pay |
$700.80
|
|
|
US Echocardiogram Complete
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
1161150
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna of AZ Commercial |
$788.40
|
| Rate for Payer: Aetna of AZ Medicare |
$245.28
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$131.40
|
| Rate for Payer: Amerigroup Medicare |
$131.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$327.19
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$131.40
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$131.40
|
| Rate for Payer: Bisbee Police All Plans |
$227.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$595.68
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cigna of AZ Commercial |
$613.20
|
| Rate for Payer: Copperpoint Commercial |
$216.81
|
| Rate for Payer: Health Net of AZ Commercial |
$525.60
|
| Rate for Payer: Health Net of AZ Medicare |
$245.28
|
| Rate for Payer: Humana of AZ Medicare |
$131.40
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$700.80
|
| Rate for Payer: TriWest Medicare |
$131.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$510.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$157.68
|
|
|
US ECHO Complete
|
Facility
|
OP
|
$1,995.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
10443714
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$1,795.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,795.50
|
| Rate for Payer: Aetna of AZ Medicare |
$558.60
|
| Rate for Payer: AHCCCS Medicaid |
$700.20
|
| Rate for Payer: Allwell Medicaid |
$700.20
|
| Rate for Payer: Allwell Medicare |
$299.25
|
| Rate for Payer: Amerigroup Medicare |
$299.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$745.13
|
| Rate for Payer: AZCH Complete Medicaid |
$700.20
|
| Rate for Payer: AZCH Complete Medicare |
$299.25
|
| Rate for Payer: Banner UC Health Medicaid |
$700.20
|
| Rate for Payer: Banner UC Health Medicare |
$299.25
|
| Rate for Payer: Bisbee Police All Plans |
$518.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,356.60
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,396.50
|
| Rate for Payer: Copperpoint Commercial |
$493.76
|
| Rate for Payer: Health Net of AZ Commercial |
$1,197.00
|
| Rate for Payer: Health Net of AZ Medicare |
$558.60
|
| Rate for Payer: Humana of AZ Medicare |
$299.25
|
| Rate for Payer: Mercy Care Medicaid |
$700.20
|
| Rate for Payer: Self Pay Self Pay |
$1,596.00
|
| Rate for Payer: TriWest Medicare |
$299.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,163.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$359.10
|
|
|
US ECHO Complete
|
Facility
|
IP
|
$1,995.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
10443714
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$518.70 |
| Max. Negotiated Rate |
$1,795.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,795.50
|
| Rate for Payer: Bisbee Police All Plans |
$518.70
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Self Pay Self Pay |
$1,596.00
|
|
|
US Fetal Biophysical Profile
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
1007763
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$238.94 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Aetna of AZ Commercial |
$827.10
|
| Rate for Payer: Bisbee Police All Plans |
$238.94
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Self Pay Self Pay |
$735.20
|
|
|
US Fetal Biophysical Profile
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
1007763
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.85 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Aetna of AZ Commercial |
$827.10
|
| Rate for Payer: Aetna of AZ Medicare |
$257.32
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$137.85
|
| Rate for Payer: Amerigroup Medicare |
$137.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$343.25
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$137.85
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$137.85
|
| Rate for Payer: Bisbee Police All Plans |
$238.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$624.92
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cigna of AZ Commercial |
$643.30
|
| Rate for Payer: Copperpoint Commercial |
$227.45
|
| Rate for Payer: Health Net of AZ Commercial |
$551.40
|
| Rate for Payer: Health Net of AZ Medicare |
$257.32
|
| Rate for Payer: Humana of AZ Medicare |
$137.85
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$735.20
|
| Rate for Payer: TriWest Medicare |
$137.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$535.78
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$165.42
|
|
|
US Fetal Eval Complete
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1007766
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna of AZ Commercial |
$734.40
|
| Rate for Payer: Bisbee Police All Plans |
$212.16
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Self Pay Self Pay |
$652.80
|
|
|
US Fetal Eval Complete
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1007766
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna of AZ Commercial |
$734.40
|
| Rate for Payer: Aetna of AZ Medicare |
$228.48
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$122.40
|
| Rate for Payer: Amerigroup Medicare |
$122.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$304.78
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$122.40
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$122.40
|
| Rate for Payer: Bisbee Police All Plans |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$554.88
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna of AZ Commercial |
$571.20
|
| Rate for Payer: Copperpoint Commercial |
$201.96
|
| Rate for Payer: Health Net of AZ Commercial |
$489.60
|
| Rate for Payer: Health Net of AZ Medicare |
$228.48
|
| Rate for Payer: Humana of AZ Medicare |
$122.40
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$652.80
|
| Rate for Payer: TriWest Medicare |
$122.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$475.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$146.88
|
|
|
US Gallbladder
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2214185
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$337.22 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,167.30
|
| Rate for Payer: Bisbee Police All Plans |
$337.22
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Self Pay Self Pay |
$1,037.60
|
|
|
US Gallbladder
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2214185
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,167.30
|
| Rate for Payer: Aetna of AZ Medicare |
$363.16
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$194.55
|
| Rate for Payer: Amerigroup Medicare |
$194.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$484.43
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$194.55
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$194.55
|
| Rate for Payer: Bisbee Police All Plans |
$337.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$881.96
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna of AZ Commercial |
$907.90
|
| Rate for Payer: Copperpoint Commercial |
$321.01
|
| Rate for Payer: Health Net of AZ Commercial |
$778.20
|
| Rate for Payer: Health Net of AZ Medicare |
$363.16
|
| Rate for Payer: Humana of AZ Medicare |
$194.55
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$1,037.60
|
| Rate for Payer: TriWest Medicare |
$194.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$756.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$233.46
|
|
|
US Guided Liver Biopsy
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1163747
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna of AZ Commercial |
$788.40
|
| Rate for Payer: Aetna of AZ Medicare |
$245.28
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$131.40
|
| Rate for Payer: Amerigroup Medicare |
$131.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$327.19
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$131.40
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$131.40
|
| Rate for Payer: Bisbee Police All Plans |
$227.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$595.68
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cigna of AZ Commercial |
$613.20
|
| Rate for Payer: Copperpoint Commercial |
$216.81
|
| Rate for Payer: Health Net of AZ Commercial |
$525.60
|
| Rate for Payer: Health Net of AZ Medicare |
$245.28
|
| Rate for Payer: Humana of AZ Medicare |
$131.40
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$700.80
|
| Rate for Payer: TriWest Medicare |
$131.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$510.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$157.68
|
|
|
US Guided Liver Biopsy
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1163747
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$227.76 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna of AZ Commercial |
$788.40
|
| Rate for Payer: Bisbee Police All Plans |
$227.76
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Self Pay Self Pay |
$700.80
|
|
|
US Guided Lung Biopsy
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1163750
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$177.06 |
| Max. Negotiated Rate |
$612.90 |
| Rate for Payer: Aetna of AZ Commercial |
$612.90
|
| Rate for Payer: Bisbee Police All Plans |
$177.06
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Self Pay Self Pay |
$544.80
|
|
|
US Guided Lung Biopsy
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1163750
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$612.90 |
| Rate for Payer: Aetna of AZ Commercial |
$612.90
|
| Rate for Payer: Aetna of AZ Medicare |
$190.68
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$102.15
|
| Rate for Payer: Amerigroup Medicare |
$102.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$254.35
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$102.15
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$102.15
|
| Rate for Payer: Bisbee Police All Plans |
$177.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$463.08
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna of AZ Commercial |
$476.70
|
| Rate for Payer: Copperpoint Commercial |
$168.55
|
| Rate for Payer: Health Net of AZ Commercial |
$408.60
|
| Rate for Payer: Health Net of AZ Medicare |
$190.68
|
| Rate for Payer: Humana of AZ Medicare |
$102.15
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$544.80
|
| Rate for Payer: TriWest Medicare |
$102.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$397.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$122.58
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
OP
|
$841.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
823428
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.15 |
| Max. Negotiated Rate |
$756.90 |
| Rate for Payer: Aetna of AZ Commercial |
$756.90
|
| Rate for Payer: Aetna of AZ Medicare |
$235.48
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$126.15
|
| Rate for Payer: Amerigroup Medicare |
$126.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$314.11
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$126.15
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$126.15
|
| Rate for Payer: Bisbee Police All Plans |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$571.88
|
| Rate for Payer: Cash Price |
$672.80
|
| Rate for Payer: Cash Price |
$672.80
|
| Rate for Payer: Cigna of AZ Commercial |
$588.70
|
| Rate for Payer: Copperpoint Commercial |
$208.15
|
| Rate for Payer: Health Net of AZ Commercial |
$504.60
|
| Rate for Payer: Health Net of AZ Medicare |
$235.48
|
| Rate for Payer: Humana of AZ Medicare |
$126.15
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$672.80
|
| Rate for Payer: TriWest Medicare |
$126.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$490.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$151.38
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
IP
|
$841.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
823428
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$218.66 |
| Max. Negotiated Rate |
$756.90 |
| Rate for Payer: Aetna of AZ Commercial |
$756.90
|
| Rate for Payer: Bisbee Police All Plans |
$218.66
|
| Rate for Payer: Cash Price |
$672.80
|
| Rate for Payer: Self Pay Self Pay |
$672.80
|
|
|
US LE Arterial Duplex Bilateral
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 93925 50
|
| Hospital Charge Code |
823436
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$227.40 |
| Max. Negotiated Rate |
$1,364.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,364.40
|
| Rate for Payer: Aetna of AZ Medicare |
$424.48
|
| Rate for Payer: Allwell Medicare |
$227.40
|
| Rate for Payer: Amerigroup Medicare |
$227.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$566.23
|
| Rate for Payer: AZCH Complete Medicare |
$227.40
|
| Rate for Payer: Banner UC Health Medicare |
$227.40
|
| Rate for Payer: Bisbee Police All Plans |
$394.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,030.88
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,061.20
|
| Rate for Payer: Copperpoint Commercial |
$375.21
|
| Rate for Payer: Health Net of AZ Commercial |
$909.60
|
| Rate for Payer: Health Net of AZ Medicare |
$424.48
|
| Rate for Payer: Humana of AZ Medicare |
$227.40
|
| Rate for Payer: Self Pay Self Pay |
$1,212.80
|
| Rate for Payer: TriWest Medicare |
$227.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$883.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$272.88
|
|
|
US LE Arterial Duplex Bilateral
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 93925 50
|
| Hospital Charge Code |
823436
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$394.16 |
| Max. Negotiated Rate |
$1,364.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,364.40
|
| Rate for Payer: Bisbee Police All Plans |
$394.16
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Self Pay Self Pay |
$1,212.80
|
|
|
US LE Arterial Duplex Left
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
823438
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$224.12 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna of AZ Commercial |
$775.80
|
| Rate for Payer: Bisbee Police All Plans |
$224.12
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Self Pay Self Pay |
$689.60
|
|
|
US LE Arterial Duplex Left
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
823438
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$129.30 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna of AZ Commercial |
$775.80
|
| Rate for Payer: Aetna of AZ Medicare |
$241.36
|
| Rate for Payer: Allwell Medicare |
$129.30
|
| Rate for Payer: Amerigroup Medicare |
$129.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$321.96
|
| Rate for Payer: AZCH Complete Medicare |
$129.30
|
| Rate for Payer: Banner UC Health Medicare |
$129.30
|
| Rate for Payer: Bisbee Police All Plans |
$224.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$586.16
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cigna of AZ Commercial |
$603.40
|
| Rate for Payer: Copperpoint Commercial |
$213.34
|
| Rate for Payer: Health Net of AZ Commercial |
$517.20
|
| Rate for Payer: Health Net of AZ Medicare |
$241.36
|
| Rate for Payer: Humana of AZ Medicare |
$129.30
|
| Rate for Payer: Self Pay Self Pay |
$689.60
|
| Rate for Payer: TriWest Medicare |
$129.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$502.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$155.16
|
|
|
US LE Arterial Duplex Right
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
823440
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$224.12 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna of AZ Commercial |
$775.80
|
| Rate for Payer: Bisbee Police All Plans |
$224.12
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Self Pay Self Pay |
$689.60
|
|
|
US LE Arterial Duplex Right
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
823440
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$129.30 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna of AZ Commercial |
$775.80
|
| Rate for Payer: Aetna of AZ Medicare |
$241.36
|
| Rate for Payer: Allwell Medicare |
$129.30
|
| Rate for Payer: Amerigroup Medicare |
$129.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$321.96
|
| Rate for Payer: AZCH Complete Medicare |
$129.30
|
| Rate for Payer: Banner UC Health Medicare |
$129.30
|
| Rate for Payer: Bisbee Police All Plans |
$224.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$586.16
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cigna of AZ Commercial |
$603.40
|
| Rate for Payer: Copperpoint Commercial |
$213.34
|
| Rate for Payer: Health Net of AZ Commercial |
$517.20
|
| Rate for Payer: Health Net of AZ Medicare |
$241.36
|
| Rate for Payer: Humana of AZ Medicare |
$129.30
|
| Rate for Payer: Self Pay Self Pay |
$689.60
|
| Rate for Payer: TriWest Medicare |
$129.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$502.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$155.16
|
|
