|
US LE Venous Duplex Bilateral
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 93970 50
|
| Hospital Charge Code |
823442
|
|
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 Venous Duplex Bilateral
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 93970 50
|
| Hospital Charge Code |
823442
|
|
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 Venous Duplex Left
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
823444
|
|
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 Venous Duplex Left
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
823444
|
|
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 Venous Duplex Right
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
823446
|
|
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 Venous Duplex Right
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
823446
|
|
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 Liver
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2214209
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$317.72 |
| Max. Negotiated Rate |
$1,099.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,099.80
|
| Rate for Payer: Bisbee Police All Plans |
$317.72
|
| Rate for Payer: Cash Price |
$977.60
|
| Rate for Payer: Self Pay Self Pay |
$977.60
|
|
|
US Liver
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2214209
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$1,099.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,099.80
|
| Rate for Payer: Aetna of AZ Medicare |
$342.16
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$183.30
|
| Rate for Payer: Amerigroup Medicare |
$183.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$456.42
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$183.30
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$183.30
|
| Rate for Payer: Bisbee Police All Plans |
$317.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$830.96
|
| Rate for Payer: Cash Price |
$977.60
|
| Rate for Payer: Cash Price |
$977.60
|
| Rate for Payer: Cigna of AZ Commercial |
$855.40
|
| Rate for Payer: Copperpoint Commercial |
$302.44
|
| Rate for Payer: Health Net of AZ Commercial |
$733.20
|
| Rate for Payer: Health Net of AZ Medicare |
$342.16
|
| Rate for Payer: Humana of AZ Medicare |
$183.30
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$977.60
|
| Rate for Payer: TriWest Medicare |
$183.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$712.43
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$219.96
|
|
|
US OB<14weeks add gestational
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
3166180
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$109.95 |
| Max. Negotiated Rate |
$659.70 |
| Rate for Payer: Aetna of AZ Commercial |
$659.70
|
| Rate for Payer: Aetna of AZ Medicare |
$205.24
|
| Rate for Payer: AHCCCS Medicaid |
$191.54
|
| Rate for Payer: Allwell Medicaid |
$191.54
|
| Rate for Payer: Allwell Medicare |
$109.95
|
| Rate for Payer: Amerigroup Medicare |
$109.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$273.78
|
| Rate for Payer: AZCH Complete Medicaid |
$191.54
|
| Rate for Payer: AZCH Complete Medicare |
$109.95
|
| Rate for Payer: Banner UC Health Medicaid |
$191.54
|
| Rate for Payer: Banner UC Health Medicare |
$109.95
|
| Rate for Payer: Bisbee Police All Plans |
$190.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$498.44
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cigna of AZ Commercial |
$513.10
|
| Rate for Payer: Copperpoint Commercial |
$181.42
|
| Rate for Payer: Health Net of AZ Commercial |
$439.80
|
| Rate for Payer: Health Net of AZ Medicare |
$205.24
|
| Rate for Payer: Humana of AZ Medicare |
$109.95
|
| Rate for Payer: Mercy Care Medicaid |
$191.54
|
| Rate for Payer: Self Pay Self Pay |
$586.40
|
| Rate for Payer: TriWest Medicare |
$109.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$427.34
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$131.94
|
|
|
US OB<14weeks add gestational
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
3166180
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$190.58 |
| Max. Negotiated Rate |
$659.70 |
| Rate for Payer: Aetna of AZ Commercial |
$659.70
|
| Rate for Payer: Bisbee Police All Plans |
$190.58
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Self Pay Self Pay |
$586.40
|
|
|
US OB Complete
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
1007785
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,396.80
|
| Rate for Payer: Aetna of AZ Medicare |
$434.56
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$232.80
|
| Rate for Payer: Amerigroup Medicare |
$232.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$579.67
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$232.80
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$232.80
|
| Rate for Payer: Bisbee Police All Plans |
$403.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,055.36
|
| Rate for Payer: Cash Price |
$1,241.60
|
| Rate for Payer: Cash Price |
$1,241.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,086.40
|
| Rate for Payer: Copperpoint Commercial |
$384.12
|
| Rate for Payer: Health Net of AZ Commercial |
$931.20
|
| Rate for Payer: Health Net of AZ Medicare |
$434.56
|
| Rate for Payer: Humana of AZ Medicare |
$232.80
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$1,241.60
|
| Rate for Payer: TriWest Medicare |
$232.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$904.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$279.36
|
|
|
US OB Complete
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
1007785
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$403.52 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,396.80
|
| Rate for Payer: Bisbee Police All Plans |
$403.52
|
| Rate for Payer: Cash Price |
$1,241.60
|
| Rate for Payer: Self Pay Self Pay |
$1,241.60
|
|
|
US OB Detailed Multi
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1525535
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Aetna of AZ Commercial |
$370.80
|
| Rate for Payer: Aetna of AZ Medicare |
$115.36
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$61.80
|
| Rate for Payer: Amerigroup Medicare |
$61.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$153.88
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$61.80
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$61.80
|
| Rate for Payer: Bisbee Police All Plans |
$107.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$280.16
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cigna of AZ Commercial |
$288.40
|
| Rate for Payer: Copperpoint Commercial |
$101.97
|
| Rate for Payer: Health Net of AZ Commercial |
$247.20
|
| Rate for Payer: Health Net of AZ Medicare |
$115.36
|
| Rate for Payer: Humana of AZ Medicare |
$61.80
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$329.60
|
| Rate for Payer: TriWest Medicare |
$61.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$240.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$74.16
|
|
|
US OB Detailed Multi
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1525535
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.12 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Aetna of AZ Commercial |
$370.80
|
| Rate for Payer: Bisbee Police All Plans |
$107.12
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Self Pay Self Pay |
$329.60
|
|
|
US OB Follow-Up/Repeat
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
1284669
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.40 |
| 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 |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| 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 |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$131.40
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| 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 |
$158.00
|
| 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 OB Follow-Up/Repeat
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
1284669
|
|
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 OB Transvaginal < 14 Wks Single Gest
|
Facility
|
IP
|
$1,091.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
2214215
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$283.66 |
| Max. Negotiated Rate |
$981.90 |
| Rate for Payer: Aetna of AZ Commercial |
$981.90
|
| Rate for Payer: Bisbee Police All Plans |
$283.66
|
| Rate for Payer: Cash Price |
$872.80
|
| Rate for Payer: Self Pay Self Pay |
$872.80
|
|
|
US OB Transvaginal < 14 Wks Single Gest
|
Facility
|
OP
|
$1,091.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
2214215
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$981.90 |
| Rate for Payer: Aetna of AZ Commercial |
$981.90
|
| Rate for Payer: Aetna of AZ Medicare |
$305.48
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$163.65
|
| Rate for Payer: Amerigroup Medicare |
$163.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$407.49
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$163.65
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$163.65
|
| Rate for Payer: Bisbee Police All Plans |
$283.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$741.88
|
| Rate for Payer: Cash Price |
$872.80
|
| Rate for Payer: Cash Price |
$872.80
|
| Rate for Payer: Cigna of AZ Commercial |
$763.70
|
| Rate for Payer: Copperpoint Commercial |
$270.02
|
| Rate for Payer: Health Net of AZ Commercial |
$654.60
|
| Rate for Payer: Health Net of AZ Medicare |
$305.48
|
| Rate for Payer: Humana of AZ Medicare |
$163.65
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$872.80
|
| Rate for Payer: TriWest Medicare |
$163.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$636.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$196.38
|
|
|
US Pancreas
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
1779918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna of AZ Commercial |
$472.50
|
| Rate for Payer: Aetna of AZ Medicare |
$147.00
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$78.75
|
| Rate for Payer: Amerigroup Medicare |
$78.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$196.09
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$78.75
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$78.75
|
| Rate for Payer: Bisbee Police All Plans |
$136.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$357.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna of AZ Commercial |
$367.50
|
| Rate for Payer: Copperpoint Commercial |
$129.94
|
| Rate for Payer: Health Net of AZ Commercial |
$315.00
|
| Rate for Payer: Health Net of AZ Medicare |
$147.00
|
| Rate for Payer: Humana of AZ Medicare |
$78.75
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$420.00
|
| Rate for Payer: TriWest Medicare |
$78.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$306.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$94.50
|
|
|
US Pancreas
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
1779918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna of AZ Commercial |
$472.50
|
| Rate for Payer: Bisbee Police All Plans |
$136.50
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Self Pay Self Pay |
$420.00
|
|
|
US Pelvis Non-OB Complete
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
823448
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$353.34 |
| Max. Negotiated Rate |
$1,223.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,223.10
|
| Rate for Payer: Bisbee Police All Plans |
$353.34
|
| Rate for Payer: Cash Price |
$1,087.20
|
| Rate for Payer: Self Pay Self Pay |
$1,087.20
|
|
|
US Pelvis Non-OB Complete
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
823448
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$1,223.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,223.10
|
| Rate for Payer: Aetna of AZ Medicare |
$380.52
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$203.85
|
| Rate for Payer: Amerigroup Medicare |
$203.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$507.59
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$203.85
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$203.85
|
| Rate for Payer: Bisbee Police All Plans |
$353.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$924.12
|
| Rate for Payer: Cash Price |
$1,087.20
|
| Rate for Payer: Cash Price |
$1,087.20
|
| Rate for Payer: Cigna of AZ Commercial |
$951.30
|
| Rate for Payer: Copperpoint Commercial |
$336.35
|
| Rate for Payer: Health Net of AZ Commercial |
$815.40
|
| Rate for Payer: Health Net of AZ Medicare |
$380.52
|
| Rate for Payer: Humana of AZ Medicare |
$203.85
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$1,087.20
|
| Rate for Payer: TriWest Medicare |
$203.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$792.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$244.62
|
|
|
US Pelvis Non-OB Limited
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
823450
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of AZ Commercial |
$372.60
|
| Rate for Payer: Bisbee Police All Plans |
$107.64
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Self Pay Self Pay |
$331.20
|
|
|
US Pelvis Non-OB Limited
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
823450
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of AZ Commercial |
$372.60
|
| Rate for Payer: Aetna of AZ Medicare |
$115.92
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$62.10
|
| Rate for Payer: Amerigroup Medicare |
$62.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$154.63
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$62.10
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$62.10
|
| Rate for Payer: Bisbee Police All Plans |
$107.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$281.52
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna of AZ Commercial |
$289.80
|
| Rate for Payer: Copperpoint Commercial |
$102.46
|
| Rate for Payer: Health Net of AZ Commercial |
$248.40
|
| Rate for Payer: Health Net of AZ Medicare |
$115.92
|
| Rate for Payer: Humana of AZ Medicare |
$62.10
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$331.20
|
| Rate for Payer: TriWest Medicare |
$62.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$241.36
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$74.52
|
|
|
US Pregnancy Transvaginal
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
823456
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$678.60 |
| Rate for Payer: Aetna of AZ Commercial |
$678.60
|
| Rate for Payer: Aetna of AZ Medicare |
$211.12
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$113.10
|
| Rate for Payer: Amerigroup Medicare |
$113.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$281.62
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$113.10
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$113.10
|
| Rate for Payer: Bisbee Police All Plans |
$196.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$512.72
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cigna of AZ Commercial |
$527.80
|
| Rate for Payer: Copperpoint Commercial |
$186.62
|
| Rate for Payer: Health Net of AZ Commercial |
$452.40
|
| Rate for Payer: Health Net of AZ Medicare |
$211.12
|
| Rate for Payer: Humana of AZ Medicare |
$113.10
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$603.20
|
| Rate for Payer: TriWest Medicare |
$113.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$439.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$135.72
|
|
