|
US Pregnancy Transvaginal
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
823456
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$196.04 |
| Max. Negotiated Rate |
$678.60 |
| Rate for Payer: Aetna of AZ Commercial |
$678.60
|
| Rate for Payer: Bisbee Police All Plans |
$196.04
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Self Pay Self Pay |
$603.20
|
|
|
US Renal
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
1007818
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna of AZ Commercial |
$745.20
|
| Rate for Payer: Aetna of AZ Medicare |
$231.84
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$124.20
|
| Rate for Payer: Amerigroup Medicare |
$124.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$309.26
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$124.20
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$124.20
|
| Rate for Payer: Bisbee Police All Plans |
$215.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$563.04
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna of AZ Commercial |
$579.60
|
| Rate for Payer: Copperpoint Commercial |
$204.93
|
| Rate for Payer: Health Net of AZ Commercial |
$496.80
|
| Rate for Payer: Health Net of AZ Medicare |
$231.84
|
| Rate for Payer: Humana of AZ Medicare |
$124.20
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$662.40
|
| Rate for Payer: TriWest Medicare |
$124.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$482.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$149.04
|
|
|
US Renal
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
1007818
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$215.28 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna of AZ Commercial |
$745.20
|
| Rate for Payer: Bisbee Police All Plans |
$215.28
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Self Pay Self Pay |
$662.40
|
|
|
US Retroperitoneal Complete
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
823461
|
|
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 Retroperitoneal Complete
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
823461
|
|
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 Scrotum (Contents)
|
Facility
|
IP
|
$1,087.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
823463
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$282.62 |
| Max. Negotiated Rate |
$978.30 |
| Rate for Payer: Aetna of AZ Commercial |
$978.30
|
| Rate for Payer: Bisbee Police All Plans |
$282.62
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Self Pay Self Pay |
$869.60
|
|
|
US Scrotum (Contents)
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
823463
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$978.30 |
| Rate for Payer: Aetna of AZ Commercial |
$978.30
|
| Rate for Payer: Aetna of AZ Medicare |
$304.36
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$163.05
|
| Rate for Payer: Amerigroup Medicare |
$163.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$405.99
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$163.05
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$163.05
|
| Rate for Payer: Bisbee Police All Plans |
$282.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$739.16
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cigna of AZ Commercial |
$760.90
|
| Rate for Payer: Copperpoint Commercial |
$269.03
|
| Rate for Payer: Health Net of AZ Commercial |
$652.20
|
| Rate for Payer: Health Net of AZ Medicare |
$304.36
|
| Rate for Payer: Humana of AZ Medicare |
$163.05
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$869.60
|
| Rate for Payer: TriWest Medicare |
$163.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$633.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$195.66
|
|
|
US Spleen
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2214236
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$226.20 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Aetna of AZ Commercial |
$783.00
|
| Rate for Payer: Bisbee Police All Plans |
$226.20
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Self Pay Self Pay |
$696.00
|
|
|
US Spleen
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2214236
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Aetna of AZ Commercial |
$783.00
|
| Rate for Payer: Aetna of AZ Medicare |
$243.60
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$130.50
|
| Rate for Payer: Amerigroup Medicare |
$130.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$324.94
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$130.50
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$130.50
|
| Rate for Payer: Bisbee Police All Plans |
$226.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$591.60
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna of AZ Commercial |
$609.00
|
| Rate for Payer: Copperpoint Commercial |
$215.32
|
| Rate for Payer: Health Net of AZ Commercial |
$522.00
|
| Rate for Payer: Health Net of AZ Medicare |
$243.60
|
| Rate for Payer: Humana of AZ Medicare |
$130.50
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$696.00
|
| Rate for Payer: TriWest Medicare |
$130.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$507.21
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$156.60
|
|
|
US Superficial Mass
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
1319948
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$202.54 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Aetna of AZ Commercial |
$701.10
|
| Rate for Payer: Bisbee Police All Plans |
$202.54
|
| Rate for Payer: Cash Price |
$623.20
|
| Rate for Payer: Self Pay Self Pay |
$623.20
|
|
|
US Superficial Mass
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
1319948
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$116.85 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Aetna of AZ Commercial |
$701.10
|
| Rate for Payer: Aetna of AZ Medicare |
$218.12
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$116.85
|
| Rate for Payer: Amerigroup Medicare |
$116.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$290.96
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$116.85
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$116.85
|
| Rate for Payer: Bisbee Police All Plans |
$202.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$529.72
|
| Rate for Payer: Cash Price |
$623.20
|
| Rate for Payer: Cash Price |
$623.20
|
| Rate for Payer: Cigna of AZ Commercial |
$545.30
|
| Rate for Payer: Copperpoint Commercial |
$192.80
|
| Rate for Payer: Health Net of AZ Commercial |
$467.40
|
| Rate for Payer: Health Net of AZ Medicare |
$218.12
|
| Rate for Payer: Humana of AZ Medicare |
$116.85
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$623.20
|
| Rate for Payer: TriWest Medicare |
$116.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$454.16
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$140.22
|
|
|
US Thyroid
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
1007837
|
|
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 Thyroid
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
1007837
|
|
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 Transvaginal
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
823467
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$229.06 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of AZ Commercial |
$792.90
|
| Rate for Payer: Bisbee Police All Plans |
$229.06
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Self Pay Self Pay |
$704.80
|
|
|
US Transvaginal
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
823467
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$132.15 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of AZ Commercial |
$792.90
|
| Rate for Payer: Aetna of AZ Medicare |
$246.68
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$132.15
|
| Rate for Payer: Amerigroup Medicare |
$132.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$329.05
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$132.15
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$132.15
|
| Rate for Payer: Bisbee Police All Plans |
$229.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$599.08
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cigna of AZ Commercial |
$616.70
|
| Rate for Payer: Copperpoint Commercial |
$218.05
|
| Rate for Payer: Health Net of AZ Commercial |
$528.60
|
| Rate for Payer: Health Net of AZ Medicare |
$246.68
|
| Rate for Payer: Humana of AZ Medicare |
$132.15
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$704.80
|
| Rate for Payer: TriWest Medicare |
$132.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$513.62
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$158.58
|
|
|
US UE Arterial Duplex Bilateral
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT 93930 50
|
| Hospital Charge Code |
823471
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$232.80 |
| 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: Allwell Medicare |
$232.80
|
| Rate for Payer: Amerigroup Medicare |
$232.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$579.67
|
| Rate for Payer: AZCH Complete Medicare |
$232.80
|
| 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: 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: 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 UE Arterial Duplex Bilateral
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT 93930 50
|
| Hospital Charge Code |
823471
|
|
Hospital Revenue Code
|
921
|
| 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 UE Arterial Duplex Left
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
823473
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$700.20
|
| Rate for Payer: Aetna of AZ Medicare |
$217.84
|
| Rate for Payer: Allwell Medicare |
$116.70
|
| Rate for Payer: Amerigroup Medicare |
$116.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$290.58
|
| Rate for Payer: AZCH Complete Medicare |
$116.70
|
| Rate for Payer: Banner UC Health Medicare |
$116.70
|
| Rate for Payer: Bisbee Police All Plans |
$202.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$529.04
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cigna of AZ Commercial |
$544.60
|
| Rate for Payer: Copperpoint Commercial |
$192.56
|
| Rate for Payer: Health Net of AZ Commercial |
$466.80
|
| Rate for Payer: Health Net of AZ Medicare |
$217.84
|
| Rate for Payer: Humana of AZ Medicare |
$116.70
|
| Rate for Payer: Self Pay Self Pay |
$622.40
|
| Rate for Payer: TriWest Medicare |
$116.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$453.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$140.04
|
|
|
US UE Arterial Duplex Left
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
823473
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$202.28 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$700.20
|
| Rate for Payer: Bisbee Police All Plans |
$202.28
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Self Pay Self Pay |
$622.40
|
|
|
US UE Arterial Duplex Right
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT 93931 RT
|
| Hospital Charge Code |
823475
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$202.28 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$700.20
|
| Rate for Payer: Bisbee Police All Plans |
$202.28
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Self Pay Self Pay |
$622.40
|
|
|
US UE Arterial Duplex Right
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT 93931 RT
|
| Hospital Charge Code |
823475
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$700.20
|
| Rate for Payer: Aetna of AZ Medicare |
$217.84
|
| Rate for Payer: Allwell Medicare |
$116.70
|
| Rate for Payer: Amerigroup Medicare |
$116.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$290.58
|
| Rate for Payer: AZCH Complete Medicare |
$116.70
|
| Rate for Payer: Banner UC Health Medicare |
$116.70
|
| Rate for Payer: Bisbee Police All Plans |
$202.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$529.04
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cigna of AZ Commercial |
$544.60
|
| Rate for Payer: Copperpoint Commercial |
$192.56
|
| Rate for Payer: Health Net of AZ Commercial |
$466.80
|
| Rate for Payer: Health Net of AZ Medicare |
$217.84
|
| Rate for Payer: Humana of AZ Medicare |
$116.70
|
| Rate for Payer: Self Pay Self Pay |
$622.40
|
| Rate for Payer: TriWest Medicare |
$116.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$453.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$140.04
|
|
|
US UE Venous Duplex Bilateral
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 93970 50
|
| Hospital Charge Code |
823477
|
|
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 UE Venous Duplex Bilateral
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 93970 50
|
| Hospital Charge Code |
823477
|
|
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 UE Venous Duplex Left
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
823479
|
|
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 UE Venous Duplex Left
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
823479
|
|
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
|
|
