|
TUBING BUBBLE
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
22355703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$44.10
|
| Rate for Payer: Aetna of AZ Medicare |
$13.72
|
| Rate for Payer: Allwell Medicare |
$7.84
|
| Rate for Payer: Amerigroup Medicare |
$7.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$18.30
|
| Rate for Payer: AZCH Complete Medicare |
$7.84
|
| Rate for Payer: Banner UC Health Medicare |
$7.84
|
| Rate for Payer: Bisbee Police All Plans |
$12.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$33.32
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cigna of AZ Commercial |
$34.30
|
| Rate for Payer: Copperpoint Commercial |
$12.13
|
| Rate for Payer: Health Net of AZ Commercial |
$29.40
|
| Rate for Payer: Health Net of AZ Medicare |
$13.72
|
| Rate for Payer: Humana of AZ Medicare |
$7.84
|
| Rate for Payer: Self Pay Self Pay |
$39.20
|
| Rate for Payer: TriWest Medicare |
$7.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.82
|
|
|
TUBING BUBBLE
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
22355703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of AZ Commercial |
$44.10
|
| Rate for Payer: Bisbee Police All Plans |
$12.74
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Self Pay Self Pay |
$39.20
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
22545741
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.16 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Aetna of AZ Commercial |
$360.90
|
| Rate for Payer: Aetna of AZ Medicare |
$112.28
|
| Rate for Payer: Allwell Medicare |
$64.16
|
| Rate for Payer: Amerigroup Medicare |
$64.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$149.77
|
| Rate for Payer: AZCH Complete Medicare |
$64.16
|
| Rate for Payer: Banner UC Health Medicare |
$64.16
|
| Rate for Payer: Bisbee Police All Plans |
$104.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$272.68
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cigna of AZ Commercial |
$260.65
|
| Rate for Payer: Copperpoint Commercial |
$99.25
|
| Rate for Payer: Health Net of AZ Commercial |
$240.60
|
| Rate for Payer: Health Net of AZ Medicare |
$112.28
|
| Rate for Payer: Humana of AZ Medicare |
$64.16
|
| Rate for Payer: Self Pay Self Pay |
$320.80
|
| Rate for Payer: TriWest Medicare |
$64.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$233.78
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$72.18
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
22545741
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$104.26 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Aetna of AZ Commercial |
$360.90
|
| Rate for Payer: Bisbee Police All Plans |
$104.26
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Self Pay Self Pay |
$320.80
|
|
|
TVH/BSO
|
Facility
|
OP
|
$5,056.00
|
|
|
Service Code
|
CPT 58262
|
| Hospital Charge Code |
27281886
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$808.96 |
| Max. Negotiated Rate |
$4,550.40 |
| Rate for Payer: Aetna of AZ Commercial |
$4,550.40
|
| Rate for Payer: Aetna of AZ Medicare |
$1,415.68
|
| Rate for Payer: AHCCCS Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicare |
$808.96
|
| Rate for Payer: Amerigroup Medicare |
$808.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,888.42
|
| Rate for Payer: AZCH Complete Medicaid |
$3,196.92
|
| Rate for Payer: AZCH Complete Medicare |
$808.96
|
| Rate for Payer: Banner UC Health Medicaid |
$3,196.92
|
| Rate for Payer: Banner UC Health Medicare |
$808.96
|
| Rate for Payer: Bisbee Police All Plans |
$1,314.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,438.08
|
| Rate for Payer: Cash Price |
$4,044.80
|
| Rate for Payer: Cash Price |
$4,044.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,528.00
|
| Rate for Payer: Copperpoint Commercial |
$1,251.36
|
| Rate for Payer: Health Net of AZ Commercial |
$3,033.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,415.68
|
| Rate for Payer: Humana of AZ Medicare |
$808.96
|
| Rate for Payer: Mercy Care Medicaid |
$3,196.92
|
| Rate for Payer: Self Pay Self Pay |
$4,044.80
|
| Rate for Payer: TriWest Medicare |
$808.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,947.65
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$910.08
|
|
|
TVH/BSO
|
Facility
|
IP
|
$5,056.00
|
|
|
Service Code
|
CPT 58262
|
| Hospital Charge Code |
27281886
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,314.56 |
| Max. Negotiated Rate |
$4,550.40 |
| Rate for Payer: Aetna of AZ Commercial |
$4,550.40
|
| Rate for Payer: Bisbee Police All Plans |
$1,314.56
|
| Rate for Payer: Cash Price |
$4,044.80
|
| Rate for Payer: Self Pay Self Pay |
$4,044.80
|
|
|
TVH/BSO w/enterocele
|
Facility
|
IP
|
$4,877.00
|
|
|
Service Code
|
CPT 58270
|
| Hospital Charge Code |
27281887
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,268.02 |
| Max. Negotiated Rate |
$4,389.30 |
| Rate for Payer: Aetna of AZ Commercial |
$4,389.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,268.02
|
| Rate for Payer: Cash Price |
$3,901.60
|
| Rate for Payer: Self Pay Self Pay |
$3,901.60
|
|
|
TVH/BSO w/enterocele
|
Facility
|
OP
|
$4,877.00
|
|
|
Service Code
|
CPT 58270
|
| Hospital Charge Code |
27281887
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.32 |
| Max. Negotiated Rate |
$4,389.30 |
| Rate for Payer: Aetna of AZ Commercial |
$4,389.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,365.56
|
| Rate for Payer: AHCCCS Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicare |
$780.32
|
| Rate for Payer: Amerigroup Medicare |
$780.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,821.56
|
| Rate for Payer: AZCH Complete Medicaid |
$3,196.92
|
| Rate for Payer: AZCH Complete Medicare |
$780.32
|
| Rate for Payer: Banner UC Health Medicaid |
$3,196.92
|
| Rate for Payer: Banner UC Health Medicare |
$780.32
|
| Rate for Payer: Bisbee Police All Plans |
$1,268.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,316.36
|
| Rate for Payer: Cash Price |
$3,901.60
|
| Rate for Payer: Cash Price |
$3,901.60
|
| Rate for Payer: Cigna of AZ Commercial |
$2,438.50
|
| Rate for Payer: Copperpoint Commercial |
$1,207.06
|
| Rate for Payer: Health Net of AZ Commercial |
$2,926.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,365.56
|
| Rate for Payer: Humana of AZ Medicare |
$780.32
|
| Rate for Payer: Mercy Care Medicaid |
$3,196.92
|
| Rate for Payer: Self Pay Self Pay |
$3,901.60
|
| Rate for Payer: TriWest Medicare |
$780.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,843.29
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$877.86
|
|
|
TVH w/vaginectomy (colpocleisis)
|
Facility
|
IP
|
$5,402.00
|
|
|
Service Code
|
CPT 58275
|
| Hospital Charge Code |
27281888
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,404.52 |
| Max. Negotiated Rate |
$4,861.80 |
| Rate for Payer: Aetna of AZ Commercial |
$4,861.80
|
| Rate for Payer: Bisbee Police All Plans |
$1,404.52
|
| Rate for Payer: Cash Price |
$4,321.60
|
| Rate for Payer: Self Pay Self Pay |
$4,321.60
|
|
|
TVH w/vaginectomy (colpocleisis)
|
Facility
|
OP
|
$5,402.00
|
|
|
Service Code
|
CPT 58275
|
| Hospital Charge Code |
27281888
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$864.32 |
| Max. Negotiated Rate |
$4,861.80 |
| Rate for Payer: Aetna of AZ Commercial |
$4,861.80
|
| Rate for Payer: Aetna of AZ Medicare |
$1,512.56
|
| Rate for Payer: Allwell Medicare |
$864.32
|
| Rate for Payer: Amerigroup Medicare |
$864.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,017.65
|
| Rate for Payer: AZCH Complete Medicare |
$864.32
|
| Rate for Payer: Banner UC Health Medicare |
$864.32
|
| Rate for Payer: Bisbee Police All Plans |
$1,404.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,673.36
|
| Rate for Payer: Cash Price |
$4,321.60
|
| Rate for Payer: Cigna of AZ Commercial |
$2,701.00
|
| Rate for Payer: Copperpoint Commercial |
$1,336.99
|
| Rate for Payer: Health Net of AZ Commercial |
$3,241.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,512.56
|
| Rate for Payer: Humana of AZ Medicare |
$864.32
|
| Rate for Payer: Self Pay Self Pay |
$4,321.60
|
| Rate for Payer: TriWest Medicare |
$864.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,149.37
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$972.36
|
|
|
TWIN CATH 18/20 MULT-LUMEN PERIPH CATH
|
Facility
|
OP
|
$103.00
|
|
| Hospital Charge Code |
22355400
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.48 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of AZ Commercial |
$92.70
|
| Rate for Payer: Aetna of AZ Medicare |
$28.84
|
| Rate for Payer: Allwell Medicare |
$16.48
|
| Rate for Payer: Amerigroup Medicare |
$16.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$38.47
|
| Rate for Payer: AZCH Complete Medicare |
$16.48
|
| Rate for Payer: Banner UC Health Medicare |
$16.48
|
| Rate for Payer: Bisbee Police All Plans |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$70.04
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cigna of AZ Commercial |
$72.10
|
| Rate for Payer: Copperpoint Commercial |
$25.49
|
| Rate for Payer: Health Net of AZ Commercial |
$61.80
|
| Rate for Payer: Health Net of AZ Medicare |
$28.84
|
| Rate for Payer: Humana of AZ Medicare |
$16.48
|
| Rate for Payer: Self Pay Self Pay |
$82.40
|
| Rate for Payer: TriWest Medicare |
$16.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$60.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.54
|
|
|
TWIN CATH 18/20 MULT-LUMEN PERIPH CATH
|
Facility
|
IP
|
$103.00
|
|
| Hospital Charge Code |
22355400
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of AZ Commercial |
$92.70
|
| Rate for Payer: Bisbee Police All Plans |
$26.78
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Self Pay Self Pay |
$82.40
|
|
|
TWIN-CATH 20/22 MULT-LUMEN PERIPH CATH
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
22355399
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of AZ Commercial |
$93.60
|
| Rate for Payer: Aetna of AZ Medicare |
$29.12
|
| Rate for Payer: Allwell Medicare |
$16.64
|
| Rate for Payer: Amerigroup Medicare |
$16.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$38.84
|
| Rate for Payer: AZCH Complete Medicare |
$16.64
|
| Rate for Payer: Banner UC Health Medicare |
$16.64
|
| Rate for Payer: Bisbee Police All Plans |
$27.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$70.72
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cigna of AZ Commercial |
$72.80
|
| Rate for Payer: Copperpoint Commercial |
$25.74
|
| Rate for Payer: Health Net of AZ Commercial |
$62.40
|
| Rate for Payer: Health Net of AZ Medicare |
$29.12
|
| Rate for Payer: Humana of AZ Medicare |
$16.64
|
| Rate for Payer: Self Pay Self Pay |
$83.20
|
| Rate for Payer: TriWest Medicare |
$16.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$60.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.72
|
|
|
TWIN-CATH 20/22 MULT-LUMEN PERIPH CATH
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
22355399
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of AZ Commercial |
$93.60
|
| Rate for Payer: Bisbee Police All Plans |
$27.04
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Self Pay Self Pay |
$83.20
|
|
|
U24 Microalbumin/Creat
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
1279989
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of AZ Commercial |
$123.30
|
| Rate for Payer: Aetna of AZ Medicare |
$38.36
|
| Rate for Payer: Allwell Medicare |
$21.92
|
| Rate for Payer: Amerigroup Medicare |
$21.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$51.17
|
| Rate for Payer: AZCH Complete Medicare |
$21.92
|
| Rate for Payer: Banner UC Health Medicare |
$21.92
|
| Rate for Payer: Bisbee Police All Plans |
$35.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$93.16
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cigna of AZ Commercial |
$89.05
|
| Rate for Payer: Copperpoint Commercial |
$33.91
|
| Rate for Payer: Health Net of AZ Commercial |
$82.20
|
| Rate for Payer: Health Net of AZ Medicare |
$38.36
|
| Rate for Payer: Humana of AZ Medicare |
$21.92
|
| Rate for Payer: Self Pay Self Pay |
$109.60
|
| Rate for Payer: TriWest Medicare |
$21.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$79.87
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$24.66
|
|
|
U24 Microalbumin/Creat
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
1279989
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of AZ Commercial |
$123.30
|
| Rate for Payer: Bisbee Police All Plans |
$35.62
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Self Pay Self Pay |
$109.60
|
|
|
UA Micro Standard
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
22207838
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of AZ Commercial |
$33.30
|
| Rate for Payer: Bisbee Police All Plans |
$9.62
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Self Pay Self Pay |
$29.60
|
|
|
UA Micro Standard
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
22207838
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of AZ Commercial |
$33.30
|
| Rate for Payer: Aetna of AZ Medicare |
$10.36
|
| Rate for Payer: Allwell Medicare |
$5.92
|
| Rate for Payer: Amerigroup Medicare |
$5.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$13.82
|
| Rate for Payer: AZCH Complete Medicare |
$5.92
|
| Rate for Payer: Banner UC Health Medicare |
$5.92
|
| Rate for Payer: Bisbee Police All Plans |
$9.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$25.16
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cigna of AZ Commercial |
$24.05
|
| Rate for Payer: Copperpoint Commercial |
$9.16
|
| Rate for Payer: Health Net of AZ Commercial |
$22.20
|
| Rate for Payer: Health Net of AZ Medicare |
$10.36
|
| Rate for Payer: Humana of AZ Medicare |
$5.92
|
| Rate for Payer: Self Pay Self Pay |
$29.60
|
| Rate for Payer: TriWest Medicare |
$5.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$21.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.66
|
|
|
UA/M w/rflx Culture, Routine LC
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
22311208
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Aetna of AZ Medicare |
$23.52
|
| Rate for Payer: Allwell Medicare |
$13.44
|
| Rate for Payer: Amerigroup Medicare |
$13.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$31.37
|
| Rate for Payer: AZCH Complete Medicare |
$13.44
|
| Rate for Payer: Banner UC Health Medicare |
$13.44
|
| Rate for Payer: Bisbee Police All Plans |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$57.12
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna of AZ Commercial |
$54.60
|
| Rate for Payer: Copperpoint Commercial |
$20.79
|
| Rate for Payer: Health Net of AZ Commercial |
$50.40
|
| Rate for Payer: Health Net of AZ Medicare |
$23.52
|
| Rate for Payer: Humana of AZ Medicare |
$13.44
|
| Rate for Payer: Self Pay Self Pay |
$67.20
|
| Rate for Payer: TriWest Medicare |
$13.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$48.97
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.12
|
|
|
UA/M w/rflx Culture, Routine LC
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
22311208
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Bisbee Police All Plans |
$21.84
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Self Pay Self Pay |
$67.20
|
|
|
ULTRASOUND NEEDLE 21G X 3 IN
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
27554884
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of AZ Commercial |
$52.20
|
| Rate for Payer: Bisbee Police All Plans |
$15.08
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Self Pay Self Pay |
$46.40
|
|
|
ULTRASOUND NEEDLE 21G X 3 IN
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
27554884
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of AZ Commercial |
$52.20
|
| Rate for Payer: Aetna of AZ Medicare |
$16.24
|
| Rate for Payer: Allwell Medicare |
$9.28
|
| Rate for Payer: Amerigroup Medicare |
$9.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$21.66
|
| Rate for Payer: AZCH Complete Medicare |
$9.28
|
| Rate for Payer: Banner UC Health Medicare |
$9.28
|
| Rate for Payer: Bisbee Police All Plans |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$39.44
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cigna of AZ Commercial |
$40.60
|
| Rate for Payer: Copperpoint Commercial |
$14.36
|
| Rate for Payer: Health Net of AZ Commercial |
$34.80
|
| Rate for Payer: Health Net of AZ Medicare |
$16.24
|
| Rate for Payer: Humana of AZ Medicare |
$9.28
|
| Rate for Payer: Self Pay Self Pay |
$46.40
|
| Rate for Payer: TriWest Medicare |
$9.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$33.81
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.44
|
|
|
ULTRASOUND SCAN OF ORGAN TISSUE FOR MEASURING ELASTICITY
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
22282742
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna of AZ Commercial |
$756.00
|
| Rate for Payer: Aetna of AZ Medicare |
$235.20
|
| Rate for Payer: Allwell Medicare |
$134.40
|
| Rate for Payer: Amerigroup Medicare |
$134.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$313.74
|
| Rate for Payer: AZCH Complete Medicare |
$134.40
|
| Rate for Payer: Banner UC Health Medicare |
$134.40
|
| Rate for Payer: Bisbee Police All Plans |
$218.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$571.20
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cigna of AZ Commercial |
$588.00
|
| Rate for Payer: Copperpoint Commercial |
$207.90
|
| Rate for Payer: Health Net of AZ Commercial |
$504.00
|
| Rate for Payer: Health Net of AZ Medicare |
$235.20
|
| Rate for Payer: Humana of AZ Medicare |
$134.40
|
| Rate for Payer: Self Pay Self Pay |
$672.00
|
| Rate for Payer: TriWest Medicare |
$134.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$489.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$151.20
|
|
|
ULTRASOUND SCAN OF ORGAN TISSUE FOR MEASURING ELASTICITY
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
22282742
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna of AZ Commercial |
$756.00
|
| Rate for Payer: Bisbee Police All Plans |
$218.40
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Self Pay Self Pay |
$672.00
|
|
|
UNIHEART LO FLOW NEB
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
22355556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Aetna of AZ Medicare |
$11.48
|
| Rate for Payer: Allwell Medicare |
$6.56
|
| Rate for Payer: Amerigroup Medicare |
$6.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.31
|
| Rate for Payer: AZCH Complete Medicare |
$6.56
|
| Rate for Payer: Banner UC Health Medicare |
$6.56
|
| Rate for Payer: Bisbee Police All Plans |
$10.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$27.88
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cigna of AZ Commercial |
$28.70
|
| Rate for Payer: Copperpoint Commercial |
$10.15
|
| Rate for Payer: Health Net of AZ Commercial |
$24.60
|
| Rate for Payer: Health Net of AZ Medicare |
$11.48
|
| Rate for Payer: Humana of AZ Medicare |
$6.56
|
| Rate for Payer: Self Pay Self Pay |
$32.80
|
| Rate for Payer: TriWest Medicare |
$6.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$23.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.38
|
|