|
US LE Venous Duplex Bilateral
|
Facility
|
OP
|
$1,728.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
823442
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$166.84 |
| Max. Negotiated Rate |
$1,555.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,555.20
|
| Rate for Payer: Aetna of AZ Medicare |
$483.84
|
| Rate for Payer: AHCCCS Medicaid |
$166.84
|
| Rate for Payer: Allwell Medicaid |
$166.84
|
| Rate for Payer: Allwell Medicare |
$276.48
|
| Rate for Payer: Amerigroup Medicare |
$276.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$645.41
|
| Rate for Payer: AZCH Complete Medicaid |
$166.84
|
| Rate for Payer: AZCH Complete Medicare |
$276.48
|
| Rate for Payer: Banner UC Health Medicaid |
$166.84
|
| Rate for Payer: Banner UC Health Medicare |
$276.48
|
| Rate for Payer: Bisbee Police All Plans |
$449.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,175.04
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,209.60
|
| Rate for Payer: Copperpoint Commercial |
$427.68
|
| Rate for Payer: Health Net of AZ Commercial |
$1,036.80
|
| Rate for Payer: Health Net of AZ Medicare |
$483.84
|
| Rate for Payer: Humana of AZ Medicare |
$276.48
|
| Rate for Payer: Mercy Care Medicaid |
$166.84
|
| Rate for Payer: Self Pay Self Pay |
$1,382.40
|
| Rate for Payer: TriWest Medicare |
$276.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,007.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$311.04
|
|
|
US LE Venous Duplex Left
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
823444
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna of AZ Commercial |
$993.60
|
| Rate for Payer: Aetna of AZ Medicare |
$309.12
|
| Rate for Payer: AHCCCS Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicare |
$176.64
|
| Rate for Payer: Amerigroup Medicare |
$176.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$412.34
|
| Rate for Payer: AZCH Complete Medicaid |
$79.00
|
| Rate for Payer: AZCH Complete Medicare |
$176.64
|
| Rate for Payer: Banner UC Health Medicaid |
$79.00
|
| Rate for Payer: Banner UC Health Medicare |
$176.64
|
| Rate for Payer: Bisbee Police All Plans |
$287.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$750.72
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna of AZ Commercial |
$772.80
|
| Rate for Payer: Copperpoint Commercial |
$273.24
|
| Rate for Payer: Health Net of AZ Commercial |
$662.40
|
| Rate for Payer: Health Net of AZ Medicare |
$309.12
|
| Rate for Payer: Humana of AZ Medicare |
$176.64
|
| Rate for Payer: Mercy Care Medicaid |
$79.00
|
| Rate for Payer: Self Pay Self Pay |
$883.20
|
| Rate for Payer: TriWest Medicare |
$176.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$643.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$198.72
|
|
|
US LE Venous Duplex Left
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
823444
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$287.04 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna of AZ Commercial |
$993.60
|
| Rate for Payer: Bisbee Police All Plans |
$287.04
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Self Pay Self Pay |
$883.20
|
|
|
US LE Venous Duplex Right
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 93971
|
| 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
|
| Hospital Charge Code |
823446
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$79.00 |
| 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: AHCCCS Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicare |
$137.92
|
| Rate for Payer: Amerigroup Medicare |
$137.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$321.96
|
| Rate for Payer: AZCH Complete Medicaid |
$79.00
|
| Rate for Payer: AZCH Complete Medicare |
$137.92
|
| Rate for Payer: Banner UC Health Medicaid |
$79.00
|
| Rate for Payer: Banner UC Health Medicare |
$137.92
|
| 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: 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 |
$137.92
|
| Rate for Payer: Mercy Care Medicaid |
$79.00
|
| Rate for Payer: Self Pay Self Pay |
$689.60
|
| Rate for Payer: TriWest Medicare |
$137.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$502.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$155.16
|
|
|
US Liver
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2214209
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$301.86 |
| Max. Negotiated Rate |
$1,044.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,044.90
|
| Rate for Payer: Bisbee Police All Plans |
$301.86
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Self Pay Self Pay |
$928.80
|
|
|
US Liver
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2214209
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$185.76 |
| Max. Negotiated Rate |
$1,044.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,044.90
|
| Rate for Payer: Aetna of AZ Medicare |
$325.08
|
| Rate for Payer: Allwell Medicare |
$185.76
|
| Rate for Payer: Amerigroup Medicare |
$185.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$433.63
|
| Rate for Payer: AZCH Complete Medicare |
$185.76
|
| Rate for Payer: Banner UC Health Medicare |
$185.76
|
| Rate for Payer: Bisbee Police All Plans |
$301.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$789.48
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cigna of AZ Commercial |
$812.70
|
| Rate for Payer: Copperpoint Commercial |
$287.35
|
| Rate for Payer: Health Net of AZ Commercial |
$696.60
|
| Rate for Payer: Health Net of AZ Medicare |
$325.08
|
| Rate for Payer: Humana of AZ Medicare |
$185.76
|
| Rate for Payer: Self Pay Self Pay |
$928.80
|
| Rate for Payer: TriWest Medicare |
$185.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$676.86
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$208.98
|
|
|
US OB<14weeks add gestational
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
3166180
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.77 |
| Max. Negotiated Rate |
$626.40 |
| Rate for Payer: Aetna of AZ Commercial |
$626.40
|
| Rate for Payer: Aetna of AZ Medicare |
$194.88
|
| Rate for Payer: AHCCCS Medicaid |
$95.77
|
| Rate for Payer: Allwell Medicaid |
$95.77
|
| Rate for Payer: Allwell Medicare |
$111.36
|
| Rate for Payer: Amerigroup Medicare |
$111.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$259.96
|
| Rate for Payer: AZCH Complete Medicaid |
$95.77
|
| Rate for Payer: AZCH Complete Medicare |
$111.36
|
| Rate for Payer: Banner UC Health Medicaid |
$95.77
|
| Rate for Payer: Banner UC Health Medicare |
$111.36
|
| Rate for Payer: Bisbee Police All Plans |
$180.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$473.28
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna of AZ Commercial |
$487.20
|
| Rate for Payer: Copperpoint Commercial |
$172.26
|
| Rate for Payer: Health Net of AZ Commercial |
$417.60
|
| Rate for Payer: Health Net of AZ Medicare |
$194.88
|
| Rate for Payer: Humana of AZ Medicare |
$111.36
|
| Rate for Payer: Mercy Care Medicaid |
$95.77
|
| Rate for Payer: Self Pay Self Pay |
$556.80
|
| Rate for Payer: TriWest Medicare |
$111.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$405.77
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$125.28
|
|
|
US OB<14weeks add gestational
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
3166180
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$626.40 |
| Rate for Payer: Aetna of AZ Commercial |
$626.40
|
| Rate for Payer: Bisbee Police All Plans |
$180.96
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Self Pay Self Pay |
$556.80
|
|
|
US OB Complete
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
1007785
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$383.24 |
| Max. Negotiated Rate |
$1,326.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,326.60
|
| Rate for Payer: Bisbee Police All Plans |
$383.24
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Self Pay Self Pay |
$1,179.20
|
|
|
US OB Complete
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
1007785
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$1,326.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,326.60
|
| Rate for Payer: Aetna of AZ Medicare |
$412.72
|
| Rate for Payer: AHCCCS Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicare |
$235.84
|
| Rate for Payer: Amerigroup Medicare |
$235.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$550.54
|
| Rate for Payer: AZCH Complete Medicaid |
$79.00
|
| Rate for Payer: AZCH Complete Medicare |
$235.84
|
| Rate for Payer: Banner UC Health Medicaid |
$79.00
|
| Rate for Payer: Banner UC Health Medicare |
$235.84
|
| Rate for Payer: Bisbee Police All Plans |
$383.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,002.32
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,031.80
|
| Rate for Payer: Copperpoint Commercial |
$364.81
|
| Rate for Payer: Health Net of AZ Commercial |
$884.40
|
| Rate for Payer: Health Net of AZ Medicare |
$412.72
|
| Rate for Payer: Humana of AZ Medicare |
$235.84
|
| Rate for Payer: Mercy Care Medicaid |
$79.00
|
| Rate for Payer: Self Pay Self Pay |
$1,179.20
|
| Rate for Payer: TriWest Medicare |
$235.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$859.34
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$265.32
|
|
|
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 Detailed Multi
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1525535
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.92 |
| 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 |
$79.00
|
| Rate for Payer: Allwell Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicare |
$65.92
|
| Rate for Payer: Amerigroup Medicare |
$65.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$153.88
|
| Rate for Payer: AZCH Complete Medicaid |
$79.00
|
| Rate for Payer: AZCH Complete Medicare |
$65.92
|
| Rate for Payer: Banner UC Health Medicaid |
$79.00
|
| Rate for Payer: Banner UC Health Medicare |
$65.92
|
| 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 |
$65.92
|
| Rate for Payer: Mercy Care Medicaid |
$79.00
|
| Rate for Payer: Self Pay Self Pay |
$329.60
|
| Rate for Payer: TriWest Medicare |
$65.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$240.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$74.16
|
|
|
US OB Follow-Up/Repeat
|
Facility
|
IP
|
$832.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
1284669
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$216.32 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna of AZ Commercial |
$748.80
|
| Rate for Payer: Bisbee Police All Plans |
$216.32
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Self Pay Self Pay |
$665.60
|
|
|
US OB Follow-Up/Repeat
|
Facility
|
OP
|
$832.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
1284669
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna of AZ Commercial |
$748.80
|
| Rate for Payer: Aetna of AZ Medicare |
$232.96
|
| Rate for Payer: AHCCCS Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicare |
$133.12
|
| Rate for Payer: Amerigroup Medicare |
$133.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$310.75
|
| Rate for Payer: AZCH Complete Medicaid |
$79.00
|
| Rate for Payer: AZCH Complete Medicare |
$133.12
|
| Rate for Payer: Banner UC Health Medicaid |
$79.00
|
| Rate for Payer: Banner UC Health Medicare |
$133.12
|
| Rate for Payer: Bisbee Police All Plans |
$216.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$565.76
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cigna of AZ Commercial |
$582.40
|
| Rate for Payer: Copperpoint Commercial |
$205.92
|
| Rate for Payer: Health Net of AZ Commercial |
$499.20
|
| Rate for Payer: Health Net of AZ Medicare |
$232.96
|
| Rate for Payer: Humana of AZ Medicare |
$133.12
|
| Rate for Payer: Mercy Care Medicaid |
$79.00
|
| Rate for Payer: Self Pay Self Pay |
$665.60
|
| Rate for Payer: TriWest Medicare |
$133.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$485.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$149.76
|
|
|
US OB Transvaginal < 14 Wks Single Gest
|
Facility
|
IP
|
$1,036.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
2214215
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$269.36 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Aetna of AZ Commercial |
$932.40
|
| Rate for Payer: Bisbee Police All Plans |
$269.36
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Self Pay Self Pay |
$828.80
|
|
|
US OB Transvaginal < 14 Wks Single Gest
|
Facility
|
OP
|
$1,036.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
2214215
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Aetna of AZ Commercial |
$932.40
|
| Rate for Payer: Aetna of AZ Medicare |
$290.08
|
| Rate for Payer: AHCCCS Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicare |
$165.76
|
| Rate for Payer: Amerigroup Medicare |
$165.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$386.95
|
| Rate for Payer: AZCH Complete Medicaid |
$79.00
|
| Rate for Payer: AZCH Complete Medicare |
$165.76
|
| Rate for Payer: Banner UC Health Medicaid |
$79.00
|
| Rate for Payer: Banner UC Health Medicare |
$165.76
|
| Rate for Payer: Bisbee Police All Plans |
$269.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$704.48
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cigna of AZ Commercial |
$725.20
|
| Rate for Payer: Copperpoint Commercial |
$256.41
|
| Rate for Payer: Health Net of AZ Commercial |
$621.60
|
| Rate for Payer: Health Net of AZ Medicare |
$290.08
|
| Rate for Payer: Humana of AZ Medicare |
$165.76
|
| Rate for Payer: Mercy Care Medicaid |
$79.00
|
| Rate for Payer: Self Pay Self Pay |
$828.80
|
| Rate for Payer: TriWest Medicare |
$165.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$603.99
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$186.48
|
|
|
US Pancreas
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
1779918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.00 |
| 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: Allwell Medicare |
$84.00
|
| Rate for Payer: Amerigroup Medicare |
$84.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$196.09
|
| Rate for Payer: AZCH Complete Medicare |
$84.00
|
| Rate for Payer: Banner UC Health Medicare |
$84.00
|
| 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: 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 |
$84.00
|
| Rate for Payer: Self Pay Self Pay |
$420.00
|
| Rate for Payer: TriWest Medicare |
$84.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$306.07
|
| 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
|
$1,291.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
823448
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$335.66 |
| Max. Negotiated Rate |
$1,161.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,161.90
|
| Rate for Payer: Bisbee Police All Plans |
$335.66
|
| Rate for Payer: Cash Price |
$1,032.80
|
| Rate for Payer: Self Pay Self Pay |
$1,032.80
|
|
|
US Pelvis Non-OB Complete
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
823448
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$206.56 |
| Max. Negotiated Rate |
$1,161.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,161.90
|
| Rate for Payer: Aetna of AZ Medicare |
$361.48
|
| Rate for Payer: Allwell Medicare |
$206.56
|
| Rate for Payer: Amerigroup Medicare |
$206.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$482.19
|
| Rate for Payer: AZCH Complete Medicare |
$206.56
|
| Rate for Payer: Banner UC Health Medicare |
$206.56
|
| Rate for Payer: Bisbee Police All Plans |
$335.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$877.88
|
| Rate for Payer: Cash Price |
$1,032.80
|
| Rate for Payer: Cigna of AZ Commercial |
$903.70
|
| Rate for Payer: Copperpoint Commercial |
$319.52
|
| Rate for Payer: Health Net of AZ Commercial |
$774.60
|
| Rate for Payer: Health Net of AZ Medicare |
$361.48
|
| Rate for Payer: Humana of AZ Medicare |
$206.56
|
| Rate for Payer: Self Pay Self Pay |
$1,032.80
|
| Rate for Payer: TriWest Medicare |
$206.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$752.65
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$232.38
|
|
|
US Pelvis Non-OB Limited
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
823450
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.18 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Aetna of AZ Commercial |
$353.70
|
| Rate for Payer: Bisbee Police All Plans |
$102.18
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Self Pay Self Pay |
$314.40
|
|
|
US Pelvis Non-OB Limited
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
823450
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Aetna of AZ Commercial |
$353.70
|
| Rate for Payer: Aetna of AZ Medicare |
$110.04
|
| Rate for Payer: Allwell Medicare |
$62.88
|
| Rate for Payer: Amerigroup Medicare |
$62.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$146.79
|
| Rate for Payer: AZCH Complete Medicare |
$62.88
|
| Rate for Payer: Banner UC Health Medicare |
$62.88
|
| Rate for Payer: Bisbee Police All Plans |
$102.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$267.24
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna of AZ Commercial |
$275.10
|
| Rate for Payer: Copperpoint Commercial |
$97.27
|
| Rate for Payer: Health Net of AZ Commercial |
$235.80
|
| Rate for Payer: Health Net of AZ Medicare |
$110.04
|
| Rate for Payer: Humana of AZ Medicare |
$62.88
|
| Rate for Payer: Self Pay Self Pay |
$314.40
|
| Rate for Payer: TriWest Medicare |
$62.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$229.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$70.74
|
|
|
US Pregnancy Transvaginal
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
823456
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$644.40 |
| Rate for Payer: Aetna of AZ Commercial |
$644.40
|
| Rate for Payer: Aetna of AZ Medicare |
$200.48
|
| Rate for Payer: AHCCCS Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicaid |
$79.00
|
| Rate for Payer: Allwell Medicare |
$114.56
|
| Rate for Payer: Amerigroup Medicare |
$114.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$267.43
|
| Rate for Payer: AZCH Complete Medicaid |
$79.00
|
| Rate for Payer: AZCH Complete Medicare |
$114.56
|
| Rate for Payer: Banner UC Health Medicaid |
$79.00
|
| Rate for Payer: Banner UC Health Medicare |
$114.56
|
| Rate for Payer: Bisbee Police All Plans |
$186.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$486.88
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cigna of AZ Commercial |
$501.20
|
| Rate for Payer: Copperpoint Commercial |
$177.21
|
| Rate for Payer: Health Net of AZ Commercial |
$429.60
|
| Rate for Payer: Health Net of AZ Medicare |
$200.48
|
| Rate for Payer: Humana of AZ Medicare |
$114.56
|
| Rate for Payer: Mercy Care Medicaid |
$79.00
|
| Rate for Payer: Self Pay Self Pay |
$572.80
|
| Rate for Payer: TriWest Medicare |
$114.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$417.43
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$128.88
|
|
|
US Pregnancy Transvaginal
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
823456
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$186.16 |
| Max. Negotiated Rate |
$644.40 |
| Rate for Payer: Aetna of AZ Commercial |
$644.40
|
| Rate for Payer: Bisbee Police All Plans |
$186.16
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Self Pay Self Pay |
$572.80
|
|
