|
WHITE OXYGEN DELIVERY MODULEM PEDS
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
23175701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of AZ Commercial |
$108.90
|
| Rate for Payer: Aetna of AZ Medicare |
$33.88
|
| Rate for Payer: Allwell Medicare |
$18.15
|
| Rate for Payer: Amerigroup Medicare |
$18.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$45.19
|
| Rate for Payer: AZCH Complete Medicare |
$18.15
|
| Rate for Payer: Banner UC Health Medicare |
$18.15
|
| Rate for Payer: Bisbee Police All Plans |
$31.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$82.28
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cigna of AZ Commercial |
$84.70
|
| Rate for Payer: Copperpoint Commercial |
$29.95
|
| Rate for Payer: Health Net of AZ Commercial |
$72.60
|
| Rate for Payer: Health Net of AZ Medicare |
$33.88
|
| Rate for Payer: Humana of AZ Medicare |
$18.15
|
| Rate for Payer: Self Pay Self Pay |
$96.80
|
| Rate for Payer: TriWest Medicare |
$18.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$70.54
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.78
|
|
|
WILSON RETRACTOR
|
Facility
|
IP
|
$1,629.00
|
|
| Hospital Charge Code |
23110712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.54 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,466.10
|
| Rate for Payer: Bisbee Police All Plans |
$423.54
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Self Pay Self Pay |
$1,303.20
|
|
|
WILSON RETRACTOR
|
Facility
|
OP
|
$1,629.00
|
|
| Hospital Charge Code |
23110712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.35 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,466.10
|
| Rate for Payer: Aetna of AZ Medicare |
$456.12
|
| Rate for Payer: Allwell Medicare |
$244.35
|
| Rate for Payer: Amerigroup Medicare |
$244.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$608.43
|
| Rate for Payer: AZCH Complete Medicare |
$244.35
|
| Rate for Payer: Banner UC Health Medicare |
$244.35
|
| Rate for Payer: Bisbee Police All Plans |
$423.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,107.72
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,140.30
|
| Rate for Payer: Copperpoint Commercial |
$403.18
|
| Rate for Payer: Health Net of AZ Commercial |
$977.40
|
| Rate for Payer: Health Net of AZ Medicare |
$456.12
|
| Rate for Payer: Humana of AZ Medicare |
$244.35
|
| Rate for Payer: Self Pay Self Pay |
$1,303.20
|
| Rate for Payer: TriWest Medicare |
$244.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$949.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$293.22
|
|
|
Wound Culture
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
858007
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Aetna of AZ Commercial |
$294.30
|
| Rate for Payer: Aetna of AZ Medicare |
$91.56
|
| Rate for Payer: AHCCCS Medicaid |
$8.62
|
| Rate for Payer: Allwell Medicaid |
$8.62
|
| Rate for Payer: Allwell Medicare |
$49.05
|
| Rate for Payer: Amerigroup Medicare |
$49.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$122.13
|
| Rate for Payer: AZCH Complete Medicaid |
$8.62
|
| Rate for Payer: AZCH Complete Medicare |
$49.05
|
| Rate for Payer: Banner UC Health Medicaid |
$8.62
|
| Rate for Payer: Banner UC Health Medicare |
$49.05
|
| Rate for Payer: Bisbee Police All Plans |
$85.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$222.36
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna of AZ Commercial |
$212.55
|
| Rate for Payer: Copperpoint Commercial |
$80.93
|
| Rate for Payer: Health Net of AZ Commercial |
$196.20
|
| Rate for Payer: Health Net of AZ Medicare |
$91.56
|
| Rate for Payer: Humana of AZ Medicare |
$49.05
|
| Rate for Payer: Mercy Care Medicaid |
$8.62
|
| Rate for Payer: Self Pay Self Pay |
$261.60
|
| Rate for Payer: TriWest Medicare |
$49.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$190.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$58.86
|
|
|
Wound Culture
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
858007
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.02 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Aetna of AZ Commercial |
$294.30
|
| Rate for Payer: Bisbee Police All Plans |
$85.02
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Self Pay Self Pay |
$261.60
|
|
|
Woven Ureteral Catheter Cone Tip 10Fr
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
22926427
|
|
Hospital Revenue Code
|
272
|
| 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: Allwell Medicare |
$78.75
|
| Rate for Payer: Amerigroup Medicare |
$78.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$196.09
|
| Rate for Payer: AZCH Complete Medicare |
$78.75
|
| 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: 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: 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
|
|
|
Woven Ureteral Catheter Cone Tip 10Fr
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
22926427
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
Woven Ureteral Catheter Cone Tip 8Fr
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
22926428
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
Woven Ureteral Catheter Cone Tip 8Fr
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
22926428
|
|
Hospital Revenue Code
|
272
|
| 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: Allwell Medicare |
$78.75
|
| Rate for Payer: Amerigroup Medicare |
$78.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$196.09
|
| Rate for Payer: AZCH Complete Medicare |
$78.75
|
| 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: 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: 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
|
|
|
WRIST SPLINT COCKUP
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
22354262
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of AZ Commercial |
$30.60
|
| Rate for Payer: Aetna of AZ Medicare |
$9.52
|
| Rate for Payer: Allwell Medicare |
$5.10
|
| Rate for Payer: Amerigroup Medicare |
$5.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$12.70
|
| Rate for Payer: AZCH Complete Medicare |
$5.10
|
| Rate for Payer: Banner UC Health Medicare |
$5.10
|
| Rate for Payer: Bisbee Police All Plans |
$8.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$23.12
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cigna of AZ Commercial |
$23.80
|
| Rate for Payer: Copperpoint Commercial |
$8.42
|
| Rate for Payer: Health Net of AZ Commercial |
$20.40
|
| Rate for Payer: Health Net of AZ Medicare |
$9.52
|
| Rate for Payer: Humana of AZ Medicare |
$5.10
|
| Rate for Payer: Self Pay Self Pay |
$27.20
|
| Rate for Payer: TriWest Medicare |
$5.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$19.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.12
|
|
|
WRIST SPLINT COCKUP
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
22354262
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of AZ Commercial |
$30.60
|
| Rate for Payer: Bisbee Police All Plans |
$8.84
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Self Pay Self Pay |
$27.20
|
|
|
XCEL 11MM TROCAR ENDOPATH
|
Facility
|
OP
|
$256.00
|
|
| Hospital Charge Code |
23152395
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna of AZ Commercial |
$230.40
|
| Rate for Payer: Aetna of AZ Medicare |
$71.68
|
| Rate for Payer: Allwell Medicare |
$38.40
|
| Rate for Payer: Amerigroup Medicare |
$38.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$95.62
|
| Rate for Payer: AZCH Complete Medicare |
$38.40
|
| Rate for Payer: Banner UC Health Medicare |
$38.40
|
| Rate for Payer: Bisbee Police All Plans |
$66.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$174.08
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cigna of AZ Commercial |
$179.20
|
| Rate for Payer: Copperpoint Commercial |
$63.36
|
| Rate for Payer: Health Net of AZ Commercial |
$153.60
|
| Rate for Payer: Health Net of AZ Medicare |
$71.68
|
| Rate for Payer: Humana of AZ Medicare |
$38.40
|
| Rate for Payer: Self Pay Self Pay |
$204.80
|
| Rate for Payer: TriWest Medicare |
$38.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$149.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$46.08
|
|
|
XCEL 11MM TROCAR ENDOPATH
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
23152395
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna of AZ Commercial |
$230.40
|
| Rate for Payer: Bisbee Police All Plans |
$66.56
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Self Pay Self Pay |
$204.80
|
|
|
XCEL 5MM TROCAR ENDOPATH
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
23152394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of AZ Commercial |
$180.00
|
| Rate for Payer: Aetna of AZ Medicare |
$56.00
|
| Rate for Payer: Allwell Medicare |
$30.00
|
| Rate for Payer: Amerigroup Medicare |
$30.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$74.70
|
| Rate for Payer: AZCH Complete Medicare |
$30.00
|
| Rate for Payer: Banner UC Health Medicare |
$30.00
|
| Rate for Payer: Bisbee Police All Plans |
$52.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$136.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna of AZ Commercial |
$140.00
|
| Rate for Payer: Copperpoint Commercial |
$49.50
|
| Rate for Payer: Health Net of AZ Commercial |
$120.00
|
| Rate for Payer: Health Net of AZ Medicare |
$56.00
|
| Rate for Payer: Humana of AZ Medicare |
$30.00
|
| Rate for Payer: Self Pay Self Pay |
$160.00
|
| Rate for Payer: TriWest Medicare |
$30.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$116.60
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$36.00
|
|
|
XCEL 5MM TROCAR ENDOPATH
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
23152394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of AZ Commercial |
$180.00
|
| Rate for Payer: Bisbee Police All Plans |
$52.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Self Pay Self Pay |
$160.00
|
|
|
XFORCE U30 BALLOON CATHETER 6FRX10CM
|
Facility
|
OP
|
$1,893.00
|
|
| Hospital Charge Code |
27770320
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$283.95 |
| Max. Negotiated Rate |
$1,703.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,703.70
|
| Rate for Payer: Aetna of AZ Medicare |
$530.04
|
| Rate for Payer: Allwell Medicare |
$283.95
|
| Rate for Payer: Amerigroup Medicare |
$283.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$707.04
|
| Rate for Payer: AZCH Complete Medicare |
$283.95
|
| Rate for Payer: Banner UC Health Medicare |
$283.95
|
| Rate for Payer: Bisbee Police All Plans |
$492.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,287.24
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,325.10
|
| Rate for Payer: Copperpoint Commercial |
$468.52
|
| Rate for Payer: Health Net of AZ Commercial |
$1,135.80
|
| Rate for Payer: Health Net of AZ Medicare |
$530.04
|
| Rate for Payer: Humana of AZ Medicare |
$283.95
|
| Rate for Payer: Self Pay Self Pay |
$1,514.40
|
| Rate for Payer: TriWest Medicare |
$283.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,103.62
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$340.74
|
|
|
XFORCE U30 BALLOON CATHETER 6FRX10CM
|
Facility
|
IP
|
$1,893.00
|
|
| Hospital Charge Code |
27770320
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$492.18 |
| Max. Negotiated Rate |
$1,703.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,703.70
|
| Rate for Payer: Bisbee Police All Plans |
$492.18
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Self Pay Self Pay |
$1,514.40
|
|
|
XFORCE U30 BALLOON CATHETER 6FRX4CM
|
Facility
|
IP
|
$1,893.00
|
|
| Hospital Charge Code |
27778599
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$492.18 |
| Max. Negotiated Rate |
$1,703.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,703.70
|
| Rate for Payer: Bisbee Police All Plans |
$492.18
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Self Pay Self Pay |
$1,514.40
|
|
|
XFORCE U30 BALLOON CATHETER 6FRX4CM
|
Facility
|
OP
|
$1,893.00
|
|
| Hospital Charge Code |
27778599
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$283.95 |
| Max. Negotiated Rate |
$1,703.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,703.70
|
| Rate for Payer: Aetna of AZ Medicare |
$530.04
|
| Rate for Payer: Allwell Medicare |
$283.95
|
| Rate for Payer: Amerigroup Medicare |
$283.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$707.04
|
| Rate for Payer: AZCH Complete Medicare |
$283.95
|
| Rate for Payer: Banner UC Health Medicare |
$283.95
|
| Rate for Payer: Bisbee Police All Plans |
$492.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,287.24
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,325.10
|
| Rate for Payer: Copperpoint Commercial |
$468.52
|
| Rate for Payer: Health Net of AZ Commercial |
$1,135.80
|
| Rate for Payer: Health Net of AZ Medicare |
$530.04
|
| Rate for Payer: Humana of AZ Medicare |
$283.95
|
| Rate for Payer: Self Pay Self Pay |
$1,514.40
|
| Rate for Payer: TriWest Medicare |
$283.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,103.62
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$340.74
|
|
|
XR Abdomen 1 View
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
823483
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Aetna of AZ Commercial |
$334.80
|
| Rate for Payer: Bisbee Police All Plans |
$96.72
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Self Pay Self Pay |
$297.60
|
|
|
XR Abdomen 1 View
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
823483
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Aetna of AZ Commercial |
$334.80
|
| Rate for Payer: Aetna of AZ Medicare |
$104.16
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicare |
$55.80
|
| Rate for Payer: Amerigroup Medicare |
$55.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$138.94
|
| Rate for Payer: AZCH Complete Medicaid |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$55.80
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| Rate for Payer: Banner UC Health Medicare |
$55.80
|
| Rate for Payer: Bisbee Police All Plans |
$96.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$252.96
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna of AZ Commercial |
$241.80
|
| Rate for Payer: Copperpoint Commercial |
$92.07
|
| Rate for Payer: Health Net of AZ Commercial |
$223.20
|
| Rate for Payer: Health Net of AZ Medicare |
$104.16
|
| Rate for Payer: Humana of AZ Medicare |
$55.80
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: Self Pay Self Pay |
$297.60
|
| Rate for Payer: TriWest Medicare |
$55.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$216.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$66.96
|
|
|
XR Abdomen 1 View w/Decub
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
11849879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna of AZ Commercial |
$421.20
|
| Rate for Payer: Bisbee Police All Plans |
$121.68
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Self Pay Self Pay |
$374.40
|
|
|
XR Abdomen 1 View w/Decub
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
11849879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna of AZ Commercial |
$421.20
|
| Rate for Payer: Aetna of AZ Medicare |
$131.04
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicare |
$70.20
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$174.80
|
| Rate for Payer: AZCH Complete Medicaid |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$70.20
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| Rate for Payer: Banner UC Health Medicare |
$70.20
|
| Rate for Payer: Bisbee Police All Plans |
$121.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$318.24
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cigna of AZ Commercial |
$304.20
|
| Rate for Payer: Copperpoint Commercial |
$115.83
|
| Rate for Payer: Health Net of AZ Commercial |
$280.80
|
| Rate for Payer: Health Net of AZ Medicare |
$131.04
|
| Rate for Payer: Humana of AZ Medicare |
$70.20
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: Self Pay Self Pay |
$374.40
|
| Rate for Payer: TriWest Medicare |
$70.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$272.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$84.24
|
|
|
XR Abdomen 2 Views
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
823486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$375.30 |
| Rate for Payer: Aetna of AZ Commercial |
$375.30
|
| Rate for Payer: Bisbee Police All Plans |
$108.42
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Self Pay Self Pay |
$333.60
|
|
|
XR Abdomen 2 Views
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
823486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$375.30 |
| Rate for Payer: Aetna of AZ Commercial |
$375.30
|
| Rate for Payer: Aetna of AZ Medicare |
$116.76
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$62.55
|
| Rate for Payer: Amerigroup Medicare |
$62.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$155.75
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$62.55
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$62.55
|
| Rate for Payer: Bisbee Police All Plans |
$108.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$283.56
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna of AZ Commercial |
$271.05
|
| Rate for Payer: Copperpoint Commercial |
$103.21
|
| Rate for Payer: Health Net of AZ Commercial |
$250.20
|
| Rate for Payer: Health Net of AZ Medicare |
$116.76
|
| Rate for Payer: Humana of AZ Medicare |
$62.55
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$333.60
|
| Rate for Payer: TriWest Medicare |
$62.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$243.11
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$75.06
|
|
