|
XR Orbits Complete Right
|
Facility
IP
|
$972.00
|
|
|
Service Code
|
CPT 70200 RT
|
| Hospital Charge Code |
1163870
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.72 |
| Max. Negotiated Rate |
$874.80 |
| Rate for Payer: Aetna of AZ Commercial |
$874.80
|
| Rate for Payer: Bisbee Police All Plans |
$252.72
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Self Pay Self Pay |
$777.60
|
|
|
XR Pelvis 1 View
|
Facility
OP
|
$357.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
1319989
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna of AZ Commercial |
$321.30
|
| Rate for Payer: Aetna of AZ Medicare |
$99.96
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$53.55
|
| Rate for Payer: Amerigroup Medicare |
$53.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$133.34
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$53.55
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$53.55
|
| Rate for Payer: Bisbee Police All Plans |
$92.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$242.76
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna of AZ Commercial |
$232.05
|
| Rate for Payer: Copperpoint Commercial |
$88.36
|
| Rate for Payer: Health Net of AZ Commercial |
$214.20
|
| Rate for Payer: Health Net of AZ Medicare |
$99.96
|
| Rate for Payer: Humana of AZ Medicare |
$53.55
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$285.60
|
| Rate for Payer: TriWest Medicare |
$53.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$208.13
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$64.26
|
|
|
XR Pelvis 1 View
|
Facility
IP
|
$357.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
1319989
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna of AZ Commercial |
$321.30
|
| Rate for Payer: Bisbee Police All Plans |
$92.82
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Self Pay Self Pay |
$285.60
|
|
|
XR Pelvis Complete Minimum 3 Views
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
1021656
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna of AZ Commercial |
$525.60
|
| Rate for Payer: Aetna of AZ Medicare |
$163.52
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$87.60
|
| Rate for Payer: Amerigroup Medicare |
$87.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$218.12
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$87.60
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$87.60
|
| Rate for Payer: Bisbee Police All Plans |
$151.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$397.12
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cigna of AZ Commercial |
$379.60
|
| Rate for Payer: Copperpoint Commercial |
$144.54
|
| Rate for Payer: Health Net of AZ Commercial |
$350.40
|
| Rate for Payer: Health Net of AZ Medicare |
$163.52
|
| Rate for Payer: Humana of AZ Medicare |
$87.60
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$467.20
|
| Rate for Payer: TriWest Medicare |
$87.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$340.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$105.12
|
|
|
XR Pelvis Complete Minimum 3 Views
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
1021656
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.84 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna of AZ Commercial |
$525.60
|
| Rate for Payer: Bisbee Police All Plans |
$151.84
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Self Pay Self Pay |
$467.20
|
|
|
XR Radiological Specimen
|
Facility
OP
|
$226.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
2214272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$203.40
|
| Rate for Payer: Aetna of AZ Medicare |
$63.28
|
| Rate for Payer: AHCCCS Medicaid |
$700.20
|
| Rate for Payer: Allwell Medicaid |
$700.20
|
| Rate for Payer: Allwell Medicare |
$33.90
|
| Rate for Payer: Amerigroup Medicare |
$33.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$84.41
|
| Rate for Payer: AZCH Complete Medicaid |
$700.20
|
| Rate for Payer: AZCH Complete Medicare |
$33.90
|
| Rate for Payer: Banner UC Health Medicaid |
$700.20
|
| Rate for Payer: Banner UC Health Medicare |
$33.90
|
| Rate for Payer: Bisbee Police All Plans |
$58.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$153.68
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cigna of AZ Commercial |
$146.90
|
| Rate for Payer: Copperpoint Commercial |
$55.94
|
| Rate for Payer: Health Net of AZ Commercial |
$135.60
|
| Rate for Payer: Health Net of AZ Medicare |
$63.28
|
| Rate for Payer: Humana of AZ Medicare |
$33.90
|
| Rate for Payer: Mercy Care Medicaid |
$700.20
|
| Rate for Payer: Self Pay Self Pay |
$180.80
|
| Rate for Payer: TriWest Medicare |
$33.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$131.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.68
|
|
|
XR Radiological Specimen
|
Facility
IP
|
$226.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
2214272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna of AZ Commercial |
$203.40
|
| Rate for Payer: Bisbee Police All Plans |
$58.76
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Self Pay Self Pay |
$180.80
|
|
|
XR Ribs 3 Views Left
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 71100 LT
|
| Hospital Charge Code |
7003381
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
|
|
XR Ribs 3 Views Left
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 71100 LT
|
| Hospital Charge Code |
7003381
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Aetna of AZ Medicare |
$136.64
|
| Rate for Payer: Allwell Medicare |
$73.20
|
| Rate for Payer: Amerigroup Medicare |
$73.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$182.27
|
| Rate for Payer: AZCH Complete Medicare |
$73.20
|
| Rate for Payer: Banner UC Health Medicare |
$73.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$331.84
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cigna of AZ Commercial |
$317.20
|
| Rate for Payer: Copperpoint Commercial |
$120.78
|
| Rate for Payer: Health Net of AZ Commercial |
$292.80
|
| Rate for Payer: Health Net of AZ Medicare |
$136.64
|
| Rate for Payer: Humana of AZ Medicare |
$73.20
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
| Rate for Payer: TriWest Medicare |
$73.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$284.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$87.84
|
|
|
XR Ribs 3 Views Right
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 71100 RT
|
| Hospital Charge Code |
7003384
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
|
|
XR Ribs 3 Views Right
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 71100 RT
|
| Hospital Charge Code |
7003384
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Aetna of AZ Medicare |
$136.64
|
| Rate for Payer: Allwell Medicare |
$73.20
|
| Rate for Payer: Amerigroup Medicare |
$73.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$182.27
|
| Rate for Payer: AZCH Complete Medicare |
$73.20
|
| Rate for Payer: Banner UC Health Medicare |
$73.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$331.84
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cigna of AZ Commercial |
$317.20
|
| Rate for Payer: Copperpoint Commercial |
$120.78
|
| Rate for Payer: Health Net of AZ Commercial |
$292.80
|
| Rate for Payer: Health Net of AZ Medicare |
$136.64
|
| Rate for Payer: Humana of AZ Medicare |
$73.20
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
| Rate for Payer: TriWest Medicare |
$73.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$284.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$87.84
|
|
|
XR Ribs Min 4 Views Bilateral
|
Facility
OP
|
$650.00
|
|
|
Service Code
|
CPT 71110 50
|
| Hospital Charge Code |
2214281
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of AZ Commercial |
$585.00
|
| Rate for Payer: Aetna of AZ Medicare |
$182.00
|
| Rate for Payer: Allwell Medicare |
$97.50
|
| Rate for Payer: Amerigroup Medicare |
$97.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$242.78
|
| Rate for Payer: AZCH Complete Medicare |
$97.50
|
| Rate for Payer: Banner UC Health Medicare |
$97.50
|
| Rate for Payer: Bisbee Police All Plans |
$169.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$442.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna of AZ Commercial |
$422.50
|
| Rate for Payer: Copperpoint Commercial |
$160.88
|
| Rate for Payer: Health Net of AZ Commercial |
$390.00
|
| Rate for Payer: Health Net of AZ Medicare |
$182.00
|
| Rate for Payer: Humana of AZ Medicare |
$97.50
|
| Rate for Payer: Self Pay Self Pay |
$520.00
|
| Rate for Payer: TriWest Medicare |
$97.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$378.95
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$117.00
|
|
|
XR Ribs Min 4 Views Bilateral
|
Facility
IP
|
$650.00
|
|
|
Service Code
|
CPT 71110 50
|
| Hospital Charge Code |
2214281
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of AZ Commercial |
$585.00
|
| Rate for Payer: Bisbee Police All Plans |
$169.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Self Pay Self Pay |
$520.00
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Facility
IP
|
$622.00
|
|
|
Service Code
|
CPT 71111 50
|
| Hospital Charge Code |
1008048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna of AZ Commercial |
$559.80
|
| Rate for Payer: Bisbee Police All Plans |
$161.72
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Self Pay Self Pay |
$497.60
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Facility
OP
|
$622.00
|
|
|
Service Code
|
CPT 71111 50
|
| Hospital Charge Code |
1008048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.30 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna of AZ Commercial |
$559.80
|
| Rate for Payer: Aetna of AZ Medicare |
$174.16
|
| Rate for Payer: Allwell Medicare |
$93.30
|
| Rate for Payer: Amerigroup Medicare |
$93.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$232.32
|
| Rate for Payer: AZCH Complete Medicare |
$93.30
|
| Rate for Payer: Banner UC Health Medicare |
$93.30
|
| Rate for Payer: Bisbee Police All Plans |
$161.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$422.96
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cigna of AZ Commercial |
$404.30
|
| Rate for Payer: Copperpoint Commercial |
$153.94
|
| Rate for Payer: Health Net of AZ Commercial |
$373.20
|
| Rate for Payer: Health Net of AZ Medicare |
$174.16
|
| Rate for Payer: Humana of AZ Medicare |
$93.30
|
| Rate for Payer: Self Pay Self Pay |
$497.60
|
| Rate for Payer: TriWest Medicare |
$93.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$362.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$111.96
|
|
|
XR Ribs w/ PA Chest Left
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 71101 LT
|
| Hospital Charge Code |
1008050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
|
|
XR Ribs w/ PA Chest Left
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 71101 LT
|
| Hospital Charge Code |
1008050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Aetna of AZ Medicare |
$136.64
|
| Rate for Payer: Allwell Medicare |
$73.20
|
| Rate for Payer: Amerigroup Medicare |
$73.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$182.27
|
| Rate for Payer: AZCH Complete Medicare |
$73.20
|
| Rate for Payer: Banner UC Health Medicare |
$73.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$331.84
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cigna of AZ Commercial |
$317.20
|
| Rate for Payer: Copperpoint Commercial |
$120.78
|
| Rate for Payer: Health Net of AZ Commercial |
$292.80
|
| Rate for Payer: Health Net of AZ Medicare |
$136.64
|
| Rate for Payer: Humana of AZ Medicare |
$73.20
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
| Rate for Payer: TriWest Medicare |
$73.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$284.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$87.84
|
|
|
XR Ribs w/ PA Chest Right
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 71101 RT
|
| Hospital Charge Code |
1008052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
|
|
XR Ribs w/ PA Chest Right
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 71101 RT
|
| Hospital Charge Code |
1008052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Aetna of AZ Medicare |
$136.64
|
| Rate for Payer: Allwell Medicare |
$73.20
|
| Rate for Payer: Amerigroup Medicare |
$73.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$182.27
|
| Rate for Payer: AZCH Complete Medicare |
$73.20
|
| Rate for Payer: Banner UC Health Medicare |
$73.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$331.84
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cigna of AZ Commercial |
$317.20
|
| Rate for Payer: Copperpoint Commercial |
$120.78
|
| Rate for Payer: Health Net of AZ Commercial |
$292.80
|
| Rate for Payer: Health Net of AZ Medicare |
$136.64
|
| Rate for Payer: Humana of AZ Medicare |
$73.20
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
| Rate for Payer: TriWest Medicare |
$73.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$284.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$87.84
|
|
|
XR Sacroiliac Joints 1 or 2 Views
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
1008054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Aetna of AZ Commercial |
$351.00
|
| Rate for Payer: Bisbee Police All Plans |
$101.40
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Self Pay Self Pay |
$312.00
|
|
|
XR Sacroiliac Joints 1 or 2 Views
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
1008054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Aetna of AZ Commercial |
$351.00
|
| Rate for Payer: Aetna of AZ Medicare |
$109.20
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$58.50
|
| Rate for Payer: Amerigroup Medicare |
$58.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$145.66
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$58.50
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$58.50
|
| Rate for Payer: Bisbee Police All Plans |
$101.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$265.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna of AZ Commercial |
$253.50
|
| Rate for Payer: Copperpoint Commercial |
$96.52
|
| Rate for Payer: Health Net of AZ Commercial |
$234.00
|
| Rate for Payer: Health Net of AZ Medicare |
$109.20
|
| Rate for Payer: Humana of AZ Medicare |
$58.50
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$312.00
|
| Rate for Payer: TriWest Medicare |
$58.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$227.37
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$70.20
|
|
|
XR Sacroiliac Joints Minimum 3 Views
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
1021658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Aetna of AZ Medicare |
$136.64
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$73.20
|
| Rate for Payer: Amerigroup Medicare |
$73.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$182.27
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$73.20
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$73.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$331.84
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cigna of AZ Commercial |
$317.20
|
| Rate for Payer: Copperpoint Commercial |
$120.78
|
| Rate for Payer: Health Net of AZ Commercial |
$292.80
|
| Rate for Payer: Health Net of AZ Medicare |
$136.64
|
| Rate for Payer: Humana of AZ Medicare |
$73.20
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
| Rate for Payer: TriWest Medicare |
$73.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$284.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$87.84
|
|
|
XR Sacroiliac Joints Minimum 3 Views
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
1021658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
|
|
XR Sacrum and Coccyx
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
1163877
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
|
|
XR Sacrum and Coccyx
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
1163877
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of AZ Commercial |
$439.20
|
| Rate for Payer: Aetna of AZ Medicare |
$136.64
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicare |
$73.20
|
| Rate for Payer: Amerigroup Medicare |
$73.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$182.27
|
| Rate for Payer: AZCH Complete Medicaid |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$73.20
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| Rate for Payer: Banner UC Health Medicare |
$73.20
|
| Rate for Payer: Bisbee Police All Plans |
$126.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$331.84
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cigna of AZ Commercial |
$317.20
|
| Rate for Payer: Copperpoint Commercial |
$120.78
|
| Rate for Payer: Health Net of AZ Commercial |
$292.80
|
| Rate for Payer: Health Net of AZ Medicare |
$136.64
|
| Rate for Payer: Humana of AZ Medicare |
$73.20
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: Self Pay Self Pay |
$390.40
|
| Rate for Payer: TriWest Medicare |
$73.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$284.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$87.84
|
|
