|
XR Scapula Left
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 73010 LT
|
| Hospital Charge Code |
823619
|
|
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 Scapula Left
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 73010 LT
|
| Hospital Charge Code |
823619
|
|
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 Scapula Right
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 73010 RT
|
| Hospital Charge Code |
823621
|
|
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 Scapula Right
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 73010 RT
|
| Hospital Charge Code |
823621
|
|
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 Sella Turcica
|
Facility
IP
|
$352.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
1008063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna of AZ Commercial |
$316.80
|
| Rate for Payer: Bisbee Police All Plans |
$91.52
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Self Pay Self Pay |
$281.60
|
|
|
XR Sella Turcica
|
Facility
OP
|
$352.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
1008063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna of AZ Commercial |
$316.80
|
| Rate for Payer: Aetna of AZ Medicare |
$98.56
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicare |
$52.80
|
| Rate for Payer: Amerigroup Medicare |
$52.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$131.47
|
| Rate for Payer: AZCH Complete Medicaid |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$52.80
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| Rate for Payer: Banner UC Health Medicare |
$52.80
|
| Rate for Payer: Bisbee Police All Plans |
$91.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$239.36
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cigna of AZ Commercial |
$228.80
|
| Rate for Payer: Copperpoint Commercial |
$87.12
|
| Rate for Payer: Health Net of AZ Commercial |
$211.20
|
| Rate for Payer: Health Net of AZ Medicare |
$98.56
|
| Rate for Payer: Humana of AZ Medicare |
$52.80
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: Self Pay Self Pay |
$281.60
|
| Rate for Payer: TriWest Medicare |
$52.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$205.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$63.36
|
|
|
XR Shoulder 2 Views Left
|
Facility
IP
|
$468.00
|
|
|
Service Code
|
CPT 73020 LT
|
| Hospital Charge Code |
1284694
|
|
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 Shoulder 2 Views Left
|
Facility
OP
|
$468.00
|
|
|
Service Code
|
CPT 73020 LT
|
| Hospital Charge Code |
1284694
|
|
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: Allwell Medicare |
$70.20
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$174.80
|
| Rate for Payer: AZCH Complete Medicare |
$70.20
|
| 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: 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: 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 Shoulder 2 Views Right
|
Facility
IP
|
$468.00
|
|
|
Service Code
|
CPT 73020 RT
|
| Hospital Charge Code |
1284697
|
|
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 Shoulder 2 Views Right
|
Facility
OP
|
$468.00
|
|
|
Service Code
|
CPT 73020 RT
|
| Hospital Charge Code |
1284697
|
|
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: Allwell Medicare |
$70.20
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$174.80
|
| Rate for Payer: AZCH Complete Medicare |
$70.20
|
| 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: 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: 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 Shoulder Complete Left
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT 73030 LT
|
| Hospital Charge Code |
823627
|
|
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 Shoulder Complete Left
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT 73030 LT
|
| Hospital Charge Code |
823627
|
|
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: Allwell Medicare |
$87.60
|
| Rate for Payer: Amerigroup Medicare |
$87.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$218.12
|
| Rate for Payer: AZCH Complete Medicare |
$87.60
|
| 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: 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: 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 Shoulder Complete Right
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT 73030 RT
|
| Hospital Charge Code |
823629
|
|
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 Shoulder Complete Right
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT 73030 RT
|
| Hospital Charge Code |
823629
|
|
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: Allwell Medicare |
$87.60
|
| Rate for Payer: Amerigroup Medicare |
$87.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$218.12
|
| Rate for Payer: AZCH Complete Medicare |
$87.60
|
| 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: 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: 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 Sinuses Paranasal < 3 Views
|
Facility
OP
|
$489.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
1008070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$440.10 |
| Rate for Payer: Aetna of AZ Commercial |
$440.10
|
| Rate for Payer: Aetna of AZ Medicare |
$136.92
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicare |
$73.35
|
| Rate for Payer: Amerigroup Medicare |
$73.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$182.64
|
| Rate for Payer: AZCH Complete Medicaid |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$73.35
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| Rate for Payer: Banner UC Health Medicare |
$73.35
|
| Rate for Payer: Bisbee Police All Plans |
$127.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$332.52
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna of AZ Commercial |
$317.85
|
| Rate for Payer: Copperpoint Commercial |
$121.03
|
| Rate for Payer: Health Net of AZ Commercial |
$293.40
|
| Rate for Payer: Health Net of AZ Medicare |
$136.92
|
| Rate for Payer: Humana of AZ Medicare |
$73.35
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: Self Pay Self Pay |
$391.20
|
| Rate for Payer: TriWest Medicare |
$73.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$285.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$88.02
|
|
|
XR Sinuses Paranasal < 3 Views
|
Facility
IP
|
$489.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
1008070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$440.10 |
| Rate for Payer: Aetna of AZ Commercial |
$440.10
|
| Rate for Payer: Bisbee Police All Plans |
$127.14
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Self Pay Self Pay |
$391.20
|
|
|
XR Sinuses Paranasal Complete
|
Facility
OP
|
$972.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
823631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$874.80 |
| Rate for Payer: Aetna of AZ Commercial |
$874.80
|
| Rate for Payer: Aetna of AZ Medicare |
$272.16
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicare |
$145.80
|
| Rate for Payer: Amerigroup Medicare |
$145.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$363.04
|
| Rate for Payer: AZCH Complete Medicaid |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$145.80
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| Rate for Payer: Banner UC Health Medicare |
$145.80
|
| Rate for Payer: Bisbee Police All Plans |
$252.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$660.96
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna of AZ Commercial |
$631.80
|
| Rate for Payer: Copperpoint Commercial |
$240.57
|
| Rate for Payer: Health Net of AZ Commercial |
$583.20
|
| Rate for Payer: Health Net of AZ Medicare |
$272.16
|
| Rate for Payer: Humana of AZ Medicare |
$145.80
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: Self Pay Self Pay |
$777.60
|
| Rate for Payer: TriWest Medicare |
$145.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$566.68
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$174.96
|
|
|
XR Sinuses Paranasal Complete
|
Facility
IP
|
$972.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
823631
|
|
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 Skull < 4 Views
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
823633
|
|
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 Skull < 4 Views
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
823633
|
|
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 Skull Complete
|
Facility
IP
|
$1,166.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
1008072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.16 |
| Max. Negotiated Rate |
$1,049.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,049.40
|
| Rate for Payer: Bisbee Police All Plans |
$303.16
|
| Rate for Payer: Cash Price |
$932.80
|
| Rate for Payer: Self Pay Self Pay |
$932.80
|
|
|
XR Skull Complete
|
Facility
OP
|
$1,166.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
1008072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$1,049.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,049.40
|
| Rate for Payer: Aetna of AZ Medicare |
$326.48
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$174.90
|
| Rate for Payer: Amerigroup Medicare |
$174.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$435.50
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$174.90
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$174.90
|
| Rate for Payer: Bisbee Police All Plans |
$303.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$792.88
|
| Rate for Payer: Cash Price |
$932.80
|
| Rate for Payer: Cash Price |
$932.80
|
| Rate for Payer: Cigna of AZ Commercial |
$757.90
|
| Rate for Payer: Copperpoint Commercial |
$288.58
|
| Rate for Payer: Health Net of AZ Commercial |
$699.60
|
| Rate for Payer: Health Net of AZ Medicare |
$326.48
|
| Rate for Payer: Humana of AZ Medicare |
$174.90
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$932.80
|
| Rate for Payer: TriWest Medicare |
$174.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$679.78
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$209.88
|
|
|
XR Spine Cervical 2 or 3 Views
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
823635
|
|
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 |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| 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 |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$87.60
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| 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 |
$117.30
|
| 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 Spine Cervical 2 or 3 Views
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
823635
|
|
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 Spine Cervical 4 or 5 Views
|
Facility
IP
|
$1,166.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
4694460
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.16 |
| Max. Negotiated Rate |
$1,049.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,049.40
|
| Rate for Payer: Bisbee Police All Plans |
$303.16
|
| Rate for Payer: Cash Price |
$932.80
|
| Rate for Payer: Self Pay Self Pay |
$932.80
|
|
