|
XR Spine Cervical 4 or 5 Views
|
Facility
OP
|
$1,166.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
4694460
|
|
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 Comp w/ Flex/Ext
|
Facility
IP
|
$887.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
1008084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.62 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Aetna of AZ Commercial |
$798.30
|
| Rate for Payer: Bisbee Police All Plans |
$230.62
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Self Pay Self Pay |
$709.60
|
|
|
XR Spine Cervical Comp w/ Flex/Ext
|
Facility
OP
|
$887.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
1008084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.05 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Aetna of AZ Commercial |
$798.30
|
| Rate for Payer: Aetna of AZ Medicare |
$248.36
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$133.05
|
| Rate for Payer: Amerigroup Medicare |
$133.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$331.29
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$133.05
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$133.05
|
| Rate for Payer: Bisbee Police All Plans |
$230.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$603.16
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cigna of AZ Commercial |
$576.55
|
| Rate for Payer: Copperpoint Commercial |
$219.53
|
| Rate for Payer: Health Net of AZ Commercial |
$532.20
|
| Rate for Payer: Health Net of AZ Medicare |
$248.36
|
| Rate for Payer: Humana of AZ Medicare |
$133.05
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$709.60
|
| Rate for Payer: TriWest Medicare |
$133.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$517.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$159.66
|
|
|
XR Spine Entire 1 View
|
Facility
OP
|
$743.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
22200642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.45 |
| Max. Negotiated Rate |
$668.70 |
| Rate for Payer: Aetna of AZ Commercial |
$668.70
|
| Rate for Payer: Aetna of AZ Medicare |
$208.04
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicare |
$111.45
|
| Rate for Payer: Amerigroup Medicare |
$111.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$277.51
|
| Rate for Payer: AZCH Complete Medicaid |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$111.45
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| Rate for Payer: Banner UC Health Medicare |
$111.45
|
| Rate for Payer: Bisbee Police All Plans |
$193.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$505.24
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cigna of AZ Commercial |
$482.95
|
| Rate for Payer: Copperpoint Commercial |
$183.89
|
| Rate for Payer: Health Net of AZ Commercial |
$445.80
|
| Rate for Payer: Health Net of AZ Medicare |
$208.04
|
| Rate for Payer: Humana of AZ Medicare |
$111.45
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: Self Pay Self Pay |
$594.40
|
| Rate for Payer: TriWest Medicare |
$111.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$433.17
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$133.74
|
|
|
XR Spine Entire 1 View
|
Facility
IP
|
$743.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
22200642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.18 |
| Max. Negotiated Rate |
$668.70 |
| Rate for Payer: Aetna of AZ Commercial |
$668.70
|
| Rate for Payer: Bisbee Police All Plans |
$193.18
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Self Pay Self Pay |
$594.40
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
OP
|
$972.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
823641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.80 |
| 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 |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| 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 |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$145.80
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| 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 |
$158.00
|
| 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 Spine Lumbosacral 2 or 3 Views
|
Facility
IP
|
$972.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
823641
|
|
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 Spine Lumbosacral Bending Only
|
Facility
OP
|
$972.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
1163883
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.80 |
| 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 |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| 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 |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$145.80
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| 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 |
$158.00
|
| 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 Spine Lumbosacral Bending Only
|
Facility
IP
|
$972.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
1163883
|
|
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 Spine Lumbosacral Complete w/ Bending
|
Facility
IP
|
$887.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
1008092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.62 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Aetna of AZ Commercial |
$798.30
|
| Rate for Payer: Bisbee Police All Plans |
$230.62
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Self Pay Self Pay |
$709.60
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Facility
OP
|
$887.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
1008092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.05 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Aetna of AZ Commercial |
$798.30
|
| Rate for Payer: Aetna of AZ Medicare |
$248.36
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$133.05
|
| Rate for Payer: Amerigroup Medicare |
$133.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$331.29
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$133.05
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$133.05
|
| Rate for Payer: Bisbee Police All Plans |
$230.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$603.16
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cigna of AZ Commercial |
$576.55
|
| Rate for Payer: Copperpoint Commercial |
$219.53
|
| Rate for Payer: Health Net of AZ Commercial |
$532.20
|
| Rate for Payer: Health Net of AZ Medicare |
$248.36
|
| Rate for Payer: Humana of AZ Medicare |
$133.05
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$709.60
|
| Rate for Payer: TriWest Medicare |
$133.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$517.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$159.66
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
IP
|
$887.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
823643
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.62 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Aetna of AZ Commercial |
$798.30
|
| Rate for Payer: Bisbee Police All Plans |
$230.62
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Self Pay Self Pay |
$709.60
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
OP
|
$887.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
823643
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.05 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Aetna of AZ Commercial |
$798.30
|
| Rate for Payer: Aetna of AZ Medicare |
$248.36
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$133.05
|
| Rate for Payer: Amerigroup Medicare |
$133.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$331.29
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$133.05
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$133.05
|
| Rate for Payer: Bisbee Police All Plans |
$230.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$603.16
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cigna of AZ Commercial |
$576.55
|
| Rate for Payer: Copperpoint Commercial |
$219.53
|
| Rate for Payer: Health Net of AZ Commercial |
$532.20
|
| Rate for Payer: Health Net of AZ Medicare |
$248.36
|
| Rate for Payer: Humana of AZ Medicare |
$133.05
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$709.60
|
| Rate for Payer: TriWest Medicare |
$133.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$517.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$159.66
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
OP
|
$778.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
823645
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$700.20
|
| Rate for Payer: Aetna of AZ Medicare |
$217.84
|
| Rate for Payer: AHCCCS Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicaid |
$158.00
|
| Rate for Payer: Allwell Medicare |
$116.70
|
| Rate for Payer: Amerigroup Medicare |
$116.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$290.58
|
| Rate for Payer: AZCH Complete Medicaid |
$158.00
|
| Rate for Payer: AZCH Complete Medicare |
$116.70
|
| Rate for Payer: Banner UC Health Medicaid |
$158.00
|
| Rate for Payer: Banner UC Health Medicare |
$116.70
|
| Rate for Payer: Bisbee Police All Plans |
$202.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$529.04
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cigna of AZ Commercial |
$505.70
|
| Rate for Payer: Copperpoint Commercial |
$192.56
|
| Rate for Payer: Health Net of AZ Commercial |
$466.80
|
| Rate for Payer: Health Net of AZ Medicare |
$217.84
|
| Rate for Payer: Humana of AZ Medicare |
$116.70
|
| Rate for Payer: Mercy Care Medicaid |
$158.00
|
| Rate for Payer: Self Pay Self Pay |
$622.40
|
| Rate for Payer: TriWest Medicare |
$116.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$453.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$140.04
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
IP
|
$778.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
823645
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.28 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$700.20
|
| Rate for Payer: Bisbee Police All Plans |
$202.28
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Self Pay Self Pay |
$622.40
|
|
|
XR Spine Thoracic 3 Views
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
823649
|
|
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 Spine Thoracic 3 Views
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
823649
|
|
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 Spine Thoracolumbar 2 Views
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
1008101
|
|
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
|
|
|
XR Spine Thoracolumbar 2 Views
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
1008101
|
|
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 Sternoclavicular Joint(s)
|
Facility
OP
|
$447.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
823651
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$402.30 |
| Rate for Payer: Aetna of AZ Commercial |
$402.30
|
| Rate for Payer: Aetna of AZ Medicare |
$125.16
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicare |
$67.05
|
| Rate for Payer: Amerigroup Medicare |
$67.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$166.95
|
| Rate for Payer: AZCH Complete Medicaid |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$67.05
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| Rate for Payer: Banner UC Health Medicare |
$67.05
|
| Rate for Payer: Bisbee Police All Plans |
$116.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$303.96
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna of AZ Commercial |
$290.55
|
| Rate for Payer: Copperpoint Commercial |
$110.63
|
| Rate for Payer: Health Net of AZ Commercial |
$268.20
|
| Rate for Payer: Health Net of AZ Medicare |
$125.16
|
| Rate for Payer: Humana of AZ Medicare |
$67.05
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: Self Pay Self Pay |
$357.60
|
| Rate for Payer: TriWest Medicare |
$67.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$260.60
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$80.46
|
|
|
XR Sternoclavicular Joint(s)
|
Facility
IP
|
$447.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
823651
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.22 |
| Max. Negotiated Rate |
$402.30 |
| Rate for Payer: Aetna of AZ Commercial |
$402.30
|
| Rate for Payer: Bisbee Police All Plans |
$116.22
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Self Pay Self Pay |
$357.60
|
|
|
XR Sternum Minimum 2 Views
|
Facility
IP
|
$680.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
823653
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna of AZ Commercial |
$612.00
|
| Rate for Payer: Bisbee Police All Plans |
$176.80
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Self Pay Self Pay |
$544.00
|
|
|
XR Sternum Minimum 2 Views
|
Facility
OP
|
$680.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
823653
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna of AZ Commercial |
$612.00
|
| Rate for Payer: Aetna of AZ Medicare |
$190.40
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicare |
$102.00
|
| Rate for Payer: Amerigroup Medicare |
$102.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$253.98
|
| Rate for Payer: AZCH Complete Medicaid |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$102.00
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| Rate for Payer: Banner UC Health Medicare |
$102.00
|
| Rate for Payer: Bisbee Police All Plans |
$176.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$462.40
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cigna of AZ Commercial |
$442.00
|
| Rate for Payer: Copperpoint Commercial |
$168.30
|
| Rate for Payer: Health Net of AZ Commercial |
$408.00
|
| Rate for Payer: Health Net of AZ Medicare |
$190.40
|
| Rate for Payer: Humana of AZ Medicare |
$102.00
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: Self Pay Self Pay |
$544.00
|
| Rate for Payer: TriWest Medicare |
$102.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$396.44
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$122.40
|
|
|
XR Temporomandibular Joints
|
Facility
IP
|
$778.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
1008107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.28 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$700.20
|
| Rate for Payer: Bisbee Police All Plans |
$202.28
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Self Pay Self Pay |
$622.40
|
|
|
XR Temporomandibular Joints
|
Facility
OP
|
$778.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
1008107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$700.20
|
| Rate for Payer: Aetna of AZ Medicare |
$217.84
|
| Rate for Payer: AHCCCS Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicaid |
$117.30
|
| Rate for Payer: Allwell Medicare |
$116.70
|
| Rate for Payer: Amerigroup Medicare |
$116.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$290.58
|
| Rate for Payer: AZCH Complete Medicaid |
$117.30
|
| Rate for Payer: AZCH Complete Medicare |
$116.70
|
| Rate for Payer: Banner UC Health Medicaid |
$117.30
|
| Rate for Payer: Banner UC Health Medicare |
$116.70
|
| Rate for Payer: Bisbee Police All Plans |
$202.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$529.04
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cigna of AZ Commercial |
$505.70
|
| Rate for Payer: Copperpoint Commercial |
$192.56
|
| Rate for Payer: Health Net of AZ Commercial |
$466.80
|
| Rate for Payer: Health Net of AZ Medicare |
$217.84
|
| Rate for Payer: Humana of AZ Medicare |
$116.70
|
| Rate for Payer: Mercy Care Medicaid |
$117.30
|
| Rate for Payer: Self Pay Self Pay |
$622.40
|
| Rate for Payer: TriWest Medicare |
$116.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$453.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$140.04
|
|
