|
US Transvaginal
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
823467
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Aetna of AZ Commercial |
$867.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$154.24
|
| Rate for Payer: Banner UC Health Medicare |
$154.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$655.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$154.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$154.24
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cigna of AZ Commercial |
$674.80
|
| Rate for Payer: Devoted Health Medicare |
$173.52
|
| Rate for Payer: Humana of AZ Medicare |
$154.24
|
| Rate for Payer: Seven Corners Travel Insurance |
$161.76
|
| Rate for Payer: Southwest Service Administrators UFCW |
$655.52
|
| Rate for Payer: TriWest Medicare |
$154.24
|
| Rate for Payer: United Healthcare Commercial |
$551.41
|
| Rate for Payer: United Healthcare Medicare |
$154.24
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$183.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$152.70
|
|
|
US Transvaginal
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
823467
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$867.60 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Aetna of AZ Commercial |
$867.60
|
| Rate for Payer: Cash Price |
$771.20
|
|
|
US UE Arterial Duplex Bilateral
|
Facility
|
IP
|
$1,807.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
823471
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,626.30 |
| Max. Negotiated Rate |
$1,626.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,626.30
|
| Rate for Payer: Cash Price |
$1,445.60
|
|
|
US UE Arterial Duplex Bilateral
|
Facility
|
OP
|
$1,807.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
823471
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$286.23 |
| Max. Negotiated Rate |
$1,626.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,626.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$289.12
|
| Rate for Payer: Banner UC Health Medicare |
$289.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,228.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$289.12
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$289.12
|
| Rate for Payer: Cash Price |
$1,445.60
|
| Rate for Payer: Cash Price |
$1,445.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,264.90
|
| Rate for Payer: Devoted Health Medicare |
$325.26
|
| Rate for Payer: Humana of AZ Medicare |
$289.12
|
| Rate for Payer: Seven Corners Travel Insurance |
$369.18
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,228.76
|
| Rate for Payer: TriWest Medicare |
$289.12
|
| Rate for Payer: United Healthcare Commercial |
$1,033.60
|
| Rate for Payer: United Healthcare Medicare |
$289.12
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$343.33
|
| Rate for Payer: Veterans Affairs TRICARE |
$286.23
|
|
|
US UE Arterial Duplex Left
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
823473
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna of AZ Commercial |
$945.00
|
| Rate for Payer: Cash Price |
$840.00
|
|
|
US UE Arterial Duplex Left
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
823473
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$161.76 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna of AZ Commercial |
$945.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$168.00
|
| Rate for Payer: Banner UC Health Medicare |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$168.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$168.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna of AZ Commercial |
$735.00
|
| Rate for Payer: Devoted Health Medicare |
$189.00
|
| Rate for Payer: Humana of AZ Medicare |
$168.00
|
| Rate for Payer: Seven Corners Travel Insurance |
$161.76
|
| Rate for Payer: Southwest Service Administrators UFCW |
$714.00
|
| Rate for Payer: TriWest Medicare |
$168.00
|
| Rate for Payer: United Healthcare Commercial |
$600.60
|
| Rate for Payer: United Healthcare Medicare |
$168.00
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$199.50
|
| Rate for Payer: Veterans Affairs TRICARE |
$166.32
|
|
|
US UE Arterial Duplex Right
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
823475
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$123.24 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$700.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$124.48
|
| Rate for Payer: Banner UC Health Medicare |
$124.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$529.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$124.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$124.48
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cigna of AZ Commercial |
$544.60
|
| Rate for Payer: Devoted Health Medicare |
$140.04
|
| Rate for Payer: Humana of AZ Medicare |
$124.48
|
| Rate for Payer: Seven Corners Travel Insurance |
$161.76
|
| Rate for Payer: Southwest Service Administrators UFCW |
$529.04
|
| Rate for Payer: TriWest Medicare |
$124.48
|
| Rate for Payer: United Healthcare Commercial |
$445.02
|
| Rate for Payer: United Healthcare Medicare |
$124.48
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$147.82
|
| Rate for Payer: Veterans Affairs TRICARE |
$123.24
|
|
|
US UE Arterial Duplex Right
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
823475
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$700.20 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna of AZ Commercial |
$700.20
|
| Rate for Payer: Cash Price |
$622.40
|
|
|
US UE Venous Duplex Bilateral
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
823477
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$240.13 |
| Max. Negotiated Rate |
$1,364.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,364.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$242.56
|
| Rate for Payer: Banner UC Health Medicare |
$242.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,030.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$242.56
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$242.56
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,061.20
|
| Rate for Payer: Devoted Health Medicare |
$272.88
|
| Rate for Payer: Humana of AZ Medicare |
$242.56
|
| Rate for Payer: Seven Corners Travel Insurance |
$369.18
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,030.88
|
| Rate for Payer: TriWest Medicare |
$242.56
|
| Rate for Payer: United Healthcare Commercial |
$867.15
|
| Rate for Payer: United Healthcare Medicare |
$242.56
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$288.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$240.13
|
|
|
US UE Venous Duplex Bilateral
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
823477
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,364.40 |
| Max. Negotiated Rate |
$1,364.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,364.40
|
| Rate for Payer: Cash Price |
$1,212.80
|
|
|
US UE Venous Duplex Left
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
823479
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$775.80 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna of AZ Commercial |
$775.80
|
| Rate for Payer: Cash Price |
$689.60
|
|
|
US UE Venous Duplex Left
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
823479
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$136.54 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna of AZ Commercial |
$775.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$137.92
|
| Rate for Payer: Banner UC Health Medicare |
$137.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$586.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$137.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$137.92
|
| 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: Devoted Health Medicare |
$155.16
|
| Rate for Payer: Humana of AZ Medicare |
$137.92
|
| Rate for Payer: Seven Corners Travel Insurance |
$161.76
|
| Rate for Payer: Southwest Service Administrators UFCW |
$586.16
|
| Rate for Payer: TriWest Medicare |
$137.92
|
| Rate for Payer: United Healthcare Commercial |
$493.06
|
| Rate for Payer: United Healthcare Medicare |
$137.92
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$163.78
|
| Rate for Payer: Veterans Affairs TRICARE |
$136.54
|
|
|
US UE Venous Duplex Right
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
823481
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$136.54 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna of AZ Commercial |
$775.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$137.92
|
| Rate for Payer: Banner UC Health Medicare |
$137.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$586.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$137.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$137.92
|
| 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: Devoted Health Medicare |
$155.16
|
| Rate for Payer: Humana of AZ Medicare |
$137.92
|
| Rate for Payer: Seven Corners Travel Insurance |
$161.76
|
| Rate for Payer: Southwest Service Administrators UFCW |
$586.16
|
| Rate for Payer: TriWest Medicare |
$137.92
|
| Rate for Payer: United Healthcare Commercial |
$493.06
|
| Rate for Payer: United Healthcare Medicare |
$137.92
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$163.78
|
| Rate for Payer: Veterans Affairs TRICARE |
$136.54
|
|
|
US UE Venous Duplex Right
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
823481
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$775.80 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna of AZ Commercial |
$775.80
|
| Rate for Payer: Cash Price |
$689.60
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$7,312.10
|
|
|
Service Code
|
APR-DRG 5192
|
| Hospital Charge Code |
APRDRG5193
|
| Min. Negotiated Rate |
$7,312.10 |
| Max. Negotiated Rate |
$7,312.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,312.10
|
| Rate for Payer: Mercy Care Medicaid |
$7,312.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,312.10
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$24,321.05
|
|
|
Service Code
|
APR-DRG 5194
|
| Hospital Charge Code |
APRDRG5193
|
| Min. Negotiated Rate |
$24,321.05 |
| Max. Negotiated Rate |
$24,321.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$24,321.05
|
| Rate for Payer: Mercy Care Medicaid |
$24,321.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$24,321.05
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$24,321.05
|
|
|
Service Code
|
APR-DRG 5194
|
| Hospital Charge Code |
APRDRG5194
|
| Min. Negotiated Rate |
$24,321.05 |
| Max. Negotiated Rate |
$24,321.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$24,321.05
|
| Rate for Payer: Mercy Care Medicaid |
$24,321.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$24,321.05
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$12,665.18
|
|
|
Service Code
|
APR-DRG 5193
|
| Hospital Charge Code |
APRDRG5194
|
| Min. Negotiated Rate |
$12,665.18 |
| Max. Negotiated Rate |
$12,665.18 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,665.18
|
| Rate for Payer: Mercy Care Medicaid |
$12,665.18
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,665.18
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$12,665.18
|
|
|
Service Code
|
APR-DRG 5193
|
| Hospital Charge Code |
APRDRG5191
|
| Min. Negotiated Rate |
$12,665.18 |
| Max. Negotiated Rate |
$12,665.18 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,665.18
|
| Rate for Payer: Mercy Care Medicaid |
$12,665.18
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,665.18
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$5,874.93
|
|
|
Service Code
|
APR-DRG 5191
|
| Hospital Charge Code |
APRDRG5191
|
| Min. Negotiated Rate |
$5,874.93 |
| Max. Negotiated Rate |
$5,874.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,874.93
|
| Rate for Payer: Mercy Care Medicaid |
$5,874.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,874.93
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$7,312.10
|
|
|
Service Code
|
APR-DRG 5192
|
| Hospital Charge Code |
APRDRG5191
|
| Min. Negotiated Rate |
$7,312.10 |
| Max. Negotiated Rate |
$7,312.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,312.10
|
| Rate for Payer: Mercy Care Medicaid |
$7,312.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,312.10
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$7,312.10
|
|
|
Service Code
|
APR-DRG 5192
|
| Hospital Charge Code |
APRDRG5194
|
| Min. Negotiated Rate |
$7,312.10 |
| Max. Negotiated Rate |
$7,312.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,312.10
|
| Rate for Payer: Mercy Care Medicaid |
$7,312.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,312.10
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$5,874.93
|
|
|
Service Code
|
APR-DRG 5191
|
| Hospital Charge Code |
APRDRG5192
|
| Min. Negotiated Rate |
$5,874.93 |
| Max. Negotiated Rate |
$5,874.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,874.93
|
| Rate for Payer: Mercy Care Medicaid |
$5,874.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,874.93
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$5,874.93
|
|
|
Service Code
|
APR-DRG 5191
|
| Hospital Charge Code |
APRDRG5194
|
| Min. Negotiated Rate |
$5,874.93 |
| Max. Negotiated Rate |
$5,874.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,874.93
|
| Rate for Payer: Mercy Care Medicaid |
$5,874.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,874.93
|
|
|
Uterine And Adnexa Procedures For Leiomyoma
|
Facility
|
IP
|
$24,321.05
|
|
|
Service Code
|
APR-DRG 5194
|
| Hospital Charge Code |
APRDRG5191
|
| Min. Negotiated Rate |
$24,321.05 |
| Max. Negotiated Rate |
$24,321.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$24,321.05
|
| Rate for Payer: Mercy Care Medicaid |
$24,321.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$24,321.05
|
|
