|
ANTI RNP/SMITH
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22664811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of AZ Commercial |
$201.60
|
| Rate for Payer: Aetna of AZ Medicare |
$62.72
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicare |
$33.60
|
| Rate for Payer: Amerigroup Medicare |
$33.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$83.66
|
| Rate for Payer: AZCH Complete Medicaid |
$17.93
|
| Rate for Payer: AZCH Complete Medicare |
$33.60
|
| Rate for Payer: Banner UC Health Medicaid |
$17.93
|
| Rate for Payer: Banner UC Health Medicare |
$33.60
|
| Rate for Payer: Bisbee Police All Plans |
$58.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$152.32
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cigna of AZ Commercial |
$145.60
|
| Rate for Payer: Copperpoint Commercial |
$55.44
|
| Rate for Payer: Health Net of AZ Commercial |
$134.40
|
| Rate for Payer: Health Net of AZ Medicare |
$62.72
|
| Rate for Payer: Humana of AZ Medicare |
$33.60
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: Self Pay Self Pay |
$179.20
|
| Rate for Payer: TriWest Medicare |
$33.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$130.59
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.32
|
|
|
ANTI RNP/SMITH
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22664811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of AZ Commercial |
$201.60
|
| Rate for Payer: Bisbee Police All Plans |
$58.24
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Self Pay Self Pay |
$179.20
|
|
|
ANTISCLERODERMA
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22664812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Aetna of AZ Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicare |
$18.00
|
| Rate for Payer: Amerigroup Medicare |
$18.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicaid |
$17.93
|
| Rate for Payer: AZCH Complete Medicare |
$18.00
|
| Rate for Payer: Banner UC Health Medicaid |
$17.93
|
| Rate for Payer: Banner UC Health Medicare |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of AZ Commercial |
$78.00
|
| Rate for Payer: Copperpoint Commercial |
$29.70
|
| Rate for Payer: Health Net of AZ Commercial |
$72.00
|
| Rate for Payer: Health Net of AZ Medicare |
$33.60
|
| Rate for Payer: Humana of AZ Medicare |
$18.00
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$18.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.60
|
|
|
ANTISCLERODERMA
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22664812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
|
|
Antiscleroderma-70 Antibodies LC
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
1905589
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of AZ Commercial |
$201.60
|
| Rate for Payer: Bisbee Police All Plans |
$58.24
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Self Pay Self Pay |
$179.20
|
|
|
Antiscleroderma-70 Antibodies LC
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
1905589
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of AZ Commercial |
$201.60
|
| Rate for Payer: Aetna of AZ Medicare |
$62.72
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicare |
$33.60
|
| Rate for Payer: Amerigroup Medicare |
$33.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$83.66
|
| Rate for Payer: AZCH Complete Medicaid |
$17.93
|
| Rate for Payer: AZCH Complete Medicare |
$33.60
|
| Rate for Payer: Banner UC Health Medicaid |
$17.93
|
| Rate for Payer: Banner UC Health Medicare |
$33.60
|
| Rate for Payer: Bisbee Police All Plans |
$58.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$152.32
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cigna of AZ Commercial |
$145.60
|
| Rate for Payer: Copperpoint Commercial |
$55.44
|
| Rate for Payer: Health Net of AZ Commercial |
$134.40
|
| Rate for Payer: Health Net of AZ Medicare |
$62.72
|
| Rate for Payer: Humana of AZ Medicare |
$33.60
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: Self Pay Self Pay |
$179.20
|
| Rate for Payer: TriWest Medicare |
$33.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$130.59
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.32
|
|
|
Antistreptolysin O Ab LC
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
1906788
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of AZ Commercial |
$215.10
|
| Rate for Payer: Aetna of AZ Medicare |
$66.92
|
| Rate for Payer: AHCCCS Medicaid |
$7.30
|
| Rate for Payer: Allwell Medicaid |
$7.30
|
| Rate for Payer: Allwell Medicare |
$35.85
|
| Rate for Payer: Amerigroup Medicare |
$35.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$89.27
|
| Rate for Payer: AZCH Complete Medicaid |
$7.30
|
| Rate for Payer: AZCH Complete Medicare |
$35.85
|
| Rate for Payer: Banner UC Health Medicaid |
$7.30
|
| Rate for Payer: Banner UC Health Medicare |
$35.85
|
| Rate for Payer: Bisbee Police All Plans |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$162.52
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cigna of AZ Commercial |
$155.35
|
| Rate for Payer: Copperpoint Commercial |
$59.15
|
| Rate for Payer: Health Net of AZ Commercial |
$143.40
|
| Rate for Payer: Health Net of AZ Medicare |
$66.92
|
| Rate for Payer: Humana of AZ Medicare |
$35.85
|
| Rate for Payer: Mercy Care Medicaid |
$7.30
|
| Rate for Payer: Self Pay Self Pay |
$191.20
|
| Rate for Payer: TriWest Medicare |
$35.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$139.34
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$43.02
|
|
|
Antistreptolysin O Ab LC
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
1906788
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of AZ Commercial |
$215.10
|
| Rate for Payer: Bisbee Police All Plans |
$62.14
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Self Pay Self Pay |
$191.20
|
|
|
Antithrombin Activity LC
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
2029226
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna of AZ Commercial |
$248.40
|
| Rate for Payer: Aetna of AZ Medicare |
$77.28
|
| Rate for Payer: AHCCCS Medicaid |
$11.85
|
| Rate for Payer: Allwell Medicaid |
$11.85
|
| Rate for Payer: Allwell Medicare |
$41.40
|
| Rate for Payer: Amerigroup Medicare |
$41.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$103.09
|
| Rate for Payer: AZCH Complete Medicaid |
$11.85
|
| Rate for Payer: AZCH Complete Medicare |
$41.40
|
| Rate for Payer: Banner UC Health Medicaid |
$11.85
|
| Rate for Payer: Banner UC Health Medicare |
$41.40
|
| Rate for Payer: Bisbee Police All Plans |
$71.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$187.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna of AZ Commercial |
$179.40
|
| Rate for Payer: Copperpoint Commercial |
$68.31
|
| Rate for Payer: Health Net of AZ Commercial |
$165.60
|
| Rate for Payer: Health Net of AZ Medicare |
$77.28
|
| Rate for Payer: Humana of AZ Medicare |
$41.40
|
| Rate for Payer: Mercy Care Medicaid |
$11.85
|
| Rate for Payer: Self Pay Self Pay |
$220.80
|
| Rate for Payer: TriWest Medicare |
$41.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$160.91
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$49.68
|
|
|
Antithrombin Activity LC
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
2029226
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna of AZ Commercial |
$248.40
|
| Rate for Payer: Bisbee Police All Plans |
$71.76
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Self Pay Self Pay |
$220.80
|
|
|
Antithrombin Deficiency Profile LC
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
22012108
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$420.30 |
| Rate for Payer: Aetna of AZ Commercial |
$420.30
|
| Rate for Payer: Aetna of AZ Medicare |
$130.76
|
| Rate for Payer: AHCCCS Medicaid |
$11.85
|
| Rate for Payer: Allwell Medicaid |
$11.85
|
| Rate for Payer: Allwell Medicare |
$70.05
|
| Rate for Payer: Amerigroup Medicare |
$70.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$174.42
|
| Rate for Payer: AZCH Complete Medicaid |
$11.85
|
| Rate for Payer: AZCH Complete Medicare |
$70.05
|
| Rate for Payer: Banner UC Health Medicaid |
$11.85
|
| Rate for Payer: Banner UC Health Medicare |
$70.05
|
| Rate for Payer: Bisbee Police All Plans |
$121.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$317.56
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Cigna of AZ Commercial |
$303.55
|
| Rate for Payer: Copperpoint Commercial |
$115.58
|
| Rate for Payer: Health Net of AZ Commercial |
$280.20
|
| Rate for Payer: Health Net of AZ Medicare |
$130.76
|
| Rate for Payer: Humana of AZ Medicare |
$70.05
|
| Rate for Payer: Mercy Care Medicaid |
$11.85
|
| Rate for Payer: Self Pay Self Pay |
$373.60
|
| Rate for Payer: TriWest Medicare |
$70.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$272.26
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$84.06
|
|
|
Antithrombin Deficiency Profile LC
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
22012108
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$121.42 |
| Max. Negotiated Rate |
$420.30 |
| Rate for Payer: Aetna of AZ Commercial |
$420.30
|
| Rate for Payer: Bisbee Police All Plans |
$121.42
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Self Pay Self Pay |
$373.60
|
|
|
antivenin (Crotalidae) polyvalent - Anavip [CQCH]
|
Facility
|
IP
|
$1,166.62
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
215305345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.32 |
| Max. Negotiated Rate |
$1,049.96 |
| Rate for Payer: Bisbee Police All Plans |
$303.32
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Self Pay Self Pay |
$933.30
|
|
|
antivenin (Crotalidae) polyvalent - Anavip [CQCH]
|
Facility
|
OP
|
$1,166.62
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
215305345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$1,579.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,049.96
|
| Rate for Payer: Aetna of AZ Medicare |
$326.65
|
| Rate for Payer: AHCCCS Medicaid |
$1,579.20
|
| Rate for Payer: Allwell Medicaid |
$1,579.20
|
| Rate for Payer: Allwell Medicare |
$174.99
|
| Rate for Payer: Amerigroup Medicare |
$174.99
|
| Rate for Payer: APIPA Medicare/Medicaid |
$435.73
|
| Rate for Payer: AZCH Complete Medicaid |
$1,579.20
|
| Rate for Payer: AZCH Complete Medicare |
$174.99
|
| Rate for Payer: Banner UC Health Medicaid |
$1,579.20
|
| Rate for Payer: Banner UC Health Medicare |
$174.99
|
| Rate for Payer: Bisbee Police All Plans |
$303.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$793.30
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna of AZ Commercial |
$816.63
|
| Rate for Payer: Copperpoint Commercial |
$288.74
|
| Rate for Payer: Health Net of AZ Commercial |
$699.97
|
| Rate for Payer: Health Net of AZ Medicare |
$326.65
|
| Rate for Payer: Humana of AZ Medicare |
$174.99
|
| Rate for Payer: Mercy Care Medicaid |
$1,579.20
|
| Rate for Payer: Self Pay Self Pay |
$933.30
|
| Rate for Payer: TriWest Medicare |
$174.99
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$680.14
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$209.99
|
|
|
Aph FFP ACDA
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
857632
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Aetna of AZ Medicare |
$49.56
|
| Rate for Payer: AHCCCS Medicaid |
$119.86
|
| Rate for Payer: Allwell Medicaid |
$119.86
|
| Rate for Payer: Allwell Medicare |
$26.55
|
| Rate for Payer: Amerigroup Medicare |
$26.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$66.11
|
| Rate for Payer: AZCH Complete Medicaid |
$119.86
|
| Rate for Payer: AZCH Complete Medicare |
$26.55
|
| Rate for Payer: Banner UC Health Medicaid |
$119.86
|
| Rate for Payer: Banner UC Health Medicare |
$26.55
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$120.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$115.05
|
| Rate for Payer: Copperpoint Commercial |
$43.81
|
| Rate for Payer: Health Net of AZ Commercial |
$106.20
|
| Rate for Payer: Health Net of AZ Medicare |
$49.56
|
| Rate for Payer: Humana of AZ Medicare |
$26.55
|
| Rate for Payer: Mercy Care Medicaid |
$119.86
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
| Rate for Payer: TriWest Medicare |
$26.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$103.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.86
|
|
|
Aph FFP ACDA
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
857632
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Aph FFP ACDA Thawed
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
1221767
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Aetna of AZ Medicare |
$49.56
|
| Rate for Payer: AHCCCS Medicaid |
$119.86
|
| Rate for Payer: Allwell Medicaid |
$119.86
|
| Rate for Payer: Allwell Medicare |
$26.55
|
| Rate for Payer: Amerigroup Medicare |
$26.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$66.11
|
| Rate for Payer: AZCH Complete Medicaid |
$119.86
|
| Rate for Payer: AZCH Complete Medicare |
$26.55
|
| Rate for Payer: Banner UC Health Medicaid |
$119.86
|
| Rate for Payer: Banner UC Health Medicare |
$26.55
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$120.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$115.05
|
| Rate for Payer: Copperpoint Commercial |
$43.81
|
| Rate for Payer: Health Net of AZ Commercial |
$106.20
|
| Rate for Payer: Health Net of AZ Medicare |
$49.56
|
| Rate for Payer: Humana of AZ Medicare |
$26.55
|
| Rate for Payer: Mercy Care Medicaid |
$119.86
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
| Rate for Payer: TriWest Medicare |
$26.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$103.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.86
|
|
|
Aph FFP ACDA Thawed
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
1221767
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Aph Plt ACDA LR
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
CPT P9034
|
| Hospital Charge Code |
857738
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,462.50
|
| Rate for Payer: Aetna of AZ Medicare |
$455.00
|
| Rate for Payer: AHCCCS Medicaid |
$469.78
|
| Rate for Payer: Allwell Medicaid |
$469.78
|
| Rate for Payer: Allwell Medicare |
$243.75
|
| Rate for Payer: Amerigroup Medicare |
$243.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$606.94
|
| Rate for Payer: AZCH Complete Medicaid |
$469.78
|
| Rate for Payer: AZCH Complete Medicare |
$243.75
|
| Rate for Payer: Banner UC Health Medicaid |
$469.78
|
| Rate for Payer: Banner UC Health Medicare |
$243.75
|
| Rate for Payer: Bisbee Police All Plans |
$422.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,105.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,056.25
|
| Rate for Payer: Copperpoint Commercial |
$402.19
|
| Rate for Payer: Health Net of AZ Commercial |
$975.00
|
| Rate for Payer: Health Net of AZ Medicare |
$455.00
|
| Rate for Payer: Humana of AZ Medicare |
$243.75
|
| Rate for Payer: Mercy Care Medicaid |
$469.78
|
| Rate for Payer: Self Pay Self Pay |
$1,300.00
|
| Rate for Payer: TriWest Medicare |
$243.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$947.38
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$292.50
|
|
|
Aph Plt ACDA LR
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
CPT P9034
|
| Hospital Charge Code |
857738
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,462.50
|
| Rate for Payer: Bisbee Police All Plans |
$422.50
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Self Pay Self Pay |
$1,300.00
|
|
|
Aph Plt ACDA LR 1
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
CPT P9034
|
| Hospital Charge Code |
857739
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,462.50
|
| Rate for Payer: Aetna of AZ Medicare |
$455.00
|
| Rate for Payer: AHCCCS Medicaid |
$469.78
|
| Rate for Payer: Allwell Medicaid |
$469.78
|
| Rate for Payer: Allwell Medicare |
$243.75
|
| Rate for Payer: Amerigroup Medicare |
$243.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$606.94
|
| Rate for Payer: AZCH Complete Medicaid |
$469.78
|
| Rate for Payer: AZCH Complete Medicare |
$243.75
|
| Rate for Payer: Banner UC Health Medicaid |
$469.78
|
| Rate for Payer: Banner UC Health Medicare |
$243.75
|
| Rate for Payer: Bisbee Police All Plans |
$422.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,105.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,056.25
|
| Rate for Payer: Copperpoint Commercial |
$402.19
|
| Rate for Payer: Health Net of AZ Commercial |
$975.00
|
| Rate for Payer: Health Net of AZ Medicare |
$455.00
|
| Rate for Payer: Humana of AZ Medicare |
$243.75
|
| Rate for Payer: Mercy Care Medicaid |
$469.78
|
| Rate for Payer: Self Pay Self Pay |
$1,300.00
|
| Rate for Payer: TriWest Medicare |
$243.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$947.38
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$292.50
|
|
|
Aph Plt ACDA LR 1
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
CPT P9034
|
| Hospital Charge Code |
857739
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,462.50
|
| Rate for Payer: Bisbee Police All Plans |
$422.50
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Self Pay Self Pay |
$1,300.00
|
|
|
Aph Plt ACDA LR 2
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
CPT P9034
|
| Hospital Charge Code |
857740
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,462.50
|
| Rate for Payer: Bisbee Police All Plans |
$422.50
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Self Pay Self Pay |
$1,300.00
|
|
|
Aph Plt ACDA LR 2
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
CPT P9034
|
| Hospital Charge Code |
857740
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,462.50
|
| Rate for Payer: Aetna of AZ Medicare |
$455.00
|
| Rate for Payer: AHCCCS Medicaid |
$469.78
|
| Rate for Payer: Allwell Medicaid |
$469.78
|
| Rate for Payer: Allwell Medicare |
$243.75
|
| Rate for Payer: Amerigroup Medicare |
$243.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$606.94
|
| Rate for Payer: AZCH Complete Medicaid |
$469.78
|
| Rate for Payer: AZCH Complete Medicare |
$243.75
|
| Rate for Payer: Banner UC Health Medicaid |
$469.78
|
| Rate for Payer: Banner UC Health Medicare |
$243.75
|
| Rate for Payer: Bisbee Police All Plans |
$422.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,105.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,056.25
|
| Rate for Payer: Copperpoint Commercial |
$402.19
|
| Rate for Payer: Health Net of AZ Commercial |
$975.00
|
| Rate for Payer: Health Net of AZ Medicare |
$455.00
|
| Rate for Payer: Humana of AZ Medicare |
$243.75
|
| Rate for Payer: Mercy Care Medicaid |
$469.78
|
| Rate for Payer: Self Pay Self Pay |
$1,300.00
|
| Rate for Payer: TriWest Medicare |
$243.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$947.38
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$292.50
|
|
|
Aph Plt ACDA LR 3
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
CPT P9034
|
| Hospital Charge Code |
857741
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,462.50
|
| Rate for Payer: Bisbee Police All Plans |
$422.50
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Self Pay Self Pay |
$1,300.00
|
|
