|
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LA
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
27357091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$441.75 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$2,650.50
|
| Rate for Payer: Aetna of AZ Medicare |
$824.60
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$441.75
|
| Rate for Payer: Amerigroup Medicare |
$441.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,099.96
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$441.75
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$441.75
|
| Rate for Payer: Bisbee Police All Plans |
$765.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,002.60
|
| Rate for Payer: Cash Price |
$2,356.00
|
| Rate for Payer: Cash Price |
$2,356.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,472.50
|
| Rate for Payer: Copperpoint Commercial |
$728.89
|
| Rate for Payer: Health Net of AZ Commercial |
$1,767.00
|
| Rate for Payer: Health Net of AZ Medicare |
$824.60
|
| Rate for Payer: Humana of AZ Medicare |
$441.75
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$2,356.00
|
| Rate for Payer: TriWest Medicare |
$441.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$530.10
|
|
|
ARTHROTOMY ANKLE WITH JOINT EXPLORATION WITH OR WITHOUT BIOPSY WITH OR WITHO
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
CPT 27620
|
| Hospital Charge Code |
24043333
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$569.40 |
| Max. Negotiated Rate |
$1,971.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,971.00
|
| Rate for Payer: Bisbee Police All Plans |
$569.40
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Self Pay Self Pay |
$1,752.00
|
|
|
ARTHROTOMY ANKLE WITH JOINT EXPLORATION WITH OR WITHOUT BIOPSY WITH OR WITHO
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
CPT 27620
|
| Hospital Charge Code |
24043333
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.50 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,971.00
|
| Rate for Payer: Aetna of AZ Medicare |
$613.20
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$328.50
|
| Rate for Payer: Amerigroup Medicare |
$328.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$817.96
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$328.50
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$328.50
|
| Rate for Payer: Bisbee Police All Plans |
$569.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,489.20
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,095.00
|
| Rate for Payer: Copperpoint Commercial |
$542.02
|
| Rate for Payer: Health Net of AZ Commercial |
$1,314.00
|
| Rate for Payer: Health Net of AZ Medicare |
$613.20
|
| Rate for Payer: Humana of AZ Medicare |
$328.50
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,752.00
|
| Rate for Payer: TriWest Medicare |
$328.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$394.20
|
|
|
ARTHROTOMY INCLUDING EXPLORATION DRAINAGE OR REMOVAL OF LOOSE OR FOREIGN
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 28024
|
| Hospital Charge Code |
24043319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$383.24 |
| Max. Negotiated Rate |
$1,326.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,326.60
|
| Rate for Payer: Bisbee Police All Plans |
$383.24
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Self Pay Self Pay |
$1,179.20
|
|
|
ARTHROTOMY INCLUDING EXPLORATION DRAINAGE OR REMOVAL OF LOOSE OR FOREIGN
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 28024
|
| Hospital Charge Code |
24043319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$221.10 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,326.60
|
| Rate for Payer: Aetna of AZ Medicare |
$412.72
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$221.10
|
| Rate for Payer: Amerigroup Medicare |
$221.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$550.54
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$221.10
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$221.10
|
| Rate for Payer: Bisbee Police All Plans |
$383.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,002.32
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cigna of AZ Commercial |
$737.00
|
| Rate for Payer: Copperpoint Commercial |
$364.82
|
| Rate for Payer: Health Net of AZ Commercial |
$884.40
|
| Rate for Payer: Health Net of AZ Medicare |
$412.72
|
| Rate for Payer: Humana of AZ Medicare |
$221.10
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$1,179.20
|
| Rate for Payer: TriWest Medicare |
$221.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$265.32
|
|
|
artificial tear ointment [CQCH]
|
Facility
|
OP
|
$5.86
|
|
|
Service Code
|
NDC 17478006235
|
| Hospital Charge Code |
105934694
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$5.27 |
| Rate for Payer: Aetna of AZ Commercial |
$5.27
|
| Rate for Payer: Aetna of AZ Medicare |
$1.64
|
| Rate for Payer: Allwell Medicare |
$0.88
|
| Rate for Payer: Amerigroup Medicare |
$0.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.19
|
| Rate for Payer: AZCH Complete Medicare |
$0.88
|
| Rate for Payer: Banner UC Health Medicare |
$0.88
|
| Rate for Payer: Bisbee Police All Plans |
$1.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.98
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cigna of AZ Commercial |
$3.81
|
| Rate for Payer: Copperpoint Commercial |
$1.45
|
| Rate for Payer: Health Net of AZ Commercial |
$3.52
|
| Rate for Payer: Health Net of AZ Medicare |
$1.64
|
| Rate for Payer: Humana of AZ Medicare |
$0.88
|
| Rate for Payer: Self Pay Self Pay |
$4.69
|
| Rate for Payer: TriWest Medicare |
$0.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.05
|
|
|
artificial tear ointment [CQCH]
|
Facility
|
IP
|
$5.86
|
|
|
Service Code
|
NDC 17478006235
|
| Hospital Charge Code |
105934694
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$5.27 |
| Rate for Payer: Aetna of AZ Commercial |
$5.27
|
| Rate for Payer: Bisbee Police All Plans |
$1.52
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Self Pay Self Pay |
$4.69
|
|
|
artificial tears ophth soln [CQCH]
|
Facility
|
IP
|
$4.97
|
|
|
Service Code
|
NDC 17478006012
|
| Hospital Charge Code |
105934755
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna of AZ Commercial |
$4.47
|
| Rate for Payer: Bisbee Police All Plans |
$1.29
|
| Rate for Payer: Cash Price |
$3.98
|
| Rate for Payer: Self Pay Self Pay |
$3.98
|
|
|
artificial tears ophth soln [CQCH]
|
Facility
|
OP
|
$4.97
|
|
|
Service Code
|
NDC 17478006012
|
| Hospital Charge Code |
105934755
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna of AZ Commercial |
$4.47
|
| Rate for Payer: Aetna of AZ Medicare |
$1.39
|
| Rate for Payer: Allwell Medicare |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.86
|
| Rate for Payer: AZCH Complete Medicare |
$0.75
|
| Rate for Payer: Banner UC Health Medicare |
$0.75
|
| Rate for Payer: Bisbee Police All Plans |
$1.29
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$3.98
|
| Rate for Payer: Cigna of AZ Commercial |
$3.23
|
| Rate for Payer: Copperpoint Commercial |
$1.23
|
| Rate for Payer: Health Net of AZ Commercial |
$2.98
|
| Rate for Payer: Health Net of AZ Medicare |
$1.39
|
| Rate for Payer: Humana of AZ Medicare |
$0.75
|
| Rate for Payer: Self Pay Self Pay |
$3.98
|
| Rate for Payer: TriWest Medicare |
$0.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.89
|
|
|
Ascend AQ Ureteral Dilation Baloon Catheter Set
|
Facility
|
IP
|
$1,685.00
|
|
| Hospital Charge Code |
22926476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.10 |
| Max. Negotiated Rate |
$1,516.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,516.50
|
| Rate for Payer: Bisbee Police All Plans |
$438.10
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Self Pay Self Pay |
$1,348.00
|
|
|
Ascend AQ Ureteral Dilation Baloon Catheter Set
|
Facility
|
OP
|
$1,685.00
|
|
| Hospital Charge Code |
22926476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.75 |
| Max. Negotiated Rate |
$1,516.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,516.50
|
| Rate for Payer: Aetna of AZ Medicare |
$471.80
|
| Rate for Payer: Allwell Medicare |
$252.75
|
| Rate for Payer: Amerigroup Medicare |
$252.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$629.35
|
| Rate for Payer: AZCH Complete Medicare |
$252.75
|
| Rate for Payer: Banner UC Health Medicare |
$252.75
|
| Rate for Payer: Bisbee Police All Plans |
$438.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,145.80
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,179.50
|
| Rate for Payer: Copperpoint Commercial |
$417.04
|
| Rate for Payer: Health Net of AZ Commercial |
$1,011.00
|
| Rate for Payer: Health Net of AZ Medicare |
$471.80
|
| Rate for Payer: Humana of AZ Medicare |
$252.75
|
| Rate for Payer: Self Pay Self Pay |
$1,348.00
|
| Rate for Payer: TriWest Medicare |
$252.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$982.36
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$303.30
|
|
|
ascorbic acid 500 mg/mL Sol[CQCH]
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 67157010150
|
| Hospital Charge Code |
200236188
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna of AZ Commercial |
$4.46
|
| Rate for Payer: Aetna of AZ Medicare |
$1.39
|
| Rate for Payer: Allwell Medicare |
$0.74
|
| Rate for Payer: Amerigroup Medicare |
$0.74
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.85
|
| Rate for Payer: AZCH Complete Medicare |
$0.74
|
| Rate for Payer: Banner UC Health Medicare |
$0.74
|
| Rate for Payer: Bisbee Police All Plans |
$1.29
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.37
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cigna of AZ Commercial |
$3.22
|
| Rate for Payer: Copperpoint Commercial |
$1.23
|
| Rate for Payer: Health Net of AZ Commercial |
$2.97
|
| Rate for Payer: Health Net of AZ Medicare |
$1.39
|
| Rate for Payer: Humana of AZ Medicare |
$0.74
|
| Rate for Payer: Self Pay Self Pay |
$3.96
|
| Rate for Payer: TriWest Medicare |
$0.74
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.89
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.89
|
|
|
ascorbic acid 500 mg/mL Sol[CQCH]
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 67157010150
|
| Hospital Charge Code |
200236188
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna of AZ Commercial |
$4.46
|
| Rate for Payer: Bisbee Police All Plans |
$1.29
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Self Pay Self Pay |
$3.96
|
|
|
ascorbic acid 500 mg Tab [CQCH]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 904052380
|
| Hospital Charge Code |
105911388
|
|
Hospital Revenue Code
|
251
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of AZ Commercial |
$0.02
|
| Rate for Payer: Aetna of AZ Medicare |
$0.01
|
| Rate for Payer: Allwell Medicare |
$0.00
|
| Rate for Payer: Amerigroup Medicare |
$0.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.01
|
| Rate for Payer: AZCH Complete Medicare |
$0.00
|
| Rate for Payer: Banner UC Health Medicare |
$0.00
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of AZ Commercial |
$0.01
|
| Rate for Payer: Copperpoint Commercial |
$0.00
|
| Rate for Payer: Health Net of AZ Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Medicare |
$0.01
|
| Rate for Payer: Humana of AZ Medicare |
$0.00
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
| Rate for Payer: TriWest Medicare |
$0.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.00
|
|
|
ascorbic acid 500 mg Tab [CQCH]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 904052380
|
| Hospital Charge Code |
105911388
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of AZ Commercial |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
|
|
ASCORBIC ACID (VITAMIN C), BLOOD
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
23603251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of AZ Commercial |
$38.70
|
| Rate for Payer: Bisbee Police All Plans |
$11.18
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Self Pay Self Pay |
$34.40
|
|
|
ASCORBIC ACID (VITAMIN C), BLOOD
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
23603251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of AZ Commercial |
$38.70
|
| Rate for Payer: Aetna of AZ Medicare |
$12.04
|
| Rate for Payer: AHCCCS Medicaid |
$9.89
|
| Rate for Payer: Allwell Medicaid |
$9.89
|
| Rate for Payer: Allwell Medicare |
$6.45
|
| Rate for Payer: Amerigroup Medicare |
$6.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$16.06
|
| Rate for Payer: AZCH Complete Medicaid |
$9.89
|
| Rate for Payer: AZCH Complete Medicare |
$6.45
|
| Rate for Payer: Banner UC Health Medicaid |
$9.89
|
| Rate for Payer: Banner UC Health Medicare |
$6.45
|
| Rate for Payer: Bisbee Police All Plans |
$11.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$29.24
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cigna of AZ Commercial |
$27.95
|
| Rate for Payer: Copperpoint Commercial |
$10.64
|
| Rate for Payer: Health Net of AZ Commercial |
$25.80
|
| Rate for Payer: Health Net of AZ Medicare |
$12.04
|
| Rate for Payer: Humana of AZ Medicare |
$6.45
|
| Rate for Payer: Mercy Care Medicaid |
$9.89
|
| Rate for Payer: Self Pay Self Pay |
$34.40
|
| Rate for Payer: TriWest Medicare |
$6.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$25.07
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.74
|
|
|
Aspartate Aminotransferase
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
633633
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of AZ Commercial |
$117.00
|
| Rate for Payer: Aetna of AZ Medicare |
$36.40
|
| Rate for Payer: AHCCCS Medicaid |
$5.18
|
| Rate for Payer: Allwell Medicaid |
$5.18
|
| Rate for Payer: Allwell Medicare |
$19.50
|
| Rate for Payer: Amerigroup Medicare |
$19.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$48.56
|
| Rate for Payer: AZCH Complete Medicaid |
$5.18
|
| Rate for Payer: AZCH Complete Medicare |
$19.50
|
| Rate for Payer: Banner UC Health Medicaid |
$5.18
|
| Rate for Payer: Banner UC Health Medicare |
$19.50
|
| Rate for Payer: Bisbee Police All Plans |
$33.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$88.40
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna of AZ Commercial |
$84.50
|
| Rate for Payer: Copperpoint Commercial |
$32.18
|
| Rate for Payer: Health Net of AZ Commercial |
$78.00
|
| Rate for Payer: Health Net of AZ Medicare |
$36.40
|
| Rate for Payer: Humana of AZ Medicare |
$19.50
|
| Rate for Payer: Mercy Care Medicaid |
$5.18
|
| Rate for Payer: Self Pay Self Pay |
$104.00
|
| Rate for Payer: TriWest Medicare |
$19.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$75.79
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$23.40
|
|
|
Aspartate Aminotransferase
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
633633
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of AZ Commercial |
$117.00
|
| Rate for Payer: Bisbee Police All Plans |
$33.80
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Self Pay Self Pay |
$104.00
|
|
|
Aspergillus Antibodies, Quantitative LC
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
12689406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna of AZ Commercial |
$381.60
|
| Rate for Payer: Bisbee Police All Plans |
$110.24
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Self Pay Self Pay |
$339.20
|
|
|
Aspergillus Antibodies, Quantitative LC
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
12689406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna of AZ Commercial |
$381.60
|
| Rate for Payer: Aetna of AZ Medicare |
$118.72
|
| Rate for Payer: AHCCCS Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicare |
$63.60
|
| Rate for Payer: Amerigroup Medicare |
$63.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$158.36
|
| Rate for Payer: AZCH Complete Medicaid |
$15.05
|
| Rate for Payer: AZCH Complete Medicare |
$63.60
|
| Rate for Payer: Banner UC Health Medicaid |
$15.05
|
| Rate for Payer: Banner UC Health Medicare |
$63.60
|
| Rate for Payer: Bisbee Police All Plans |
$110.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$288.32
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cigna of AZ Commercial |
$275.60
|
| Rate for Payer: Copperpoint Commercial |
$104.94
|
| Rate for Payer: Health Net of AZ Commercial |
$254.40
|
| Rate for Payer: Health Net of AZ Medicare |
$118.72
|
| Rate for Payer: Humana of AZ Medicare |
$63.60
|
| Rate for Payer: Mercy Care Medicaid |
$15.05
|
| Rate for Payer: Self Pay Self Pay |
$339.20
|
| Rate for Payer: TriWest Medicare |
$63.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$247.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$76.32
|
|
|
ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
24049291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$182.70
|
| Rate for Payer: Aetna of AZ Medicare |
$56.84
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicare |
$30.45
|
| Rate for Payer: Amerigroup Medicare |
$30.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$75.82
|
| Rate for Payer: AZCH Complete Medicaid |
$378.70
|
| Rate for Payer: AZCH Complete Medicare |
$30.45
|
| Rate for Payer: Banner UC Health Medicaid |
$378.70
|
| Rate for Payer: Banner UC Health Medicare |
$30.45
|
| Rate for Payer: Bisbee Police All Plans |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$138.04
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cigna of AZ Commercial |
$101.50
|
| Rate for Payer: Copperpoint Commercial |
$50.24
|
| Rate for Payer: Health Net of AZ Commercial |
$121.80
|
| Rate for Payer: Health Net of AZ Medicare |
$56.84
|
| Rate for Payer: Humana of AZ Medicare |
$30.45
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: Self Pay Self Pay |
$162.40
|
| Rate for Payer: TriWest Medicare |
$30.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$36.54
|
|
|
ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
24049291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.78 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna of AZ Commercial |
$182.70
|
| Rate for Payer: Bisbee Police All Plans |
$52.78
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Self Pay Self Pay |
$162.40
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$8,052.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
2084169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,093.52 |
| Max. Negotiated Rate |
$7,246.80 |
| Rate for Payer: Aetna of AZ Commercial |
$7,246.80
|
| Rate for Payer: Bisbee Police All Plans |
$2,093.52
|
| Rate for Payer: Cash Price |
$6,441.60
|
| Rate for Payer: Self Pay Self Pay |
$6,441.60
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$8,052.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
2084169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,207.80 |
| Max. Negotiated Rate |
$7,246.80 |
| Rate for Payer: Aetna of AZ Commercial |
$7,246.80
|
| Rate for Payer: Aetna of AZ Medicare |
$2,254.56
|
| Rate for Payer: AHCCCS Medicaid |
$2,599.84
|
| Rate for Payer: Allwell Medicaid |
$2,599.84
|
| Rate for Payer: Allwell Medicare |
$1,207.80
|
| Rate for Payer: Amerigroup Medicare |
$1,207.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3,007.42
|
| Rate for Payer: AZCH Complete Medicaid |
$2,599.84
|
| Rate for Payer: AZCH Complete Medicare |
$1,207.80
|
| Rate for Payer: Banner UC Health Medicaid |
$2,599.84
|
| Rate for Payer: Banner UC Health Medicare |
$1,207.80
|
| Rate for Payer: Bisbee Police All Plans |
$2,093.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5,475.36
|
| Rate for Payer: Cash Price |
$6,441.60
|
| Rate for Payer: Cash Price |
$6,441.60
|
| Rate for Payer: Cigna of AZ Commercial |
$5,636.40
|
| Rate for Payer: Copperpoint Commercial |
$1,992.87
|
| Rate for Payer: Health Net of AZ Commercial |
$4,831.20
|
| Rate for Payer: Health Net of AZ Medicare |
$2,254.56
|
| Rate for Payer: Humana of AZ Medicare |
$1,207.80
|
| Rate for Payer: Mercy Care Medicaid |
$2,599.84
|
| Rate for Payer: Self Pay Self Pay |
$6,441.60
|
| Rate for Payer: TriWest Medicare |
$1,207.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,449.36
|
|
