|
Bill BRCAssure Comp
|
Facility
|
OP
|
$5,269.00
|
|
| Hospital Charge Code |
23568393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$790.35 |
| Max. Negotiated Rate |
$4,742.10 |
| Rate for Payer: Aetna of AZ Commercial |
$4,742.10
|
| Rate for Payer: Aetna of AZ Medicare |
$1,475.32
|
| Rate for Payer: Allwell Medicare |
$790.35
|
| Rate for Payer: Amerigroup Medicare |
$790.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,967.97
|
| Rate for Payer: AZCH Complete Medicare |
$790.35
|
| Rate for Payer: Banner UC Health Medicare |
$790.35
|
| Rate for Payer: Bisbee Police All Plans |
$1,369.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,582.92
|
| Rate for Payer: Cash Price |
$4,215.20
|
| Rate for Payer: Cigna of AZ Commercial |
$3,424.85
|
| Rate for Payer: Copperpoint Commercial |
$1,304.08
|
| Rate for Payer: Health Net of AZ Commercial |
$3,161.40
|
| Rate for Payer: Health Net of AZ Medicare |
$1,475.32
|
| Rate for Payer: Humana of AZ Medicare |
$790.35
|
| Rate for Payer: Self Pay Self Pay |
$4,215.20
|
| Rate for Payer: TriWest Medicare |
$790.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,071.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$948.42
|
|
|
Bill Capillary Draw
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
10443835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of AZ Commercial |
$30.60
|
| Rate for Payer: Bisbee Police All Plans |
$8.84
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Self Pay Self Pay |
$27.20
|
|
|
Bill Capillary Draw
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
10443835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of AZ Commercial |
$30.60
|
| Rate for Payer: Aetna of AZ Medicare |
$9.52
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$5.10
|
| Rate for Payer: Amerigroup Medicare |
$5.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$12.70
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$5.10
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$5.10
|
| Rate for Payer: Bisbee Police All Plans |
$8.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$23.12
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cigna of AZ Commercial |
$22.10
|
| Rate for Payer: Copperpoint Commercial |
$8.42
|
| Rate for Payer: Health Net of AZ Commercial |
$20.40
|
| Rate for Payer: Health Net of AZ Medicare |
$9.52
|
| Rate for Payer: Humana of AZ Medicare |
$5.10
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$27.20
|
| Rate for Payer: TriWest Medicare |
$5.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$19.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.12
|
|
|
Bill CMV Quant DNA PCR
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
23568396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna of AZ Commercial |
$288.00
|
| Rate for Payer: Aetna of AZ Medicare |
$89.60
|
| Rate for Payer: AHCCCS Medicaid |
$42.84
|
| Rate for Payer: Allwell Medicaid |
$42.84
|
| Rate for Payer: Allwell Medicare |
$48.00
|
| Rate for Payer: Amerigroup Medicare |
$48.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$119.52
|
| Rate for Payer: AZCH Complete Medicaid |
$42.84
|
| Rate for Payer: AZCH Complete Medicare |
$48.00
|
| Rate for Payer: Banner UC Health Medicaid |
$42.84
|
| Rate for Payer: Banner UC Health Medicare |
$48.00
|
| Rate for Payer: Bisbee Police All Plans |
$83.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$217.60
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cigna of AZ Commercial |
$208.00
|
| Rate for Payer: Copperpoint Commercial |
$79.20
|
| Rate for Payer: Health Net of AZ Commercial |
$192.00
|
| Rate for Payer: Health Net of AZ Medicare |
$89.60
|
| Rate for Payer: Humana of AZ Medicare |
$48.00
|
| Rate for Payer: Mercy Care Medicaid |
$42.84
|
| Rate for Payer: Self Pay Self Pay |
$256.00
|
| Rate for Payer: TriWest Medicare |
$48.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$186.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$57.60
|
|
|
Bill CMV Quant DNA PCR
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
23568396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna of AZ Commercial |
$288.00
|
| Rate for Payer: Bisbee Police All Plans |
$83.20
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Self Pay Self Pay |
$256.00
|
|
|
Bill Cryo Prep/Thaw
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 86931
|
| Hospital Charge Code |
22248792
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$211.16 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Aetna of AZ Medicare |
$49.56
|
| Rate for Payer: AHCCCS Medicaid |
$211.16
|
| Rate for Payer: Allwell Medicaid |
$211.16
|
| 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 |
$211.16
|
| Rate for Payer: AZCH Complete Medicare |
$26.55
|
| Rate for Payer: Banner UC Health Medicaid |
$211.16
|
| 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 |
$211.16
|
| 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
|
|
|
Bill Cryo Prep/Thaw
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 86931
|
| Hospital Charge Code |
22248792
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
Bill Culture ID Aerobie Confirm
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
22374498
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of AZ Commercial |
$130.50
|
| Rate for Payer: Bisbee Police All Plans |
$37.70
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Self Pay Self Pay |
$116.00
|
|
|
Bill Culture ID Aerobie Confirm
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
22374498
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of AZ Commercial |
$130.50
|
| Rate for Payer: Aetna of AZ Medicare |
$40.60
|
| Rate for Payer: AHCCCS Medicaid |
$8.08
|
| Rate for Payer: Allwell Medicaid |
$8.08
|
| Rate for Payer: Allwell Medicare |
$21.75
|
| Rate for Payer: Amerigroup Medicare |
$21.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$54.16
|
| Rate for Payer: AZCH Complete Medicaid |
$8.08
|
| Rate for Payer: AZCH Complete Medicare |
$21.75
|
| Rate for Payer: Banner UC Health Medicaid |
$8.08
|
| Rate for Payer: Banner UC Health Medicare |
$21.75
|
| Rate for Payer: Bisbee Police All Plans |
$37.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna of AZ Commercial |
$94.25
|
| Rate for Payer: Copperpoint Commercial |
$35.89
|
| Rate for Payer: Health Net of AZ Commercial |
$87.00
|
| Rate for Payer: Health Net of AZ Medicare |
$40.60
|
| Rate for Payer: Humana of AZ Medicare |
$21.75
|
| Rate for Payer: Mercy Care Medicaid |
$8.08
|
| Rate for Payer: Self Pay Self Pay |
$116.00
|
| Rate for Payer: TriWest Medicare |
$21.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$84.54
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.10
|
|
|
Bill Culture Stool, Vibrio Only
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
22374496
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of AZ Commercial |
$79.20
|
| Rate for Payer: Aetna of AZ Medicare |
$24.64
|
| Rate for Payer: AHCCCS Medicaid |
$9.44
|
| Rate for Payer: Allwell Medicaid |
$9.44
|
| Rate for Payer: Allwell Medicare |
$13.20
|
| Rate for Payer: Amerigroup Medicare |
$13.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$32.87
|
| Rate for Payer: AZCH Complete Medicaid |
$9.44
|
| Rate for Payer: AZCH Complete Medicare |
$13.20
|
| Rate for Payer: Banner UC Health Medicaid |
$9.44
|
| Rate for Payer: Banner UC Health Medicare |
$13.20
|
| Rate for Payer: Bisbee Police All Plans |
$22.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$59.84
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cigna of AZ Commercial |
$57.20
|
| Rate for Payer: Copperpoint Commercial |
$21.78
|
| Rate for Payer: Health Net of AZ Commercial |
$52.80
|
| Rate for Payer: Health Net of AZ Medicare |
$24.64
|
| Rate for Payer: Humana of AZ Medicare |
$13.20
|
| Rate for Payer: Mercy Care Medicaid |
$9.44
|
| Rate for Payer: Self Pay Self Pay |
$70.40
|
| Rate for Payer: TriWest Medicare |
$13.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$51.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.84
|
|
|
Bill Culture Stool, Vibrio Only
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
22374496
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of AZ Commercial |
$79.20
|
| Rate for Payer: Bisbee Police All Plans |
$22.88
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Self Pay Self Pay |
$70.40
|
|
|
BILL CULTURE STOOL, YERSINIA ONLY
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
22374494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of AZ Commercial |
$104.40
|
| Rate for Payer: Aetna of AZ Medicare |
$32.48
|
| Rate for Payer: AHCCCS Medicaid |
$9.44
|
| Rate for Payer: Allwell Medicaid |
$9.44
|
| Rate for Payer: Allwell Medicare |
$17.40
|
| Rate for Payer: Amerigroup Medicare |
$17.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$43.33
|
| Rate for Payer: AZCH Complete Medicaid |
$9.44
|
| Rate for Payer: AZCH Complete Medicare |
$17.40
|
| Rate for Payer: Banner UC Health Medicaid |
$9.44
|
| Rate for Payer: Banner UC Health Medicare |
$17.40
|
| Rate for Payer: Bisbee Police All Plans |
$30.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$78.88
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cigna of AZ Commercial |
$75.40
|
| Rate for Payer: Copperpoint Commercial |
$28.71
|
| Rate for Payer: Health Net of AZ Commercial |
$69.60
|
| Rate for Payer: Health Net of AZ Medicare |
$32.48
|
| Rate for Payer: Humana of AZ Medicare |
$17.40
|
| Rate for Payer: Mercy Care Medicaid |
$9.44
|
| Rate for Payer: Self Pay Self Pay |
$92.80
|
| Rate for Payer: TriWest Medicare |
$17.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$67.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$20.88
|
|
|
BILL CULTURE STOOL, YERSINIA ONLY
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
22374494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of AZ Commercial |
$104.40
|
| Rate for Payer: Bisbee Police All Plans |
$30.16
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Self Pay Self Pay |
$92.80
|
|
|
Bill Cystic Fibrosis Profile
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
23568394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$556.60 |
| Rate for Payer: Aetna of AZ Commercial |
$226.80
|
| Rate for Payer: Aetna of AZ Medicare |
$70.56
|
| Rate for Payer: AHCCCS Medicaid |
$556.60
|
| Rate for Payer: Allwell Medicaid |
$556.60
|
| Rate for Payer: Allwell Medicare |
$37.80
|
| Rate for Payer: Amerigroup Medicare |
$37.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$94.12
|
| Rate for Payer: AZCH Complete Medicaid |
$556.60
|
| Rate for Payer: AZCH Complete Medicare |
$37.80
|
| Rate for Payer: Banner UC Health Medicaid |
$556.60
|
| Rate for Payer: Banner UC Health Medicare |
$37.80
|
| Rate for Payer: Bisbee Police All Plans |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$171.36
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna of AZ Commercial |
$163.80
|
| Rate for Payer: Copperpoint Commercial |
$62.37
|
| Rate for Payer: Health Net of AZ Commercial |
$151.20
|
| Rate for Payer: Health Net of AZ Medicare |
$70.56
|
| Rate for Payer: Humana of AZ Medicare |
$37.80
|
| Rate for Payer: Mercy Care Medicaid |
$556.60
|
| Rate for Payer: Self Pay Self Pay |
$201.60
|
| Rate for Payer: TriWest Medicare |
$37.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$146.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$45.36
|
|
|
Bill Cystic Fibrosis Profile
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
23568394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna of AZ Commercial |
$226.80
|
| Rate for Payer: Bisbee Police All Plans |
$65.52
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Self Pay Self Pay |
$201.60
|
|
|
Bill FFP Prep/Thaw
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
22248793
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Aetna of AZ Medicare |
$71.40
|
| Rate for Payer: AHCCCS Medicaid |
$108.14
|
| Rate for Payer: Allwell Medicaid |
$108.14
|
| Rate for Payer: Allwell Medicare |
$38.25
|
| Rate for Payer: Amerigroup Medicare |
$38.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$95.24
|
| Rate for Payer: AZCH Complete Medicaid |
$108.14
|
| Rate for Payer: AZCH Complete Medicare |
$38.25
|
| Rate for Payer: Banner UC Health Medicaid |
$108.14
|
| Rate for Payer: Banner UC Health Medicare |
$38.25
|
| Rate for Payer: Bisbee Police All Plans |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna of AZ Commercial |
$165.75
|
| Rate for Payer: Copperpoint Commercial |
$63.11
|
| Rate for Payer: Health Net of AZ Commercial |
$153.00
|
| Rate for Payer: Health Net of AZ Medicare |
$71.40
|
| Rate for Payer: Humana of AZ Medicare |
$38.25
|
| Rate for Payer: Mercy Care Medicaid |
$108.14
|
| Rate for Payer: Self Pay Self Pay |
$204.00
|
| Rate for Payer: TriWest Medicare |
$38.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$148.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$45.90
|
|
|
Bill FFP Prep/Thaw
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
22248793
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Bisbee Police All Plans |
$66.30
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Self Pay Self Pay |
$204.00
|
|
|
Bill Hep b dna quant
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
23568533
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$368.16 |
| Max. Negotiated Rate |
$1,274.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,274.40
|
| Rate for Payer: Bisbee Police All Plans |
$368.16
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Self Pay Self Pay |
$1,132.80
|
|
|
Bill Hep b dna quant
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
23568533
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$1,274.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,274.40
|
| Rate for Payer: Aetna of AZ Medicare |
$396.48
|
| Rate for Payer: AHCCCS Medicaid |
$257.45
|
| Rate for Payer: Allwell Medicaid |
$257.45
|
| Rate for Payer: Allwell Medicare |
$212.40
|
| Rate for Payer: Amerigroup Medicare |
$212.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$528.88
|
| Rate for Payer: AZCH Complete Medicaid |
$257.45
|
| Rate for Payer: AZCH Complete Medicare |
$212.40
|
| Rate for Payer: Banner UC Health Medicaid |
$257.45
|
| Rate for Payer: Banner UC Health Medicare |
$212.40
|
| Rate for Payer: Bisbee Police All Plans |
$368.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$962.88
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cigna of AZ Commercial |
$920.40
|
| Rate for Payer: Copperpoint Commercial |
$350.46
|
| Rate for Payer: Health Net of AZ Commercial |
$849.60
|
| Rate for Payer: Health Net of AZ Medicare |
$396.48
|
| Rate for Payer: Humana of AZ Medicare |
$212.40
|
| Rate for Payer: Mercy Care Medicaid |
$257.45
|
| Rate for Payer: Self Pay Self Pay |
$1,132.80
|
| Rate for Payer: TriWest Medicare |
$212.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$825.53
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$254.88
|
|
|
Bill Hep b genotype
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
23568534
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Aetna of AZ Commercial |
$491.40
|
| Rate for Payer: Aetna of AZ Medicare |
$152.88
|
| Rate for Payer: AHCCCS Medicaid |
$257.45
|
| Rate for Payer: Allwell Medicaid |
$257.45
|
| Rate for Payer: Allwell Medicare |
$81.90
|
| Rate for Payer: Amerigroup Medicare |
$81.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$203.93
|
| Rate for Payer: AZCH Complete Medicaid |
$257.45
|
| Rate for Payer: AZCH Complete Medicare |
$81.90
|
| Rate for Payer: Banner UC Health Medicaid |
$257.45
|
| Rate for Payer: Banner UC Health Medicare |
$81.90
|
| Rate for Payer: Bisbee Police All Plans |
$141.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$371.28
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna of AZ Commercial |
$354.90
|
| Rate for Payer: Copperpoint Commercial |
$135.14
|
| Rate for Payer: Health Net of AZ Commercial |
$327.60
|
| Rate for Payer: Health Net of AZ Medicare |
$152.88
|
| Rate for Payer: Humana of AZ Medicare |
$81.90
|
| Rate for Payer: Mercy Care Medicaid |
$257.45
|
| Rate for Payer: Self Pay Self Pay |
$436.80
|
| Rate for Payer: TriWest Medicare |
$81.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$318.32
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$98.28
|
|
|
Bill Hep b genotype
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
23568534
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Aetna of AZ Commercial |
$491.40
|
| Rate for Payer: Bisbee Police All Plans |
$141.96
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Self Pay Self Pay |
$436.80
|
|
|
Bill HIV-1 RNA
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
22985134
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$169.78 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Aetna of AZ Commercial |
$587.70
|
| Rate for Payer: Bisbee Police All Plans |
$169.78
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Self Pay Self Pay |
$522.40
|
|
|
Bill HIV-1 RNA
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
22985134
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Aetna of AZ Commercial |
$587.70
|
| Rate for Payer: Aetna of AZ Medicare |
$182.84
|
| Rate for Payer: AHCCCS Medicaid |
$85.10
|
| Rate for Payer: Allwell Medicaid |
$85.10
|
| Rate for Payer: Allwell Medicare |
$97.95
|
| Rate for Payer: Amerigroup Medicare |
$97.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$243.90
|
| Rate for Payer: AZCH Complete Medicaid |
$85.10
|
| Rate for Payer: AZCH Complete Medicare |
$97.95
|
| Rate for Payer: Banner UC Health Medicaid |
$85.10
|
| Rate for Payer: Banner UC Health Medicare |
$97.95
|
| Rate for Payer: Bisbee Police All Plans |
$169.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$444.04
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cigna of AZ Commercial |
$424.45
|
| Rate for Payer: Copperpoint Commercial |
$161.62
|
| Rate for Payer: Health Net of AZ Commercial |
$391.80
|
| Rate for Payer: Health Net of AZ Medicare |
$182.84
|
| Rate for Payer: Humana of AZ Medicare |
$97.95
|
| Rate for Payer: Mercy Care Medicaid |
$85.10
|
| Rate for Payer: Self Pay Self Pay |
$522.40
|
| Rate for Payer: TriWest Medicare |
$97.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$380.70
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$117.54
|
|
|
Bill Ige Dog dander
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
23217726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of AZ Commercial |
$68.40
|
| Rate for Payer: Aetna of AZ Medicare |
$21.28
|
| Rate for Payer: AHCCCS Medicaid |
$5.22
|
| Rate for Payer: Allwell Medicaid |
$5.22
|
| Rate for Payer: Allwell Medicare |
$11.40
|
| Rate for Payer: Amerigroup Medicare |
$11.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$28.39
|
| Rate for Payer: AZCH Complete Medicaid |
$5.22
|
| Rate for Payer: AZCH Complete Medicare |
$11.40
|
| Rate for Payer: Banner UC Health Medicaid |
$5.22
|
| Rate for Payer: Banner UC Health Medicare |
$11.40
|
| Rate for Payer: Bisbee Police All Plans |
$19.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$51.68
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cigna of AZ Commercial |
$49.40
|
| Rate for Payer: Copperpoint Commercial |
$18.81
|
| Rate for Payer: Health Net of AZ Commercial |
$45.60
|
| Rate for Payer: Health Net of AZ Medicare |
$21.28
|
| Rate for Payer: Humana of AZ Medicare |
$11.40
|
| Rate for Payer: Mercy Care Medicaid |
$5.22
|
| Rate for Payer: Self Pay Self Pay |
$60.80
|
| Rate for Payer: TriWest Medicare |
$11.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$44.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.68
|
|
|
Bill Ige Dog dander
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
23217726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of AZ Commercial |
$68.40
|
| Rate for Payer: Bisbee Police All Plans |
$19.76
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Self Pay Self Pay |
$60.80
|
|
