|
Body Fluid Culture
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
858005
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.02 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Aetna of AZ Commercial |
$294.30
|
| Rate for Payer: Bisbee Police All Plans |
$85.02
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Self Pay Self Pay |
$261.60
|
|
|
Body Fluid Culture
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Aetna of AZ Commercial |
$279.90
|
| Rate for Payer: Bisbee Police All Plans |
$80.86
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Self Pay Self Pay |
$248.80
|
|
|
BOSS DISPOSABLE DRILL 10MM
|
Facility
|
OP
|
$1,223.00
|
|
| Hospital Charge Code |
27745954
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.45 |
| Max. Negotiated Rate |
$1,100.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,100.70
|
| Rate for Payer: Aetna of AZ Medicare |
$342.44
|
| Rate for Payer: Allwell Medicare |
$183.45
|
| Rate for Payer: Amerigroup Medicare |
$183.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$456.79
|
| Rate for Payer: AZCH Complete Medicare |
$183.45
|
| Rate for Payer: Banner UC Health Medicare |
$183.45
|
| Rate for Payer: Bisbee Police All Plans |
$317.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$831.64
|
| Rate for Payer: Cash Price |
$978.40
|
| Rate for Payer: Cigna of AZ Commercial |
$856.10
|
| Rate for Payer: Copperpoint Commercial |
$302.69
|
| Rate for Payer: Health Net of AZ Commercial |
$733.80
|
| Rate for Payer: Health Net of AZ Medicare |
$342.44
|
| Rate for Payer: Humana of AZ Medicare |
$183.45
|
| Rate for Payer: Self Pay Self Pay |
$978.40
|
| Rate for Payer: TriWest Medicare |
$183.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$713.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$220.14
|
|
|
BOSS DISPOSABLE DRILL 10MM
|
Facility
|
IP
|
$1,223.00
|
|
| Hospital Charge Code |
27745954
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$317.98 |
| Max. Negotiated Rate |
$1,100.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,100.70
|
| Rate for Payer: Bisbee Police All Plans |
$317.98
|
| Rate for Payer: Cash Price |
$978.40
|
| Rate for Payer: Self Pay Self Pay |
$978.40
|
|
|
Botox injection
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
27281910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$783.00
|
| Rate for Payer: Aetna of AZ Medicare |
$243.60
|
| Rate for Payer: AHCCCS Medicaid |
$2,599.84
|
| Rate for Payer: Allwell Medicaid |
$2,599.84
|
| Rate for Payer: Allwell Medicare |
$130.50
|
| Rate for Payer: Amerigroup Medicare |
$130.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$324.94
|
| Rate for Payer: AZCH Complete Medicaid |
$2,599.84
|
| Rate for Payer: AZCH Complete Medicare |
$130.50
|
| Rate for Payer: Banner UC Health Medicaid |
$2,599.84
|
| Rate for Payer: Banner UC Health Medicare |
$130.50
|
| Rate for Payer: Bisbee Police All Plans |
$226.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$591.60
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna of AZ Commercial |
$435.00
|
| Rate for Payer: Copperpoint Commercial |
$215.32
|
| Rate for Payer: Health Net of AZ Commercial |
$522.00
|
| Rate for Payer: Health Net of AZ Medicare |
$243.60
|
| Rate for Payer: Humana of AZ Medicare |
$130.50
|
| Rate for Payer: Mercy Care Medicaid |
$2,599.84
|
| Rate for Payer: Self Pay Self Pay |
$696.00
|
| Rate for Payer: TriWest Medicare |
$130.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$156.60
|
|
|
Botox injection
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
27281910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.20 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Aetna of AZ Commercial |
$783.00
|
| Rate for Payer: Bisbee Police All Plans |
$226.20
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Self Pay Self Pay |
$696.00
|
|
|
Botox (onabotulinumtoxinA) 100 units REC [CQCH]
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
109337996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of AZ Commercial |
$521.10
|
| Rate for Payer: Aetna of AZ Medicare |
$162.12
|
| Rate for Payer: AHCCCS Medicaid |
$10.12
|
| Rate for Payer: Allwell Medicaid |
$10.12
|
| Rate for Payer: Allwell Medicare |
$86.85
|
| Rate for Payer: Amerigroup Medicare |
$86.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$216.26
|
| Rate for Payer: AZCH Complete Medicaid |
$10.12
|
| Rate for Payer: AZCH Complete Medicare |
$86.85
|
| Rate for Payer: Banner UC Health Medicaid |
$10.12
|
| Rate for Payer: Banner UC Health Medicare |
$86.85
|
| Rate for Payer: Bisbee Police All Plans |
$150.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$393.72
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna of AZ Commercial |
$376.35
|
| Rate for Payer: Copperpoint Commercial |
$143.30
|
| Rate for Payer: Health Net of AZ Commercial |
$347.40
|
| Rate for Payer: Health Net of AZ Medicare |
$162.12
|
| Rate for Payer: Humana of AZ Medicare |
$86.85
|
| Rate for Payer: Mercy Care Medicaid |
$10.12
|
| Rate for Payer: Self Pay Self Pay |
$463.20
|
| Rate for Payer: TriWest Medicare |
$86.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$337.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$104.22
|
|
|
Botox (onabotulinumtoxinA) 100 units REC [CQCH]
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
109337996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.54 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of AZ Commercial |
$521.10
|
| Rate for Payer: Bisbee Police All Plans |
$150.54
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Self Pay Self Pay |
$463.20
|
|
|
Botox (onabotulinumtoxinA) 200 units REC [CQCH]
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
105934816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: TriWest Medicare |
$173.70
|
| Rate for Payer: Aetna of AZ Commercial |
$1,042.20
|
| Rate for Payer: Aetna of AZ Medicare |
$324.24
|
| Rate for Payer: AHCCCS Medicaid |
$10.12
|
| Rate for Payer: Allwell Medicaid |
$10.12
|
| Rate for Payer: Allwell Medicare |
$173.70
|
| Rate for Payer: Amerigroup Medicare |
$173.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$432.51
|
| Rate for Payer: AZCH Complete Medicaid |
$10.12
|
| Rate for Payer: AZCH Complete Medicare |
$173.70
|
| Rate for Payer: Banner UC Health Medicaid |
$10.12
|
| Rate for Payer: Banner UC Health Medicare |
$173.70
|
| Rate for Payer: Bisbee Police All Plans |
$301.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$787.44
|
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cigna of AZ Commercial |
$752.70
|
| Rate for Payer: Copperpoint Commercial |
$286.60
|
| Rate for Payer: Health Net of AZ Commercial |
$694.80
|
| Rate for Payer: Health Net of AZ Medicare |
$324.24
|
| Rate for Payer: Humana of AZ Medicare |
$173.70
|
| Rate for Payer: Mercy Care Medicaid |
$10.12
|
| Rate for Payer: Self Pay Self Pay |
$926.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$675.11
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$208.44
|
|
|
Botox (onabotulinumtoxinA) 200 units REC [CQCH]
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
105934816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$301.08 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,042.20
|
| Rate for Payer: Bisbee Police All Plans |
$301.08
|
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Self Pay Self Pay |
$926.40
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$3,174.54
|
|
|
Service Code
|
APR-DRG 1321
|
| Hospital Charge Code |
APRDRG1323
|
| Min. Negotiated Rate |
$3,174.54 |
| Max. Negotiated Rate |
$3,174.54 |
| Rate for Payer: AHCCCS Medicaid |
$3,174.54
|
| Rate for Payer: Allwell Medicaid |
$3,174.54
|
| Rate for Payer: AZCH Complete Medicaid |
$3,174.54
|
| Rate for Payer: Banner UC Health Medicaid |
$3,174.54
|
| Rate for Payer: Mercy Care Medicaid |
$3,174.54
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$7,028.73
|
|
|
Service Code
|
APR-DRG 1323
|
| Hospital Charge Code |
APRDRG1323
|
| Min. Negotiated Rate |
$7,028.73 |
| Max. Negotiated Rate |
$7,028.73 |
| Rate for Payer: AHCCCS Medicaid |
$7,028.73
|
| Rate for Payer: Allwell Medicaid |
$7,028.73
|
| Rate for Payer: AZCH Complete Medicaid |
$7,028.73
|
| Rate for Payer: Banner UC Health Medicaid |
$7,028.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,028.73
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$4,208.40
|
|
|
Service Code
|
APR-DRG 1322
|
| Hospital Charge Code |
APRDRG1321
|
| Min. Negotiated Rate |
$4,208.40 |
| Max. Negotiated Rate |
$4,208.40 |
| Rate for Payer: AHCCCS Medicaid |
$4,208.40
|
| Rate for Payer: Allwell Medicaid |
$4,208.40
|
| Rate for Payer: AZCH Complete Medicaid |
$4,208.40
|
| Rate for Payer: Banner UC Health Medicaid |
$4,208.40
|
| Rate for Payer: Mercy Care Medicaid |
$4,208.40
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$12,227.51
|
|
|
Service Code
|
APR-DRG 1324
|
| Hospital Charge Code |
APRDRG1321
|
| Min. Negotiated Rate |
$12,227.51 |
| Max. Negotiated Rate |
$12,227.51 |
| Rate for Payer: AHCCCS Medicaid |
$12,227.51
|
| Rate for Payer: Allwell Medicaid |
$12,227.51
|
| Rate for Payer: AZCH Complete Medicaid |
$12,227.51
|
| Rate for Payer: Banner UC Health Medicaid |
$12,227.51
|
| Rate for Payer: Mercy Care Medicaid |
$12,227.51
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$7,028.73
|
|
|
Service Code
|
APR-DRG 1323
|
| Hospital Charge Code |
APRDRG1322
|
| Min. Negotiated Rate |
$7,028.73 |
| Max. Negotiated Rate |
$7,028.73 |
| Rate for Payer: AHCCCS Medicaid |
$7,028.73
|
| Rate for Payer: Allwell Medicaid |
$7,028.73
|
| Rate for Payer: AZCH Complete Medicaid |
$7,028.73
|
| Rate for Payer: Banner UC Health Medicaid |
$7,028.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,028.73
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$7,028.73
|
|
|
Service Code
|
APR-DRG 1323
|
| Hospital Charge Code |
APRDRG1324
|
| Min. Negotiated Rate |
$7,028.73 |
| Max. Negotiated Rate |
$7,028.73 |
| Rate for Payer: AHCCCS Medicaid |
$7,028.73
|
| Rate for Payer: Allwell Medicaid |
$7,028.73
|
| Rate for Payer: AZCH Complete Medicaid |
$7,028.73
|
| Rate for Payer: Banner UC Health Medicaid |
$7,028.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,028.73
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$12,227.51
|
|
|
Service Code
|
APR-DRG 1324
|
| Hospital Charge Code |
APRDRG1324
|
| Min. Negotiated Rate |
$12,227.51 |
| Max. Negotiated Rate |
$12,227.51 |
| Rate for Payer: AHCCCS Medicaid |
$12,227.51
|
| Rate for Payer: Allwell Medicaid |
$12,227.51
|
| Rate for Payer: AZCH Complete Medicaid |
$12,227.51
|
| Rate for Payer: Banner UC Health Medicaid |
$12,227.51
|
| Rate for Payer: Mercy Care Medicaid |
$12,227.51
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$7,028.73
|
|
|
Service Code
|
APR-DRG 1323
|
| Hospital Charge Code |
APRDRG1321
|
| Min. Negotiated Rate |
$7,028.73 |
| Max. Negotiated Rate |
$7,028.73 |
| Rate for Payer: AHCCCS Medicaid |
$7,028.73
|
| Rate for Payer: Allwell Medicaid |
$7,028.73
|
| Rate for Payer: AZCH Complete Medicaid |
$7,028.73
|
| Rate for Payer: Banner UC Health Medicaid |
$7,028.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,028.73
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$3,174.54
|
|
|
Service Code
|
APR-DRG 1321
|
| Hospital Charge Code |
APRDRG1321
|
| Min. Negotiated Rate |
$3,174.54 |
| Max. Negotiated Rate |
$3,174.54 |
| Rate for Payer: AHCCCS Medicaid |
$3,174.54
|
| Rate for Payer: Allwell Medicaid |
$3,174.54
|
| Rate for Payer: AZCH Complete Medicaid |
$3,174.54
|
| Rate for Payer: Banner UC Health Medicaid |
$3,174.54
|
| Rate for Payer: Mercy Care Medicaid |
$3,174.54
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$12,227.51
|
|
|
Service Code
|
APR-DRG 1324
|
| Hospital Charge Code |
APRDRG1323
|
| Min. Negotiated Rate |
$12,227.51 |
| Max. Negotiated Rate |
$12,227.51 |
| Rate for Payer: AHCCCS Medicaid |
$12,227.51
|
| Rate for Payer: Allwell Medicaid |
$12,227.51
|
| Rate for Payer: AZCH Complete Medicaid |
$12,227.51
|
| Rate for Payer: Banner UC Health Medicaid |
$12,227.51
|
| Rate for Payer: Mercy Care Medicaid |
$12,227.51
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$4,208.40
|
|
|
Service Code
|
APR-DRG 1322
|
| Hospital Charge Code |
APRDRG1324
|
| Min. Negotiated Rate |
$4,208.40 |
| Max. Negotiated Rate |
$4,208.40 |
| Rate for Payer: AHCCCS Medicaid |
$4,208.40
|
| Rate for Payer: Allwell Medicaid |
$4,208.40
|
| Rate for Payer: AZCH Complete Medicaid |
$4,208.40
|
| Rate for Payer: Banner UC Health Medicaid |
$4,208.40
|
| Rate for Payer: Mercy Care Medicaid |
$4,208.40
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$3,174.54
|
|
|
Service Code
|
APR-DRG 1321
|
| Hospital Charge Code |
APRDRG1322
|
| Min. Negotiated Rate |
$3,174.54 |
| Max. Negotiated Rate |
$3,174.54 |
| Rate for Payer: AHCCCS Medicaid |
$3,174.54
|
| Rate for Payer: Allwell Medicaid |
$3,174.54
|
| Rate for Payer: AZCH Complete Medicaid |
$3,174.54
|
| Rate for Payer: Banner UC Health Medicaid |
$3,174.54
|
| Rate for Payer: Mercy Care Medicaid |
$3,174.54
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$12,227.51
|
|
|
Service Code
|
APR-DRG 1324
|
| Hospital Charge Code |
APRDRG1322
|
| Min. Negotiated Rate |
$12,227.51 |
| Max. Negotiated Rate |
$12,227.51 |
| Rate for Payer: AHCCCS Medicaid |
$12,227.51
|
| Rate for Payer: Allwell Medicaid |
$12,227.51
|
| Rate for Payer: AZCH Complete Medicaid |
$12,227.51
|
| Rate for Payer: Banner UC Health Medicaid |
$12,227.51
|
| Rate for Payer: Mercy Care Medicaid |
$12,227.51
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$3,174.54
|
|
|
Service Code
|
APR-DRG 1321
|
| Hospital Charge Code |
APRDRG1324
|
| Min. Negotiated Rate |
$3,174.54 |
| Max. Negotiated Rate |
$3,174.54 |
| Rate for Payer: AHCCCS Medicaid |
$3,174.54
|
| Rate for Payer: Allwell Medicaid |
$3,174.54
|
| Rate for Payer: AZCH Complete Medicaid |
$3,174.54
|
| Rate for Payer: Banner UC Health Medicaid |
$3,174.54
|
| Rate for Payer: Mercy Care Medicaid |
$3,174.54
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$4,208.40
|
|
|
Service Code
|
APR-DRG 1322
|
| Hospital Charge Code |
APRDRG1322
|
| Min. Negotiated Rate |
$4,208.40 |
| Max. Negotiated Rate |
$4,208.40 |
| Rate for Payer: AHCCCS Medicaid |
$4,208.40
|
| Rate for Payer: Allwell Medicaid |
$4,208.40
|
| Rate for Payer: AZCH Complete Medicaid |
$4,208.40
|
| Rate for Payer: Banner UC Health Medicaid |
$4,208.40
|
| Rate for Payer: Mercy Care Medicaid |
$4,208.40
|
|
