|
Blood Admininstration
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
22349429
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$153.28 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$862.20
|
| Rate for Payer: Aetna of AZ Medicare |
$268.24
|
| Rate for Payer: AHCCCS Medicaid |
$287.87
|
| Rate for Payer: Allwell Medicaid |
$287.87
|
| Rate for Payer: Allwell Medicare |
$153.28
|
| Rate for Payer: Amerigroup Medicare |
$153.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$357.81
|
| Rate for Payer: AZCH Complete Medicaid |
$287.87
|
| Rate for Payer: AZCH Complete Medicare |
$153.28
|
| Rate for Payer: Banner UC Health Medicaid |
$287.87
|
| Rate for Payer: Banner UC Health Medicare |
$153.28
|
| Rate for Payer: Bisbee Police All Plans |
$249.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$651.44
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cigna of AZ Commercial |
$670.60
|
| Rate for Payer: Copperpoint Commercial |
$237.10
|
| Rate for Payer: Health Net of AZ Commercial |
$574.80
|
| Rate for Payer: Health Net of AZ Medicare |
$268.24
|
| Rate for Payer: Humana of AZ Medicare |
$153.28
|
| Rate for Payer: Mercy Care Medicaid |
$287.87
|
| Rate for Payer: Self Pay Self Pay |
$766.40
|
| Rate for Payer: TriWest Medicare |
$153.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$172.44
|
|
|
Blood Administration
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
609598
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$138.56 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$779.40
|
| Rate for Payer: Aetna of AZ Medicare |
$242.48
|
| Rate for Payer: AHCCCS Medicaid |
$287.87
|
| Rate for Payer: Allwell Medicaid |
$287.87
|
| Rate for Payer: Allwell Medicare |
$138.56
|
| Rate for Payer: Amerigroup Medicare |
$138.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$323.45
|
| Rate for Payer: AZCH Complete Medicaid |
$287.87
|
| Rate for Payer: AZCH Complete Medicare |
$138.56
|
| Rate for Payer: Banner UC Health Medicaid |
$287.87
|
| Rate for Payer: Banner UC Health Medicare |
$138.56
|
| Rate for Payer: Bisbee Police All Plans |
$225.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$588.88
|
| Rate for Payer: Cash Price |
$692.80
|
| Rate for Payer: Cash Price |
$692.80
|
| Rate for Payer: Cigna of AZ Commercial |
$606.20
|
| Rate for Payer: Copperpoint Commercial |
$214.34
|
| Rate for Payer: Health Net of AZ Commercial |
$519.60
|
| Rate for Payer: Health Net of AZ Medicare |
$242.48
|
| Rate for Payer: Humana of AZ Medicare |
$138.56
|
| Rate for Payer: Mercy Care Medicaid |
$287.87
|
| Rate for Payer: Self Pay Self Pay |
$692.80
|
| Rate for Payer: TriWest Medicare |
$138.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$155.88
|
|
|
Blood Administration
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
609598
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$225.16 |
| Max. Negotiated Rate |
$779.40 |
| Rate for Payer: Aetna of AZ Commercial |
$779.40
|
| Rate for Payer: Bisbee Police All Plans |
$225.16
|
| Rate for Payer: Cash Price |
$692.80
|
| Rate for Payer: Self Pay Self Pay |
$692.80
|
|
|
Blood Culture
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
850752
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna of AZ Commercial |
$142.20
|
| Rate for Payer: Aetna of AZ Medicare |
$44.24
|
| Rate for Payer: Allwell Medicare |
$25.28
|
| Rate for Payer: Amerigroup Medicare |
$25.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$59.01
|
| Rate for Payer: AZCH Complete Medicare |
$25.28
|
| Rate for Payer: Banner UC Health Medicare |
$25.28
|
| Rate for Payer: Bisbee Police All Plans |
$41.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$107.44
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cigna of AZ Commercial |
$102.70
|
| Rate for Payer: Copperpoint Commercial |
$39.10
|
| Rate for Payer: Health Net of AZ Commercial |
$94.80
|
| Rate for Payer: Health Net of AZ Medicare |
$44.24
|
| Rate for Payer: Humana of AZ Medicare |
$25.28
|
| Rate for Payer: Self Pay Self Pay |
$126.40
|
| Rate for Payer: TriWest Medicare |
$25.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$92.11
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.44
|
|
|
Blood Culture
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
850752
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna of AZ Commercial |
$142.20
|
| Rate for Payer: Bisbee Police All Plans |
$41.08
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Self Pay Self Pay |
$126.40
|
|
|
Blood Culture Identification 2 Panel (Biofire)
|
Facility
|
OP
|
$1,090.30
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
27355883
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$981.27 |
| Rate for Payer: Aetna of AZ Commercial |
$981.27
|
| Rate for Payer: Aetna of AZ Medicare |
$305.28
|
| Rate for Payer: Allwell Medicare |
$174.45
|
| Rate for Payer: Amerigroup Medicare |
$174.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$407.23
|
| Rate for Payer: AZCH Complete Medicare |
$174.45
|
| Rate for Payer: Banner UC Health Medicare |
$174.45
|
| Rate for Payer: Bisbee Police All Plans |
$283.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$741.40
|
| Rate for Payer: Cash Price |
$872.24
|
| Rate for Payer: Cigna of AZ Commercial |
$708.70
|
| Rate for Payer: Copperpoint Commercial |
$269.85
|
| Rate for Payer: Health Net of AZ Commercial |
$654.18
|
| Rate for Payer: Health Net of AZ Medicare |
$305.28
|
| Rate for Payer: Humana of AZ Medicare |
$174.45
|
| Rate for Payer: Self Pay Self Pay |
$872.24
|
| Rate for Payer: TriWest Medicare |
$174.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$635.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$196.25
|
|
|
Blood Culture Identification 2 Panel (Biofire)
|
Facility
|
IP
|
$1,090.30
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
27355883
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$283.48 |
| Max. Negotiated Rate |
$981.27 |
| Rate for Payer: Aetna of AZ Commercial |
$981.27
|
| Rate for Payer: Bisbee Police All Plans |
$283.48
|
| Rate for Payer: Cash Price |
$872.24
|
| Rate for Payer: Self Pay Self Pay |
$872.24
|
|
|
Blood Drugs of Abuse, 7,WB LC
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 80101
|
| Hospital Charge Code |
22311178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of AZ Commercial |
$72.00
|
| Rate for Payer: Bisbee Police All Plans |
$20.80
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Self Pay Self Pay |
$64.00
|
|
|
Blood Drugs of Abuse, 7,WB LC
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 80101
|
| Hospital Charge Code |
22311178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of AZ Commercial |
$72.00
|
| Rate for Payer: Aetna of AZ Medicare |
$22.40
|
| Rate for Payer: Allwell Medicare |
$12.80
|
| Rate for Payer: Amerigroup Medicare |
$12.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$29.88
|
| Rate for Payer: AZCH Complete Medicare |
$12.80
|
| Rate for Payer: Banner UC Health Medicare |
$12.80
|
| Rate for Payer: Bisbee Police All Plans |
$20.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$54.40
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna of AZ Commercial |
$52.00
|
| Rate for Payer: Copperpoint Commercial |
$19.80
|
| Rate for Payer: Health Net of AZ Commercial |
$48.00
|
| Rate for Payer: Health Net of AZ Medicare |
$22.40
|
| Rate for Payer: Humana of AZ Medicare |
$12.80
|
| Rate for Payer: Self Pay Self Pay |
$64.00
|
| Rate for Payer: TriWest Medicare |
$12.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$46.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.40
|
|
|
Blood Urea Nitrogen
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633605
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of AZ Commercial |
$54.90
|
| Rate for Payer: Aetna of AZ Medicare |
$17.08
|
| Rate for Payer: Allwell Medicare |
$9.76
|
| Rate for Payer: Amerigroup Medicare |
$9.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$22.78
|
| Rate for Payer: AZCH Complete Medicare |
$9.76
|
| Rate for Payer: Banner UC Health Medicare |
$9.76
|
| Rate for Payer: Bisbee Police All Plans |
$15.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$41.48
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cigna of AZ Commercial |
$39.65
|
| Rate for Payer: Copperpoint Commercial |
$15.10
|
| Rate for Payer: Health Net of AZ Commercial |
$36.60
|
| Rate for Payer: Health Net of AZ Medicare |
$17.08
|
| Rate for Payer: Humana of AZ Medicare |
$9.76
|
| Rate for Payer: Self Pay Self Pay |
$48.80
|
| Rate for Payer: TriWest Medicare |
$9.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$35.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.98
|
|
|
Blood Urea Nitrogen
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633605
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of AZ Commercial |
$54.90
|
| Rate for Payer: Bisbee Police All Plans |
$15.86
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Self Pay Self Pay |
$48.80
|
|
|
Body Fluid Culture
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
858005
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Aetna of AZ Commercial |
$294.30
|
| Rate for Payer: Aetna of AZ Medicare |
$91.56
|
| Rate for Payer: Allwell Medicare |
$52.32
|
| Rate for Payer: Amerigroup Medicare |
$52.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$122.13
|
| Rate for Payer: AZCH Complete Medicare |
$52.32
|
| Rate for Payer: Banner UC Health Medicare |
$52.32
|
| Rate for Payer: Bisbee Police All Plans |
$85.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$222.36
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna of AZ Commercial |
$212.55
|
| Rate for Payer: Copperpoint Commercial |
$80.93
|
| Rate for Payer: Health Net of AZ Commercial |
$196.20
|
| Rate for Payer: Health Net of AZ Medicare |
$91.56
|
| Rate for Payer: Humana of AZ Medicare |
$52.32
|
| Rate for Payer: Self Pay Self Pay |
$261.60
|
| Rate for Payer: TriWest Medicare |
$52.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$190.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$58.86
|
|
|
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
|
|
|
Body Fluid Culture
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.76 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Aetna of AZ Commercial |
$279.90
|
| Rate for Payer: Aetna of AZ Medicare |
$87.08
|
| Rate for Payer: Allwell Medicare |
$49.76
|
| Rate for Payer: Amerigroup Medicare |
$49.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$116.16
|
| Rate for Payer: AZCH Complete Medicare |
$49.76
|
| Rate for Payer: Banner UC Health Medicare |
$49.76
|
| Rate for Payer: Bisbee Police All Plans |
$80.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$211.48
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cigna of AZ Commercial |
$202.15
|
| Rate for Payer: Copperpoint Commercial |
$76.97
|
| Rate for Payer: Health Net of AZ Commercial |
$186.60
|
| Rate for Payer: Health Net of AZ Medicare |
$87.08
|
| Rate for Payer: Humana of AZ Medicare |
$49.76
|
| Rate for Payer: Self Pay Self Pay |
$248.80
|
| Rate for Payer: TriWest Medicare |
$49.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$181.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.98
|
|
|
BOSS DISPOSABLE DRILL 10MM
|
Facility
|
OP
|
$1,223.00
|
|
| Hospital Charge Code |
27745954
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.68 |
| 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 |
$195.68
|
| Rate for Payer: Amerigroup Medicare |
$195.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$456.79
|
| Rate for Payer: AZCH Complete Medicare |
$195.68
|
| Rate for Payer: Banner UC Health Medicare |
$195.68
|
| 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 |
$195.68
|
| Rate for Payer: Self Pay Self Pay |
$978.40
|
| Rate for Payer: TriWest Medicare |
$195.68
|
| 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 |
$139.20 |
| 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 |
$1,299.92
|
| Rate for Payer: Allwell Medicaid |
$1,299.92
|
| Rate for Payer: Allwell Medicare |
$139.20
|
| Rate for Payer: Amerigroup Medicare |
$139.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$324.94
|
| Rate for Payer: AZCH Complete Medicaid |
$1,299.92
|
| Rate for Payer: AZCH Complete Medicare |
$139.20
|
| Rate for Payer: Banner UC Health Medicaid |
$1,299.92
|
| Rate for Payer: Banner UC Health Medicare |
$139.20
|
| 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 |
$139.20
|
| Rate for Payer: Mercy Care Medicaid |
$1,299.92
|
| Rate for Payer: Self Pay Self Pay |
$696.00
|
| Rate for Payer: TriWest Medicare |
$139.20
|
| 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
|
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) 100 units REC [CQCH]
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
109337996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.64 |
| 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: Allwell Medicare |
$92.64
|
| Rate for Payer: Amerigroup Medicare |
$92.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$216.26
|
| Rate for Payer: AZCH Complete Medicare |
$92.64
|
| Rate for Payer: Banner UC Health Medicare |
$92.64
|
| 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: 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 |
$92.64
|
| Rate for Payer: Self Pay Self Pay |
$463.20
|
| Rate for Payer: TriWest Medicare |
$92.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$337.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$104.22
|
|
|
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
|
|
|
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 |
$185.28 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,042.20
|
| Rate for Payer: Aetna of AZ Medicare |
$324.24
|
| Rate for Payer: Allwell Medicare |
$185.28
|
| Rate for Payer: Amerigroup Medicare |
$185.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$432.51
|
| Rate for Payer: AZCH Complete Medicare |
$185.28
|
| Rate for Payer: Banner UC Health Medicare |
$185.28
|
| 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: Cigna of AZ Commercial |
$752.70
|
| Rate for Payer: Copperpoint Commercial |
$286.61
|
| 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 |
$185.28
|
| Rate for Payer: Self Pay Self Pay |
$926.40
|
| Rate for Payer: TriWest Medicare |
$185.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$675.11
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$208.44
|
|
|
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
|
$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
|
|
