|
12032 REPAIR INTMD WND 2.6CM TO 7.5CM
|
Facility
IP
|
$1,361.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
22282783
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$231.37 |
| Max. Negotiated Rate |
$1,224.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,224.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$231.37
|
| Rate for Payer: Amerigroup Medicare |
$231.37
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$231.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$231.37
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$353.86
|
| Rate for Payer: Copperpoint |
$381.76
|
| Rate for Payer: Humana Medicare |
$231.37
|
| Rate for Payer: SELF PAY |
$1,088.80
|
| Rate for Payer: Veterans (Triwest) |
$231.37
|
|
|
12034 REPAIR INTMD WND 7.6CM TO 12.5CM
|
Facility
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
22282784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.28 |
| Max. Negotiated Rate |
$1,245.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,245.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$235.28
|
| Rate for Payer: Amerigroup Medicare |
$235.28
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$235.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$235.28
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$359.84
|
| Rate for Payer: Copperpoint |
$388.21
|
| Rate for Payer: Humana Medicare |
$235.28
|
| Rate for Payer: SELF PAY |
$1,107.20
|
| Rate for Payer: Veterans (Triwest) |
$235.28
|
|
|
12034 REPAIR INTMD WND 7.6CM TO 12.5CM
|
Facility
OP
|
$1,384.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
22282784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.28 |
| Max. Negotiated Rate |
$1,245.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,245.60
|
| Rate for Payer: Aetna Medicare |
$387.52
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$235.28
|
| Rate for Payer: Amerigroup Medicare |
$235.28
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$516.92
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$235.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$235.28
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$359.84
|
| Rate for Payer: Cigna All Products |
$968.80
|
| Rate for Payer: Copperpoint |
$388.21
|
| Rate for Payer: HealthNet Commercial |
$830.40
|
| Rate for Payer: HealthNet Medicare |
$387.52
|
| Rate for Payer: Humana Medicare |
$235.28
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$1,107.20
|
| Rate for Payer: Veterans (Triwest) |
$235.28
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$806.87
|
| Rate for Payer: United Healthcare Medicare |
$249.12
|
|
|
12035 LYR SPL 12.6CM-20.0CM
|
Facility
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
22282785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.16 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$943.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$178.16
|
| Rate for Payer: Amerigroup Medicare |
$178.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$178.16
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$178.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$272.48
|
| Rate for Payer: Copperpoint |
$293.96
|
| Rate for Payer: Humana Medicare |
$178.16
|
| Rate for Payer: SELF PAY |
$838.40
|
| Rate for Payer: Veterans (Triwest) |
$178.16
|
|
|
12035 LYR SPL 12.6CM-20.0CM
|
Facility
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
22282785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.16 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$943.20
|
| Rate for Payer: Aetna Medicare |
$293.44
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$178.16
|
| Rate for Payer: Amerigroup Medicare |
$178.16
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$391.43
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$178.16
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$178.16
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$272.48
|
| Rate for Payer: Cigna All Products |
$733.60
|
| Rate for Payer: Copperpoint |
$293.96
|
| Rate for Payer: HealthNet Commercial |
$628.80
|
| Rate for Payer: HealthNet Medicare |
$293.44
|
| Rate for Payer: Humana Medicare |
$178.16
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$838.40
|
| Rate for Payer: Veterans (Triwest) |
$178.16
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$610.98
|
| Rate for Payer: United Healthcare Medicare |
$188.64
|
|
|
12036 LYR S/P AXL TNK 20.1-30
|
Facility
OP
|
$1,284.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
22282786
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.28 |
| Max. Negotiated Rate |
$1,155.60 |
| Rate for Payer: SELF PAY |
$1,027.20
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: Aetna POS, PPO, HMO |
$1,155.60
|
| Rate for Payer: Aetna Medicare |
$359.52
|
| Rate for Payer: AHCCCS Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$218.28
|
| Rate for Payer: Amerigroup Medicare |
$218.28
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$479.57
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$218.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$218.28
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$333.84
|
| Rate for Payer: Cigna All Products |
$898.80
|
| Rate for Payer: Copperpoint |
$360.16
|
| Rate for Payer: HealthNet Commercial |
$770.40
|
| Rate for Payer: HealthNet Medicare |
$359.52
|
| Rate for Payer: Humana Medicare |
$218.28
|
| Rate for Payer: Veterans (Triwest) |
$218.28
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$748.57
|
| Rate for Payer: United Healthcare Medicare |
$231.12
|
|
|
12036 LYR S/P AXL TNK 20.1-30
|
Facility
IP
|
$1,284.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
22282786
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.28 |
| Max. Negotiated Rate |
$1,155.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,155.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$218.28
|
| Rate for Payer: Amerigroup Medicare |
$218.28
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$218.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$218.28
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$333.84
|
| Rate for Payer: Copperpoint |
$360.16
|
| Rate for Payer: Humana Medicare |
$218.28
|
| Rate for Payer: SELF PAY |
$1,027.20
|
| Rate for Payer: Veterans (Triwest) |
$218.28
|
|
|
12037 LYR S/P AXL TNK>30
|
Facility
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
22282787
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.08 |
| Max. Negotiated Rate |
$2,487.28 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,371.60
|
| Rate for Payer: Aetna Medicare |
$426.72
|
| Rate for Payer: AHCCCS Medicaid |
$2,487.28
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,487.28
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$259.08
|
| Rate for Payer: Amerigroup Medicare |
$259.08
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$569.21
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,487.28
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$259.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$259.08
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,487.28
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$396.24
|
| Rate for Payer: Cigna All Products |
$1,066.80
|
| Rate for Payer: Copperpoint |
$427.48
|
| Rate for Payer: HealthNet Commercial |
$914.40
|
| Rate for Payer: HealthNet Medicare |
$426.72
|
| Rate for Payer: Humana Medicare |
$259.08
|
| Rate for Payer: Mercy Care Medicaid |
$2,487.28
|
| Rate for Payer: SELF PAY |
$1,219.20
|
| Rate for Payer: Veterans (Triwest) |
$259.08
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$888.49
|
| Rate for Payer: United Healthcare Medicare |
$274.32
|
|
|
12037 LYR S/P AXL TNK>30
|
Facility
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
22282787
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.08 |
| Max. Negotiated Rate |
$1,371.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,371.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$259.08
|
| Rate for Payer: Amerigroup Medicare |
$259.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$259.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$259.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$396.24
|
| Rate for Payer: Copperpoint |
$427.48
|
| Rate for Payer: Humana Medicare |
$259.08
|
| Rate for Payer: SELF PAY |
$1,219.20
|
| Rate for Payer: Veterans (Triwest) |
$259.08
|
|
|
12041 LYR NK HND FT EXGEN 2.5
|
Facility
OP
|
$632.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
22282788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$568.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$568.80
|
| Rate for Payer: Aetna Medicare |
$176.96
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$107.44
|
| Rate for Payer: Amerigroup Medicare |
$107.44
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$236.05
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$107.44
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$107.44
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$164.32
|
| Rate for Payer: Cigna All Products |
$442.40
|
| Rate for Payer: Copperpoint |
$177.28
|
| Rate for Payer: HealthNet Commercial |
$379.20
|
| Rate for Payer: HealthNet Medicare |
$176.96
|
| Rate for Payer: Humana Medicare |
$107.44
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$505.60
|
| Rate for Payer: Veterans (Triwest) |
$107.44
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$368.46
|
| Rate for Payer: United Healthcare Medicare |
$113.76
|
|
|
12041 LYR NK HND FT EXGEN 2.5
|
Facility
IP
|
$632.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
22282788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$568.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$568.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$107.44
|
| Rate for Payer: Amerigroup Medicare |
$107.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$107.44
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$107.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$164.32
|
| Rate for Payer: Copperpoint |
$177.28
|
| Rate for Payer: Humana Medicare |
$107.44
|
| Rate for Payer: SELF PAY |
$505.60
|
| Rate for Payer: Veterans (Triwest) |
$107.44
|
|
|
12042 LR NK HD FT XGEN 2.6-7.5
|
Facility
IP
|
$734.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
22282789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.78 |
| Max. Negotiated Rate |
$660.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$660.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$124.78
|
| Rate for Payer: Amerigroup Medicare |
$124.78
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$124.78
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$124.78
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$190.84
|
| Rate for Payer: Copperpoint |
$205.89
|
| Rate for Payer: Humana Medicare |
$124.78
|
| Rate for Payer: SELF PAY |
$587.20
|
| Rate for Payer: Veterans (Triwest) |
$124.78
|
|
|
12042 LR NK HD FT XGEN 2.6-7.5
|
Facility
OP
|
$734.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
22282789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.78 |
| Max. Negotiated Rate |
$660.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$660.60
|
| Rate for Payer: Aetna Medicare |
$205.52
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$124.78
|
| Rate for Payer: Amerigroup Medicare |
$124.78
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$274.15
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$124.78
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$124.78
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$190.84
|
| Rate for Payer: Cigna All Products |
$513.80
|
| Rate for Payer: Copperpoint |
$205.89
|
| Rate for Payer: HealthNet Commercial |
$440.40
|
| Rate for Payer: HealthNet Medicare |
$205.52
|
| Rate for Payer: Humana Medicare |
$124.78
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$587.20
|
| Rate for Payer: Veterans (Triwest) |
$124.78
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$427.92
|
| Rate for Payer: United Healthcare Medicare |
$132.12
|
|
|
12044 LR NK HD FT XGN 7.5-12.5
|
Facility
OP
|
$944.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
22282790
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.48 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$849.60
|
| Rate for Payer: Aetna Medicare |
$264.32
|
| Rate for Payer: AHCCCS Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$160.48
|
| Rate for Payer: Amerigroup Medicare |
$160.48
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$352.58
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$160.48
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$160.48
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$245.44
|
| Rate for Payer: Cigna All Products |
$660.80
|
| Rate for Payer: Copperpoint |
$264.79
|
| Rate for Payer: HealthNet Commercial |
$566.40
|
| Rate for Payer: HealthNet Medicare |
$264.32
|
| Rate for Payer: Humana Medicare |
$160.48
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$755.20
|
| Rate for Payer: Veterans (Triwest) |
$160.48
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$550.35
|
| Rate for Payer: United Healthcare Medicare |
$169.92
|
|
|
12044 LR NK HD FT XGN 7.5-12.5
|
Facility
IP
|
$944.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
22282790
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.48 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$849.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$160.48
|
| Rate for Payer: Amerigroup Medicare |
$160.48
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$160.48
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$160.48
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$245.44
|
| Rate for Payer: Copperpoint |
$264.79
|
| Rate for Payer: Humana Medicare |
$160.48
|
| Rate for Payer: SELF PAY |
$755.20
|
| Rate for Payer: Veterans (Triwest) |
$160.48
|
|
|
12045 LR NK HD FT XGN 12.5-20.
|
Facility
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
22282791
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.91 |
| Max. Negotiated Rate |
$1,010.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,010.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$190.91
|
| Rate for Payer: Amerigroup Medicare |
$190.91
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$190.91
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$190.91
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$291.98
|
| Rate for Payer: Copperpoint |
$315.00
|
| Rate for Payer: Humana Medicare |
$190.91
|
| Rate for Payer: SELF PAY |
$898.40
|
| Rate for Payer: Veterans (Triwest) |
$190.91
|
|
|
12045 LR NK HD FT XGN 12.5-20.
|
Facility
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
22282791
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.91 |
| Max. Negotiated Rate |
$1,010.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,010.70
|
| Rate for Payer: Aetna Medicare |
$314.44
|
| Rate for Payer: AHCCCS Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$190.91
|
| Rate for Payer: Amerigroup Medicare |
$190.91
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$419.44
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$190.91
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$190.91
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$291.98
|
| Rate for Payer: Cigna All Products |
$786.10
|
| Rate for Payer: Copperpoint |
$315.00
|
| Rate for Payer: HealthNet Commercial |
$673.80
|
| Rate for Payer: HealthNet Medicare |
$314.44
|
| Rate for Payer: Humana Medicare |
$190.91
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$898.40
|
| Rate for Payer: Veterans (Triwest) |
$190.91
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$654.71
|
| Rate for Payer: United Healthcare Medicare |
$202.14
|
|
|
12046 LR NK HD FT XGN 20.-30.
|
Facility
IP
|
$1,468.00
|
|
|
Service Code
|
CPT 12046
|
| Hospital Charge Code |
22282792
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.56 |
| Max. Negotiated Rate |
$1,321.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,321.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$249.56
|
| Rate for Payer: Amerigroup Medicare |
$249.56
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$249.56
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$249.56
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$381.68
|
| Rate for Payer: Copperpoint |
$411.77
|
| Rate for Payer: Humana Medicare |
$249.56
|
| Rate for Payer: SELF PAY |
$1,174.40
|
| Rate for Payer: Veterans (Triwest) |
$249.56
|
|
|
12046 LR NK HD FT XGN 20.-30.
|
Facility
OP
|
$1,468.00
|
|
|
Service Code
|
CPT 12046
|
| Hospital Charge Code |
22282792
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.56 |
| Max. Negotiated Rate |
$1,321.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,321.20
|
| Rate for Payer: Aetna Medicare |
$411.04
|
| Rate for Payer: AHCCCS Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$249.56
|
| Rate for Payer: Amerigroup Medicare |
$249.56
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$548.30
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$249.56
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$249.56
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$381.68
|
| Rate for Payer: Cigna All Products |
$1,027.60
|
| Rate for Payer: Copperpoint |
$411.77
|
| Rate for Payer: HealthNet Commercial |
$880.80
|
| Rate for Payer: HealthNet Medicare |
$411.04
|
| Rate for Payer: Humana Medicare |
$249.56
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$1,174.40
|
| Rate for Payer: Veterans (Triwest) |
$249.56
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$855.84
|
| Rate for Payer: United Healthcare Medicare |
$264.24
|
|
|
12047 LR NK HD FT XGN >30
|
Facility
OP
|
$1,729.00
|
|
|
Service Code
|
CPT 12047
|
| Hospital Charge Code |
22282793
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.93 |
| Max. Negotiated Rate |
$2,487.28 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,556.10
|
| Rate for Payer: Aetna Medicare |
$484.12
|
| Rate for Payer: AHCCCS Medicaid |
$2,487.28
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,487.28
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$293.93
|
| Rate for Payer: Amerigroup Medicare |
$293.93
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$645.78
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,487.28
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$293.93
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$293.93
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,487.28
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$449.54
|
| Rate for Payer: Cigna All Products |
$1,210.30
|
| Rate for Payer: Copperpoint |
$484.98
|
| Rate for Payer: HealthNet Commercial |
$1,037.40
|
| Rate for Payer: HealthNet Medicare |
$484.12
|
| Rate for Payer: Humana Medicare |
$293.93
|
| Rate for Payer: Mercy Care Medicaid |
$2,487.28
|
| Rate for Payer: SELF PAY |
$1,383.20
|
| Rate for Payer: Veterans (Triwest) |
$293.93
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,008.01
|
| Rate for Payer: United Healthcare Medicare |
$311.22
|
|
|
12047 LR NK HD FT XGN >30
|
Facility
IP
|
$1,729.00
|
|
|
Service Code
|
CPT 12047
|
| Hospital Charge Code |
22282793
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.93 |
| Max. Negotiated Rate |
$1,556.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,556.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$293.93
|
| Rate for Payer: Amerigroup Medicare |
$293.93
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$293.93
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$293.93
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$449.54
|
| Rate for Payer: Copperpoint |
$484.98
|
| Rate for Payer: Humana Medicare |
$293.93
|
| Rate for Payer: SELF PAY |
$1,383.20
|
| Rate for Payer: Veterans (Triwest) |
$293.93
|
|
|
12051 LR FACE MUC MEMB 2.5
|
Facility
OP
|
$673.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
22282794
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.41 |
| Max. Negotiated Rate |
$605.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$605.70
|
| Rate for Payer: Aetna Medicare |
$188.44
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$114.41
|
| Rate for Payer: Amerigroup Medicare |
$114.41
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$251.37
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$114.41
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$114.41
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$174.98
|
| Rate for Payer: Cigna All Products |
$471.10
|
| Rate for Payer: Copperpoint |
$188.78
|
| Rate for Payer: HealthNet Commercial |
$403.80
|
| Rate for Payer: HealthNet Medicare |
$188.44
|
| Rate for Payer: Humana Medicare |
$114.41
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$538.40
|
| Rate for Payer: Veterans (Triwest) |
$114.41
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$392.36
|
| Rate for Payer: United Healthcare Medicare |
$121.14
|
|
|
12051 LR FACE MUC MEMB 2.5
|
Facility
IP
|
$673.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
22282794
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.41 |
| Max. Negotiated Rate |
$605.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$605.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$114.41
|
| Rate for Payer: Amerigroup Medicare |
$114.41
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$114.41
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$114.41
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$174.98
|
| Rate for Payer: Copperpoint |
$188.78
|
| Rate for Payer: Humana Medicare |
$114.41
|
| Rate for Payer: SELF PAY |
$538.40
|
| Rate for Payer: Veterans (Triwest) |
$114.41
|
|
|
12052 LR FACE MUC MEMB 2.6-5.0
|
Facility
IP
|
$999.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
22282795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.83 |
| Max. Negotiated Rate |
$899.10 |
| Rate for Payer: SELF PAY |
$799.20
|
| Rate for Payer: Aetna POS, PPO, HMO |
$899.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$169.83
|
| Rate for Payer: Amerigroup Medicare |
$169.83
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$169.83
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$169.83
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$259.74
|
| Rate for Payer: Copperpoint |
$280.22
|
| Rate for Payer: Humana Medicare |
$169.83
|
| Rate for Payer: Veterans (Triwest) |
$169.83
|
|
|
12052 LR FACE MUC MEMB 2.6-5.0
|
Facility
OP
|
$999.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
22282795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.83 |
| Max. Negotiated Rate |
$899.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$899.10
|
| Rate for Payer: Aetna Medicare |
$279.72
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$169.83
|
| Rate for Payer: Amerigroup Medicare |
$169.83
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$373.13
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$169.83
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$169.83
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$259.74
|
| Rate for Payer: Cigna All Products |
$699.30
|
| Rate for Payer: Copperpoint |
$280.22
|
| Rate for Payer: HealthNet Commercial |
$599.40
|
| Rate for Payer: HealthNet Medicare |
$279.72
|
| Rate for Payer: Humana Medicare |
$169.83
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$799.20
|
| Rate for Payer: Veterans (Triwest) |
$169.83
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$582.42
|
| Rate for Payer: United Healthcare Medicare |
$179.82
|
|