|
12053 LR FACE MUC MEMB 5.1-7.5
|
Facility
IP
|
$943.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
22282796
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.31 |
| Max. Negotiated Rate |
$848.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$848.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$160.31
|
| Rate for Payer: Amerigroup Medicare |
$160.31
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$160.31
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$160.31
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$245.18
|
| Rate for Payer: Copperpoint |
$264.51
|
| Rate for Payer: Humana Medicare |
$160.31
|
| Rate for Payer: SELF PAY |
$754.40
|
| Rate for Payer: Veterans (Triwest) |
$160.31
|
|
|
12053 LR FACE MUC MEMB 5.1-7.5
|
Facility
OP
|
$943.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
22282796
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.31 |
| Max. Negotiated Rate |
$848.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$848.70
|
| Rate for Payer: Aetna Medicare |
$264.04
|
| 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 |
$160.31
|
| Rate for Payer: Amerigroup Medicare |
$160.31
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$352.21
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$160.31
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$160.31
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$245.18
|
| Rate for Payer: Cigna All Products |
$660.10
|
| Rate for Payer: Copperpoint |
$264.51
|
| Rate for Payer: HealthNet Commercial |
$565.80
|
| Rate for Payer: HealthNet Medicare |
$264.04
|
| Rate for Payer: Humana Medicare |
$160.31
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$754.40
|
| Rate for Payer: Veterans (Triwest) |
$160.31
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$549.77
|
| Rate for Payer: United Healthcare Medicare |
$169.74
|
|
|
12054 LR FACE MUC MEB 7.6-12.5
|
Facility
IP
|
$1,186.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
22282797
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.62 |
| Max. Negotiated Rate |
$1,067.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,067.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$201.62
|
| Rate for Payer: Amerigroup Medicare |
$201.62
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$201.62
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$201.62
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$308.36
|
| Rate for Payer: Copperpoint |
$332.67
|
| Rate for Payer: Humana Medicare |
$201.62
|
| Rate for Payer: SELF PAY |
$948.80
|
| Rate for Payer: Veterans (Triwest) |
$201.62
|
|
|
12054 LR FACE MUC MEB 7.6-12.5
|
Facility
OP
|
$1,186.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
22282797
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.62 |
| Max. Negotiated Rate |
$1,067.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,067.40
|
| Rate for Payer: Aetna Medicare |
$332.08
|
| 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 |
$201.62
|
| Rate for Payer: Amerigroup Medicare |
$201.62
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$442.97
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$201.62
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$201.62
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$308.36
|
| Rate for Payer: Cigna All Products |
$830.20
|
| Rate for Payer: Copperpoint |
$332.67
|
| Rate for Payer: HealthNet Commercial |
$711.60
|
| Rate for Payer: HealthNet Medicare |
$332.08
|
| Rate for Payer: Humana Medicare |
$201.62
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$948.80
|
| Rate for Payer: Veterans (Triwest) |
$201.62
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$691.44
|
| Rate for Payer: United Healthcare Medicare |
$213.48
|
|
|
12055 LR FACE MUC MEN 12.6-20
|
Facility
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
22282798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.91 |
| Max. Negotiated Rate |
$1,370.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,370.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$258.91
|
| Rate for Payer: Amerigroup Medicare |
$258.91
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$258.91
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$258.91
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$395.98
|
| Rate for Payer: Copperpoint |
$427.20
|
| Rate for Payer: Humana Medicare |
$258.91
|
| Rate for Payer: SELF PAY |
$1,218.40
|
| Rate for Payer: Veterans (Triwest) |
$258.91
|
|
|
12055 LR FACE MUC MEN 12.6-20
|
Facility
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
22282798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.91 |
| Max. Negotiated Rate |
$1,370.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,370.70
|
| Rate for Payer: Aetna Medicare |
$426.44
|
| 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 |
$258.91
|
| Rate for Payer: Amerigroup Medicare |
$258.91
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$568.84
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$258.91
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$258.91
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$395.98
|
| Rate for Payer: Cigna All Products |
$1,066.10
|
| Rate for Payer: Copperpoint |
$427.20
|
| Rate for Payer: HealthNet Commercial |
$913.80
|
| Rate for Payer: HealthNet Medicare |
$426.44
|
| Rate for Payer: Humana Medicare |
$258.91
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$1,218.40
|
| Rate for Payer: Veterans (Triwest) |
$258.91
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$887.91
|
| Rate for Payer: United Healthcare Medicare |
$274.14
|
|
|
12056 LR FACE MUC MEMB 20.1-30
|
Facility
OP
|
$1,801.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
22282799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$306.17 |
| Max. Negotiated Rate |
$1,620.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,620.90
|
| Rate for Payer: Aetna Medicare |
$504.28
|
| 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 |
$306.17
|
| Rate for Payer: Amerigroup Medicare |
$306.17
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$672.67
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$306.17
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$306.17
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$468.26
|
| Rate for Payer: Cigna All Products |
$1,260.70
|
| Rate for Payer: Copperpoint |
$505.18
|
| Rate for Payer: HealthNet Commercial |
$1,080.60
|
| Rate for Payer: HealthNet Medicare |
$504.28
|
| Rate for Payer: Humana Medicare |
$306.17
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$1,440.80
|
| Rate for Payer: Veterans (Triwest) |
$306.17
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,049.98
|
| Rate for Payer: United Healthcare Medicare |
$324.18
|
|
|
12056 LR FACE MUC MEMB 20.1-30
|
Facility
IP
|
$1,801.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
22282799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$306.17 |
| Max. Negotiated Rate |
$1,620.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,620.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$306.17
|
| Rate for Payer: Amerigroup Medicare |
$306.17
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$306.17
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$306.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$468.26
|
| Rate for Payer: Copperpoint |
$505.18
|
| Rate for Payer: Humana Medicare |
$306.17
|
| Rate for Payer: SELF PAY |
$1,440.80
|
| Rate for Payer: Veterans (Triwest) |
$306.17
|
|
|
12057 LR FACE MUC MEM>30
|
Facility
IP
|
$2,083.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
22282800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$354.11 |
| Max. Negotiated Rate |
$1,874.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,874.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$354.11
|
| Rate for Payer: Amerigroup Medicare |
$354.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$354.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$354.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$541.58
|
| Rate for Payer: Copperpoint |
$584.28
|
| Rate for Payer: Humana Medicare |
$354.11
|
| Rate for Payer: SELF PAY |
$1,666.40
|
| Rate for Payer: Veterans (Triwest) |
$354.11
|
|
|
12057 LR FACE MUC MEM>30
|
Facility
OP
|
$2,083.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
22282800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$354.11 |
| Max. Negotiated Rate |
$1,874.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,874.70
|
| Rate for Payer: Aetna Medicare |
$583.24
|
| 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 |
$354.11
|
| Rate for Payer: Amerigroup Medicare |
$354.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$778.00
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$354.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$354.11
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$541.58
|
| Rate for Payer: Cigna All Products |
$1,458.10
|
| Rate for Payer: Copperpoint |
$584.28
|
| Rate for Payer: HealthNet Commercial |
$1,249.80
|
| Rate for Payer: HealthNet Medicare |
$583.24
|
| Rate for Payer: Humana Medicare |
$354.11
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$1,666.40
|
| Rate for Payer: Veterans (Triwest) |
$354.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,214.39
|
| Rate for Payer: United Healthcare Medicare |
$374.94
|
|
|
13100 RPRELX TRUNK 1.1CM-2.5CM
|
Facility
OP
|
$849.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
22282801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.33 |
| Max. Negotiated Rate |
$764.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$764.10
|
| Rate for Payer: Aetna Medicare |
$237.72
|
| 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 |
$144.33
|
| Rate for Payer: Amerigroup Medicare |
$144.33
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$317.10
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$144.33
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$144.33
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$220.74
|
| Rate for Payer: Cigna All Products |
$594.30
|
| Rate for Payer: Copperpoint |
$238.14
|
| Rate for Payer: HealthNet Commercial |
$509.40
|
| Rate for Payer: HealthNet Medicare |
$237.72
|
| Rate for Payer: Humana Medicare |
$144.33
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$679.20
|
| Rate for Payer: Veterans (Triwest) |
$144.33
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$494.97
|
| Rate for Payer: United Healthcare Medicare |
$152.82
|
|
|
13100 RPRELX TRUNK 1.1CM-2.5CM
|
Facility
IP
|
$849.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
22282801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.33 |
| Max. Negotiated Rate |
$764.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$764.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$144.33
|
| Rate for Payer: Amerigroup Medicare |
$144.33
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$144.33
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$144.33
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$220.74
|
| Rate for Payer: Copperpoint |
$238.14
|
| Rate for Payer: Humana Medicare |
$144.33
|
| Rate for Payer: SELF PAY |
$679.20
|
| Rate for Payer: Veterans (Triwest) |
$144.33
|
|
|
13101 RPRELX TRUNK 2.6CM-7.5CM
|
Facility
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
22282802
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.62 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$977.40
|
| Rate for Payer: Aetna Medicare |
$304.08
|
| 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 |
$184.62
|
| Rate for Payer: Amerigroup Medicare |
$184.62
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$405.62
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$184.62
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$184.62
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$282.36
|
| Rate for Payer: Cigna All Products |
$760.20
|
| Rate for Payer: Copperpoint |
$304.62
|
| Rate for Payer: HealthNet Commercial |
$651.60
|
| Rate for Payer: HealthNet Medicare |
$304.08
|
| Rate for Payer: Humana Medicare |
$184.62
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$868.80
|
| Rate for Payer: Veterans (Triwest) |
$184.62
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$633.14
|
| Rate for Payer: United Healthcare Medicare |
$195.48
|
|
|
13101 RPRELX TRUNK 2.6CM-7.5CM
|
Facility
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
22282802
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.62 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$977.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$184.62
|
| Rate for Payer: Amerigroup Medicare |
$184.62
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$184.62
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$184.62
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$282.36
|
| Rate for Payer: Copperpoint |
$304.62
|
| Rate for Payer: Humana Medicare |
$184.62
|
| Rate for Payer: SELF PAY |
$868.80
|
| Rate for Payer: Veterans (Triwest) |
$184.62
|
|
|
13102 REPAIR WOUND COMPLEX 5CM OR LESS
|
Facility
OP
|
$491.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
22282803
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$83.47
|
| Rate for Payer: Aetna POS, PPO, HMO |
$441.90
|
| Rate for Payer: Aetna Medicare |
$137.48
|
| Rate for Payer: AHCCCS Medicaid |
$485.00
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$485.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$83.47
|
| Rate for Payer: Amerigroup Medicare |
$83.47
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$183.39
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$485.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$83.47
|
| Rate for Payer: Banner University Family Care Medicaid |
$485.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$127.66
|
| Rate for Payer: Cigna All Products |
$343.70
|
| Rate for Payer: Copperpoint |
$137.73
|
| Rate for Payer: HealthNet Commercial |
$294.60
|
| Rate for Payer: HealthNet Medicare |
$137.48
|
| Rate for Payer: Humana Medicare |
$83.47
|
| Rate for Payer: Mercy Care Medicaid |
$485.00
|
| Rate for Payer: SELF PAY |
$392.80
|
| Rate for Payer: Veterans (Triwest) |
$83.47
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$286.25
|
| Rate for Payer: United Healthcare Medicare |
$88.38
|
|
|
13102 REPAIR WOUND COMPLEX 5CM OR LESS
|
Facility
IP
|
$491.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
22282803
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$441.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$441.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$83.47
|
| Rate for Payer: Amerigroup Medicare |
$83.47
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$83.47
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$83.47
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$127.66
|
| Rate for Payer: Copperpoint |
$137.73
|
| Rate for Payer: Humana Medicare |
$83.47
|
| Rate for Payer: SELF PAY |
$392.80
|
| Rate for Payer: Veterans (Triwest) |
$83.47
|
|
|
13120 REPAIR COMPLEX WND 1.1CM TO 2.5
|
Facility
OP
|
$1,455.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
22282804
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.35 |
| Max. Negotiated Rate |
$1,309.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,309.50
|
| Rate for Payer: Aetna Medicare |
$407.40
|
| 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 |
$247.35
|
| Rate for Payer: Amerigroup Medicare |
$247.35
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$543.44
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$247.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$247.35
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$905.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$378.30
|
| Rate for Payer: Cigna All Products |
$1,018.50
|
| Rate for Payer: Copperpoint |
$408.13
|
| Rate for Payer: HealthNet Commercial |
$873.00
|
| Rate for Payer: HealthNet Medicare |
$407.40
|
| Rate for Payer: Humana Medicare |
$247.35
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$1,164.00
|
| Rate for Payer: Veterans (Triwest) |
$247.35
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$848.26
|
| Rate for Payer: United Healthcare Medicare |
$261.90
|
|
|
13120 REPAIR COMPLEX WND 1.1CM TO 2.5
|
Facility
IP
|
$1,455.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
22282804
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.35 |
| Max. Negotiated Rate |
$1,309.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,309.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$247.35
|
| Rate for Payer: Amerigroup Medicare |
$247.35
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$247.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$247.35
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$905.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$378.30
|
| Rate for Payer: Copperpoint |
$408.13
|
| Rate for Payer: Humana Medicare |
$247.35
|
| Rate for Payer: SELF PAY |
$1,164.00
|
| Rate for Payer: Veterans (Triwest) |
$247.35
|
|
|
13121 REPAIR COMPLEX WND 2.6CM-7.5CM
|
Facility
OP
|
$1,984.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
22282805
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.28 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,785.60
|
| Rate for Payer: Aetna Medicare |
$555.52
|
| 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 |
$337.28
|
| Rate for Payer: Amerigroup Medicare |
$337.28
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$741.02
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$337.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$337.28
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$515.84
|
| Rate for Payer: Cigna All Products |
$1,388.80
|
| Rate for Payer: Copperpoint |
$556.51
|
| Rate for Payer: HealthNet Commercial |
$1,190.40
|
| Rate for Payer: HealthNet Medicare |
$555.52
|
| Rate for Payer: Humana Medicare |
$337.28
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$1,587.20
|
| Rate for Payer: Veterans (Triwest) |
$337.28
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,156.67
|
| Rate for Payer: United Healthcare Medicare |
$357.12
|
|
|
13121 REPAIR COMPLEX WND 2.6CM-7.5CM
|
Facility
IP
|
$1,984.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
22282805
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.28 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,785.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$337.28
|
| Rate for Payer: Amerigroup Medicare |
$337.28
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$337.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$337.28
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$515.84
|
| Rate for Payer: Copperpoint |
$556.51
|
| Rate for Payer: Humana Medicare |
$337.28
|
| Rate for Payer: SELF PAY |
$1,587.20
|
| Rate for Payer: Veterans (Triwest) |
$337.28
|
|
|
13122 RPR WND EA ADDL 5CM
|
Facility
IP
|
$411.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
22282806
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.87 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$369.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$69.87
|
| Rate for Payer: Amerigroup Medicare |
$69.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$69.87
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$69.87
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$106.86
|
| Rate for Payer: Copperpoint |
$115.29
|
| Rate for Payer: Humana Medicare |
$69.87
|
| Rate for Payer: SELF PAY |
$328.80
|
| Rate for Payer: Veterans (Triwest) |
$69.87
|
|
|
13122 RPR WND EA ADDL 5CM
|
Facility
OP
|
$411.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
22282806
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.87 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$369.90
|
| Rate for Payer: Aetna Medicare |
$115.08
|
| Rate for Payer: AHCCCS Medicaid |
$165.38
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$165.38
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$69.87
|
| Rate for Payer: Amerigroup Medicare |
$69.87
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$153.51
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$165.38
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$69.87
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$69.87
|
| Rate for Payer: Banner University Family Care Medicaid |
$165.38
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$106.86
|
| Rate for Payer: Cigna All Products |
$287.70
|
| Rate for Payer: Copperpoint |
$115.29
|
| Rate for Payer: HealthNet Commercial |
$246.60
|
| Rate for Payer: HealthNet Medicare |
$115.08
|
| Rate for Payer: Humana Medicare |
$69.87
|
| Rate for Payer: Mercy Care Medicaid |
$165.38
|
| Rate for Payer: SELF PAY |
$328.80
|
| Rate for Payer: Veterans (Triwest) |
$69.87
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$239.61
|
| Rate for Payer: United Healthcare Medicare |
$73.98
|
|
|
13131 RPCLX FRHD ETC 1.1-2.5CM
|
Facility
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
22282807
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$179.52 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: City of Bisbee Police Bisbee Police |
$274.56
|
| Rate for Payer: Aetna POS, PPO, HMO |
$950.40
|
| Rate for Payer: Aetna Medicare |
$295.68
|
| 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 |
$179.52
|
| Rate for Payer: Amerigroup Medicare |
$179.52
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$394.42
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$179.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$179.52
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: Cigna All Products |
$739.20
|
| Rate for Payer: Copperpoint |
$296.21
|
| Rate for Payer: HealthNet Commercial |
$633.60
|
| Rate for Payer: HealthNet Medicare |
$295.68
|
| Rate for Payer: Humana Medicare |
$179.52
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$844.80
|
| Rate for Payer: Veterans (Triwest) |
$179.52
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$615.65
|
| Rate for Payer: United Healthcare Medicare |
$190.08
|
|
|
13131 RPCLX FRHD ETC 1.1-2.5CM
|
Facility
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
22282807
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$179.52 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$950.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$179.52
|
| Rate for Payer: Amerigroup Medicare |
$179.52
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$179.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$179.52
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$274.56
|
| Rate for Payer: Copperpoint |
$296.21
|
| Rate for Payer: Humana Medicare |
$179.52
|
| Rate for Payer: SELF PAY |
$844.80
|
| Rate for Payer: Veterans (Triwest) |
$179.52
|
|
|
13132 RP CLX FHD ETC 2.6-7.5CM
|
Facility
OP
|
$1,267.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
22282808
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.39 |
| Max. Negotiated Rate |
$1,140.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,140.30
|
| Rate for Payer: Aetna Medicare |
$354.76
|
| 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 |
$215.39
|
| Rate for Payer: Amerigroup Medicare |
$215.39
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$473.22
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$215.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$215.39
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$329.42
|
| Rate for Payer: Cigna All Products |
$886.90
|
| Rate for Payer: Copperpoint |
$355.39
|
| Rate for Payer: HealthNet Commercial |
$760.20
|
| Rate for Payer: HealthNet Medicare |
$354.76
|
| Rate for Payer: Humana Medicare |
$215.39
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$1,013.60
|
| Rate for Payer: Veterans (Triwest) |
$215.39
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$738.66
|
| Rate for Payer: United Healthcare Medicare |
$228.06
|
|