|
13150 RP CLX EYLD ETC 1.0CM/<
|
Facility
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 13150
|
| Hospital Charge Code |
22282810
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.95 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,109.70
|
| Rate for Payer: Aetna of AZ Medicare |
$345.24
|
| Rate for Payer: Allwell Medicare |
$184.95
|
| Rate for Payer: Amerigroup Medicare |
$184.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$460.53
|
| Rate for Payer: AZCH Complete Medicare |
$184.95
|
| Rate for Payer: Banner UC Health Medicare |
$184.95
|
| Rate for Payer: Bisbee Police All Plans |
$320.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$838.44
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cigna of AZ Commercial |
$863.10
|
| Rate for Payer: Copperpoint Commercial |
$305.17
|
| Rate for Payer: Health Net of AZ Commercial |
$739.80
|
| Rate for Payer: Health Net of AZ Medicare |
$345.24
|
| Rate for Payer: Humana of AZ Medicare |
$184.95
|
| Rate for Payer: Self Pay Self Pay |
$986.40
|
| Rate for Payer: TriWest Medicare |
$184.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$718.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$221.94
|
|
|
13151 RP CLX EYLD ETC 1.1-2.5CM
|
Facility
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
22282811
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$979.20
|
| Rate for Payer: Aetna of AZ Medicare |
$304.64
|
| Rate for Payer: AHCCCS Medicaid |
$760.04
|
| Rate for Payer: Allwell Medicaid |
$760.04
|
| Rate for Payer: Allwell Medicare |
$163.20
|
| Rate for Payer: Amerigroup Medicare |
$163.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$406.37
|
| Rate for Payer: AZCH Complete Medicaid |
$760.04
|
| Rate for Payer: AZCH Complete Medicare |
$163.20
|
| Rate for Payer: Banner UC Health Medicaid |
$760.04
|
| Rate for Payer: Banner UC Health Medicare |
$163.20
|
| Rate for Payer: Bisbee Police All Plans |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$739.84
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cigna of AZ Commercial |
$761.60
|
| Rate for Payer: Copperpoint Commercial |
$269.28
|
| Rate for Payer: Health Net of AZ Commercial |
$652.80
|
| Rate for Payer: Health Net of AZ Medicare |
$304.64
|
| Rate for Payer: Humana of AZ Medicare |
$163.20
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: Self Pay Self Pay |
$870.40
|
| Rate for Payer: TriWest Medicare |
$163.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$195.84
|
|
|
13151 RP CLX EYLD ETC 1.1-2.5CM
|
Facility
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
22282811
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$282.88 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: Aetna of AZ Commercial |
$979.20
|
| Rate for Payer: Bisbee Police All Plans |
$282.88
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Self Pay Self Pay |
$870.40
|
|
|
13152 RP CLX EYLD 2.6-7.5CM
|
Facility
OP
|
$1,958.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
22282812
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.70 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,762.20
|
| Rate for Payer: Aetna of AZ Medicare |
$548.24
|
| Rate for Payer: AHCCCS Medicaid |
$760.04
|
| Rate for Payer: Allwell Medicaid |
$760.04
|
| Rate for Payer: Allwell Medicare |
$293.70
|
| Rate for Payer: Amerigroup Medicare |
$293.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$731.31
|
| Rate for Payer: AZCH Complete Medicaid |
$760.04
|
| Rate for Payer: AZCH Complete Medicare |
$293.70
|
| Rate for Payer: Banner UC Health Medicaid |
$760.04
|
| Rate for Payer: Banner UC Health Medicare |
$293.70
|
| Rate for Payer: Bisbee Police All Plans |
$509.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,331.44
|
| Rate for Payer: Cash Price |
$1,566.40
|
| Rate for Payer: Cash Price |
$1,566.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,370.60
|
| Rate for Payer: Copperpoint Commercial |
$484.60
|
| Rate for Payer: Health Net of AZ Commercial |
$1,174.80
|
| Rate for Payer: Health Net of AZ Medicare |
$548.24
|
| Rate for Payer: Humana of AZ Medicare |
$293.70
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: Self Pay Self Pay |
$1,566.40
|
| Rate for Payer: TriWest Medicare |
$293.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$352.44
|
|
|
13152 RP CLX EYLD 2.6-7.5CM
|
Facility
IP
|
$1,958.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
22282812
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.08 |
| Max. Negotiated Rate |
$1,762.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,762.20
|
| Rate for Payer: Bisbee Police All Plans |
$509.08
|
| Rate for Payer: Cash Price |
$1,566.40
|
| Rate for Payer: Self Pay Self Pay |
$1,566.40
|
|
|
13153 RP CLX EYLD ETC ADDL 5CM
|
Facility
IP
|
$712.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
22282813
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.12 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Aetna of AZ Commercial |
$640.80
|
| Rate for Payer: Bisbee Police All Plans |
$185.12
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Self Pay Self Pay |
$569.60
|
|
|
13153 RP CLX EYLD ETC ADDL 5CM
|
Facility
OP
|
$712.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
22282813
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$640.80
|
| Rate for Payer: Aetna of AZ Medicare |
$199.36
|
| Rate for Payer: AHCCCS Medicaid |
$485.00
|
| Rate for Payer: Allwell Medicaid |
$485.00
|
| Rate for Payer: Allwell Medicare |
$106.80
|
| Rate for Payer: Amerigroup Medicare |
$106.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$265.93
|
| Rate for Payer: AZCH Complete Medicaid |
$485.00
|
| Rate for Payer: AZCH Complete Medicare |
$106.80
|
| Rate for Payer: Banner UC Health Medicaid |
$485.00
|
| Rate for Payer: Banner UC Health Medicare |
$106.80
|
| Rate for Payer: Bisbee Police All Plans |
$185.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$484.16
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cigna of AZ Commercial |
$498.40
|
| Rate for Payer: Copperpoint Commercial |
$176.22
|
| Rate for Payer: Health Net of AZ Commercial |
$427.20
|
| Rate for Payer: Health Net of AZ Medicare |
$199.36
|
| Rate for Payer: Humana of AZ Medicare |
$106.80
|
| Rate for Payer: Mercy Care Medicaid |
$485.00
|
| Rate for Payer: Self Pay Self Pay |
$569.60
|
| Rate for Payer: TriWest Medicare |
$106.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$128.16
|
|
|
140002 HEPATOCELLULAR CARCINOMA RISK PROFILE
|
Facility
OP
|
$226.00
|
|
| Hospital Charge Code |
23173819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna of AZ Commercial |
$203.40
|
| Rate for Payer: Aetna of AZ Medicare |
$63.28
|
| Rate for Payer: Allwell Medicare |
$33.90
|
| Rate for Payer: Amerigroup Medicare |
$33.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$84.41
|
| Rate for Payer: AZCH Complete Medicare |
$33.90
|
| Rate for Payer: Banner UC Health Medicare |
$33.90
|
| Rate for Payer: Bisbee Police All Plans |
$58.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$153.68
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cigna of AZ Commercial |
$146.90
|
| Rate for Payer: Copperpoint Commercial |
$55.94
|
| Rate for Payer: Health Net of AZ Commercial |
$135.60
|
| Rate for Payer: Health Net of AZ Medicare |
$63.28
|
| Rate for Payer: Humana of AZ Medicare |
$33.90
|
| Rate for Payer: Self Pay Self Pay |
$180.80
|
| Rate for Payer: TriWest Medicare |
$33.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$131.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.68
|
|
|
140002 HEPATOCELLULAR CARCINOMA RISK PROFILE
|
Facility
IP
|
$226.00
|
|
| Hospital Charge Code |
23173819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna of AZ Commercial |
$203.40
|
| Rate for Payer: Bisbee Police All Plans |
$58.76
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Self Pay Self Pay |
$180.80
|
|
|
15274 APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, L
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
24053068
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna of AZ Commercial |
$202.50
|
| Rate for Payer: Bisbee Police All Plans |
$58.50
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Self Pay Self Pay |
$180.00
|
|
|
15274 APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, L
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
24053068
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$202.50
|
| Rate for Payer: Aetna of AZ Medicare |
$63.00
|
| Rate for Payer: AHCCCS Medicaid |
$485.00
|
| Rate for Payer: Allwell Medicaid |
$485.00
|
| Rate for Payer: Allwell Medicare |
$33.75
|
| Rate for Payer: Amerigroup Medicare |
$33.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$84.04
|
| Rate for Payer: AZCH Complete Medicaid |
$485.00
|
| Rate for Payer: AZCH Complete Medicare |
$33.75
|
| Rate for Payer: Banner UC Health Medicaid |
$485.00
|
| Rate for Payer: Banner UC Health Medicare |
$33.75
|
| Rate for Payer: Bisbee Police All Plans |
$58.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of AZ Commercial |
$157.50
|
| Rate for Payer: Copperpoint Commercial |
$55.69
|
| Rate for Payer: Health Net of AZ Commercial |
$135.00
|
| Rate for Payer: Health Net of AZ Medicare |
$63.00
|
| Rate for Payer: Humana of AZ Medicare |
$33.75
|
| Rate for Payer: Mercy Care Medicaid |
$485.00
|
| Rate for Payer: Self Pay Self Pay |
$180.00
|
| Rate for Payer: TriWest Medicare |
$33.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.50
|
|
|
16000 TRT 1ST LOCAL
|
Facility
OP
|
$238.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
22282814
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$214.20
|
| Rate for Payer: Aetna of AZ Medicare |
$66.64
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$35.70
|
| Rate for Payer: Amerigroup Medicare |
$35.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$88.89
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$35.70
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$35.70
|
| Rate for Payer: Bisbee Police All Plans |
$61.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$161.84
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cigna of AZ Commercial |
$166.60
|
| Rate for Payer: Copperpoint Commercial |
$58.90
|
| Rate for Payer: Health Net of AZ Commercial |
$142.80
|
| Rate for Payer: Health Net of AZ Medicare |
$66.64
|
| Rate for Payer: Humana of AZ Medicare |
$35.70
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$190.40
|
| Rate for Payer: TriWest Medicare |
$35.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$42.84
|
|
|
16000 TRT 1ST LOCAL
|
Facility
IP
|
$238.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
22282814
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna of AZ Commercial |
$214.20
|
| Rate for Payer: Bisbee Police All Plans |
$61.88
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Self Pay Self Pay |
$190.40
|
|
|
16010 DSG/DBD WANES SMALL
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 16010
|
| Hospital Charge Code |
22282815
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna of AZ Commercial |
$217.80
|
| Rate for Payer: Aetna of AZ Medicare |
$67.76
|
| Rate for Payer: Allwell Medicare |
$36.30
|
| Rate for Payer: Amerigroup Medicare |
$36.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$90.39
|
| Rate for Payer: AZCH Complete Medicare |
$36.30
|
| Rate for Payer: Banner UC Health Medicare |
$36.30
|
| Rate for Payer: Bisbee Police All Plans |
$62.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$164.56
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cigna of AZ Commercial |
$169.40
|
| Rate for Payer: Copperpoint Commercial |
$59.90
|
| Rate for Payer: Health Net of AZ Commercial |
$145.20
|
| Rate for Payer: Health Net of AZ Medicare |
$67.76
|
| Rate for Payer: Humana of AZ Medicare |
$36.30
|
| Rate for Payer: Self Pay Self Pay |
$193.60
|
| Rate for Payer: TriWest Medicare |
$36.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$141.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$43.56
|
|
|
16010 DSG/DBD WANES SMALL
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 16010
|
| Hospital Charge Code |
22282815
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna of AZ Commercial |
$217.80
|
| Rate for Payer: Bisbee Police All Plans |
$62.92
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Self Pay Self Pay |
$193.60
|
|
|
16015 DSG/MJR DBRD W/ANES M/L
|
Facility
OP
|
$816.00
|
|
|
Service Code
|
CPT 16015
|
| Hospital Charge Code |
22282816
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna of AZ Commercial |
$734.40
|
| Rate for Payer: Aetna of AZ Medicare |
$228.48
|
| Rate for Payer: Allwell Medicare |
$122.40
|
| Rate for Payer: Amerigroup Medicare |
$122.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$304.78
|
| Rate for Payer: AZCH Complete Medicare |
$122.40
|
| Rate for Payer: Banner UC Health Medicare |
$122.40
|
| Rate for Payer: Bisbee Police All Plans |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$554.88
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna of AZ Commercial |
$571.20
|
| Rate for Payer: Copperpoint Commercial |
$201.96
|
| Rate for Payer: Health Net of AZ Commercial |
$489.60
|
| Rate for Payer: Health Net of AZ Medicare |
$228.48
|
| Rate for Payer: Humana of AZ Medicare |
$122.40
|
| Rate for Payer: Self Pay Self Pay |
$652.80
|
| Rate for Payer: TriWest Medicare |
$122.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$475.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$146.88
|
|
|
16015 DSG/MJR DBRD W/ANES M/L
|
Facility
IP
|
$816.00
|
|
|
Service Code
|
CPT 16015
|
| Hospital Charge Code |
22282816
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna of AZ Commercial |
$734.40
|
| Rate for Payer: Bisbee Police All Plans |
$212.16
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Self Pay Self Pay |
$652.80
|
|
|
16020 DSG/DBD W/O ANES SM
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
22282817
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$193.50
|
| Rate for Payer: Aetna of AZ Medicare |
$60.20
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$32.25
|
| Rate for Payer: Amerigroup Medicare |
$32.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$80.30
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$32.25
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$32.25
|
| Rate for Payer: Bisbee Police All Plans |
$55.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$146.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna of AZ Commercial |
$150.50
|
| Rate for Payer: Copperpoint Commercial |
$53.21
|
| Rate for Payer: Health Net of AZ Commercial |
$129.00
|
| Rate for Payer: Health Net of AZ Medicare |
$60.20
|
| Rate for Payer: Humana of AZ Medicare |
$32.25
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$172.00
|
| Rate for Payer: TriWest Medicare |
$32.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.70
|
|
|
16020 DSG/DBD W/O ANES SM
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
22282817
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of AZ Commercial |
$193.50
|
| Rate for Payer: Bisbee Police All Plans |
$55.90
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Self Pay Self Pay |
$172.00
|
|
|
16025 DSG/DBD W/O ANES MED
|
Facility
OP
|
$490.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
22282818
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$441.00
|
| Rate for Payer: Aetna of AZ Medicare |
$137.20
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$73.50
|
| Rate for Payer: Amerigroup Medicare |
$73.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$183.02
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$73.50
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$73.50
|
| Rate for Payer: Bisbee Police All Plans |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$333.20
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna of AZ Commercial |
$343.00
|
| Rate for Payer: Copperpoint Commercial |
$121.28
|
| Rate for Payer: Health Net of AZ Commercial |
$294.00
|
| Rate for Payer: Health Net of AZ Medicare |
$137.20
|
| Rate for Payer: Humana of AZ Medicare |
$73.50
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$392.00
|
| Rate for Payer: TriWest Medicare |
$73.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$88.20
|
|
|
16025 DSG/DBD W/O ANES MED
|
Facility
IP
|
$490.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
22282818
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of AZ Commercial |
$441.00
|
| Rate for Payer: Bisbee Police All Plans |
$127.40
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Self Pay Self Pay |
$392.00
|
|
|
16030 DSG/DBD W/O ANES LG
|
Facility
IP
|
$600.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
22282819
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of AZ Commercial |
$540.00
|
| Rate for Payer: Bisbee Police All Plans |
$156.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Self Pay Self Pay |
$480.00
|
|
|
16030 DSG/DBD W/O ANES LG
|
Facility
OP
|
$600.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
22282819
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$540.00
|
| Rate for Payer: Aetna of AZ Medicare |
$168.00
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicare |
$90.00
|
| Rate for Payer: Amerigroup Medicare |
$90.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$224.10
|
| Rate for Payer: AZCH Complete Medicaid |
$501.46
|
| Rate for Payer: AZCH Complete Medicare |
$90.00
|
| Rate for Payer: Banner UC Health Medicaid |
$501.46
|
| Rate for Payer: Banner UC Health Medicare |
$90.00
|
| Rate for Payer: Bisbee Police All Plans |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$408.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna of AZ Commercial |
$420.00
|
| Rate for Payer: Copperpoint Commercial |
$148.50
|
| Rate for Payer: Health Net of AZ Commercial |
$360.00
|
| Rate for Payer: Health Net of AZ Medicare |
$168.00
|
| Rate for Payer: Humana of AZ Medicare |
$90.00
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: Self Pay Self Pay |
$480.00
|
| Rate for Payer: TriWest Medicare |
$90.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$108.00
|
|
|
1.6MM K WIRE
|
Facility
IP
|
$69.00
|
|
| Hospital Charge Code |
22354195
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of AZ Commercial |
$62.10
|
| Rate for Payer: Bisbee Police All Plans |
$17.94
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Self Pay Self Pay |
$55.20
|
|
|
1.6MM K WIRE
|
Facility
OP
|
$69.00
|
|
| Hospital Charge Code |
22354195
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of AZ Commercial |
$62.10
|
| Rate for Payer: Aetna of AZ Medicare |
$19.32
|
| Rate for Payer: Allwell Medicare |
$10.35
|
| Rate for Payer: Amerigroup Medicare |
$10.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$25.77
|
| Rate for Payer: AZCH Complete Medicare |
$10.35
|
| Rate for Payer: Banner UC Health Medicare |
$10.35
|
| Rate for Payer: Bisbee Police All Plans |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$46.92
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna of AZ Commercial |
$48.30
|
| Rate for Payer: Copperpoint Commercial |
$17.08
|
| Rate for Payer: Health Net of AZ Commercial |
$41.40
|
| Rate for Payer: Health Net of AZ Medicare |
$19.32
|
| Rate for Payer: Humana of AZ Medicare |
$10.35
|
| Rate for Payer: Self Pay Self Pay |
$55.20
|
| Rate for Payer: TriWest Medicare |
$10.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$40.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.42
|
|
