|
13132 RP CLX FHD ETC 2.6-7.5CM
|
Facility
IP
|
$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: Allwell from Arizona Complete Health Medicare Advantage |
$215.39
|
| Rate for Payer: Amerigroup Medicare |
$215.39
|
| 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: City of Bisbee Police Bisbee Police |
$329.42
|
| Rate for Payer: Copperpoint |
$355.39
|
| Rate for Payer: Humana Medicare |
$215.39
|
| Rate for Payer: SELF PAY |
$1,013.60
|
| Rate for Payer: Veterans (Triwest) |
$215.39
|
|
|
13133 RP CLX FORHD @ ADDL 5CM
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
22282809
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.23 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$557.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$105.23
|
| Rate for Payer: Amerigroup Medicare |
$105.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$105.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$105.23
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$160.94
|
| Rate for Payer: Copperpoint |
$173.63
|
| Rate for Payer: Humana Medicare |
$105.23
|
| Rate for Payer: SELF PAY |
$495.20
|
| Rate for Payer: Veterans (Triwest) |
$105.23
|
|
|
13133 RP CLX FORHD @ ADDL 5CM
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
22282809
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.23 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$557.10
|
| Rate for Payer: Aetna Medicare |
$173.32
|
| 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 |
$105.23
|
| Rate for Payer: Amerigroup Medicare |
$105.23
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$231.20
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$485.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$105.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$105.23
|
| Rate for Payer: Banner University Family Care Medicaid |
$485.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$160.94
|
| Rate for Payer: Cigna All Products |
$433.30
|
| Rate for Payer: Copperpoint |
$173.63
|
| Rate for Payer: HealthNet Commercial |
$371.40
|
| Rate for Payer: HealthNet Medicare |
$173.32
|
| Rate for Payer: Humana Medicare |
$105.23
|
| Rate for Payer: Mercy Care Medicaid |
$485.00
|
| Rate for Payer: SELF PAY |
$495.20
|
| Rate for Payer: Veterans (Triwest) |
$105.23
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$360.88
|
| Rate for Payer: United Healthcare Medicare |
$111.42
|
|
|
13150 RP CLX EYLD ETC 1.0CM/<
|
Facility
IP
|
$1,174.00
|
|
|
Service Code
|
CPT 13150
|
| Hospital Charge Code |
22282810
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.58 |
| Max. Negotiated Rate |
$1,056.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,056.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$199.58
|
| Rate for Payer: Amerigroup Medicare |
$199.58
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$199.58
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$199.58
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$305.24
|
| Rate for Payer: Copperpoint |
$329.31
|
| Rate for Payer: Humana Medicare |
$199.58
|
| Rate for Payer: SELF PAY |
$939.20
|
| Rate for Payer: Veterans (Triwest) |
$199.58
|
|
|
13150 RP CLX EYLD ETC 1.0CM/<
|
Facility
OP
|
$1,174.00
|
|
|
Service Code
|
CPT 13150
|
| Hospital Charge Code |
22282810
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.58 |
| Max. Negotiated Rate |
$1,056.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,056.60
|
| Rate for Payer: Aetna Medicare |
$328.72
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$199.58
|
| Rate for Payer: Amerigroup Medicare |
$199.58
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$438.49
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$199.58
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$199.58
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$305.24
|
| Rate for Payer: Cigna All Products |
$821.80
|
| Rate for Payer: Copperpoint |
$329.31
|
| Rate for Payer: HealthNet Commercial |
$704.40
|
| Rate for Payer: HealthNet Medicare |
$328.72
|
| Rate for Payer: Humana Medicare |
$199.58
|
| Rate for Payer: SELF PAY |
$939.20
|
| Rate for Payer: Veterans (Triwest) |
$199.58
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$684.44
|
| Rate for Payer: United Healthcare Medicare |
$211.32
|
|
|
13151 RP CLX EYLD ETC 1.1-2.5CM
|
Facility
OP
|
$1,036.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
22282811
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.12 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$932.40
|
| Rate for Payer: Aetna Medicare |
$290.08
|
| 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 |
$176.12
|
| Rate for Payer: Amerigroup Medicare |
$176.12
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$386.95
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$176.12
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$176.12
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$269.36
|
| Rate for Payer: Cigna All Products |
$725.20
|
| Rate for Payer: Copperpoint |
$290.60
|
| Rate for Payer: HealthNet Commercial |
$621.60
|
| Rate for Payer: HealthNet Medicare |
$290.08
|
| Rate for Payer: Humana Medicare |
$176.12
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$828.80
|
| Rate for Payer: Veterans (Triwest) |
$176.12
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$603.99
|
| Rate for Payer: United Healthcare Medicare |
$186.48
|
|
|
13151 RP CLX EYLD ETC 1.1-2.5CM
|
Facility
IP
|
$1,036.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
22282811
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.12 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$932.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$176.12
|
| Rate for Payer: Amerigroup Medicare |
$176.12
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$176.12
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$176.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$269.36
|
| Rate for Payer: Copperpoint |
$290.60
|
| Rate for Payer: Humana Medicare |
$176.12
|
| Rate for Payer: SELF PAY |
$828.80
|
| Rate for Payer: Veterans (Triwest) |
$176.12
|
|
|
13152 RP CLX EYLD 2.6-7.5CM
|
Facility
OP
|
$1,865.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
22282812
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.05 |
| Max. Negotiated Rate |
$1,678.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,678.50
|
| Rate for Payer: Aetna Medicare |
$522.20
|
| 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 |
$317.05
|
| Rate for Payer: Amerigroup Medicare |
$317.05
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$696.58
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$317.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$317.05
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$484.90
|
| Rate for Payer: Cigna All Products |
$1,305.50
|
| Rate for Payer: Copperpoint |
$523.13
|
| Rate for Payer: HealthNet Commercial |
$1,119.00
|
| Rate for Payer: HealthNet Medicare |
$522.20
|
| Rate for Payer: Humana Medicare |
$317.05
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$1,492.00
|
| Rate for Payer: Veterans (Triwest) |
$317.05
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,087.29
|
| Rate for Payer: United Healthcare Medicare |
$335.70
|
|
|
13152 RP CLX EYLD 2.6-7.5CM
|
Facility
IP
|
$1,865.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
22282812
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.05 |
| Max. Negotiated Rate |
$1,678.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,678.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$317.05
|
| Rate for Payer: Amerigroup Medicare |
$317.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$317.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$317.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$484.90
|
| Rate for Payer: Copperpoint |
$523.13
|
| Rate for Payer: Humana Medicare |
$317.05
|
| Rate for Payer: SELF PAY |
$1,492.00
|
| Rate for Payer: Veterans (Triwest) |
$317.05
|
|
|
13153 RP CLX EYLD ETC ADDL 5CM
|
Facility
OP
|
$678.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
22282813
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.26 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$610.20
|
| Rate for Payer: Aetna Medicare |
$189.84
|
| 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 |
$115.26
|
| Rate for Payer: Amerigroup Medicare |
$115.26
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$253.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$485.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$115.26
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$115.26
|
| Rate for Payer: Banner University Family Care Medicaid |
$485.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$176.28
|
| Rate for Payer: Cigna All Products |
$474.60
|
| Rate for Payer: Copperpoint |
$190.18
|
| Rate for Payer: HealthNet Commercial |
$406.80
|
| Rate for Payer: HealthNet Medicare |
$189.84
|
| Rate for Payer: Humana Medicare |
$115.26
|
| Rate for Payer: Mercy Care Medicaid |
$485.00
|
| Rate for Payer: SELF PAY |
$542.40
|
| Rate for Payer: Veterans (Triwest) |
$115.26
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$395.27
|
| Rate for Payer: United Healthcare Medicare |
$122.04
|
|
|
13153 RP CLX EYLD ETC ADDL 5CM
|
Facility
IP
|
$678.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
22282813
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.26 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$610.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$115.26
|
| Rate for Payer: Amerigroup Medicare |
$115.26
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$115.26
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$115.26
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$176.28
|
| Rate for Payer: Copperpoint |
$190.18
|
| Rate for Payer: Humana Medicare |
$115.26
|
| Rate for Payer: SELF PAY |
$542.40
|
| Rate for Payer: Veterans (Triwest) |
$115.26
|
|
|
140002 HEPATOCELLULAR CARCINOMA RISK PROFILE
|
Facility
OP
|
$226.00
|
|
| Hospital Charge Code |
23173819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$203.40
|
| Rate for Payer: Aetna Medicare |
$63.28
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.42
|
| Rate for Payer: Amerigroup Medicare |
$38.42
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$84.41
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.42
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$58.76
|
| Rate for Payer: Cigna All Products |
$146.90
|
| Rate for Payer: Copperpoint |
$63.39
|
| Rate for Payer: HealthNet Commercial |
$135.60
|
| Rate for Payer: HealthNet Medicare |
$63.28
|
| Rate for Payer: Humana Medicare |
$38.42
|
| Rate for Payer: SELF PAY |
$180.80
|
| Rate for Payer: Veterans (Triwest) |
$38.42
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$131.76
|
| Rate for Payer: United Healthcare Medicare |
$40.68
|
|
|
140002 HEPATOCELLULAR CARCINOMA RISK PROFILE
|
Facility
IP
|
$226.00
|
|
| Hospital Charge Code |
23173819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$203.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.42
|
| Rate for Payer: Amerigroup Medicare |
$38.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.42
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$58.76
|
| Rate for Payer: Copperpoint |
$63.39
|
| Rate for Payer: Humana Medicare |
$38.42
|
| Rate for Payer: SELF PAY |
$180.80
|
| Rate for Payer: Veterans (Triwest) |
$38.42
|
|
|
15 18 CRE WIREGUDIED
|
Facility
OP
|
$1,030.00
|
|
| Hospital Charge Code |
22586871
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.10 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$927.00
|
| Rate for Payer: Aetna Medicare |
$288.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$175.10
|
| Rate for Payer: Amerigroup Medicare |
$175.10
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$384.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$175.10
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$175.10
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$267.80
|
| Rate for Payer: Cigna All Products |
$721.00
|
| Rate for Payer: Copperpoint |
$288.92
|
| Rate for Payer: HealthNet Commercial |
$618.00
|
| Rate for Payer: HealthNet Medicare |
$288.40
|
| Rate for Payer: Humana Medicare |
$175.10
|
| Rate for Payer: SELF PAY |
$824.00
|
| Rate for Payer: Veterans (Triwest) |
$175.10
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$600.49
|
| Rate for Payer: United Healthcare Medicare |
$185.40
|
|
|
15 18 CRE WIREGUDIED
|
Facility
IP
|
$1,030.00
|
|
| Hospital Charge Code |
22586871
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.10 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$927.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$175.10
|
| Rate for Payer: Amerigroup Medicare |
$175.10
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$175.10
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$175.10
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$267.80
|
| Rate for Payer: Copperpoint |
$288.92
|
| Rate for Payer: Humana Medicare |
$175.10
|
| Rate for Payer: SELF PAY |
$824.00
|
| Rate for Payer: Veterans (Triwest) |
$175.10
|
|
|
15274 APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, L
|
Facility
IP
|
$214.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
24053068
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$192.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$36.38
|
| Rate for Payer: Amerigroup Medicare |
$36.38
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$36.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$36.38
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$55.64
|
| Rate for Payer: Copperpoint |
$60.03
|
| Rate for Payer: Humana Medicare |
$36.38
|
| Rate for Payer: SELF PAY |
$171.20
|
| Rate for Payer: Veterans (Triwest) |
$36.38
|
|
|
15274 APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, L
|
Facility
OP
|
$214.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
24053068
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$192.60
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| 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 |
$36.38
|
| Rate for Payer: Amerigroup Medicare |
$36.38
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$79.93
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$485.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$36.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$36.38
|
| Rate for Payer: Banner University Family Care Medicaid |
$485.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$55.64
|
| Rate for Payer: Cigna All Products |
$149.80
|
| Rate for Payer: Copperpoint |
$60.03
|
| Rate for Payer: HealthNet Commercial |
$128.40
|
| Rate for Payer: HealthNet Medicare |
$59.92
|
| Rate for Payer: Humana Medicare |
$36.38
|
| Rate for Payer: Mercy Care Medicaid |
$485.00
|
| Rate for Payer: SELF PAY |
$171.20
|
| Rate for Payer: Veterans (Triwest) |
$36.38
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$124.76
|
| Rate for Payer: United Healthcare Medicare |
$38.52
|
|
|
16000 TRT 1ST LOCAL
|
Facility
OP
|
$227.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
22282814
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.59 |
| Max. Negotiated Rate |
$260.34 |
| Rate for Payer: United Healthcare Medicare |
$40.86
|
| Rate for Payer: Aetna POS, PPO, HMO |
$204.30
|
| Rate for Payer: Aetna Medicare |
$63.56
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.59
|
| Rate for Payer: Amerigroup Medicare |
$38.59
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$84.78
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.59
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.59
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$59.02
|
| Rate for Payer: Cigna All Products |
$158.90
|
| Rate for Payer: Copperpoint |
$63.67
|
| Rate for Payer: HealthNet Commercial |
$136.20
|
| Rate for Payer: HealthNet Medicare |
$63.56
|
| Rate for Payer: Humana Medicare |
$38.59
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$181.60
|
| Rate for Payer: Veterans (Triwest) |
$38.59
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$132.34
|
|
|
16000 TRT 1ST LOCAL
|
Facility
IP
|
$227.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
22282814
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.59 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$204.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.59
|
| Rate for Payer: Amerigroup Medicare |
$38.59
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.59
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.59
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$59.02
|
| Rate for Payer: Copperpoint |
$63.67
|
| Rate for Payer: Humana Medicare |
$38.59
|
| Rate for Payer: SELF PAY |
$181.60
|
| Rate for Payer: Veterans (Triwest) |
$38.59
|
|
|
16010 DSG/DBD WANES SMALL
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT 16010
|
| Hospital Charge Code |
22282815
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$207.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$39.10
|
| Rate for Payer: Amerigroup Medicare |
$39.10
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$39.10
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$39.10
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$59.80
|
| Rate for Payer: Copperpoint |
$64.52
|
| Rate for Payer: Humana Medicare |
$39.10
|
| Rate for Payer: SELF PAY |
$184.00
|
| Rate for Payer: Veterans (Triwest) |
$39.10
|
|
|
16010 DSG/DBD WANES SMALL
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
CPT 16010
|
| Hospital Charge Code |
22282815
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$207.00
|
| Rate for Payer: Aetna Medicare |
$64.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$39.10
|
| Rate for Payer: Amerigroup Medicare |
$39.10
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$85.91
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$39.10
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$39.10
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$59.80
|
| Rate for Payer: Cigna All Products |
$161.00
|
| Rate for Payer: Copperpoint |
$64.52
|
| Rate for Payer: HealthNet Commercial |
$138.00
|
| Rate for Payer: HealthNet Medicare |
$64.40
|
| Rate for Payer: Humana Medicare |
$39.10
|
| Rate for Payer: SELF PAY |
$184.00
|
| Rate for Payer: Veterans (Triwest) |
$39.10
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$134.09
|
| Rate for Payer: United Healthcare Medicare |
$41.40
|
|
|
16015 DSG/MJR DBRD W/ANES M/L
|
Facility
IP
|
$777.00
|
|
|
Service Code
|
CPT 16015
|
| Hospital Charge Code |
22282816
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.09 |
| Max. Negotiated Rate |
$699.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$699.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$132.09
|
| Rate for Payer: Amerigroup Medicare |
$132.09
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$132.09
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$132.09
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$202.02
|
| Rate for Payer: Copperpoint |
$217.95
|
| Rate for Payer: Humana Medicare |
$132.09
|
| Rate for Payer: SELF PAY |
$621.60
|
| Rate for Payer: Veterans (Triwest) |
$132.09
|
|
|
16015 DSG/MJR DBRD W/ANES M/L
|
Facility
OP
|
$777.00
|
|
|
Service Code
|
CPT 16015
|
| Hospital Charge Code |
22282816
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.09 |
| Max. Negotiated Rate |
$699.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$699.30
|
| Rate for Payer: Aetna Medicare |
$217.56
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$132.09
|
| Rate for Payer: Amerigroup Medicare |
$132.09
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$290.21
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$132.09
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$132.09
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$202.02
|
| Rate for Payer: Cigna All Products |
$543.90
|
| Rate for Payer: Copperpoint |
$217.95
|
| Rate for Payer: HealthNet Commercial |
$466.20
|
| Rate for Payer: HealthNet Medicare |
$217.56
|
| Rate for Payer: Humana Medicare |
$132.09
|
| Rate for Payer: SELF PAY |
$621.60
|
| Rate for Payer: Veterans (Triwest) |
$132.09
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$452.99
|
| Rate for Payer: United Healthcare Medicare |
$139.86
|
|
|
16020 DSG/DBD W/O ANES SM
|
Facility
OP
|
$205.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
22282817
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$260.34 |
| Rate for Payer: Aetna POS, PPO, HMO |
$184.50
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$34.85
|
| Rate for Payer: Amerigroup Medicare |
$34.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$76.57
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$34.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$34.85
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$53.30
|
| Rate for Payer: Cigna All Products |
$143.50
|
| Rate for Payer: Copperpoint |
$57.50
|
| Rate for Payer: HealthNet Commercial |
$123.00
|
| Rate for Payer: HealthNet Medicare |
$57.40
|
| Rate for Payer: Humana Medicare |
$34.85
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$164.00
|
| Rate for Payer: Veterans (Triwest) |
$34.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$119.51
|
| Rate for Payer: United Healthcare Medicare |
$36.90
|
|
|
16020 DSG/DBD W/O ANES SM
|
Facility
IP
|
$205.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
22282817
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$184.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$34.85
|
| Rate for Payer: Amerigroup Medicare |
$34.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$34.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$34.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$53.30
|
| Rate for Payer: Copperpoint |
$57.50
|
| Rate for Payer: Humana Medicare |
$34.85
|
| Rate for Payer: SELF PAY |
$164.00
|
| Rate for Payer: Veterans (Triwest) |
$34.85
|
|