|
1 6MM TAPER SIDE CUTTING CARBIDE BUR
|
Facility
IP
|
$56.00
|
|
| Hospital Charge Code |
27433627
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of AZ Commercial |
$50.40
|
| Rate for Payer: Bisbee Police All Plans |
$14.56
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Self Pay Self Pay |
$44.80
|
|
|
1 6MM TAPER SIDE CUTTING CARBIDE BUR
|
Facility
OP
|
$56.00
|
|
| Hospital Charge Code |
27433627
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of AZ Commercial |
$50.40
|
| Rate for Payer: Aetna of AZ Medicare |
$15.68
|
| Rate for Payer: Allwell Medicare |
$8.40
|
| Rate for Payer: Amerigroup Medicare |
$8.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$20.92
|
| Rate for Payer: AZCH Complete Medicare |
$8.40
|
| Rate for Payer: Banner UC Health Medicare |
$8.40
|
| Rate for Payer: Bisbee Police All Plans |
$14.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$38.08
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cigna of AZ Commercial |
$39.20
|
| Rate for Payer: Copperpoint Commercial |
$13.86
|
| Rate for Payer: Health Net of AZ Commercial |
$33.60
|
| Rate for Payer: Health Net of AZ Medicare |
$15.68
|
| Rate for Payer: Humana of AZ Medicare |
$8.40
|
| Rate for Payer: Self Pay Self Pay |
$44.80
|
| Rate for Payer: TriWest Medicare |
$8.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$32.65
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.08
|
|
|
17-Hydroxypregnenolone MS LC
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
6780894
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of AZ Commercial |
$255.60
|
| Rate for Payer: Aetna of AZ Medicare |
$79.52
|
| Rate for Payer: AHCCCS Medicaid |
$22.81
|
| Rate for Payer: Allwell Medicaid |
$22.81
|
| Rate for Payer: Allwell Medicare |
$42.60
|
| Rate for Payer: Amerigroup Medicare |
$42.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$106.07
|
| Rate for Payer: AZCH Complete Medicaid |
$22.81
|
| Rate for Payer: AZCH Complete Medicare |
$42.60
|
| Rate for Payer: Banner UC Health Medicaid |
$22.81
|
| Rate for Payer: Banner UC Health Medicare |
$42.60
|
| Rate for Payer: Bisbee Police All Plans |
$73.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$193.12
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cigna of AZ Commercial |
$184.60
|
| Rate for Payer: Copperpoint Commercial |
$70.29
|
| Rate for Payer: Health Net of AZ Commercial |
$170.40
|
| Rate for Payer: Health Net of AZ Medicare |
$79.52
|
| Rate for Payer: Humana of AZ Medicare |
$42.60
|
| Rate for Payer: Mercy Care Medicaid |
$22.81
|
| Rate for Payer: Self Pay Self Pay |
$227.20
|
| Rate for Payer: TriWest Medicare |
$42.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$165.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$51.12
|
|
|
17-Hydroxypregnenolone MS LC
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
6780894
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of AZ Commercial |
$255.60
|
| Rate for Payer: Bisbee Police All Plans |
$73.84
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Self Pay Self Pay |
$227.20
|
|
|
17-OH Progesterone LC
|
Facility
OP
|
$464.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
6738679
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of AZ Commercial |
$417.60
|
| Rate for Payer: Aetna of AZ Medicare |
$129.92
|
| Rate for Payer: AHCCCS Medicaid |
$27.17
|
| Rate for Payer: Allwell Medicaid |
$27.17
|
| Rate for Payer: Allwell Medicare |
$69.60
|
| Rate for Payer: Amerigroup Medicare |
$69.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$173.30
|
| Rate for Payer: AZCH Complete Medicaid |
$27.17
|
| Rate for Payer: AZCH Complete Medicare |
$69.60
|
| Rate for Payer: Banner UC Health Medicaid |
$27.17
|
| Rate for Payer: Banner UC Health Medicare |
$69.60
|
| Rate for Payer: Bisbee Police All Plans |
$120.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$315.52
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cigna of AZ Commercial |
$301.60
|
| Rate for Payer: Copperpoint Commercial |
$114.84
|
| Rate for Payer: Health Net of AZ Commercial |
$278.40
|
| Rate for Payer: Health Net of AZ Medicare |
$129.92
|
| Rate for Payer: Humana of AZ Medicare |
$69.60
|
| Rate for Payer: Mercy Care Medicaid |
$27.17
|
| Rate for Payer: Self Pay Self Pay |
$371.20
|
| Rate for Payer: TriWest Medicare |
$69.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$270.51
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$83.52
|
|
|
17-OH Progesterone LC
|
Facility
IP
|
$464.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
6738679
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.64 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of AZ Commercial |
$417.60
|
| Rate for Payer: Bisbee Police All Plans |
$120.64
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Self Pay Self Pay |
$371.20
|
|
|
18 GA Percutaneous Acce+B2:B102ss Needle
|
Facility
IP
|
$292.00
|
|
| Hospital Charge Code |
22926475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna of AZ Commercial |
$262.80
|
| Rate for Payer: Bisbee Police All Plans |
$75.92
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Self Pay Self Pay |
$233.60
|
|
|
18 GA Percutaneous Acce+B2:B102ss Needle
|
Facility
OP
|
$292.00
|
|
| Hospital Charge Code |
22926475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna of AZ Commercial |
$262.80
|
| Rate for Payer: Aetna of AZ Medicare |
$81.76
|
| Rate for Payer: Allwell Medicare |
$43.80
|
| Rate for Payer: Amerigroup Medicare |
$43.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$109.06
|
| Rate for Payer: AZCH Complete Medicare |
$43.80
|
| Rate for Payer: Banner UC Health Medicare |
$43.80
|
| Rate for Payer: Bisbee Police All Plans |
$75.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$198.56
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cigna of AZ Commercial |
$204.40
|
| Rate for Payer: Copperpoint Commercial |
$72.27
|
| Rate for Payer: Health Net of AZ Commercial |
$175.20
|
| Rate for Payer: Health Net of AZ Medicare |
$81.76
|
| Rate for Payer: Humana of AZ Medicare |
$43.80
|
| Rate for Payer: Self Pay Self Pay |
$233.60
|
| Rate for Payer: TriWest Medicare |
$43.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$170.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$52.56
|
|
|
1 Ethibond Excel CCS
|
Facility
IP
|
$109.00
|
|
| Hospital Charge Code |
22926435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Bisbee Police All Plans |
$28.34
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Self Pay Self Pay |
$87.20
|
|
|
1 Ethibond Excel CCS
|
Facility
OP
|
$109.00
|
|
| Hospital Charge Code |
22926435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Aetna of AZ Medicare |
$30.52
|
| Rate for Payer: Allwell Medicare |
$16.35
|
| Rate for Payer: Amerigroup Medicare |
$16.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$40.71
|
| Rate for Payer: AZCH Complete Medicare |
$16.35
|
| Rate for Payer: Banner UC Health Medicare |
$16.35
|
| Rate for Payer: Bisbee Police All Plans |
$28.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$74.12
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cigna of AZ Commercial |
$76.30
|
| Rate for Payer: Copperpoint Commercial |
$26.98
|
| Rate for Payer: Health Net of AZ Commercial |
$65.40
|
| Rate for Payer: Health Net of AZ Medicare |
$30.52
|
| Rate for Payer: Humana of AZ Medicare |
$16.35
|
| Rate for Payer: Self Pay Self Pay |
$87.20
|
| Rate for Payer: TriWest Medicare |
$16.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$63.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.62
|
|
|
1 Ethibond Excel OS-8
|
Facility
OP
|
$19.00
|
|
| Hospital Charge Code |
22926437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of AZ Commercial |
$17.10
|
| Rate for Payer: Aetna of AZ Medicare |
$5.32
|
| Rate for Payer: Allwell Medicare |
$2.85
|
| Rate for Payer: Amerigroup Medicare |
$2.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$7.10
|
| Rate for Payer: AZCH Complete Medicare |
$2.85
|
| Rate for Payer: Banner UC Health Medicare |
$2.85
|
| Rate for Payer: Bisbee Police All Plans |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$12.92
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cigna of AZ Commercial |
$13.30
|
| Rate for Payer: Copperpoint Commercial |
$4.70
|
| Rate for Payer: Health Net of AZ Commercial |
$11.40
|
| Rate for Payer: Health Net of AZ Medicare |
$5.32
|
| Rate for Payer: Humana of AZ Medicare |
$2.85
|
| Rate for Payer: Self Pay Self Pay |
$15.20
|
| Rate for Payer: TriWest Medicare |
$2.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$11.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.42
|
|
|
1 Ethibond Excel OS-8
|
Facility
IP
|
$19.00
|
|
| Hospital Charge Code |
22926437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of AZ Commercial |
$17.10
|
| Rate for Payer: Bisbee Police All Plans |
$4.94
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Self Pay Self Pay |
$15.20
|
|
|
1 Silk Ties
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
22926441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Aetna of AZ Medicare |
$2.52
|
| Rate for Payer: Allwell Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicare |
$1.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.36
|
| Rate for Payer: AZCH Complete Medicare |
$1.35
|
| Rate for Payer: Banner UC Health Medicare |
$1.35
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of AZ Commercial |
$6.30
|
| Rate for Payer: Copperpoint Commercial |
$2.23
|
| Rate for Payer: Health Net of AZ Commercial |
$5.40
|
| Rate for Payer: Health Net of AZ Medicare |
$2.52
|
| Rate for Payer: Humana of AZ Medicare |
$1.35
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
| Rate for Payer: TriWest Medicare |
$1.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.62
|
|
|
1 Silk Ties
|
Facility
IP
|
$9.00
|
|
| Hospital Charge Code |
22926441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
|
|
2019 Novel Coronavirus (CoVID-19), NAA LC
|
Facility
OP
|
$998.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
23925248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$898.20 |
| Rate for Payer: Aetna of AZ Commercial |
$898.20
|
| Rate for Payer: Aetna of AZ Medicare |
$279.44
|
| Rate for Payer: AHCCCS Medicaid |
$51.31
|
| Rate for Payer: Allwell Medicaid |
$51.31
|
| Rate for Payer: Allwell Medicare |
$149.70
|
| Rate for Payer: Amerigroup Medicare |
$149.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$372.75
|
| Rate for Payer: AZCH Complete Medicaid |
$51.31
|
| Rate for Payer: AZCH Complete Medicare |
$149.70
|
| Rate for Payer: Banner UC Health Medicaid |
$51.31
|
| Rate for Payer: Banner UC Health Medicare |
$149.70
|
| Rate for Payer: Bisbee Police All Plans |
$259.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$678.64
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cigna of AZ Commercial |
$648.70
|
| Rate for Payer: Copperpoint Commercial |
$247.00
|
| Rate for Payer: Health Net of AZ Commercial |
$598.80
|
| Rate for Payer: Health Net of AZ Medicare |
$279.44
|
| Rate for Payer: Humana of AZ Medicare |
$149.70
|
| Rate for Payer: Mercy Care Medicaid |
$51.31
|
| Rate for Payer: Self Pay Self Pay |
$798.40
|
| Rate for Payer: TriWest Medicare |
$149.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$581.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$179.64
|
|
|
2019 Novel Coronavirus (CoVID-19), NAA LC
|
Facility
IP
|
$998.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
23925248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$259.48 |
| Max. Negotiated Rate |
$898.20 |
| Rate for Payer: Aetna of AZ Commercial |
$898.20
|
| Rate for Payer: Bisbee Police All Plans |
$259.48
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Self Pay Self Pay |
$798.40
|
|
|
20520 RMV FB MSCL/TDN SMPL
|
Facility
IP
|
$710.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
22282820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Aetna of AZ Commercial |
$639.00
|
| Rate for Payer: Bisbee Police All Plans |
$184.60
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Self Pay Self Pay |
$568.00
|
|
|
20520 RMV FB MSCL/TDN SMPL
|
Facility
OP
|
$710.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
22282820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$639.00
|
| Rate for Payer: Aetna of AZ Medicare |
$198.80
|
| Rate for Payer: AHCCCS Medicaid |
$2,040.16
|
| Rate for Payer: Allwell Medicaid |
$2,040.16
|
| Rate for Payer: Allwell Medicare |
$106.50
|
| Rate for Payer: Amerigroup Medicare |
$106.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$265.18
|
| Rate for Payer: AZCH Complete Medicaid |
$2,040.16
|
| Rate for Payer: AZCH Complete Medicare |
$106.50
|
| Rate for Payer: Banner UC Health Medicaid |
$2,040.16
|
| Rate for Payer: Banner UC Health Medicare |
$106.50
|
| Rate for Payer: Bisbee Police All Plans |
$184.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$482.80
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cigna of AZ Commercial |
$497.00
|
| Rate for Payer: Copperpoint Commercial |
$175.72
|
| Rate for Payer: Health Net of AZ Commercial |
$426.00
|
| Rate for Payer: Health Net of AZ Medicare |
$198.80
|
| Rate for Payer: Humana of AZ Medicare |
$106.50
|
| Rate for Payer: Mercy Care Medicaid |
$2,040.16
|
| Rate for Payer: Self Pay Self Pay |
$568.00
|
| Rate for Payer: TriWest Medicare |
$106.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$127.80
|
|
|
20550 INJ TENDON ETC
|
Facility
IP
|
$226.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
22282821
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
20550 INJ TENDON ETC
|
Facility
OP
|
$226.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
22282821
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$203.40
|
| Rate for Payer: Aetna of AZ Medicare |
$63.28
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicaid |
$378.70
|
| 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 Medicaid |
$378.70
|
| Rate for Payer: AZCH Complete Medicare |
$33.90
|
| Rate for Payer: Banner UC Health Medicaid |
$378.70
|
| 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: Cash Price |
$180.80
|
| Rate for Payer: Cigna of AZ Commercial |
$158.20
|
| 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: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: Self Pay Self Pay |
$180.80
|
| Rate for Payer: TriWest Medicare |
$33.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.68
|
|
|
20600 ASP / INJECTIONS JOINT SMALL
|
Facility
IP
|
$258.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
22282822
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Aetna of AZ Commercial |
$232.20
|
| Rate for Payer: Bisbee Police All Plans |
$67.08
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Self Pay Self Pay |
$206.40
|
|
|
20600 ASP / INJECTIONS JOINT SMALL
|
Facility
OP
|
$258.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
22282822
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$232.20
|
| Rate for Payer: Aetna of AZ Medicare |
$72.24
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicare |
$38.70
|
| Rate for Payer: Amerigroup Medicare |
$38.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$96.36
|
| Rate for Payer: AZCH Complete Medicaid |
$378.70
|
| Rate for Payer: AZCH Complete Medicare |
$38.70
|
| Rate for Payer: Banner UC Health Medicaid |
$378.70
|
| Rate for Payer: Banner UC Health Medicare |
$38.70
|
| Rate for Payer: Bisbee Police All Plans |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$175.44
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna of AZ Commercial |
$180.60
|
| Rate for Payer: Copperpoint Commercial |
$63.86
|
| Rate for Payer: Health Net of AZ Commercial |
$154.80
|
| Rate for Payer: Health Net of AZ Medicare |
$72.24
|
| Rate for Payer: Humana of AZ Medicare |
$38.70
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: Self Pay Self Pay |
$206.40
|
| Rate for Payer: TriWest Medicare |
$38.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$46.44
|
|
|
20605 ASP / INJECTIONS JOINT INTERMEDIATE
|
Facility
IP
|
$272.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
22282823
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna of AZ Commercial |
$244.80
|
| Rate for Payer: Bisbee Police All Plans |
$70.72
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Self Pay Self Pay |
$217.60
|
|
|
20605 ASP / INJECTIONS JOINT INTERMEDIATE
|
Facility
OP
|
$272.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
22282823
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$244.80
|
| Rate for Payer: Aetna of AZ Medicare |
$76.16
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicare |
$40.80
|
| Rate for Payer: Amerigroup Medicare |
$40.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$101.59
|
| Rate for Payer: AZCH Complete Medicaid |
$378.70
|
| Rate for Payer: AZCH Complete Medicare |
$40.80
|
| Rate for Payer: Banner UC Health Medicaid |
$378.70
|
| Rate for Payer: Banner UC Health Medicare |
$40.80
|
| Rate for Payer: Bisbee Police All Plans |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$184.96
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cigna of AZ Commercial |
$190.40
|
| Rate for Payer: Copperpoint Commercial |
$67.32
|
| Rate for Payer: Health Net of AZ Commercial |
$163.20
|
| Rate for Payer: Health Net of AZ Medicare |
$76.16
|
| Rate for Payer: Humana of AZ Medicare |
$40.80
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: Self Pay Self Pay |
$217.60
|
| Rate for Payer: TriWest Medicare |
$40.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.96
|
|
|
20610 ASP / INJECTIONS JOINT MAJOR
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
22282824
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$299.70
|
| Rate for Payer: Aetna of AZ Medicare |
$93.24
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicare |
$49.95
|
| Rate for Payer: Amerigroup Medicare |
$49.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$124.38
|
| Rate for Payer: AZCH Complete Medicaid |
$378.70
|
| Rate for Payer: AZCH Complete Medicare |
$49.95
|
| Rate for Payer: Banner UC Health Medicaid |
$378.70
|
| Rate for Payer: Banner UC Health Medicare |
$49.95
|
| Rate for Payer: Bisbee Police All Plans |
$86.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$226.44
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna of AZ Commercial |
$233.10
|
| Rate for Payer: Copperpoint Commercial |
$82.42
|
| Rate for Payer: Health Net of AZ Commercial |
$199.80
|
| Rate for Payer: Health Net of AZ Medicare |
$93.24
|
| Rate for Payer: Humana of AZ Medicare |
$49.95
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: Self Pay Self Pay |
$266.40
|
| Rate for Payer: TriWest Medicare |
$49.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$59.94
|
|
