|
16025 DSG/DBD W/O ANES MED
|
Facility
OP
|
$467.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
22282818
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.39 |
| Max. Negotiated Rate |
$420.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$420.30
|
| Rate for Payer: Aetna Medicare |
$130.76
|
| 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 |
$79.39
|
| Rate for Payer: Amerigroup Medicare |
$79.39
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$174.42
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.39
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$121.42
|
| Rate for Payer: Cigna All Products |
$326.90
|
| Rate for Payer: Copperpoint |
$130.99
|
| Rate for Payer: HealthNet Commercial |
$280.20
|
| Rate for Payer: HealthNet Medicare |
$130.76
|
| Rate for Payer: Humana Medicare |
$79.39
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$373.60
|
| Rate for Payer: Veterans (Triwest) |
$79.39
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$272.26
|
| Rate for Payer: United Healthcare Medicare |
$84.06
|
|
|
16025 DSG/DBD W/O ANES MED
|
Facility
IP
|
$467.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
22282818
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.39 |
| Max. Negotiated Rate |
$420.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$420.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$79.39
|
| Rate for Payer: Amerigroup Medicare |
$79.39
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$79.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$79.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$121.42
|
| Rate for Payer: Copperpoint |
$130.99
|
| Rate for Payer: Humana Medicare |
$79.39
|
| Rate for Payer: SELF PAY |
$373.60
|
| Rate for Payer: Veterans (Triwest) |
$79.39
|
|
|
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 |
$102.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$540.00
|
| Rate for Payer: Aetna Medicare |
$168.00
|
| 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 |
$102.00
|
| Rate for Payer: Amerigroup Medicare |
$102.00
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$224.10
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$102.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$102.00
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$156.00
|
| Rate for Payer: Cigna All Products |
$420.00
|
| Rate for Payer: Copperpoint |
$168.30
|
| Rate for Payer: HealthNet Commercial |
$360.00
|
| Rate for Payer: HealthNet Medicare |
$168.00
|
| Rate for Payer: Humana Medicare |
$102.00
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$480.00
|
| Rate for Payer: Veterans (Triwest) |
$102.00
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$349.80
|
| Rate for Payer: United Healthcare Medicare |
$108.00
|
|
|
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 |
$102.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$540.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$102.00
|
| Rate for Payer: Amerigroup Medicare |
$102.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$102.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$102.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$156.00
|
| Rate for Payer: Copperpoint |
$168.30
|
| Rate for Payer: Humana Medicare |
$102.00
|
| Rate for Payer: SELF PAY |
$480.00
|
| Rate for Payer: Veterans (Triwest) |
$102.00
|
|
|
1.6MM K WIRE
|
Facility
IP
|
$66.00
|
|
| Hospital Charge Code |
22354195
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$59.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.22
|
| Rate for Payer: Amerigroup Medicare |
$11.22
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.22
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.22
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$17.16
|
| Rate for Payer: Copperpoint |
$18.51
|
| Rate for Payer: Humana Medicare |
$11.22
|
| Rate for Payer: SELF PAY |
$52.80
|
| Rate for Payer: Veterans (Triwest) |
$11.22
|
|
|
1.6MM K WIRE
|
Facility
OP
|
$66.00
|
|
| Hospital Charge Code |
22354195
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$59.40
|
| Rate for Payer: Aetna Medicare |
$18.48
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.22
|
| Rate for Payer: Amerigroup Medicare |
$11.22
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$24.65
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.22
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.22
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$17.16
|
| Rate for Payer: Cigna All Products |
$46.20
|
| Rate for Payer: Copperpoint |
$18.51
|
| Rate for Payer: HealthNet Commercial |
$39.60
|
| Rate for Payer: HealthNet Medicare |
$18.48
|
| Rate for Payer: Humana Medicare |
$11.22
|
| Rate for Payer: SELF PAY |
$52.80
|
| Rate for Payer: Veterans (Triwest) |
$11.22
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$38.48
|
| Rate for Payer: United Healthcare Medicare |
$11.88
|
|
|
1 6MM TAPER SIDE CUTTING CARBIDE BUR
|
Facility
OP
|
$53.00
|
|
| Hospital Charge Code |
27433627
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$47.70
|
| Rate for Payer: Aetna Medicare |
$14.84
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$9.01
|
| Rate for Payer: Amerigroup Medicare |
$9.01
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$19.80
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$9.01
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$9.01
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$13.78
|
| Rate for Payer: Cigna All Products |
$37.10
|
| Rate for Payer: Copperpoint |
$14.87
|
| Rate for Payer: HealthNet Commercial |
$31.80
|
| Rate for Payer: HealthNet Medicare |
$14.84
|
| Rate for Payer: Humana Medicare |
$9.01
|
| Rate for Payer: SELF PAY |
$42.40
|
| Rate for Payer: Veterans (Triwest) |
$9.01
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$30.90
|
| Rate for Payer: United Healthcare Medicare |
$9.54
|
|
|
1 6MM TAPER SIDE CUTTING CARBIDE BUR
|
Facility
IP
|
$53.00
|
|
| Hospital Charge Code |
27433627
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$47.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$9.01
|
| Rate for Payer: Amerigroup Medicare |
$9.01
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$9.01
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$9.01
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$13.78
|
| Rate for Payer: Copperpoint |
$14.87
|
| Rate for Payer: Humana Medicare |
$9.01
|
| Rate for Payer: SELF PAY |
$42.40
|
| Rate for Payer: Veterans (Triwest) |
$9.01
|
|
|
17-Hydroxypregnenolone MS LC
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
6780894
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$255.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$48.28
|
| Rate for Payer: Amerigroup Medicare |
$48.28
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$48.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$48.28
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$73.84
|
| Rate for Payer: Copperpoint |
$79.66
|
| Rate for Payer: Humana Medicare |
$48.28
|
| Rate for Payer: SELF PAY |
$227.20
|
| Rate for Payer: Veterans (Triwest) |
$48.28
|
|
|
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 POS, PPO, HMO |
$255.60
|
| Rate for Payer: Aetna Medicare |
$79.52
|
| Rate for Payer: AHCCCS Medicaid |
$22.81
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$22.81
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$48.28
|
| Rate for Payer: Amerigroup Medicare |
$48.28
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$106.07
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$22.81
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$48.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$48.28
|
| Rate for Payer: Banner University Family Care Medicaid |
$22.81
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$73.84
|
| Rate for Payer: Cigna All Products |
$184.60
|
| Rate for Payer: Copperpoint |
$79.66
|
| Rate for Payer: HealthNet Commercial |
$170.40
|
| Rate for Payer: HealthNet Medicare |
$79.52
|
| Rate for Payer: Humana Medicare |
$48.28
|
| Rate for Payer: Mercy Care Medicaid |
$22.81
|
| Rate for Payer: SELF PAY |
$227.20
|
| Rate for Payer: Veterans (Triwest) |
$48.28
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$165.57
|
| Rate for Payer: United Healthcare Medicare |
$51.12
|
|
|
17-OH Progesterone LC
|
Facility
IP
|
$442.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
6738679
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.14 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$397.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$75.14
|
| Rate for Payer: Amerigroup Medicare |
$75.14
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$75.14
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$75.14
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$114.92
|
| Rate for Payer: Copperpoint |
$123.98
|
| Rate for Payer: Humana Medicare |
$75.14
|
| Rate for Payer: SELF PAY |
$353.60
|
| Rate for Payer: Veterans (Triwest) |
$75.14
|
|
|
17-OH Progesterone LC
|
Facility
OP
|
$442.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
6738679
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$397.80
|
| Rate for Payer: Aetna Medicare |
$123.76
|
| Rate for Payer: AHCCCS Medicaid |
$27.17
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$27.17
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$75.14
|
| Rate for Payer: Amerigroup Medicare |
$75.14
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$165.09
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$27.17
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$75.14
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$75.14
|
| Rate for Payer: Banner University Family Care Medicaid |
$27.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$114.92
|
| Rate for Payer: Cigna All Products |
$287.30
|
| Rate for Payer: Copperpoint |
$123.98
|
| Rate for Payer: HealthNet Commercial |
$265.20
|
| Rate for Payer: HealthNet Medicare |
$123.76
|
| Rate for Payer: Humana Medicare |
$75.14
|
| Rate for Payer: Mercy Care Medicaid |
$27.17
|
| Rate for Payer: SELF PAY |
$353.60
|
| Rate for Payer: Veterans (Triwest) |
$75.14
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$257.69
|
| Rate for Payer: United Healthcare Medicare |
$79.56
|
|
|
18 GA Percutaneous Acce+B2:B102ss Needle
|
Facility
OP
|
$292.00
|
|
| Hospital Charge Code |
22926475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.64 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$262.80
|
| Rate for Payer: Aetna Medicare |
$81.76
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$49.64
|
| Rate for Payer: Amerigroup Medicare |
$49.64
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$109.06
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$49.64
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$49.64
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$75.92
|
| Rate for Payer: Cigna All Products |
$204.40
|
| Rate for Payer: Copperpoint |
$81.91
|
| Rate for Payer: HealthNet Commercial |
$175.20
|
| Rate for Payer: HealthNet Medicare |
$81.76
|
| Rate for Payer: Humana Medicare |
$49.64
|
| Rate for Payer: SELF PAY |
$233.60
|
| Rate for Payer: Veterans (Triwest) |
$49.64
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$170.24
|
| Rate for Payer: United Healthcare Medicare |
$52.56
|
|
|
18 GA Percutaneous Acce+B2:B102ss Needle
|
Facility
IP
|
$292.00
|
|
| Hospital Charge Code |
22926475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.64 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$262.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$49.64
|
| Rate for Payer: Amerigroup Medicare |
$49.64
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$49.64
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$49.64
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$75.92
|
| Rate for Payer: Copperpoint |
$81.91
|
| Rate for Payer: Humana Medicare |
$49.64
|
| Rate for Payer: SELF PAY |
$233.60
|
| Rate for Payer: Veterans (Triwest) |
$49.64
|
|
|
1 Ethibond Excel CCS
|
Facility
OP
|
$104.00
|
|
| Hospital Charge Code |
22926435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$93.60
|
| Rate for Payer: Aetna Medicare |
$29.12
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.68
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$38.84
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.68
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.68
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.04
|
| Rate for Payer: Cigna All Products |
$72.80
|
| Rate for Payer: Copperpoint |
$29.17
|
| Rate for Payer: HealthNet Commercial |
$62.40
|
| Rate for Payer: HealthNet Medicare |
$29.12
|
| Rate for Payer: Humana Medicare |
$17.68
|
| Rate for Payer: SELF PAY |
$83.20
|
| Rate for Payer: Veterans (Triwest) |
$17.68
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$60.63
|
| Rate for Payer: United Healthcare Medicare |
$18.72
|
|
|
1 Ethibond Excel CCS
|
Facility
IP
|
$104.00
|
|
| Hospital Charge Code |
22926435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$93.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.68
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.68
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.68
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.04
|
| Rate for Payer: Copperpoint |
$29.17
|
| Rate for Payer: Humana Medicare |
$17.68
|
| Rate for Payer: SELF PAY |
$83.20
|
| Rate for Payer: Veterans (Triwest) |
$17.68
|
|
|
1 Ethibond Excel OS-8
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
22926437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$16.20
|
| Rate for Payer: Aetna Medicare |
$5.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.06
|
| Rate for Payer: Amerigroup Medicare |
$3.06
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$6.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.06
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.06
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$4.68
|
| Rate for Payer: Cigna All Products |
$12.60
|
| Rate for Payer: Copperpoint |
$5.05
|
| Rate for Payer: HealthNet Commercial |
$10.80
|
| Rate for Payer: HealthNet Medicare |
$5.04
|
| Rate for Payer: Humana Medicare |
$3.06
|
| Rate for Payer: SELF PAY |
$14.40
|
| Rate for Payer: Veterans (Triwest) |
$3.06
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$3.24
|
|
|
1 Ethibond Excel OS-8
|
Facility
IP
|
$18.00
|
|
| Hospital Charge Code |
22926437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$16.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.06
|
| Rate for Payer: Amerigroup Medicare |
$3.06
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.06
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.06
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$4.68
|
| Rate for Payer: Copperpoint |
$5.05
|
| Rate for Payer: Humana Medicare |
$3.06
|
| Rate for Payer: SELF PAY |
$14.40
|
| Rate for Payer: Veterans (Triwest) |
$3.06
|
|
|
1 Silk Ties
|
Facility
IP
|
$9.00
|
|
| Hospital Charge Code |
22926441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$8.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.53
|
| Rate for Payer: Amerigroup Medicare |
$1.53
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2.34
|
| Rate for Payer: Copperpoint |
$2.52
|
| Rate for Payer: Humana Medicare |
$1.53
|
| Rate for Payer: SELF PAY |
$7.20
|
| Rate for Payer: Veterans (Triwest) |
$1.53
|
|
|
1 Silk Ties
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
22926441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$8.10
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.53
|
| Rate for Payer: Amerigroup Medicare |
$1.53
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$3.36
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.53
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.53
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2.34
|
| Rate for Payer: Cigna All Products |
$6.30
|
| Rate for Payer: Copperpoint |
$2.52
|
| Rate for Payer: HealthNet Commercial |
$5.40
|
| Rate for Payer: HealthNet Medicare |
$2.52
|
| Rate for Payer: Humana Medicare |
$1.53
|
| Rate for Payer: SELF PAY |
$7.20
|
| Rate for Payer: Veterans (Triwest) |
$1.53
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$5.25
|
| Rate for Payer: United Healthcare Medicare |
$1.62
|
|
|
2019 Novel Coronavirus (CoVID-19), NAA LC
|
Facility
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
23925248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$184.96 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$979.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$184.96
|
| Rate for Payer: Amerigroup Medicare |
$184.96
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$184.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$184.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$282.88
|
| Rate for Payer: Copperpoint |
$305.18
|
| Rate for Payer: Humana Medicare |
$184.96
|
| Rate for Payer: SELF PAY |
$870.40
|
| Rate for Payer: Veterans (Triwest) |
$184.96
|
|
|
2019 Novel Coronavirus (CoVID-19), NAA LC
|
Facility
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
23925248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$979.20
|
| Rate for Payer: Aetna Medicare |
$304.64
|
| Rate for Payer: AHCCCS Medicaid |
$51.31
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$51.31
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$184.96
|
| Rate for Payer: Amerigroup Medicare |
$184.96
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$406.37
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$51.31
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$184.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$184.96
|
| Rate for Payer: Banner University Family Care Medicaid |
$51.31
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$282.88
|
| Rate for Payer: Cigna All Products |
$707.20
|
| Rate for Payer: Copperpoint |
$305.18
|
| Rate for Payer: HealthNet Commercial |
$652.80
|
| Rate for Payer: HealthNet Medicare |
$304.64
|
| Rate for Payer: Humana Medicare |
$184.96
|
| Rate for Payer: Mercy Care Medicaid |
$51.31
|
| Rate for Payer: SELF PAY |
$870.40
|
| Rate for Payer: Veterans (Triwest) |
$184.96
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$634.30
|
| Rate for Payer: United Healthcare Medicare |
$195.84
|
|
|
20520 RMV FB MSCL/TDN SMPL
|
Facility
OP
|
$676.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
22282820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.92 |
| Max. Negotiated Rate |
$2,040.16 |
| Rate for Payer: Aetna POS, PPO, HMO |
$608.40
|
| Rate for Payer: Aetna Medicare |
$189.28
|
| Rate for Payer: AHCCCS Medicaid |
$2,040.16
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,040.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$114.92
|
| Rate for Payer: Amerigroup Medicare |
$114.92
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$252.49
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,040.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$114.92
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$114.92
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,040.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$175.76
|
| Rate for Payer: Cigna All Products |
$473.20
|
| Rate for Payer: Copperpoint |
$189.62
|
| Rate for Payer: HealthNet Commercial |
$405.60
|
| Rate for Payer: HealthNet Medicare |
$189.28
|
| Rate for Payer: Humana Medicare |
$114.92
|
| Rate for Payer: Mercy Care Medicaid |
$2,040.16
|
| Rate for Payer: SELF PAY |
$540.80
|
| Rate for Payer: Veterans (Triwest) |
$114.92
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$394.11
|
| Rate for Payer: United Healthcare Medicare |
$121.68
|
|
|
20520 RMV FB MSCL/TDN SMPL
|
Facility
IP
|
$676.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
22282820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.92 |
| Max. Negotiated Rate |
$608.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$608.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$114.92
|
| Rate for Payer: Amerigroup Medicare |
$114.92
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$114.92
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$114.92
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$175.76
|
| Rate for Payer: Copperpoint |
$189.62
|
| Rate for Payer: Humana Medicare |
$114.92
|
| Rate for Payer: SELF PAY |
$540.80
|
| Rate for Payer: Veterans (Triwest) |
$114.92
|
|
|
20550 INJ TENDON ETC
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
22282821
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$193.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$36.55
|
| Rate for Payer: Amerigroup Medicare |
$36.55
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$36.55
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$36.55
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$55.90
|
| Rate for Payer: Copperpoint |
$60.31
|
| Rate for Payer: Humana Medicare |
$36.55
|
| Rate for Payer: SELF PAY |
$172.00
|
| Rate for Payer: Veterans (Triwest) |
$36.55
|
|