|
20610 ASP / INJECTIONS JOINT MAJOR
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
22282824
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of AZ Commercial |
$299.70
|
| Rate for Payer: Bisbee Police All Plans |
$86.58
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Self Pay Self Pay |
$266.40
|
|
|
2-0 Ethibond Excel CT-1
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
22926439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of AZ Commercial |
$11.70
|
| Rate for Payer: Aetna of AZ Medicare |
$3.64
|
| Rate for Payer: Allwell Medicare |
$1.95
|
| Rate for Payer: Amerigroup Medicare |
$1.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4.86
|
| Rate for Payer: AZCH Complete Medicare |
$1.95
|
| Rate for Payer: Banner UC Health Medicare |
$1.95
|
| Rate for Payer: Bisbee Police All Plans |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$8.84
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cigna of AZ Commercial |
$9.10
|
| Rate for Payer: Copperpoint Commercial |
$3.22
|
| Rate for Payer: Health Net of AZ Commercial |
$7.80
|
| Rate for Payer: Health Net of AZ Medicare |
$3.64
|
| Rate for Payer: Humana of AZ Medicare |
$1.95
|
| Rate for Payer: Self Pay Self Pay |
$10.40
|
| Rate for Payer: TriWest Medicare |
$1.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$7.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.34
|
|
|
2-0 Ethibond Excel CT-1
|
Facility
IP
|
$13.00
|
|
| Hospital Charge Code |
22926439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of AZ Commercial |
$11.70
|
| Rate for Payer: Bisbee Police All Plans |
$3.38
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Self Pay Self Pay |
$10.40
|
|
|
2-0 Ethibond Excel MO-7
|
Facility
IP
|
$84.00
|
|
| Hospital Charge Code |
22926438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Bisbee Police All Plans |
$21.84
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Self Pay Self Pay |
$67.20
|
|
|
2-0 Ethibond Excel MO-7
|
Facility
OP
|
$84.00
|
|
| Hospital Charge Code |
22926438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Aetna of AZ Medicare |
$23.52
|
| Rate for Payer: Allwell Medicare |
$12.60
|
| Rate for Payer: Amerigroup Medicare |
$12.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$31.37
|
| Rate for Payer: AZCH Complete Medicare |
$12.60
|
| Rate for Payer: Banner UC Health Medicare |
$12.60
|
| Rate for Payer: Bisbee Police All Plans |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$57.12
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna of AZ Commercial |
$58.80
|
| Rate for Payer: Copperpoint Commercial |
$20.79
|
| Rate for Payer: Health Net of AZ Commercial |
$50.40
|
| Rate for Payer: Health Net of AZ Medicare |
$23.52
|
| Rate for Payer: Humana of AZ Medicare |
$12.60
|
| Rate for Payer: Self Pay Self Pay |
$67.20
|
| Rate for Payer: TriWest Medicare |
$12.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$48.97
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.12
|
|
|
20G INTROCAN SAFETY STRAIGHT FEP IV CATH
|
Facility
IP
|
$7.16
|
|
| Hospital Charge Code |
27527452
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of AZ Commercial |
$6.44
|
| Rate for Payer: Bisbee Police All Plans |
$1.86
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Self Pay Self Pay |
$5.73
|
|
|
20G INTROCAN SAFETY STRAIGHT FEP IV CATH
|
Facility
OP
|
$7.16
|
|
| Hospital Charge Code |
27527452
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of AZ Commercial |
$6.44
|
| Rate for Payer: Aetna of AZ Medicare |
$2.00
|
| Rate for Payer: Allwell Medicare |
$1.07
|
| Rate for Payer: Amerigroup Medicare |
$1.07
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.67
|
| Rate for Payer: AZCH Complete Medicare |
$1.07
|
| Rate for Payer: Banner UC Health Medicare |
$1.07
|
| Rate for Payer: Bisbee Police All Plans |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4.87
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cigna of AZ Commercial |
$5.01
|
| Rate for Payer: Copperpoint Commercial |
$1.77
|
| Rate for Payer: Health Net of AZ Commercial |
$4.30
|
| Rate for Payer: Health Net of AZ Medicare |
$2.00
|
| Rate for Payer: Humana of AZ Medicare |
$1.07
|
| Rate for Payer: Self Pay Self Pay |
$5.73
|
| Rate for Payer: TriWest Medicare |
$1.07
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4.17
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.29
|
|
|
2-0 Plain Gut FN-2
|
Facility
IP
|
$22.00
|
|
| Hospital Charge Code |
22926444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna of AZ Commercial |
$19.80
|
| Rate for Payer: Bisbee Police All Plans |
$5.72
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Self Pay Self Pay |
$17.60
|
|
|
2-0 Plain Gut FN-2
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
22926444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna of AZ Commercial |
$19.80
|
| Rate for Payer: Aetna of AZ Medicare |
$6.16
|
| Rate for Payer: Allwell Medicare |
$3.30
|
| Rate for Payer: Amerigroup Medicare |
$3.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$8.22
|
| Rate for Payer: AZCH Complete Medicare |
$3.30
|
| Rate for Payer: Banner UC Health Medicare |
$3.30
|
| Rate for Payer: Bisbee Police All Plans |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$14.96
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cigna of AZ Commercial |
$15.40
|
| Rate for Payer: Copperpoint Commercial |
$5.44
|
| Rate for Payer: Health Net of AZ Commercial |
$13.20
|
| Rate for Payer: Health Net of AZ Medicare |
$6.16
|
| Rate for Payer: Humana of AZ Medicare |
$3.30
|
| Rate for Payer: Self Pay Self Pay |
$17.60
|
| Rate for Payer: TriWest Medicare |
$3.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$12.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.96
|
|
|
2-0 Surgical Steel FSLX
|
Facility
IP
|
$14.00
|
|
| Hospital Charge Code |
22926440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of AZ Commercial |
$12.60
|
| Rate for Payer: Bisbee Police All Plans |
$3.64
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Self Pay Self Pay |
$11.20
|
|
|
2-0 Surgical Steel FSLX
|
Facility
OP
|
$14.00
|
|
| Hospital Charge Code |
22926440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of AZ Commercial |
$12.60
|
| Rate for Payer: Aetna of AZ Medicare |
$3.92
|
| Rate for Payer: Allwell Medicare |
$2.10
|
| Rate for Payer: Amerigroup Medicare |
$2.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$5.23
|
| Rate for Payer: AZCH Complete Medicare |
$2.10
|
| Rate for Payer: Banner UC Health Medicare |
$2.10
|
| Rate for Payer: Bisbee Police All Plans |
$3.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$9.52
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cigna of AZ Commercial |
$9.80
|
| Rate for Payer: Copperpoint Commercial |
$3.46
|
| Rate for Payer: Health Net of AZ Commercial |
$8.40
|
| Rate for Payer: Health Net of AZ Medicare |
$3.92
|
| Rate for Payer: Humana of AZ Medicare |
$2.10
|
| Rate for Payer: Self Pay Self Pay |
$11.20
|
| Rate for Payer: TriWest Medicare |
$2.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$8.16
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.52
|
|
|
21315 CLSD TX NOSEFX W/O STABL
|
Facility
IP
|
$609.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
22282826
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Aetna of AZ Commercial |
$548.10
|
| Rate for Payer: Bisbee Police All Plans |
$158.34
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Self Pay Self Pay |
$487.20
|
|
|
21315 CLSD TX NOSEFX W/O STABL
|
Facility
OP
|
$609.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
22282826
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.35 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$548.10
|
| Rate for Payer: Aetna of AZ Medicare |
$170.52
|
| Rate for Payer: AHCCCS Medicaid |
$1,961.54
|
| Rate for Payer: Allwell Medicaid |
$1,961.54
|
| Rate for Payer: Allwell Medicare |
$91.35
|
| Rate for Payer: Amerigroup Medicare |
$91.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$227.46
|
| Rate for Payer: AZCH Complete Medicaid |
$1,961.54
|
| Rate for Payer: AZCH Complete Medicare |
$91.35
|
| Rate for Payer: Banner UC Health Medicaid |
$1,961.54
|
| Rate for Payer: Banner UC Health Medicare |
$91.35
|
| Rate for Payer: Bisbee Police All Plans |
$158.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$414.12
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna of AZ Commercial |
$426.30
|
| Rate for Payer: Copperpoint Commercial |
$150.73
|
| Rate for Payer: Health Net of AZ Commercial |
$365.40
|
| Rate for Payer: Health Net of AZ Medicare |
$170.52
|
| Rate for Payer: Humana of AZ Medicare |
$91.35
|
| Rate for Payer: Mercy Care Medicaid |
$1,961.54
|
| Rate for Payer: Self Pay Self Pay |
$487.20
|
| Rate for Payer: TriWest Medicare |
$91.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$109.62
|
|
|
21320 CLSD TX NOSE FX W/STABL
|
Facility
IP
|
$785.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
22282827
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.10 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Aetna of AZ Commercial |
$706.50
|
| Rate for Payer: Bisbee Police All Plans |
$204.10
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Self Pay Self Pay |
$628.00
|
|
|
21320 CLSD TX NOSE FX W/STABL
|
Facility
OP
|
$785.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
22282827
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.75 |
| Max. Negotiated Rate |
$3,967.76 |
| Rate for Payer: Aetna of AZ Commercial |
$706.50
|
| Rate for Payer: Aetna of AZ Medicare |
$219.80
|
| Rate for Payer: AHCCCS Medicaid |
$3,967.76
|
| Rate for Payer: Allwell Medicaid |
$3,967.76
|
| Rate for Payer: Allwell Medicare |
$117.75
|
| Rate for Payer: Amerigroup Medicare |
$117.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$293.20
|
| Rate for Payer: AZCH Complete Medicaid |
$3,967.76
|
| Rate for Payer: AZCH Complete Medicare |
$117.75
|
| Rate for Payer: Banner UC Health Medicaid |
$3,967.76
|
| Rate for Payer: Banner UC Health Medicare |
$117.75
|
| Rate for Payer: Bisbee Police All Plans |
$204.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$533.80
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cigna of AZ Commercial |
$549.50
|
| Rate for Payer: Copperpoint Commercial |
$194.29
|
| Rate for Payer: Health Net of AZ Commercial |
$471.00
|
| Rate for Payer: Health Net of AZ Medicare |
$219.80
|
| Rate for Payer: Humana of AZ Medicare |
$117.75
|
| Rate for Payer: Mercy Care Medicaid |
$3,967.76
|
| Rate for Payer: Self Pay Self Pay |
$628.00
|
| Rate for Payer: TriWest Medicare |
$117.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$141.30
|
|
|
21800 CLSD TX RIB FX UNCOM @
|
Facility
IP
|
$379.00
|
|
|
Service Code
|
CPT 21800
|
| Hospital Charge Code |
22282828
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Aetna of AZ Commercial |
$341.10
|
| Rate for Payer: Bisbee Police All Plans |
$98.54
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Self Pay Self Pay |
$303.20
|
|
|
21800 CLSD TX RIB FX UNCOM @
|
Facility
OP
|
$379.00
|
|
|
Service Code
|
CPT 21800
|
| Hospital Charge Code |
22282828
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Aetna of AZ Commercial |
$341.10
|
| Rate for Payer: Aetna of AZ Medicare |
$106.12
|
| Rate for Payer: Allwell Medicare |
$56.85
|
| Rate for Payer: Amerigroup Medicare |
$56.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$141.56
|
| Rate for Payer: AZCH Complete Medicare |
$56.85
|
| Rate for Payer: Banner UC Health Medicare |
$56.85
|
| Rate for Payer: Bisbee Police All Plans |
$98.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$257.72
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cigna of AZ Commercial |
$265.30
|
| Rate for Payer: Copperpoint Commercial |
$93.80
|
| Rate for Payer: Health Net of AZ Commercial |
$227.40
|
| Rate for Payer: Health Net of AZ Medicare |
$106.12
|
| Rate for Payer: Humana of AZ Medicare |
$56.85
|
| Rate for Payer: Self Pay Self Pay |
$303.20
|
| Rate for Payer: TriWest Medicare |
$56.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$220.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$68.22
|
|
|
21810 TX FLAI CHEST
|
Facility
IP
|
$2,940.00
|
|
|
Service Code
|
CPT 21810
|
| Hospital Charge Code |
22282829
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$764.40 |
| Max. Negotiated Rate |
$2,646.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,646.00
|
| Rate for Payer: Bisbee Police All Plans |
$764.40
|
| Rate for Payer: Cash Price |
$2,352.00
|
| Rate for Payer: Self Pay Self Pay |
$2,352.00
|
|
|
21810 TX FLAI CHEST
|
Facility
OP
|
$2,940.00
|
|
|
Service Code
|
CPT 21810
|
| Hospital Charge Code |
22282829
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$2,646.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,646.00
|
| Rate for Payer: Aetna of AZ Medicare |
$823.20
|
| Rate for Payer: Allwell Medicare |
$441.00
|
| Rate for Payer: Amerigroup Medicare |
$441.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,098.09
|
| Rate for Payer: AZCH Complete Medicare |
$441.00
|
| Rate for Payer: Banner UC Health Medicare |
$441.00
|
| Rate for Payer: Bisbee Police All Plans |
$764.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,999.20
|
| Rate for Payer: Cash Price |
$2,352.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,058.00
|
| Rate for Payer: Copperpoint Commercial |
$727.65
|
| Rate for Payer: Health Net of AZ Commercial |
$1,764.00
|
| Rate for Payer: Health Net of AZ Medicare |
$823.20
|
| Rate for Payer: Humana of AZ Medicare |
$441.00
|
| Rate for Payer: Self Pay Self Pay |
$2,352.00
|
| Rate for Payer: TriWest Medicare |
$441.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,714.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$529.20
|
|
|
22305 CLSD TX FX VERT
|
Facility
IP
|
$852.00
|
|
| Hospital Charge Code |
22282830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.52 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Aetna of AZ Commercial |
$766.80
|
| Rate for Payer: Bisbee Police All Plans |
$221.52
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Self Pay Self Pay |
$681.60
|
|
|
22305 CLSD TX FX VERT
|
Facility
OP
|
$852.00
|
|
| Hospital Charge Code |
22282830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Aetna of AZ Commercial |
$766.80
|
| Rate for Payer: Aetna of AZ Medicare |
$238.56
|
| Rate for Payer: Allwell Medicare |
$127.80
|
| Rate for Payer: Amerigroup Medicare |
$127.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$318.22
|
| Rate for Payer: AZCH Complete Medicare |
$127.80
|
| Rate for Payer: Banner UC Health Medicare |
$127.80
|
| Rate for Payer: Bisbee Police All Plans |
$221.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$579.36
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cigna of AZ Commercial |
$596.40
|
| Rate for Payer: Copperpoint Commercial |
$210.87
|
| Rate for Payer: Health Net of AZ Commercial |
$511.20
|
| Rate for Payer: Health Net of AZ Medicare |
$238.56
|
| Rate for Payer: Humana of AZ Medicare |
$127.80
|
| Rate for Payer: Self Pay Self Pay |
$681.60
|
| Rate for Payer: TriWest Medicare |
$127.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$496.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$153.36
|
|
|
23500 CLSD TXFX CLAR W/O MANIP
|
Facility
OP
|
$837.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
22282831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.55 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$753.30
|
| Rate for Payer: Aetna of AZ Medicare |
$234.36
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$125.55
|
| Rate for Payer: Amerigroup Medicare |
$125.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$312.62
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$125.55
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$125.55
|
| Rate for Payer: Bisbee Police All Plans |
$217.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$569.16
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna of AZ Commercial |
$585.90
|
| Rate for Payer: Copperpoint Commercial |
$207.16
|
| Rate for Payer: Health Net of AZ Commercial |
$502.20
|
| Rate for Payer: Health Net of AZ Medicare |
$234.36
|
| Rate for Payer: Humana of AZ Medicare |
$125.55
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$669.60
|
| Rate for Payer: TriWest Medicare |
$125.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$150.66
|
|
|
23500 CLSD TXFX CLAR W/O MANIP
|
Facility
IP
|
$837.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
22282831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.62 |
| Max. Negotiated Rate |
$753.30 |
| Rate for Payer: Aetna of AZ Commercial |
$753.30
|
| Rate for Payer: Bisbee Police All Plans |
$217.62
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Self Pay Self Pay |
$669.60
|
|
|
23505 CLSD TX FX CLAV W/MANIP
|
Facility
IP
|
$1,400.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
22282832
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,260.00
|
| Rate for Payer: Bisbee Police All Plans |
$364.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Self Pay Self Pay |
$1,120.00
|
|
|
23505 CLSD TX FX CLAV W/MANIP
|
Facility
OP
|
$1,400.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
22282832
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,260.00
|
| Rate for Payer: Aetna of AZ Medicare |
$392.00
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$210.00
|
| Rate for Payer: Amerigroup Medicare |
$210.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$522.90
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$210.00
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$210.00
|
| Rate for Payer: Bisbee Police All Plans |
$364.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$952.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna of AZ Commercial |
$980.00
|
| Rate for Payer: Copperpoint Commercial |
$346.50
|
| Rate for Payer: Health Net of AZ Commercial |
$840.00
|
| Rate for Payer: Health Net of AZ Medicare |
$392.00
|
| Rate for Payer: Humana of AZ Medicare |
$210.00
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$1,120.00
|
| Rate for Payer: TriWest Medicare |
$210.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$252.00
|
|
