|
21315 CLSD TX NOSEFX W/O STABL
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
22282826
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.72 |
| Max. Negotiated Rate |
$739.80 |
| Rate for Payer: Aetna of AZ Commercial |
$739.80
|
| Rate for Payer: Bisbee Police All Plans |
$213.72
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Self Pay Self Pay |
$657.60
|
|
|
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 |
$125.60 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$706.50
|
| Rate for Payer: Aetna of AZ Medicare |
$219.80
|
| Rate for Payer: AHCCCS Medicaid |
$1,983.88
|
| Rate for Payer: Allwell Medicaid |
$1,983.88
|
| Rate for Payer: Allwell Medicare |
$125.60
|
| Rate for Payer: Amerigroup Medicare |
$125.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$293.20
|
| Rate for Payer: AZCH Complete Medicaid |
$1,983.88
|
| Rate for Payer: AZCH Complete Medicare |
$125.60
|
| Rate for Payer: Banner UC Health Medicaid |
$1,983.88
|
| Rate for Payer: Banner UC Health Medicare |
$125.60
|
| 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 |
$125.60
|
| Rate for Payer: Mercy Care Medicaid |
$1,983.88
|
| Rate for Payer: Self Pay Self Pay |
$628.00
|
| Rate for Payer: TriWest Medicare |
$125.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$141.30
|
|
|
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
|
|
|
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 |
$60.64 |
| 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 |
$60.64
|
| Rate for Payer: Amerigroup Medicare |
$60.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$141.56
|
| Rate for Payer: AZCH Complete Medicare |
$60.64
|
| Rate for Payer: Banner UC Health Medicare |
$60.64
|
| 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 |
$60.64
|
| Rate for Payer: Self Pay Self Pay |
$303.20
|
| Rate for Payer: TriWest Medicare |
$60.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$220.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$68.22
|
|
|
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
|
|
|
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 |
$470.40 |
| 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 |
$470.40
|
| Rate for Payer: Amerigroup Medicare |
$470.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,098.09
|
| Rate for Payer: AZCH Complete Medicare |
$470.40
|
| Rate for Payer: Banner UC Health Medicare |
$470.40
|
| 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 |
$470.40
|
| Rate for Payer: Self Pay Self Pay |
$2,352.00
|
| Rate for Payer: TriWest Medicare |
$470.40
|
| 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 |
$136.32 |
| 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 |
$136.32
|
| Rate for Payer: Amerigroup Medicare |
$136.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$318.22
|
| Rate for Payer: AZCH Complete Medicare |
$136.32
|
| Rate for Payer: Banner UC Health Medicare |
$136.32
|
| 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 |
$136.32
|
| Rate for Payer: Self Pay Self Pay |
$681.60
|
| Rate for Payer: TriWest Medicare |
$136.32
|
| 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 |
$133.92 |
| 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 |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$133.92
|
| Rate for Payer: Amerigroup Medicare |
$133.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$312.62
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$133.92
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$133.92
|
| 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 |
$133.92
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$669.60
|
| Rate for Payer: TriWest Medicare |
$133.92
|
| 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 |
$224.00 |
| 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 |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$224.00
|
| Rate for Payer: Amerigroup Medicare |
$224.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$522.90
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$224.00
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$224.00
|
| 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 |
$224.00
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,120.00
|
| Rate for Payer: TriWest Medicare |
$224.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$252.00
|
|
|
23540 CLSD TX A/C DISW/O MANIP
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
22282833
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.82 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Aetna of AZ Commercial |
$771.30
|
| Rate for Payer: Bisbee Police All Plans |
$222.82
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Self Pay Self Pay |
$685.60
|
|
|
23540 CLSD TX A/C DISW/O MANIP
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
22282833
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.12 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$771.30
|
| Rate for Payer: Aetna of AZ Medicare |
$239.96
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$137.12
|
| Rate for Payer: Amerigroup Medicare |
$137.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$320.09
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$137.12
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$137.12
|
| Rate for Payer: Bisbee Police All Plans |
$222.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$582.76
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cigna of AZ Commercial |
$599.90
|
| Rate for Payer: Copperpoint Commercial |
$212.11
|
| Rate for Payer: Health Net of AZ Commercial |
$514.20
|
| Rate for Payer: Health Net of AZ Medicare |
$239.96
|
| Rate for Payer: Humana of AZ Medicare |
$137.12
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$685.60
|
| Rate for Payer: TriWest Medicare |
$137.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$154.26
|
|
|
23545 CLSD TX FX A/C DISLW/MAN
|
Facility
|
IP
|
$1,212.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
22282834
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$315.12 |
| Max. Negotiated Rate |
$1,090.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,090.80
|
| Rate for Payer: Bisbee Police All Plans |
$315.12
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Self Pay Self Pay |
$969.60
|
|
|
23545 CLSD TX FX A/C DISLW/MAN
|
Facility
|
OP
|
$1,212.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
22282834
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,090.80
|
| Rate for Payer: Aetna of AZ Medicare |
$339.36
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$193.92
|
| Rate for Payer: Amerigroup Medicare |
$193.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$452.68
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$193.92
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$193.92
|
| Rate for Payer: Bisbee Police All Plans |
$315.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$824.16
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cigna of AZ Commercial |
$848.40
|
| Rate for Payer: Copperpoint Commercial |
$299.97
|
| Rate for Payer: Health Net of AZ Commercial |
$727.20
|
| Rate for Payer: Health Net of AZ Medicare |
$339.36
|
| Rate for Payer: Humana of AZ Medicare |
$193.92
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$969.60
|
| Rate for Payer: TriWest Medicare |
$193.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$218.16
|
|
|
23570 CLSD TX FX SCAP W/O MANI
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
22282835
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.58 |
| Max. Negotiated Rate |
$794.70 |
| Rate for Payer: Aetna of AZ Commercial |
$794.70
|
| Rate for Payer: Bisbee Police All Plans |
$229.58
|
| Rate for Payer: Cash Price |
$706.40
|
| Rate for Payer: Self Pay Self Pay |
$706.40
|
|
|
23570 CLSD TX FX SCAP W/O MANI
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
22282835
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.28 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$794.70
|
| Rate for Payer: Aetna of AZ Medicare |
$247.24
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$141.28
|
| Rate for Payer: Amerigroup Medicare |
$141.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$329.80
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$141.28
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$141.28
|
| Rate for Payer: Bisbee Police All Plans |
$229.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$600.44
|
| Rate for Payer: Cash Price |
$706.40
|
| Rate for Payer: Cash Price |
$706.40
|
| Rate for Payer: Cigna of AZ Commercial |
$618.10
|
| Rate for Payer: Copperpoint Commercial |
$218.54
|
| Rate for Payer: Health Net of AZ Commercial |
$529.80
|
| Rate for Payer: Health Net of AZ Medicare |
$247.24
|
| Rate for Payer: Humana of AZ Medicare |
$141.28
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$706.40
|
| Rate for Payer: TriWest Medicare |
$141.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$158.94
|
|
|
23575 CLSD TX FX SCAP W/MANIP
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
22282836
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.92 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,383.30
|
| Rate for Payer: Aetna of AZ Medicare |
$430.36
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$245.92
|
| Rate for Payer: Amerigroup Medicare |
$245.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$574.07
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$245.92
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$245.92
|
| Rate for Payer: Bisbee Police All Plans |
$399.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,045.16
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,075.90
|
| Rate for Payer: Copperpoint Commercial |
$380.41
|
| Rate for Payer: Health Net of AZ Commercial |
$922.20
|
| Rate for Payer: Health Net of AZ Medicare |
$430.36
|
| Rate for Payer: Humana of AZ Medicare |
$245.92
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,229.60
|
| Rate for Payer: TriWest Medicare |
$245.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$276.66
|
|
|
23575 CLSD TX FX SCAP W/MANIP
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
22282836
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.62 |
| Max. Negotiated Rate |
$1,383.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,383.30
|
| Rate for Payer: Bisbee Police All Plans |
$399.62
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Self Pay Self Pay |
$1,229.60
|
|
|
23650 CLD TX SHLDR WMANIP N/AN
|
Facility
|
OP
|
$2,799.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
22282837
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,519.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,519.10
|
| Rate for Payer: Aetna of AZ Medicare |
$783.72
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$447.84
|
| Rate for Payer: Amerigroup Medicare |
$447.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,045.43
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$447.84
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$447.84
|
| Rate for Payer: Bisbee Police All Plans |
$727.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,903.32
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,959.30
|
| Rate for Payer: Copperpoint Commercial |
$692.75
|
| Rate for Payer: Health Net of AZ Commercial |
$1,679.40
|
| Rate for Payer: Health Net of AZ Medicare |
$783.72
|
| Rate for Payer: Humana of AZ Medicare |
$447.84
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$2,239.20
|
| Rate for Payer: TriWest Medicare |
$447.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$503.82
|
|
|
23650 CLD TX SHLDR WMANIP N/AN
|
Facility
|
IP
|
$2,799.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
22282837
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$727.74 |
| Max. Negotiated Rate |
$2,519.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,519.10
|
| Rate for Payer: Bisbee Police All Plans |
$727.74
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Self Pay Self Pay |
$2,239.20
|
|
|
23655 CLD TX SHLDR DS WMANIP A
|
Facility
|
IP
|
$2,599.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
22282838
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$675.74 |
| Max. Negotiated Rate |
$2,339.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,339.10
|
| Rate for Payer: Bisbee Police All Plans |
$675.74
|
| Rate for Payer: Cash Price |
$2,079.20
|
| Rate for Payer: Self Pay Self Pay |
$2,079.20
|
|
|
23655 CLD TX SHLDR DS WMANIP A
|
Facility
|
OP
|
$2,599.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
22282838
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.84 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,339.10
|
| Rate for Payer: Aetna of AZ Medicare |
$727.72
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$415.84
|
| Rate for Payer: Amerigroup Medicare |
$415.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$970.73
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$415.84
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$415.84
|
| Rate for Payer: Bisbee Police All Plans |
$675.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,767.32
|
| Rate for Payer: Cash Price |
$2,079.20
|
| Rate for Payer: Cash Price |
$2,079.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,819.30
|
| Rate for Payer: Copperpoint Commercial |
$643.25
|
| Rate for Payer: Health Net of AZ Commercial |
$1,559.40
|
| Rate for Payer: Health Net of AZ Medicare |
$727.72
|
| Rate for Payer: Humana of AZ Medicare |
$415.84
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$2,079.20
|
| Rate for Payer: TriWest Medicare |
$415.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$467.82
|
|
