|
20550 INJ TENDON ETC
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
22282821
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$36.55
|
| Rate for Payer: Aetna POS, PPO, HMO |
$193.50
|
| Rate for Payer: Aetna Medicare |
$60.20
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$378.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$36.55
|
| Rate for Payer: Amerigroup Medicare |
$36.55
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$80.30
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$378.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$36.55
|
| Rate for Payer: Banner University Family Care Medicaid |
$378.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$55.90
|
| Rate for Payer: Cigna All Products |
$150.50
|
| Rate for Payer: Copperpoint |
$60.31
|
| Rate for Payer: HealthNet Commercial |
$129.00
|
| Rate for Payer: HealthNet Medicare |
$60.20
|
| Rate for Payer: Humana Medicare |
$36.55
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: SELF PAY |
$172.00
|
| Rate for Payer: Veterans (Triwest) |
$36.55
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$125.34
|
| Rate for Payer: United Healthcare Medicare |
$38.70
|
|
|
20600 ASP / INJECTIONS JOINT SMALL
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
22282822
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$221.40
|
| Rate for Payer: Aetna Medicare |
$68.88
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$378.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$41.82
|
| Rate for Payer: Amerigroup Medicare |
$41.82
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$91.88
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$378.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$41.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$41.82
|
| Rate for Payer: Banner University Family Care Medicaid |
$378.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$63.96
|
| Rate for Payer: Cigna All Products |
$172.20
|
| Rate for Payer: Copperpoint |
$69.00
|
| Rate for Payer: HealthNet Commercial |
$147.60
|
| Rate for Payer: HealthNet Medicare |
$68.88
|
| Rate for Payer: Humana Medicare |
$41.82
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: SELF PAY |
$196.80
|
| Rate for Payer: Veterans (Triwest) |
$41.82
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$143.42
|
| Rate for Payer: United Healthcare Medicare |
$44.28
|
|
|
20600 ASP / INJECTIONS JOINT SMALL
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
22282822
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$221.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$41.82
|
| Rate for Payer: Amerigroup Medicare |
$41.82
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$41.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$41.82
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$63.96
|
| Rate for Payer: Copperpoint |
$69.00
|
| Rate for Payer: Humana Medicare |
$41.82
|
| Rate for Payer: SELF PAY |
$196.80
|
| Rate for Payer: Veterans (Triwest) |
$41.82
|
|
|
20605 ASP / INJECTIONS JOINT INTERMEDIATE
|
Facility
IP
|
$259.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
22282823
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.03 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$233.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$44.03
|
| Rate for Payer: Amerigroup Medicare |
$44.03
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$44.03
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$44.03
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$67.34
|
| Rate for Payer: Copperpoint |
$72.65
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: SELF PAY |
$207.20
|
| Rate for Payer: Veterans (Triwest) |
$44.03
|
|
|
20605 ASP / INJECTIONS JOINT INTERMEDIATE
|
Facility
OP
|
$259.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
22282823
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.03 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$233.10
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$378.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$44.03
|
| Rate for Payer: Amerigroup Medicare |
$44.03
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$96.74
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$378.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$44.03
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$44.03
|
| Rate for Payer: Banner University Family Care Medicaid |
$378.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$67.34
|
| Rate for Payer: Cigna All Products |
$181.30
|
| Rate for Payer: Copperpoint |
$72.65
|
| Rate for Payer: HealthNet Commercial |
$155.40
|
| Rate for Payer: HealthNet Medicare |
$72.52
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: SELF PAY |
$207.20
|
| Rate for Payer: Veterans (Triwest) |
$44.03
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$151.00
|
| Rate for Payer: United Healthcare Medicare |
$46.62
|
|
|
20610 ASP / INJECTIONS JOINT MAJOR
|
Facility
OP
|
$317.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
22282824
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$285.30
|
| Rate for Payer: Aetna Medicare |
$88.76
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$378.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$53.89
|
| Rate for Payer: Amerigroup Medicare |
$53.89
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$118.40
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$378.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$53.89
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$53.89
|
| Rate for Payer: Banner University Family Care Medicaid |
$378.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$82.42
|
| Rate for Payer: Cigna All Products |
$221.90
|
| Rate for Payer: Copperpoint |
$88.92
|
| Rate for Payer: HealthNet Commercial |
$190.20
|
| Rate for Payer: HealthNet Medicare |
$88.76
|
| Rate for Payer: Humana Medicare |
$53.89
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: SELF PAY |
$253.60
|
| Rate for Payer: Veterans (Triwest) |
$53.89
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$184.81
|
| Rate for Payer: United Healthcare Medicare |
$57.06
|
|
|
20610 ASP / INJECTIONS JOINT MAJOR
|
Facility
IP
|
$317.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
22282824
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$285.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$53.89
|
| Rate for Payer: Amerigroup Medicare |
$53.89
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$53.89
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$53.89
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$82.42
|
| Rate for Payer: Copperpoint |
$88.92
|
| Rate for Payer: Humana Medicare |
$53.89
|
| Rate for Payer: SELF PAY |
$253.60
|
| Rate for Payer: Veterans (Triwest) |
$53.89
|
|
|
2-0 Ethibond Excel CT-1
|
Facility
IP
|
$12.00
|
|
| Hospital Charge Code |
22926439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$10.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.04
|
| Rate for Payer: Amerigroup Medicare |
$2.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.12
|
| Rate for Payer: Copperpoint |
$3.37
|
| Rate for Payer: Humana Medicare |
$2.04
|
| Rate for Payer: SELF PAY |
$9.60
|
| Rate for Payer: Veterans (Triwest) |
$2.04
|
|
|
2-0 Ethibond Excel CT-1
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
22926439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$10.80
|
| Rate for Payer: Aetna Medicare |
$3.36
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.04
|
| Rate for Payer: Amerigroup Medicare |
$2.04
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$4.48
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.12
|
| Rate for Payer: Cigna All Products |
$8.40
|
| Rate for Payer: Copperpoint |
$3.37
|
| Rate for Payer: HealthNet Commercial |
$7.20
|
| Rate for Payer: HealthNet Medicare |
$3.36
|
| Rate for Payer: Humana Medicare |
$2.04
|
| Rate for Payer: SELF PAY |
$9.60
|
| Rate for Payer: Veterans (Triwest) |
$2.04
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$7.00
|
| Rate for Payer: United Healthcare Medicare |
$2.16
|
|
|
2-0 Ethibond Excel MO-7
|
Facility
OP
|
$80.00
|
|
| Hospital Charge Code |
22926438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$72.00
|
| Rate for Payer: Aetna Medicare |
$22.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$13.60
|
| Rate for Payer: Amerigroup Medicare |
$13.60
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$29.88
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$13.60
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$13.60
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$20.80
|
| Rate for Payer: Cigna All Products |
$56.00
|
| Rate for Payer: Copperpoint |
$22.44
|
| Rate for Payer: HealthNet Commercial |
$48.00
|
| Rate for Payer: HealthNet Medicare |
$22.40
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: SELF PAY |
$64.00
|
| Rate for Payer: Veterans (Triwest) |
$13.60
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$46.64
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
|
|
2-0 Ethibond Excel MO-7
|
Facility
IP
|
$80.00
|
|
| Hospital Charge Code |
22926438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$72.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$13.60
|
| Rate for Payer: Amerigroup Medicare |
$13.60
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$13.60
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$13.60
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$20.80
|
| Rate for Payer: Copperpoint |
$22.44
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: SELF PAY |
$64.00
|
| Rate for Payer: Veterans (Triwest) |
$13.60
|
|
|
20G INTROCAN SAFETY STRAIGHT FEP IV CATH
|
Facility
IP
|
$7.16
|
|
| Hospital Charge Code |
27527452
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna POS, PPO, HMO |
$6.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.22
|
| Rate for Payer: Amerigroup Medicare |
$1.22
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.22
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.22
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.86
|
| Rate for Payer: Copperpoint |
$2.01
|
| Rate for Payer: Humana Medicare |
$1.22
|
| Rate for Payer: SELF PAY |
$5.73
|
| Rate for Payer: Veterans (Triwest) |
$1.22
|
|
|
20G INTROCAN SAFETY STRAIGHT FEP IV CATH
|
Facility
OP
|
$7.16
|
|
| Hospital Charge Code |
27527452
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna POS, PPO, HMO |
$6.44
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1.22
|
| Rate for Payer: Amerigroup Medicare |
$1.22
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$2.67
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1.22
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1.22
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.86
|
| Rate for Payer: Cigna All Products |
$5.01
|
| Rate for Payer: Copperpoint |
$2.01
|
| Rate for Payer: HealthNet Commercial |
$4.30
|
| Rate for Payer: HealthNet Medicare |
$2.00
|
| Rate for Payer: Humana Medicare |
$1.22
|
| Rate for Payer: SELF PAY |
$5.73
|
| Rate for Payer: Veterans (Triwest) |
$1.22
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$4.17
|
| Rate for Payer: United Healthcare Medicare |
$1.29
|
|
|
2-0 Plain Gut FN-2
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
22926444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$18.90
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.57
|
| Rate for Payer: Amerigroup Medicare |
$3.57
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$7.84
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.57
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$5.46
|
| Rate for Payer: Cigna All Products |
$14.70
|
| Rate for Payer: Copperpoint |
$5.89
|
| Rate for Payer: HealthNet Commercial |
$12.60
|
| Rate for Payer: HealthNet Medicare |
$5.88
|
| Rate for Payer: Humana Medicare |
$3.57
|
| Rate for Payer: SELF PAY |
$16.80
|
| Rate for Payer: Veterans (Triwest) |
$3.57
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$12.24
|
| Rate for Payer: United Healthcare Medicare |
$3.78
|
|
|
2-0 Plain Gut FN-2
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
22926444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$18.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.57
|
| Rate for Payer: Amerigroup Medicare |
$3.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.57
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$5.46
|
| Rate for Payer: Copperpoint |
$5.89
|
| Rate for Payer: Humana Medicare |
$3.57
|
| Rate for Payer: SELF PAY |
$16.80
|
| Rate for Payer: Veterans (Triwest) |
$3.57
|
|
|
2-0 Surgical Steel FSLX
|
Facility
IP
|
$14.00
|
|
| Hospital Charge Code |
22926440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$12.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.38
|
| Rate for Payer: Amerigroup Medicare |
$2.38
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.38
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.64
|
| Rate for Payer: Copperpoint |
$3.93
|
| Rate for Payer: Humana Medicare |
$2.38
|
| Rate for Payer: SELF PAY |
$11.20
|
| Rate for Payer: Veterans (Triwest) |
$2.38
|
|
|
2-0 Surgical Steel FSLX
|
Facility
OP
|
$14.00
|
|
| Hospital Charge Code |
22926440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$12.60
|
| Rate for Payer: Aetna Medicare |
$3.92
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.38
|
| Rate for Payer: Amerigroup Medicare |
$2.38
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$5.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.38
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.64
|
| Rate for Payer: Cigna All Products |
$9.80
|
| Rate for Payer: Copperpoint |
$3.93
|
| Rate for Payer: HealthNet Commercial |
$8.40
|
| Rate for Payer: HealthNet Medicare |
$3.92
|
| Rate for Payer: Humana Medicare |
$2.38
|
| Rate for Payer: SELF PAY |
$11.20
|
| Rate for Payer: Veterans (Triwest) |
$2.38
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$8.16
|
| Rate for Payer: United Healthcare Medicare |
$2.52
|
|
|
21315 CLSD TX NOSEFX W/O STABL
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
22282826
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$1,961.54 |
| Rate for Payer: Aetna POS, PPO, HMO |
$522.00
|
| Rate for Payer: Aetna Medicare |
$162.40
|
| Rate for Payer: AHCCCS Medicaid |
$1,961.54
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$1,961.54
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$98.60
|
| Rate for Payer: Amerigroup Medicare |
$98.60
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$216.63
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$1,961.54
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$98.60
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$98.60
|
| Rate for Payer: Banner University Family Care Medicaid |
$1,961.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$150.80
|
| Rate for Payer: Cigna All Products |
$406.00
|
| Rate for Payer: Copperpoint |
$162.69
|
| Rate for Payer: HealthNet Commercial |
$348.00
|
| Rate for Payer: HealthNet Medicare |
$162.40
|
| Rate for Payer: Humana Medicare |
$98.60
|
| Rate for Payer: Mercy Care Medicaid |
$1,961.54
|
| Rate for Payer: SELF PAY |
$464.00
|
| Rate for Payer: Veterans (Triwest) |
$98.60
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$338.14
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
|
|
21315 CLSD TX NOSEFX W/O STABL
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
22282826
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$522.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$98.60
|
| Rate for Payer: Amerigroup Medicare |
$98.60
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$98.60
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$98.60
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$150.80
|
| Rate for Payer: Copperpoint |
$162.69
|
| Rate for Payer: Humana Medicare |
$98.60
|
| Rate for Payer: SELF PAY |
$464.00
|
| Rate for Payer: Veterans (Triwest) |
$98.60
|
|
|
21320 CLSD TX NOSE FX W/STABL
|
Facility
IP
|
$748.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
22282827
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$673.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$127.16
|
| Rate for Payer: Amerigroup Medicare |
$127.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$127.16
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$127.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$194.48
|
| Rate for Payer: Copperpoint |
$209.81
|
| Rate for Payer: Humana Medicare |
$127.16
|
| Rate for Payer: SELF PAY |
$598.40
|
| Rate for Payer: Veterans (Triwest) |
$127.16
|
|
|
21320 CLSD TX NOSE FX W/STABL
|
Facility
OP
|
$748.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
22282827
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$3,967.76 |
| Rate for Payer: SELF PAY |
$598.40
|
| Rate for Payer: Mercy Care Medicaid |
$3,967.76
|
| Rate for Payer: Aetna POS, PPO, HMO |
$673.20
|
| Rate for Payer: Aetna Medicare |
$209.44
|
| Rate for Payer: AHCCCS Medicaid |
$3,967.76
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3,967.76
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$127.16
|
| Rate for Payer: Amerigroup Medicare |
$127.16
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$279.38
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3,967.76
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$127.16
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$127.16
|
| Rate for Payer: Banner University Family Care Medicaid |
$3,967.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$194.48
|
| Rate for Payer: Cigna All Products |
$523.60
|
| Rate for Payer: Copperpoint |
$209.81
|
| Rate for Payer: HealthNet Commercial |
$448.80
|
| Rate for Payer: HealthNet Medicare |
$209.44
|
| Rate for Payer: Humana Medicare |
$127.16
|
| Rate for Payer: Veterans (Triwest) |
$127.16
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$436.08
|
| Rate for Payer: United Healthcare Medicare |
$134.64
|
|
|
21800 CLSD TX RIB FX UNCOM @
|
Facility
IP
|
$361.00
|
|
|
Service Code
|
CPT 21800
|
| Hospital Charge Code |
22282828
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.37 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$324.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$61.37
|
| Rate for Payer: Amerigroup Medicare |
$61.37
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$61.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$61.37
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$93.86
|
| Rate for Payer: Copperpoint |
$101.26
|
| Rate for Payer: Humana Medicare |
$61.37
|
| Rate for Payer: SELF PAY |
$288.80
|
| Rate for Payer: Veterans (Triwest) |
$61.37
|
|
|
21800 CLSD TX RIB FX UNCOM @
|
Facility
OP
|
$361.00
|
|
|
Service Code
|
CPT 21800
|
| Hospital Charge Code |
22282828
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.37 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$324.90
|
| Rate for Payer: Aetna Medicare |
$101.08
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$61.37
|
| Rate for Payer: Amerigroup Medicare |
$61.37
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$134.83
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$61.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$61.37
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$93.86
|
| Rate for Payer: Cigna All Products |
$252.70
|
| Rate for Payer: Copperpoint |
$101.26
|
| Rate for Payer: HealthNet Commercial |
$216.60
|
| Rate for Payer: HealthNet Medicare |
$101.08
|
| Rate for Payer: Humana Medicare |
$61.37
|
| Rate for Payer: SELF PAY |
$288.80
|
| Rate for Payer: Veterans (Triwest) |
$61.37
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$210.46
|
| Rate for Payer: United Healthcare Medicare |
$64.98
|
|
|
21810 TX FLAI CHEST
|
Facility
OP
|
$2,800.00
|
|
|
Service Code
|
CPT 21810
|
| Hospital Charge Code |
22282829
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,520.00
|
| Rate for Payer: Aetna Medicare |
$784.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$476.00
|
| Rate for Payer: Amerigroup Medicare |
$476.00
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,045.80
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$476.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$476.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$728.00
|
| Rate for Payer: Cigna All Products |
$1,960.00
|
| Rate for Payer: Copperpoint |
$785.40
|
| Rate for Payer: HealthNet Commercial |
$1,680.00
|
| Rate for Payer: HealthNet Medicare |
$784.00
|
| Rate for Payer: Humana Medicare |
$476.00
|
| Rate for Payer: SELF PAY |
$2,240.00
|
| Rate for Payer: Veterans (Triwest) |
$476.00
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,632.40
|
| Rate for Payer: United Healthcare Medicare |
$504.00
|
|
|
21810 TX FLAI CHEST
|
Facility
IP
|
$2,800.00
|
|
|
Service Code
|
CPT 21810
|
| Hospital Charge Code |
22282829
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,520.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$476.00
|
| Rate for Payer: Amerigroup Medicare |
$476.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$476.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$476.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$728.00
|
| Rate for Payer: Copperpoint |
$785.40
|
| Rate for Payer: Humana Medicare |
$476.00
|
| Rate for Payer: SELF PAY |
$2,240.00
|
| Rate for Payer: Veterans (Triwest) |
$476.00
|
|