|
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 |
$128.55 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$128.55
|
| Rate for Payer: Amerigroup Medicare |
$128.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$320.09
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$128.55
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$128.55
|
| 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 |
$128.55
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$685.60
|
| Rate for Payer: TriWest Medicare |
$128.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$154.26
|
|
|
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
|
|
|
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 |
$181.80 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$181.80
|
| Rate for Payer: Amerigroup Medicare |
$181.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$452.68
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$181.80
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$181.80
|
| 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 |
$181.80
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$969.60
|
| Rate for Payer: TriWest Medicare |
$181.80
|
| 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
OP
|
$883.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
22282835
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.45 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$132.45
|
| Rate for Payer: Amerigroup Medicare |
$132.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$329.80
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$132.45
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$132.45
|
| 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 |
$132.45
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$706.40
|
| Rate for Payer: TriWest Medicare |
$132.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$158.94
|
|
|
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
|
|
|
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
|
|
|
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 |
$230.55 |
| 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 |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$230.55
|
| Rate for Payer: Amerigroup Medicare |
$230.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$574.07
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$230.55
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$230.55
|
| 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 |
$230.55
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$1,229.60
|
| Rate for Payer: TriWest Medicare |
$230.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$276.66
|
|
|
23650 CLD TX SHLDR WMANIP N/AN
|
Facility
IP
|
$2,073.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
22282837
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$538.98 |
| Max. Negotiated Rate |
$1,865.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,865.70
|
| Rate for Payer: Bisbee Police All Plans |
$538.98
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Self Pay Self Pay |
$1,658.40
|
|
|
23650 CLD TX SHLDR WMANIP N/AN
|
Facility
OP
|
$2,073.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
22282837
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.98 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,865.70
|
| Rate for Payer: Aetna of AZ Medicare |
$580.44
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$310.95
|
| Rate for Payer: Amerigroup Medicare |
$310.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$774.27
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$310.95
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$310.95
|
| Rate for Payer: Bisbee Police All Plans |
$538.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,409.64
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,451.10
|
| Rate for Payer: Copperpoint Commercial |
$513.07
|
| Rate for Payer: Health Net of AZ Commercial |
$1,243.80
|
| Rate for Payer: Health Net of AZ Medicare |
$580.44
|
| Rate for Payer: Humana of AZ Medicare |
$310.95
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$1,658.40
|
| Rate for Payer: TriWest Medicare |
$310.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$373.14
|
|
|
23655 CLD TX SHLDR DS WMANIP A
|
Facility
OP
|
$2,736.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
22282838
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$410.40 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,462.40
|
| Rate for Payer: Aetna of AZ Medicare |
$766.08
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$410.40
|
| Rate for Payer: Amerigroup Medicare |
$410.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,021.90
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$410.40
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$410.40
|
| Rate for Payer: Bisbee Police All Plans |
$711.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,860.48
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,915.20
|
| Rate for Payer: Copperpoint Commercial |
$677.16
|
| Rate for Payer: Health Net of AZ Commercial |
$1,641.60
|
| Rate for Payer: Health Net of AZ Medicare |
$766.08
|
| Rate for Payer: Humana of AZ Medicare |
$410.40
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$2,188.80
|
| Rate for Payer: TriWest Medicare |
$410.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$492.48
|
|
|
23655 CLD TX SHLDR DS WMANIP A
|
Facility
IP
|
$2,736.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
22282838
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$711.36 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,462.40
|
| Rate for Payer: Bisbee Police All Plans |
$711.36
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Self Pay Self Pay |
$2,188.80
|
|
|
24500 CLD TX HUM FX W/O MANIP
|
Facility
IP
|
$1,248.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
22282839
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$324.48 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,123.20
|
| Rate for Payer: Bisbee Police All Plans |
$324.48
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Self Pay Self Pay |
$998.40
|
|
|
24500 CLD TX HUM FX W/O MANIP
|
Facility
OP
|
$1,248.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
22282839
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,123.20
|
| Rate for Payer: Aetna of AZ Medicare |
$349.44
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$187.20
|
| Rate for Payer: Amerigroup Medicare |
$187.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$466.13
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$187.20
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$187.20
|
| Rate for Payer: Bisbee Police All Plans |
$324.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$848.64
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna of AZ Commercial |
$873.60
|
| Rate for Payer: Copperpoint Commercial |
$308.88
|
| Rate for Payer: Health Net of AZ Commercial |
$748.80
|
| Rate for Payer: Health Net of AZ Medicare |
$349.44
|
| Rate for Payer: Humana of AZ Medicare |
$187.20
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$998.40
|
| Rate for Payer: TriWest Medicare |
$187.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$224.64
|
|
|
24505 CLSD TX FX HUM W/MANIP
|
Facility
OP
|
$2,030.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
22282840
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,827.00
|
| Rate for Payer: Aetna of AZ Medicare |
$568.40
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$304.50
|
| Rate for Payer: Amerigroup Medicare |
$304.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$758.20
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$304.50
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$304.50
|
| Rate for Payer: Bisbee Police All Plans |
$527.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,380.40
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,421.00
|
| Rate for Payer: Copperpoint Commercial |
$502.42
|
| Rate for Payer: Health Net of AZ Commercial |
$1,218.00
|
| Rate for Payer: Health Net of AZ Medicare |
$568.40
|
| Rate for Payer: Humana of AZ Medicare |
$304.50
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$1,624.00
|
| Rate for Payer: TriWest Medicare |
$304.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$365.40
|
|
|
24505 CLSD TX FX HUM W/MANIP
|
Facility
IP
|
$2,030.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
22282840
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.80 |
| Max. Negotiated Rate |
$1,827.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,827.00
|
| Rate for Payer: Bisbee Police All Plans |
$527.80
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Self Pay Self Pay |
$1,624.00
|
|
|
24600 TX ELB DISL W/O ANES
|
Facility
OP
|
$1,482.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
22282841
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,333.80
|
| Rate for Payer: Aetna of AZ Medicare |
$414.96
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$222.30
|
| Rate for Payer: Amerigroup Medicare |
$222.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$553.53
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$222.30
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$222.30
|
| Rate for Payer: Bisbee Police All Plans |
$385.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,007.76
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,037.40
|
| Rate for Payer: Copperpoint Commercial |
$366.80
|
| Rate for Payer: Health Net of AZ Commercial |
$889.20
|
| Rate for Payer: Health Net of AZ Medicare |
$414.96
|
| Rate for Payer: Humana of AZ Medicare |
$222.30
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$1,185.60
|
| Rate for Payer: TriWest Medicare |
$222.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$266.76
|
|
|
24600 TX ELB DISL W/O ANES
|
Facility
IP
|
$1,482.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
22282841
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.32 |
| Max. Negotiated Rate |
$1,333.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,333.80
|
| Rate for Payer: Bisbee Police All Plans |
$385.32
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Self Pay Self Pay |
$1,185.60
|
|
|
25028 I/D FOREARM ETC DEEP
|
Facility
OP
|
$2,175.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
22282842
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$326.25 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,957.50
|
| Rate for Payer: Aetna of AZ Medicare |
$609.00
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$326.25
|
| Rate for Payer: Amerigroup Medicare |
$326.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$812.36
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$326.25
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$326.25
|
| Rate for Payer: Bisbee Police All Plans |
$565.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,479.00
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,522.50
|
| Rate for Payer: Copperpoint Commercial |
$538.31
|
| Rate for Payer: Health Net of AZ Commercial |
$1,305.00
|
| Rate for Payer: Health Net of AZ Medicare |
$609.00
|
| Rate for Payer: Humana of AZ Medicare |
$326.25
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,740.00
|
| Rate for Payer: TriWest Medicare |
$326.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$391.50
|
|
|
25028 I/D FOREARM ETC DEEP
|
Facility
IP
|
$2,175.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
22282842
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,957.50
|
| Rate for Payer: Bisbee Police All Plans |
$565.50
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Self Pay Self Pay |
$1,740.00
|
|
|
25500 CLD TX FX RADIUS W/O MAN
|
Facility
OP
|
$901.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
22282843
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$810.90
|
| Rate for Payer: Aetna of AZ Medicare |
$252.28
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$135.15
|
| Rate for Payer: Amerigroup Medicare |
$135.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$336.52
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$135.15
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$135.15
|
| Rate for Payer: Bisbee Police All Plans |
$234.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$612.68
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cigna of AZ Commercial |
$630.70
|
| Rate for Payer: Copperpoint Commercial |
$223.00
|
| Rate for Payer: Health Net of AZ Commercial |
$540.60
|
| Rate for Payer: Health Net of AZ Medicare |
$252.28
|
| Rate for Payer: Humana of AZ Medicare |
$135.15
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$720.80
|
| Rate for Payer: TriWest Medicare |
$135.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$162.18
|
|
|
25500 CLD TX FX RADIUS W/O MAN
|
Facility
IP
|
$901.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
22282843
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$234.26 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: Aetna of AZ Commercial |
$810.90
|
| Rate for Payer: Bisbee Police All Plans |
$234.26
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Self Pay Self Pay |
$720.80
|
|
|
25505 CLSD TX FX RAD W/MANIP
|
Facility
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
22282844
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.90 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,913.40
|
| Rate for Payer: Aetna of AZ Medicare |
$595.28
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$318.90
|
| Rate for Payer: Amerigroup Medicare |
$318.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$794.06
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$318.90
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$318.90
|
| Rate for Payer: Bisbee Police All Plans |
$552.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,445.68
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,488.20
|
| Rate for Payer: Copperpoint Commercial |
$526.18
|
| Rate for Payer: Health Net of AZ Commercial |
$1,275.60
|
| Rate for Payer: Health Net of AZ Medicare |
$595.28
|
| Rate for Payer: Humana of AZ Medicare |
$318.90
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$1,700.80
|
| Rate for Payer: TriWest Medicare |
$318.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$382.68
|
|
|
25505 CLSD TX FX RAD W/MANIP
|
Facility
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
22282844
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$552.76 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,913.40
|
| Rate for Payer: Bisbee Police All Plans |
$552.76
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Self Pay Self Pay |
$1,700.80
|
|
|
25530 CLD TX FX ULNA W/O MANIP
|
Facility
OP
|
$818.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
22282845
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.70 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$736.20
|
| Rate for Payer: Aetna of AZ Medicare |
$229.04
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$122.70
|
| Rate for Payer: Amerigroup Medicare |
$122.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$305.52
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$122.70
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$122.70
|
| Rate for Payer: Bisbee Police All Plans |
$212.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$556.24
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cigna of AZ Commercial |
$572.60
|
| Rate for Payer: Copperpoint Commercial |
$202.46
|
| Rate for Payer: Health Net of AZ Commercial |
$490.80
|
| Rate for Payer: Health Net of AZ Medicare |
$229.04
|
| Rate for Payer: Humana of AZ Medicare |
$122.70
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$654.40
|
| Rate for Payer: TriWest Medicare |
$122.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$147.24
|
|
