|
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 |
$149.49 |
| 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 |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$199.68
|
| Rate for Payer: Amerigroup Medicare |
$199.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$466.13
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$199.68
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$199.68
|
| 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 |
$199.68
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$998.40
|
| Rate for Payer: TriWest Medicare |
$199.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$224.64
|
|
|
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
|
|
|
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 |
$324.80 |
| 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 |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$324.80
|
| Rate for Payer: Amerigroup Medicare |
$324.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$758.21
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$324.80
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$324.80
|
| 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 |
$502.43
|
| 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 |
$324.80
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,624.00
|
| Rate for Payer: TriWest Medicare |
$324.80
|
| 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
|
IP
|
$1,408.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
22282841
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.08 |
| Max. Negotiated Rate |
$1,267.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,267.20
|
| Rate for Payer: Bisbee Police All Plans |
$366.08
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Self Pay Self Pay |
$1,126.40
|
|
|
24600 TX ELB DISL W/O ANES
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
22282841
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,267.20
|
| Rate for Payer: Aetna of AZ Medicare |
$394.24
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$225.28
|
| Rate for Payer: Amerigroup Medicare |
$225.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$525.89
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$225.28
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$225.28
|
| Rate for Payer: Bisbee Police All Plans |
$366.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$957.44
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cigna of AZ Commercial |
$985.60
|
| Rate for Payer: Copperpoint Commercial |
$348.48
|
| Rate for Payer: Health Net of AZ Commercial |
$844.80
|
| Rate for Payer: Health Net of AZ Medicare |
$394.24
|
| Rate for Payer: Humana of AZ Medicare |
$225.28
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$1,126.40
|
| Rate for Payer: TriWest Medicare |
$225.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$253.44
|
|
|
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 |
$348.00 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,957.50
|
| Rate for Payer: Aetna of AZ Medicare |
$609.00
|
| Rate for Payer: AHCCCS Medicaid |
$2,052.04
|
| Rate for Payer: Allwell Medicaid |
$2,052.04
|
| Rate for Payer: Allwell Medicare |
$348.00
|
| Rate for Payer: Amerigroup Medicare |
$348.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$812.36
|
| Rate for Payer: AZCH Complete Medicaid |
$2,052.04
|
| Rate for Payer: AZCH Complete Medicare |
$348.00
|
| Rate for Payer: Banner UC Health Medicaid |
$2,052.04
|
| Rate for Payer: Banner UC Health Medicare |
$348.00
|
| 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 |
$348.00
|
| Rate for Payer: Mercy Care Medicaid |
$2,052.04
|
| Rate for Payer: Self Pay Self Pay |
$1,740.00
|
| Rate for Payer: TriWest Medicare |
$348.00
|
| 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
|
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
|
|
|
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 |
$144.16 |
| 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 |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$144.16
|
| Rate for Payer: Amerigroup Medicare |
$144.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$336.52
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$144.16
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$144.16
|
| 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 |
$144.16
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$720.80
|
| Rate for Payer: TriWest Medicare |
$144.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$162.18
|
|
|
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
|
|
|
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 |
$340.16 |
| 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 |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$340.16
|
| Rate for Payer: Amerigroup Medicare |
$340.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$794.06
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$340.16
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$340.16
|
| 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 |
$340.16
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,700.80
|
| Rate for Payer: TriWest Medicare |
$340.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$382.68
|
|
|
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 |
$130.88 |
| 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 |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$130.88
|
| Rate for Payer: Amerigroup Medicare |
$130.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$305.52
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$130.88
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$130.88
|
| 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 |
$130.88
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$654.40
|
| Rate for Payer: TriWest Medicare |
$130.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$147.24
|
|
|
25530 CLD TX FX ULNA W/O MANIP
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
22282845
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.68 |
| Max. Negotiated Rate |
$736.20 |
| Rate for Payer: Aetna of AZ Commercial |
$736.20
|
| Rate for Payer: Bisbee Police All Plans |
$212.68
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Self Pay Self Pay |
$654.40
|
|
|
25535 CLSD TX FX ULNA W/MANIP
|
Facility
|
IP
|
$1,883.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
22282846
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$489.58 |
| Max. Negotiated Rate |
$1,694.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,694.70
|
| Rate for Payer: Bisbee Police All Plans |
$489.58
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Self Pay Self Pay |
$1,506.40
|
|
|
25535 CLSD TX FX ULNA W/MANIP
|
Facility
|
OP
|
$1,883.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
22282846
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,694.70
|
| Rate for Payer: Aetna of AZ Medicare |
$527.24
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$301.28
|
| Rate for Payer: Amerigroup Medicare |
$301.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$703.30
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$301.28
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$301.28
|
| Rate for Payer: Bisbee Police All Plans |
$489.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,280.44
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,318.10
|
| Rate for Payer: Copperpoint Commercial |
$466.04
|
| Rate for Payer: Health Net of AZ Commercial |
$1,129.80
|
| Rate for Payer: Health Net of AZ Medicare |
$527.24
|
| Rate for Payer: Humana of AZ Medicare |
$301.28
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$1,506.40
|
| Rate for Payer: TriWest Medicare |
$301.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$338.94
|
|
|
25600 CLSD TX FX DIS RAD W/OMA
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
22282847
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.36 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Aetna of AZ Commercial |
$887.40
|
| Rate for Payer: Bisbee Police All Plans |
$256.36
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Self Pay Self Pay |
$788.80
|
|
|
25600 CLSD TX FX DIS RAD W/OMA
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
22282847
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$887.40
|
| Rate for Payer: Aetna of AZ Medicare |
$276.08
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$157.76
|
| Rate for Payer: Amerigroup Medicare |
$157.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$368.27
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$157.76
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$157.76
|
| Rate for Payer: Bisbee Police All Plans |
$256.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$670.48
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cigna of AZ Commercial |
$690.20
|
| Rate for Payer: Copperpoint Commercial |
$244.03
|
| Rate for Payer: Health Net of AZ Commercial |
$591.60
|
| Rate for Payer: Health Net of AZ Medicare |
$276.08
|
| Rate for Payer: Humana of AZ Medicare |
$157.76
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$788.80
|
| Rate for Payer: TriWest Medicare |
$157.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$177.48
|
|
|
25605 CLSD TX FX DIST RAD W/M
|
Facility
|
IP
|
$4,857.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
22282848
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,262.82 |
| Max. Negotiated Rate |
$4,371.30 |
| Rate for Payer: Aetna of AZ Commercial |
$4,371.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,262.82
|
| Rate for Payer: Cash Price |
$3,885.60
|
| Rate for Payer: Self Pay Self Pay |
$3,885.60
|
|
|
25605 CLSD TX FX DIST RAD W/M
|
Facility
|
OP
|
$4,857.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
22282848
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$777.12 |
| Max. Negotiated Rate |
$4,371.30 |
| Rate for Payer: Aetna of AZ Commercial |
$4,371.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,359.96
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$777.12
|
| Rate for Payer: Amerigroup Medicare |
$777.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,814.09
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$777.12
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$777.12
|
| Rate for Payer: Bisbee Police All Plans |
$1,262.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,302.76
|
| Rate for Payer: Cash Price |
$3,885.60
|
| Rate for Payer: Cash Price |
$3,885.60
|
| Rate for Payer: Cigna of AZ Commercial |
$3,399.90
|
| Rate for Payer: Copperpoint Commercial |
$1,202.11
|
| Rate for Payer: Health Net of AZ Commercial |
$2,914.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,359.96
|
| Rate for Payer: Humana of AZ Medicare |
$777.12
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$3,885.60
|
| Rate for Payer: TriWest Medicare |
$777.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$874.26
|
|
|
25-Hydroxyvitamin D LCMS D2+D3 LC
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
22311171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$463.50 |
| Rate for Payer: Aetna of AZ Commercial |
$463.50
|
| Rate for Payer: Aetna of AZ Medicare |
$144.20
|
| Rate for Payer: Allwell Medicare |
$82.40
|
| Rate for Payer: Amerigroup Medicare |
$82.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$192.35
|
| Rate for Payer: AZCH Complete Medicare |
$82.40
|
| Rate for Payer: Banner UC Health Medicare |
$82.40
|
| Rate for Payer: Bisbee Police All Plans |
$133.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$350.20
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cigna of AZ Commercial |
$334.75
|
| Rate for Payer: Copperpoint Commercial |
$127.46
|
| Rate for Payer: Health Net of AZ Commercial |
$309.00
|
| Rate for Payer: Health Net of AZ Medicare |
$144.20
|
| Rate for Payer: Humana of AZ Medicare |
$82.40
|
| Rate for Payer: Self Pay Self Pay |
$412.00
|
| Rate for Payer: TriWest Medicare |
$82.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$300.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$92.70
|
|
|
25-Hydroxyvitamin D LCMS D2+D3 LC
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
22311171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$463.50 |
| Rate for Payer: Aetna of AZ Commercial |
$463.50
|
| Rate for Payer: Bisbee Police All Plans |
$133.90
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Self Pay Self Pay |
$412.00
|
|
|
26010 DNG FING ABSJ SIMPLE
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
22282849
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$286.78 |
| Max. Negotiated Rate |
$992.70 |
| Rate for Payer: Aetna of AZ Commercial |
$992.70
|
| Rate for Payer: Bisbee Police All Plans |
$286.78
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Self Pay Self Pay |
$882.40
|
|
|
26010 DNG FING ABSJ SIMPLE
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
22282849
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$992.70
|
| Rate for Payer: Aetna of AZ Medicare |
$308.84
|
| Rate for Payer: AHCCCS Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicare |
$176.48
|
| Rate for Payer: Amerigroup Medicare |
$176.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$411.97
|
| Rate for Payer: AZCH Complete Medicaid |
$130.17
|
| Rate for Payer: AZCH Complete Medicare |
$176.48
|
| Rate for Payer: Banner UC Health Medicaid |
$130.17
|
| Rate for Payer: Banner UC Health Medicare |
$176.48
|
| Rate for Payer: Bisbee Police All Plans |
$286.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$750.04
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cigna of AZ Commercial |
$772.10
|
| Rate for Payer: Copperpoint Commercial |
$272.99
|
| Rate for Payer: Health Net of AZ Commercial |
$661.80
|
| Rate for Payer: Health Net of AZ Medicare |
$308.84
|
| Rate for Payer: Humana of AZ Medicare |
$176.48
|
| Rate for Payer: Mercy Care Medicaid |
$130.17
|
| Rate for Payer: Self Pay Self Pay |
$882.40
|
| Rate for Payer: TriWest Medicare |
$176.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$198.54
|
|
|
26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER).
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
27414134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,422.00
|
| Rate for Payer: Aetna of AZ Medicare |
$442.40
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$252.80
|
| Rate for Payer: Amerigroup Medicare |
$252.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$590.13
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$252.80
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$252.80
|
| Rate for Payer: Bisbee Police All Plans |
$410.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Cigna of AZ Commercial |
$790.00
|
| Rate for Payer: Copperpoint Commercial |
$391.05
|
| Rate for Payer: Health Net of AZ Commercial |
$948.00
|
| Rate for Payer: Health Net of AZ Medicare |
$442.40
|
| Rate for Payer: Humana of AZ Medicare |
$252.80
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,264.00
|
| Rate for Payer: TriWest Medicare |
$252.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$284.40
|
|
