|
22305 CLSD TX FX VERT
|
Facility
IP
|
$811.00
|
|
| Hospital Charge Code |
22282830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.87 |
| Max. Negotiated Rate |
$729.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$729.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$137.87
|
| Rate for Payer: Amerigroup Medicare |
$137.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$137.87
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$137.87
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$210.86
|
| Rate for Payer: Copperpoint |
$227.49
|
| Rate for Payer: Humana Medicare |
$137.87
|
| Rate for Payer: SELF PAY |
$648.80
|
| Rate for Payer: Veterans (Triwest) |
$137.87
|
|
|
22305 CLSD TX FX VERT
|
Facility
OP
|
$811.00
|
|
| Hospital Charge Code |
22282830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.87 |
| Max. Negotiated Rate |
$729.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$729.90
|
| Rate for Payer: Aetna Medicare |
$227.08
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$137.87
|
| Rate for Payer: Amerigroup Medicare |
$137.87
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$302.91
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$137.87
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$137.87
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$210.86
|
| Rate for Payer: Cigna All Products |
$567.70
|
| Rate for Payer: Copperpoint |
$227.49
|
| Rate for Payer: HealthNet Commercial |
$486.60
|
| Rate for Payer: HealthNet Medicare |
$227.08
|
| Rate for Payer: Humana Medicare |
$137.87
|
| Rate for Payer: SELF PAY |
$648.80
|
| Rate for Payer: Veterans (Triwest) |
$137.87
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$472.81
|
| Rate for Payer: United Healthcare Medicare |
$145.98
|
|
|
23500 CLSD TXFX CLAR W/O MANIP
|
Facility
IP
|
$797.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
22282831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.49 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$717.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$135.49
|
| Rate for Payer: Amerigroup Medicare |
$135.49
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$135.49
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$135.49
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$207.22
|
| Rate for Payer: Copperpoint |
$223.56
|
| Rate for Payer: Humana Medicare |
$135.49
|
| Rate for Payer: SELF PAY |
$637.60
|
| Rate for Payer: Veterans (Triwest) |
$135.49
|
|
|
23500 CLSD TXFX CLAR W/O MANIP
|
Facility
OP
|
$797.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
22282831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.49 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$717.30
|
| Rate for Payer: Aetna Medicare |
$223.16
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$135.49
|
| Rate for Payer: Amerigroup Medicare |
$135.49
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$297.68
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$135.49
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$135.49
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$207.22
|
| Rate for Payer: Cigna All Products |
$557.90
|
| Rate for Payer: Copperpoint |
$223.56
|
| Rate for Payer: HealthNet Commercial |
$478.20
|
| Rate for Payer: HealthNet Medicare |
$223.16
|
| Rate for Payer: Humana Medicare |
$135.49
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$637.60
|
| Rate for Payer: Veterans (Triwest) |
$135.49
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$464.65
|
| Rate for Payer: United Healthcare Medicare |
$143.46
|
|
|
23505 CLSD TX FX CLAV W/MANIP
|
Facility
IP
|
$1,333.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
22282832
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.61 |
| Max. Negotiated Rate |
$1,199.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,199.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$226.61
|
| Rate for Payer: Amerigroup Medicare |
$226.61
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$226.61
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$226.61
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$346.58
|
| Rate for Payer: Copperpoint |
$373.91
|
| Rate for Payer: Humana Medicare |
$226.61
|
| Rate for Payer: SELF PAY |
$1,066.40
|
| Rate for Payer: Veterans (Triwest) |
$226.61
|
|
|
23505 CLSD TX FX CLAV W/MANIP
|
Facility
OP
|
$1,333.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
22282832
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.61 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,199.70
|
| Rate for Payer: Aetna Medicare |
$373.24
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,018.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$226.61
|
| Rate for Payer: Amerigroup Medicare |
$226.61
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$497.88
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$226.61
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$226.61
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$346.58
|
| Rate for Payer: Cigna All Products |
$933.10
|
| Rate for Payer: Copperpoint |
$373.91
|
| Rate for Payer: HealthNet Commercial |
$799.80
|
| Rate for Payer: HealthNet Medicare |
$373.24
|
| Rate for Payer: Humana Medicare |
$226.61
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$1,066.40
|
| Rate for Payer: Veterans (Triwest) |
$226.61
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$777.14
|
| Rate for Payer: United Healthcare Medicare |
$239.94
|
|
|
23540 CLSD TX A/C DISW/O MANIP
|
Facility
OP
|
$816.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
22282833
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.72 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$734.40
|
| Rate for Payer: Aetna Medicare |
$228.48
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$138.72
|
| Rate for Payer: Amerigroup Medicare |
$138.72
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$304.78
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$138.72
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$138.72
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$212.16
|
| Rate for Payer: Cigna All Products |
$571.20
|
| Rate for Payer: Copperpoint |
$228.89
|
| Rate for Payer: HealthNet Commercial |
$489.60
|
| Rate for Payer: HealthNet Medicare |
$228.48
|
| Rate for Payer: Humana Medicare |
$138.72
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$652.80
|
| Rate for Payer: Veterans (Triwest) |
$138.72
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$475.73
|
| Rate for Payer: United Healthcare Medicare |
$146.88
|
|
|
23540 CLSD TX A/C DISW/O MANIP
|
Facility
IP
|
$816.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
22282833
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.72 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$734.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$138.72
|
| Rate for Payer: Amerigroup Medicare |
$138.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$138.72
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$138.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$212.16
|
| Rate for Payer: Copperpoint |
$228.89
|
| Rate for Payer: Humana Medicare |
$138.72
|
| Rate for Payer: SELF PAY |
$652.80
|
| Rate for Payer: Veterans (Triwest) |
$138.72
|
|
|
23545 CLSD TX FX A/C DISLW/MAN
|
Facility
OP
|
$1,154.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
22282834
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.18 |
| Max. Negotiated Rate |
$1,038.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,038.60
|
| Rate for Payer: Aetna Medicare |
$323.12
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$196.18
|
| Rate for Payer: Amerigroup Medicare |
$196.18
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$431.02
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$196.18
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$196.18
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$300.04
|
| Rate for Payer: Cigna All Products |
$807.80
|
| Rate for Payer: Copperpoint |
$323.70
|
| Rate for Payer: HealthNet Commercial |
$692.40
|
| Rate for Payer: HealthNet Medicare |
$323.12
|
| Rate for Payer: Humana Medicare |
$196.18
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$923.20
|
| Rate for Payer: Veterans (Triwest) |
$196.18
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$672.78
|
| Rate for Payer: United Healthcare Medicare |
$207.72
|
|
|
23545 CLSD TX FX A/C DISLW/MAN
|
Facility
IP
|
$1,154.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
22282834
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.18 |
| Max. Negotiated Rate |
$1,038.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,038.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$196.18
|
| Rate for Payer: Amerigroup Medicare |
$196.18
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$196.18
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$196.18
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$300.04
|
| Rate for Payer: Copperpoint |
$323.70
|
| Rate for Payer: Humana Medicare |
$196.18
|
| Rate for Payer: SELF PAY |
$923.20
|
| Rate for Payer: Veterans (Triwest) |
$196.18
|
|
|
23570 CLSD TX FX SCAP W/O MANI
|
Facility
OP
|
$841.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
22282835
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.97 |
| Max. Negotiated Rate |
$756.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$756.90
|
| Rate for Payer: Aetna Medicare |
$235.48
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$142.97
|
| Rate for Payer: Amerigroup Medicare |
$142.97
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$314.11
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$142.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$142.97
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$218.66
|
| Rate for Payer: Cigna All Products |
$588.70
|
| Rate for Payer: Copperpoint |
$235.90
|
| Rate for Payer: HealthNet Commercial |
$504.60
|
| Rate for Payer: HealthNet Medicare |
$235.48
|
| Rate for Payer: Humana Medicare |
$142.97
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$672.80
|
| Rate for Payer: Veterans (Triwest) |
$142.97
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$490.30
|
| Rate for Payer: United Healthcare Medicare |
$151.38
|
|
|
23570 CLSD TX FX SCAP W/O MANI
|
Facility
IP
|
$841.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
22282835
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.97 |
| Max. Negotiated Rate |
$756.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$756.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$142.97
|
| Rate for Payer: Amerigroup Medicare |
$142.97
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$142.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$142.97
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$218.66
|
| Rate for Payer: Copperpoint |
$235.90
|
| Rate for Payer: Humana Medicare |
$142.97
|
| Rate for Payer: SELF PAY |
$672.80
|
| Rate for Payer: Veterans (Triwest) |
$142.97
|
|
|
23575 CLSD TX FX SCAP W/MANIP
|
Facility
IP
|
$1,464.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
22282836
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.88 |
| Max. Negotiated Rate |
$1,317.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,317.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$248.88
|
| Rate for Payer: Amerigroup Medicare |
$248.88
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$248.88
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$248.88
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$380.64
|
| Rate for Payer: Copperpoint |
$410.65
|
| Rate for Payer: Humana Medicare |
$248.88
|
| Rate for Payer: SELF PAY |
$1,171.20
|
| Rate for Payer: Veterans (Triwest) |
$248.88
|
|
|
23575 CLSD TX FX SCAP W/MANIP
|
Facility
OP
|
$1,464.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
22282836
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.88 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,317.60
|
| Rate for Payer: Aetna Medicare |
$409.92
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,018.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$248.88
|
| Rate for Payer: Amerigroup Medicare |
$248.88
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$546.80
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$248.88
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$248.88
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$380.64
|
| Rate for Payer: Cigna All Products |
$1,024.80
|
| Rate for Payer: Copperpoint |
$410.65
|
| Rate for Payer: HealthNet Commercial |
$878.40
|
| Rate for Payer: HealthNet Medicare |
$409.92
|
| Rate for Payer: Humana Medicare |
$248.88
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$1,171.20
|
| Rate for Payer: Veterans (Triwest) |
$248.88
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$853.51
|
| Rate for Payer: United Healthcare Medicare |
$263.52
|
|
|
23650 CLD TX SHLDR WMANIP N/AN
|
Facility
IP
|
$1,974.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
22282837
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$335.58 |
| Max. Negotiated Rate |
$1,776.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,776.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$335.58
|
| Rate for Payer: Amerigroup Medicare |
$335.58
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$335.58
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$335.58
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$513.24
|
| Rate for Payer: Copperpoint |
$553.71
|
| Rate for Payer: Humana Medicare |
$335.58
|
| Rate for Payer: SELF PAY |
$1,579.20
|
| Rate for Payer: Veterans (Triwest) |
$335.58
|
|
|
23650 CLD TX SHLDR WMANIP N/AN
|
Facility
OP
|
$1,974.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
22282837
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.98 |
| Max. Negotiated Rate |
$1,776.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,776.60
|
| Rate for Payer: Aetna Medicare |
$552.72
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$335.58
|
| Rate for Payer: Amerigroup Medicare |
$335.58
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$737.29
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$335.58
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$335.58
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$513.24
|
| Rate for Payer: Cigna All Products |
$1,381.80
|
| Rate for Payer: Copperpoint |
$553.71
|
| Rate for Payer: HealthNet Commercial |
$1,184.40
|
| Rate for Payer: HealthNet Medicare |
$552.72
|
| Rate for Payer: Humana Medicare |
$335.58
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$1,579.20
|
| Rate for Payer: Veterans (Triwest) |
$335.58
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,150.84
|
| Rate for Payer: United Healthcare Medicare |
$355.32
|
|
|
23655 CLD TX SHLDR DS WMANIP A
|
Facility
OP
|
$2,606.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
22282838
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$443.02 |
| Max. Negotiated Rate |
$2,345.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,345.40
|
| Rate for Payer: Aetna Medicare |
$729.68
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,018.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$443.02
|
| Rate for Payer: Amerigroup Medicare |
$443.02
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$973.34
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$443.02
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$443.02
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$677.56
|
| Rate for Payer: Cigna All Products |
$1,824.20
|
| Rate for Payer: Copperpoint |
$730.98
|
| Rate for Payer: HealthNet Commercial |
$1,563.60
|
| Rate for Payer: HealthNet Medicare |
$729.68
|
| Rate for Payer: Humana Medicare |
$443.02
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$2,084.80
|
| Rate for Payer: Veterans (Triwest) |
$443.02
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,519.30
|
| Rate for Payer: United Healthcare Medicare |
$469.08
|
|
|
23655 CLD TX SHLDR DS WMANIP A
|
Facility
IP
|
$2,606.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
22282838
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$443.02 |
| Max. Negotiated Rate |
$2,345.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,345.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$443.02
|
| Rate for Payer: Amerigroup Medicare |
$443.02
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$443.02
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$443.02
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$677.56
|
| Rate for Payer: Copperpoint |
$730.98
|
| Rate for Payer: Humana Medicare |
$443.02
|
| Rate for Payer: SELF PAY |
$2,084.80
|
| Rate for Payer: Veterans (Triwest) |
$443.02
|
|
|
24500 CLD TX HUM FX W/O MANIP
|
Facility
IP
|
$1,189.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
22282839
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.13 |
| Max. Negotiated Rate |
$1,070.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,070.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$202.13
|
| Rate for Payer: Amerigroup Medicare |
$202.13
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$202.13
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$202.13
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$309.14
|
| Rate for Payer: Copperpoint |
$333.51
|
| Rate for Payer: Humana Medicare |
$202.13
|
| Rate for Payer: SELF PAY |
$951.20
|
| Rate for Payer: Veterans (Triwest) |
$202.13
|
|
|
24500 CLD TX HUM FX W/O MANIP
|
Facility
OP
|
$1,189.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
22282839
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.13 |
| Max. Negotiated Rate |
$1,070.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,070.10
|
| Rate for Payer: Aetna Medicare |
$332.92
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$202.13
|
| Rate for Payer: Amerigroup Medicare |
$202.13
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$444.09
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$202.13
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$202.13
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$309.14
|
| Rate for Payer: Cigna All Products |
$832.30
|
| Rate for Payer: Copperpoint |
$333.51
|
| Rate for Payer: HealthNet Commercial |
$713.40
|
| Rate for Payer: HealthNet Medicare |
$332.92
|
| Rate for Payer: Humana Medicare |
$202.13
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$951.20
|
| Rate for Payer: Veterans (Triwest) |
$202.13
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$693.19
|
| Rate for Payer: United Healthcare Medicare |
$214.02
|
|
|
24505 CLSD TX FX HUM W/MANIP
|
Facility
IP
|
$1,933.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
22282840
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$328.61 |
| Max. Negotiated Rate |
$1,739.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,739.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$328.61
|
| Rate for Payer: Amerigroup Medicare |
$328.61
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$328.61
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$328.61
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$502.58
|
| Rate for Payer: Copperpoint |
$542.21
|
| Rate for Payer: Humana Medicare |
$328.61
|
| Rate for Payer: SELF PAY |
$1,546.40
|
| Rate for Payer: Veterans (Triwest) |
$328.61
|
|
|
24505 CLSD TX FX HUM W/MANIP
|
Facility
OP
|
$1,933.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
22282840
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$328.61 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$1,546.40
|
| Rate for Payer: Aetna POS, PPO, HMO |
$1,739.70
|
| Rate for Payer: Aetna Medicare |
$541.24
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,018.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$328.61
|
| Rate for Payer: Amerigroup Medicare |
$328.61
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$721.98
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$328.61
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$328.61
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$502.58
|
| Rate for Payer: Cigna All Products |
$1,353.10
|
| Rate for Payer: Copperpoint |
$542.21
|
| Rate for Payer: HealthNet Commercial |
$1,159.80
|
| Rate for Payer: HealthNet Medicare |
$541.24
|
| Rate for Payer: Humana Medicare |
$328.61
|
| Rate for Payer: Veterans (Triwest) |
$328.61
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,126.94
|
| Rate for Payer: United Healthcare Medicare |
$347.94
|
|
|
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 |
$251.94 |
| Max. Negotiated Rate |
$1,333.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,333.80
|
| Rate for Payer: Aetna Medicare |
$414.96
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$298.98
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$251.94
|
| Rate for Payer: Amerigroup Medicare |
$251.94
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$553.53
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$251.94
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$251.94
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$385.32
|
| Rate for Payer: Cigna All Products |
$1,037.40
|
| Rate for Payer: Copperpoint |
$415.70
|
| Rate for Payer: HealthNet Commercial |
$889.20
|
| Rate for Payer: HealthNet Medicare |
$414.96
|
| Rate for Payer: Humana Medicare |
$251.94
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$1,185.60
|
| Rate for Payer: Veterans (Triwest) |
$251.94
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$864.01
|
| Rate for Payer: United Healthcare 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 |
$251.94 |
| Max. Negotiated Rate |
$1,333.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,333.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$251.94
|
| Rate for Payer: Amerigroup Medicare |
$251.94
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$251.94
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$251.94
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$385.32
|
| Rate for Payer: Copperpoint |
$415.70
|
| Rate for Payer: Humana Medicare |
$251.94
|
| Rate for Payer: SELF PAY |
$1,185.60
|
| Rate for Payer: Veterans (Triwest) |
$251.94
|
|
|
25028 I/D FOREARM ETC DEEP
|
Facility
OP
|
$2,071.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
22282842
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$352.07 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,863.90
|
| Rate for Payer: Aetna Medicare |
$579.88
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4,104.08
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$352.07
|
| Rate for Payer: Amerigroup Medicare |
$352.07
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$773.52
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4,104.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$352.07
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$352.07
|
| Rate for Payer: Banner University Family Care Medicaid |
$4,104.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$538.46
|
| Rate for Payer: Cigna All Products |
$1,449.70
|
| Rate for Payer: Copperpoint |
$580.92
|
| Rate for Payer: HealthNet Commercial |
$1,242.60
|
| Rate for Payer: HealthNet Medicare |
$579.88
|
| Rate for Payer: Humana Medicare |
$352.07
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: SELF PAY |
$1,656.80
|
| Rate for Payer: Veterans (Triwest) |
$352.07
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,207.39
|
| Rate for Payer: United Healthcare Medicare |
$372.78
|
|