|
26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER).
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
27414134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$410.80 |
| Max. Negotiated Rate |
$1,422.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,422.00
|
| Rate for Payer: Bisbee Police All Plans |
$410.80
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Self Pay Self Pay |
$1,264.00
|
|
|
26123 REMOVAL OF TISSUE OF PALM AND RELEASE OF FINGER
|
Facility
|
IP
|
$4,531.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
27407496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,178.06 |
| Max. Negotiated Rate |
$4,077.90 |
| Rate for Payer: Aetna of AZ Commercial |
$4,077.90
|
| Rate for Payer: Bisbee Police All Plans |
$1,178.06
|
| Rate for Payer: Cash Price |
$3,624.80
|
| Rate for Payer: Self Pay Self Pay |
$3,624.80
|
|
|
26123 REMOVAL OF TISSUE OF PALM AND RELEASE OF FINGER
|
Facility
|
OP
|
$4,531.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
27407496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$724.96 |
| Max. Negotiated Rate |
$4,077.90 |
| Rate for Payer: Aetna of AZ Commercial |
$4,077.90
|
| Rate for Payer: Aetna of AZ Medicare |
$1,268.68
|
| Rate for Payer: AHCCCS Medicaid |
$2,052.04
|
| Rate for Payer: Allwell Medicaid |
$2,052.04
|
| Rate for Payer: Allwell Medicare |
$724.96
|
| Rate for Payer: Amerigroup Medicare |
$724.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,692.33
|
| Rate for Payer: AZCH Complete Medicaid |
$2,052.04
|
| Rate for Payer: AZCH Complete Medicare |
$724.96
|
| Rate for Payer: Banner UC Health Medicaid |
$2,052.04
|
| Rate for Payer: Banner UC Health Medicare |
$724.96
|
| Rate for Payer: Bisbee Police All Plans |
$1,178.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,081.08
|
| Rate for Payer: Cash Price |
$3,624.80
|
| Rate for Payer: Cash Price |
$3,624.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,265.50
|
| Rate for Payer: Copperpoint Commercial |
$1,121.42
|
| Rate for Payer: Health Net of AZ Commercial |
$2,718.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,268.68
|
| Rate for Payer: Humana of AZ Medicare |
$724.96
|
| Rate for Payer: Mercy Care Medicaid |
$2,052.04
|
| Rate for Payer: Self Pay Self Pay |
$3,624.80
|
| Rate for Payer: TriWest Medicare |
$724.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$815.58
|
|
|
26600 CLD TX FX FING W/OMANIP@
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
22282850
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.48 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna of AZ Commercial |
$673.20
|
| Rate for Payer: Bisbee Police All Plans |
$194.48
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Self Pay Self Pay |
$598.40
|
|
|
26600 CLD TX FX FING W/OMANIP@
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
22282850
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$673.20
|
| Rate for Payer: Aetna of AZ Medicare |
$209.44
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$119.68
|
| Rate for Payer: Amerigroup Medicare |
$119.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$279.38
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$119.68
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$119.68
|
| Rate for Payer: Bisbee Police All Plans |
$194.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$508.64
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cigna of AZ Commercial |
$523.60
|
| Rate for Payer: Copperpoint Commercial |
$185.13
|
| Rate for Payer: Health Net of AZ Commercial |
$448.80
|
| Rate for Payer: Health Net of AZ Medicare |
$209.44
|
| Rate for Payer: Humana of AZ Medicare |
$119.68
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$598.40
|
| Rate for Payer: TriWest Medicare |
$119.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$134.64
|
|
|
26605 CLSD TX FX FING W/MAN EA
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
22282851
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$990.90
|
| Rate for Payer: Aetna of AZ Medicare |
$308.28
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$176.16
|
| Rate for Payer: Amerigroup Medicare |
$176.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$411.22
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$176.16
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$176.16
|
| Rate for Payer: Bisbee Police All Plans |
$286.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$748.68
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna of AZ Commercial |
$770.70
|
| Rate for Payer: Copperpoint Commercial |
$272.50
|
| Rate for Payer: Health Net of AZ Commercial |
$660.60
|
| Rate for Payer: Health Net of AZ Medicare |
$308.28
|
| Rate for Payer: Humana of AZ Medicare |
$176.16
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$880.80
|
| Rate for Payer: TriWest Medicare |
$176.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$198.18
|
|
|
26605 CLSD TX FX FING W/MAN EA
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
22282851
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$286.26 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Aetna of AZ Commercial |
$990.90
|
| Rate for Payer: Bisbee Police All Plans |
$286.26
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Self Pay Self Pay |
$880.80
|
|
|
26700 CLD TX DIS HAND BN WMANP
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
22282852
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,024.20
|
| Rate for Payer: Aetna of AZ Medicare |
$318.64
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$182.08
|
| Rate for Payer: Amerigroup Medicare |
$182.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$425.04
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$182.08
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$182.08
|
| Rate for Payer: Bisbee Police All Plans |
$295.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$773.84
|
| Rate for Payer: Cash Price |
$910.40
|
| Rate for Payer: Cash Price |
$910.40
|
| Rate for Payer: Cigna of AZ Commercial |
$796.60
|
| Rate for Payer: Copperpoint Commercial |
$281.65
|
| Rate for Payer: Health Net of AZ Commercial |
$682.80
|
| Rate for Payer: Health Net of AZ Medicare |
$318.64
|
| Rate for Payer: Humana of AZ Medicare |
$182.08
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$910.40
|
| Rate for Payer: TriWest Medicare |
$182.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$204.84
|
|
|
26700 CLD TX DIS HAND BN WMANP
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
22282852
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.88 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,024.20
|
| Rate for Payer: Bisbee Police All Plans |
$295.88
|
| Rate for Payer: Cash Price |
$910.40
|
| Rate for Payer: Self Pay Self Pay |
$910.40
|
|
|
26720 CLSD TX FX PHAL W/O MANI
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
22282853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.32 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of AZ Commercial |
$478.80
|
| Rate for Payer: Bisbee Police All Plans |
$138.32
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Self Pay Self Pay |
$425.60
|
|
|
26720 CLSD TX FX PHAL W/O MANI
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
22282853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.12 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$478.80
|
| Rate for Payer: Aetna of AZ Medicare |
$148.96
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$85.12
|
| Rate for Payer: Amerigroup Medicare |
$85.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$198.70
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$85.12
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$85.12
|
| Rate for Payer: Bisbee Police All Plans |
$138.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$361.76
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cigna of AZ Commercial |
$372.40
|
| Rate for Payer: Copperpoint Commercial |
$131.67
|
| Rate for Payer: Health Net of AZ Commercial |
$319.20
|
| Rate for Payer: Health Net of AZ Medicare |
$148.96
|
| Rate for Payer: Humana of AZ Medicare |
$85.12
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$425.60
|
| Rate for Payer: TriWest Medicare |
$85.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$95.76
|
|
|
26725 CLSD TX FX PHAL W/MANIP
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
22282854
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$921.60
|
| Rate for Payer: Aetna of AZ Medicare |
$286.72
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$163.84
|
| Rate for Payer: Amerigroup Medicare |
$163.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$382.46
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$163.84
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$163.84
|
| Rate for Payer: Bisbee Police All Plans |
$266.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$696.32
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cigna of AZ Commercial |
$716.80
|
| Rate for Payer: Copperpoint Commercial |
$253.44
|
| Rate for Payer: Health Net of AZ Commercial |
$614.40
|
| Rate for Payer: Health Net of AZ Medicare |
$286.72
|
| Rate for Payer: Humana of AZ Medicare |
$163.84
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$819.20
|
| Rate for Payer: TriWest Medicare |
$163.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$184.32
|
|
|
26725 CLSD TX FX PHAL W/MANIP
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
22282854
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.24 |
| Max. Negotiated Rate |
$921.60 |
| Rate for Payer: Aetna of AZ Commercial |
$921.60
|
| Rate for Payer: Bisbee Police All Plans |
$266.24
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Self Pay Self Pay |
$819.20
|
|
|
26740 CLSD TX ARTCLR FX W/OMAN
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
22282855
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$623.70
|
| Rate for Payer: Aetna of AZ Medicare |
$194.04
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$110.88
|
| Rate for Payer: Amerigroup Medicare |
$110.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$258.84
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$110.88
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$110.88
|
| Rate for Payer: Bisbee Police All Plans |
$180.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$471.24
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna of AZ Commercial |
$485.10
|
| Rate for Payer: Copperpoint Commercial |
$171.52
|
| Rate for Payer: Health Net of AZ Commercial |
$415.80
|
| Rate for Payer: Health Net of AZ Medicare |
$194.04
|
| Rate for Payer: Humana of AZ Medicare |
$110.88
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$554.40
|
| Rate for Payer: TriWest Medicare |
$110.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$124.74
|
|
|
26740 CLSD TX ARTCLR FX W/OMAN
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
22282855
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.18 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna of AZ Commercial |
$623.70
|
| Rate for Payer: Bisbee Police All Plans |
$180.18
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Self Pay Self Pay |
$554.40
|
|
|
26742 CLSD TX ART FX W/MAN ECH
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
22282856
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.52 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,324.80
|
| Rate for Payer: Aetna of AZ Medicare |
$412.16
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$235.52
|
| Rate for Payer: Amerigroup Medicare |
$235.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$549.79
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$235.52
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$235.52
|
| Rate for Payer: Bisbee Police All Plans |
$382.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,000.96
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,030.40
|
| Rate for Payer: Copperpoint Commercial |
$364.32
|
| Rate for Payer: Health Net of AZ Commercial |
$883.20
|
| Rate for Payer: Health Net of AZ Medicare |
$412.16
|
| Rate for Payer: Humana of AZ Medicare |
$235.52
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,177.60
|
| Rate for Payer: TriWest Medicare |
$235.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$264.96
|
|
|
26742 CLSD TX ART FX W/MAN ECH
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
22282856
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$382.72 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,324.80
|
| Rate for Payer: Bisbee Police All Plans |
$382.72
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Self Pay Self Pay |
$1,177.60
|
|
|
26750 CLD TX METATARSAL
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
22282857
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of AZ Commercial |
$585.00
|
| Rate for Payer: Bisbee Police All Plans |
$169.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Self Pay Self Pay |
$520.00
|
|
|
26750 CLD TX METATARSAL
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
22282857
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$585.00
|
| Rate for Payer: Aetna of AZ Medicare |
$182.00
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$104.00
|
| Rate for Payer: Amerigroup Medicare |
$104.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$242.78
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$104.00
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$104.00
|
| Rate for Payer: Bisbee Police All Plans |
$169.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$442.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna of AZ Commercial |
$455.00
|
| Rate for Payer: Copperpoint Commercial |
$160.88
|
| Rate for Payer: Health Net of AZ Commercial |
$390.00
|
| Rate for Payer: Health Net of AZ Medicare |
$182.00
|
| Rate for Payer: Humana of AZ Medicare |
$104.00
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$520.00
|
| Rate for Payer: TriWest Medicare |
$104.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$117.00
|
|
|
26770 CLD TX IPHAL JT DIS N/AN
|
Facility
|
IP
|
$1,299.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
22282858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.74 |
| Max. Negotiated Rate |
$1,169.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,169.10
|
| Rate for Payer: Bisbee Police All Plans |
$337.74
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Self Pay Self Pay |
$1,039.20
|
|
|
26770 CLD TX IPHAL JT DIS N/AN
|
Facility
|
OP
|
$1,299.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
22282858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,169.10
|
| Rate for Payer: Aetna of AZ Medicare |
$363.72
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$207.84
|
| Rate for Payer: Amerigroup Medicare |
$207.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$485.18
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$207.84
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$207.84
|
| Rate for Payer: Bisbee Police All Plans |
$337.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$883.32
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna of AZ Commercial |
$909.30
|
| Rate for Payer: Copperpoint Commercial |
$321.50
|
| Rate for Payer: Health Net of AZ Commercial |
$779.40
|
| Rate for Payer: Health Net of AZ Medicare |
$363.72
|
| Rate for Payer: Humana of AZ Medicare |
$207.84
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$1,039.20
|
| Rate for Payer: TriWest Medicare |
$207.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$233.82
|
|
|
27200 CLSD TX COCCYX FX
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 27200
|
| Hospital Charge Code |
22282859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.52 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Aetna of AZ Commercial |
$631.80
|
| Rate for Payer: Bisbee Police All Plans |
$182.52
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Self Pay Self Pay |
$561.60
|
|
|
27200 CLSD TX COCCYX FX
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 27200
|
| Hospital Charge Code |
22282859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$631.80
|
| Rate for Payer: Aetna of AZ Medicare |
$196.56
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$112.32
|
| Rate for Payer: Amerigroup Medicare |
$112.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$262.20
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$112.32
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$112.32
|
| Rate for Payer: Bisbee Police All Plans |
$182.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$477.36
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna of AZ Commercial |
$491.40
|
| Rate for Payer: Copperpoint Commercial |
$173.75
|
| Rate for Payer: Health Net of AZ Commercial |
$421.20
|
| Rate for Payer: Health Net of AZ Medicare |
$196.56
|
| Rate for Payer: Humana of AZ Medicare |
$112.32
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$561.60
|
| Rate for Payer: TriWest Medicare |
$112.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$126.36
|
|
|
27246 CLSD TX FX GR TROCH WO/M
|
Facility
|
IP
|
$1,914.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
22282860
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$497.64 |
| Max. Negotiated Rate |
$1,722.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,722.60
|
| Rate for Payer: Bisbee Police All Plans |
$497.64
|
| Rate for Payer: Cash Price |
$1,531.20
|
| Rate for Payer: Self Pay Self Pay |
$1,531.20
|
|
|
27246 CLSD TX FX GR TROCH WO/M
|
Facility
|
OP
|
$1,914.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
22282860
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,722.60
|
| Rate for Payer: Aetna of AZ Medicare |
$535.92
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$306.24
|
| Rate for Payer: Amerigroup Medicare |
$306.24
|
| Rate for Payer: APIPA Medicare/Medicaid |
$714.88
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$306.24
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$306.24
|
| Rate for Payer: Bisbee Police All Plans |
$497.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,301.52
|
| Rate for Payer: Cash Price |
$1,531.20
|
| Rate for Payer: Cash Price |
$1,531.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,339.80
|
| Rate for Payer: Copperpoint Commercial |
$473.71
|
| Rate for Payer: Health Net of AZ Commercial |
$1,148.40
|
| Rate for Payer: Health Net of AZ Medicare |
$535.92
|
| Rate for Payer: Humana of AZ Medicare |
$306.24
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$1,531.20
|
| Rate for Payer: TriWest Medicare |
$306.24
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$344.52
|
|
