|
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 |
$282.45 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$282.45
|
| Rate for Payer: Amerigroup Medicare |
$282.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$703.30
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$282.45
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$282.45
|
| 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 |
$282.45
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$1,506.40
|
| Rate for Payer: TriWest Medicare |
$282.45
|
| 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
OP
|
$986.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
22282847
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.90 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$147.90
|
| Rate for Payer: Amerigroup Medicare |
$147.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$368.27
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$147.90
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$147.90
|
| 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 |
$244.04
|
| 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 |
$147.90
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$788.80
|
| Rate for Payer: TriWest Medicare |
$147.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$177.48
|
|
|
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
|
|
|
25605 CLSD TX FX DIST RAD W/M
|
Facility
IP
|
$3,598.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
22282848
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$935.48 |
| Max. Negotiated Rate |
$3,238.20 |
| Rate for Payer: Aetna of AZ Commercial |
$3,238.20
|
| Rate for Payer: Bisbee Police All Plans |
$935.48
|
| Rate for Payer: Cash Price |
$2,878.40
|
| Rate for Payer: Self Pay Self Pay |
$2,878.40
|
|
|
25605 CLSD TX FX DIST RAD W/M
|
Facility
OP
|
$3,598.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
22282848
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$539.70 |
| Max. Negotiated Rate |
$3,238.20 |
| Rate for Payer: Aetna of AZ Commercial |
$3,238.20
|
| Rate for Payer: Aetna of AZ Medicare |
$1,007.44
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$539.70
|
| Rate for Payer: Amerigroup Medicare |
$539.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,343.85
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$539.70
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$539.70
|
| Rate for Payer: Bisbee Police All Plans |
$935.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,446.64
|
| Rate for Payer: Cash Price |
$2,878.40
|
| Rate for Payer: Cash Price |
$2,878.40
|
| Rate for Payer: Cigna of AZ Commercial |
$2,518.60
|
| Rate for Payer: Copperpoint Commercial |
$890.50
|
| Rate for Payer: Health Net of AZ Commercial |
$2,158.80
|
| Rate for Payer: Health Net of AZ Medicare |
$1,007.44
|
| Rate for Payer: Humana of AZ Medicare |
$539.70
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$2,878.40
|
| Rate for Payer: TriWest Medicare |
$539.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$647.64
|
|
|
25-Hydroxyvitamin D LCMS D2+D3 LC
|
Facility
OP
|
$542.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
22311171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Aetna of AZ Commercial |
$487.80
|
| Rate for Payer: Aetna of AZ Medicare |
$151.76
|
| Rate for Payer: AHCCCS Medicaid |
$29.60
|
| Rate for Payer: Allwell Medicaid |
$29.60
|
| Rate for Payer: Allwell Medicare |
$81.30
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$202.44
|
| Rate for Payer: AZCH Complete Medicaid |
$29.60
|
| Rate for Payer: AZCH Complete Medicare |
$81.30
|
| Rate for Payer: Banner UC Health Medicaid |
$29.60
|
| Rate for Payer: Banner UC Health Medicare |
$81.30
|
| Rate for Payer: Bisbee Police All Plans |
$140.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$368.56
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cigna of AZ Commercial |
$352.30
|
| Rate for Payer: Copperpoint Commercial |
$134.14
|
| Rate for Payer: Health Net of AZ Commercial |
$325.20
|
| Rate for Payer: Health Net of AZ Medicare |
$151.76
|
| Rate for Payer: Humana of AZ Medicare |
$81.30
|
| Rate for Payer: Mercy Care Medicaid |
$29.60
|
| Rate for Payer: Self Pay Self Pay |
$433.60
|
| Rate for Payer: TriWest Medicare |
$81.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$315.99
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$97.56
|
|
|
25-Hydroxyvitamin D LCMS D2+D3 LC
|
Facility
IP
|
$542.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
22311171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$140.92 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Aetna of AZ Commercial |
$487.80
|
| Rate for Payer: Bisbee Police All Plans |
$140.92
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Self Pay Self Pay |
$433.60
|
|
|
26010 DNG FING ABSJ SIMPLE
|
Facility
OP
|
$817.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
22282849
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.55 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$735.30
|
| Rate for Payer: Aetna of AZ Medicare |
$228.76
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$122.55
|
| Rate for Payer: Amerigroup Medicare |
$122.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$305.15
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$122.55
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$122.55
|
| Rate for Payer: Bisbee Police All Plans |
$212.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$555.56
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cigna of AZ Commercial |
$571.90
|
| Rate for Payer: Copperpoint Commercial |
$202.21
|
| Rate for Payer: Health Net of AZ Commercial |
$490.20
|
| Rate for Payer: Health Net of AZ Medicare |
$228.76
|
| Rate for Payer: Humana of AZ Medicare |
$122.55
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$653.60
|
| Rate for Payer: TriWest Medicare |
$122.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$147.06
|
|
|
26010 DNG FING ABSJ SIMPLE
|
Facility
IP
|
$817.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
22282849
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.42 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Aetna of AZ Commercial |
$735.30
|
| Rate for Payer: Bisbee Police All Plans |
$212.42
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Self Pay Self Pay |
$653.60
|
|
|
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
|
|
|
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 |
$237.00 |
| 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 |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$237.00
|
| Rate for Payer: Amerigroup Medicare |
$237.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$590.13
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$237.00
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$237.00
|
| 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 |
$237.00
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$1,264.00
|
| Rate for Payer: TriWest Medicare |
$237.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$284.40
|
|
|
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 |
$679.65 |
| Max. Negotiated Rate |
$4,104.08 |
| 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 |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$679.65
|
| Rate for Payer: Amerigroup Medicare |
$679.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,692.33
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$679.65
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$679.65
|
| 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 |
$679.65
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$3,624.80
|
| Rate for Payer: TriWest Medicare |
$679.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$815.58
|
|
|
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
|
|
|
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 |
$112.20 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$112.20
|
| Rate for Payer: Amerigroup Medicare |
$112.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$279.38
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$112.20
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$112.20
|
| 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 |
$112.20
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$598.40
|
| Rate for Payer: TriWest Medicare |
$112.20
|
| 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 |
$165.15 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$165.15
|
| Rate for Payer: Amerigroup Medicare |
$165.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$411.22
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$165.15
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$165.15
|
| 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 |
$165.15
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$880.80
|
| Rate for Payer: TriWest Medicare |
$165.15
|
| 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
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
|
|
|
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 |
$170.70 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$170.70
|
| Rate for Payer: Amerigroup Medicare |
$170.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$425.04
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$170.70
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$170.70
|
| 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 |
$281.66
|
| 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 |
$170.70
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$910.40
|
| Rate for Payer: TriWest Medicare |
$170.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$204.84
|
|
|
26720 CLSD TX FX PHAL W/O MANI
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
22282853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna of AZ Commercial |
$504.00
|
| Rate for Payer: Bisbee Police All Plans |
$145.60
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Self Pay Self Pay |
$448.00
|
|
|
26720 CLSD TX FX PHAL W/O MANI
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
22282853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$504.00
|
| Rate for Payer: Aetna of AZ Medicare |
$156.80
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$84.00
|
| Rate for Payer: Amerigroup Medicare |
$84.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$209.16
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$84.00
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$84.00
|
| Rate for Payer: Bisbee Police All Plans |
$145.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$380.80
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cigna of AZ Commercial |
$392.00
|
| Rate for Payer: Copperpoint Commercial |
$138.60
|
| Rate for Payer: Health Net of AZ Commercial |
$336.00
|
| Rate for Payer: Health Net of AZ Medicare |
$156.80
|
| Rate for Payer: Humana of AZ Medicare |
$84.00
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$448.00
|
| Rate for Payer: TriWest Medicare |
$84.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$100.80
|
|
|
26725 CLSD TX FX PHAL W/MANIP
|
Facility
OP
|
$1,078.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
22282854
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$970.20
|
| Rate for Payer: Aetna of AZ Medicare |
$301.84
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$161.70
|
| Rate for Payer: Amerigroup Medicare |
$161.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$402.63
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$161.70
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$161.70
|
| Rate for Payer: Bisbee Police All Plans |
$280.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$733.04
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Cigna of AZ Commercial |
$754.60
|
| Rate for Payer: Copperpoint Commercial |
$266.80
|
| Rate for Payer: Health Net of AZ Commercial |
$646.80
|
| Rate for Payer: Health Net of AZ Medicare |
$301.84
|
| Rate for Payer: Humana of AZ Medicare |
$161.70
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$862.40
|
| Rate for Payer: TriWest Medicare |
$161.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$194.04
|
|
|
26725 CLSD TX FX PHAL W/MANIP
|
Facility
IP
|
$1,078.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
22282854
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$970.20 |
| Rate for Payer: Aetna of AZ Commercial |
$970.20
|
| Rate for Payer: Bisbee Police All Plans |
$280.28
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Self Pay Self Pay |
$862.40
|
|
