|
25028 I/D FOREARM ETC DEEP
|
Facility
IP
|
$2,071.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
22282842
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$352.07 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,863.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$352.07
|
| Rate for Payer: Amerigroup Medicare |
$352.07
|
| 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: City of Bisbee Police Bisbee Police |
$538.46
|
| Rate for Payer: Copperpoint |
$580.92
|
| Rate for Payer: Humana Medicare |
$352.07
|
| Rate for Payer: SELF PAY |
$1,656.80
|
| Rate for Payer: Veterans (Triwest) |
$352.07
|
|
|
25500 CLD TX FX RADIUS W/O MAN
|
Facility
OP
|
$858.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
22282843
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$772.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$772.20
|
| Rate for Payer: Aetna Medicare |
$240.24
|
| 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 |
$145.86
|
| Rate for Payer: Amerigroup Medicare |
$145.86
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$320.46
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$145.86
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$145.86
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$223.08
|
| Rate for Payer: Cigna All Products |
$600.60
|
| Rate for Payer: Copperpoint |
$240.67
|
| Rate for Payer: HealthNet Commercial |
$514.80
|
| Rate for Payer: HealthNet Medicare |
$240.24
|
| Rate for Payer: Humana Medicare |
$145.86
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$686.40
|
| Rate for Payer: Veterans (Triwest) |
$145.86
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$500.21
|
| Rate for Payer: United Healthcare Medicare |
$154.44
|
|
|
25500 CLD TX FX RADIUS W/O MAN
|
Facility
IP
|
$858.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
22282843
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$772.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$772.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$145.86
|
| Rate for Payer: Amerigroup Medicare |
$145.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$145.86
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$145.86
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$223.08
|
| Rate for Payer: Copperpoint |
$240.67
|
| Rate for Payer: Humana Medicare |
$145.86
|
| Rate for Payer: SELF PAY |
$686.40
|
| Rate for Payer: Veterans (Triwest) |
$145.86
|
|
|
25505 CLSD TX FX RAD W/MANIP
|
Facility
IP
|
$2,025.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
22282844
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.25 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,822.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$344.25
|
| Rate for Payer: Amerigroup Medicare |
$344.25
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$344.25
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$344.25
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$526.50
|
| Rate for Payer: Copperpoint |
$568.01
|
| Rate for Payer: Humana Medicare |
$344.25
|
| Rate for Payer: SELF PAY |
$1,620.00
|
| Rate for Payer: Veterans (Triwest) |
$344.25
|
|
|
25505 CLSD TX FX RAD W/MANIP
|
Facility
OP
|
$2,025.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
22282844
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.25 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,822.50
|
| Rate for Payer: Aetna Medicare |
$567.00
|
| 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 |
$344.25
|
| Rate for Payer: Amerigroup Medicare |
$344.25
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$756.34
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$344.25
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$344.25
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$526.50
|
| Rate for Payer: Cigna All Products |
$1,417.50
|
| Rate for Payer: Copperpoint |
$568.01
|
| Rate for Payer: HealthNet Commercial |
$1,215.00
|
| Rate for Payer: HealthNet Medicare |
$567.00
|
| Rate for Payer: Humana Medicare |
$344.25
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$1,620.00
|
| Rate for Payer: Veterans (Triwest) |
$344.25
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,180.57
|
| Rate for Payer: United Healthcare Medicare |
$364.50
|
|
|
25530 CLD TX FX ULNA W/O MANIP
|
Facility
IP
|
$779.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
22282845
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.43 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$701.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$132.43
|
| Rate for Payer: Amerigroup Medicare |
$132.43
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$132.43
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$132.43
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$202.54
|
| Rate for Payer: Copperpoint |
$218.51
|
| Rate for Payer: Humana Medicare |
$132.43
|
| Rate for Payer: SELF PAY |
$623.20
|
| Rate for Payer: Veterans (Triwest) |
$132.43
|
|
|
25530 CLD TX FX ULNA W/O MANIP
|
Facility
OP
|
$779.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
22282845
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.43 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$701.10
|
| Rate for Payer: Aetna Medicare |
$218.12
|
| 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 |
$132.43
|
| Rate for Payer: Amerigroup Medicare |
$132.43
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$290.96
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$132.43
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$132.43
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$202.54
|
| Rate for Payer: Cigna All Products |
$545.30
|
| Rate for Payer: Copperpoint |
$218.51
|
| Rate for Payer: HealthNet Commercial |
$467.40
|
| Rate for Payer: HealthNet Medicare |
$218.12
|
| Rate for Payer: Humana Medicare |
$132.43
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$623.20
|
| Rate for Payer: Veterans (Triwest) |
$132.43
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$454.16
|
| Rate for Payer: United Healthcare Medicare |
$140.22
|
|
|
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 |
$298.98 |
| Max. Negotiated Rate |
$1,694.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,694.70
|
| Rate for Payer: Aetna Medicare |
$527.24
|
| 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 |
$320.11
|
| Rate for Payer: Amerigroup Medicare |
$320.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$703.30
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$320.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$320.11
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$489.58
|
| Rate for Payer: Cigna All Products |
$1,318.10
|
| Rate for Payer: Copperpoint |
$528.18
|
| Rate for Payer: HealthNet Commercial |
$1,129.80
|
| Rate for Payer: HealthNet Medicare |
$527.24
|
| Rate for Payer: Humana Medicare |
$320.11
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$1,506.40
|
| Rate for Payer: Veterans (Triwest) |
$320.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,097.79
|
| Rate for Payer: United Healthcare Medicare |
$338.94
|
|
|
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 |
$320.11 |
| Max. Negotiated Rate |
$1,694.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,694.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$320.11
|
| Rate for Payer: Amerigroup Medicare |
$320.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$320.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$320.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$489.58
|
| Rate for Payer: Copperpoint |
$528.18
|
| Rate for Payer: Humana Medicare |
$320.11
|
| Rate for Payer: SELF PAY |
$1,506.40
|
| Rate for Payer: Veterans (Triwest) |
$320.11
|
|
|
25600 CLSD TX FX DIS RAD W/OMA
|
Facility
OP
|
$939.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
22282847
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.63 |
| Max. Negotiated Rate |
$845.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$845.10
|
| Rate for Payer: Aetna Medicare |
$262.92
|
| 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 |
$159.63
|
| Rate for Payer: Amerigroup Medicare |
$159.63
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$350.72
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$159.63
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$159.63
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$244.14
|
| Rate for Payer: Cigna All Products |
$657.30
|
| Rate for Payer: Copperpoint |
$263.39
|
| Rate for Payer: HealthNet Commercial |
$563.40
|
| Rate for Payer: HealthNet Medicare |
$262.92
|
| Rate for Payer: Humana Medicare |
$159.63
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$751.20
|
| Rate for Payer: Veterans (Triwest) |
$159.63
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$547.44
|
| Rate for Payer: United Healthcare Medicare |
$169.02
|
|
|
25600 CLSD TX FX DIS RAD W/OMA
|
Facility
IP
|
$939.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
22282847
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.63 |
| Max. Negotiated Rate |
$845.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$845.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$159.63
|
| Rate for Payer: Amerigroup Medicare |
$159.63
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$159.63
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$159.63
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$244.14
|
| Rate for Payer: Copperpoint |
$263.39
|
| Rate for Payer: Humana Medicare |
$159.63
|
| Rate for Payer: SELF PAY |
$751.20
|
| Rate for Payer: Veterans (Triwest) |
$159.63
|
|
|
25605 CLSD TX FX DIST RAD W/M
|
Facility
OP
|
$3,427.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
22282848
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.59 |
| Max. Negotiated Rate |
$3,084.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,084.30
|
| Rate for Payer: Aetna Medicare |
$959.56
|
| 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 |
$582.59
|
| Rate for Payer: Amerigroup Medicare |
$582.59
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,279.98
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$582.59
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$582.59
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$891.02
|
| Rate for Payer: Cigna All Products |
$2,398.90
|
| Rate for Payer: Copperpoint |
$961.27
|
| Rate for Payer: HealthNet Commercial |
$2,056.20
|
| Rate for Payer: HealthNet Medicare |
$959.56
|
| Rate for Payer: Humana Medicare |
$582.59
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$2,741.60
|
| Rate for Payer: Veterans (Triwest) |
$582.59
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,997.94
|
| Rate for Payer: United Healthcare Medicare |
$616.86
|
|
|
25605 CLSD TX FX DIST RAD W/M
|
Facility
IP
|
$3,427.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
22282848
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.59 |
| Max. Negotiated Rate |
$3,084.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,084.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$582.59
|
| Rate for Payer: Amerigroup Medicare |
$582.59
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$582.59
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$582.59
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$891.02
|
| Rate for Payer: Copperpoint |
$961.27
|
| Rate for Payer: Humana Medicare |
$582.59
|
| Rate for Payer: SELF PAY |
$2,741.60
|
| Rate for Payer: Veterans (Triwest) |
$582.59
|
|
|
25-Hydroxyvitamin D LCMS D2+D3 LC
|
Facility
OP
|
$516.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
22311171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$464.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$464.40
|
| Rate for Payer: Aetna Medicare |
$144.48
|
| Rate for Payer: AHCCCS Medicaid |
$29.60
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$29.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$87.72
|
| Rate for Payer: Amerigroup Medicare |
$87.72
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$192.73
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$29.60
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$87.72
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$87.72
|
| Rate for Payer: Banner University Family Care Medicaid |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$190.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$134.16
|
| Rate for Payer: Cigna All Products |
$335.40
|
| Rate for Payer: Copperpoint |
$144.74
|
| Rate for Payer: HealthNet Commercial |
$309.60
|
| Rate for Payer: HealthNet Medicare |
$144.48
|
| Rate for Payer: Humana Medicare |
$87.72
|
| Rate for Payer: Mercy Care Medicaid |
$29.60
|
| Rate for Payer: SELF PAY |
$412.80
|
| Rate for Payer: Veterans (Triwest) |
$87.72
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$300.83
|
| Rate for Payer: United Healthcare Medicare |
$92.88
|
|
|
25-Hydroxyvitamin D LCMS D2+D3 LC
|
Facility
IP
|
$516.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
22311171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$464.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$464.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$87.72
|
| Rate for Payer: Amerigroup Medicare |
$87.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$87.72
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$190.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$134.16
|
| Rate for Payer: Copperpoint |
$144.74
|
| Rate for Payer: Humana Medicare |
$87.72
|
| Rate for Payer: SELF PAY |
$412.80
|
| Rate for Payer: Veterans (Triwest) |
$87.72
|
|
|
26010 DNG FING ABSJ SIMPLE
|
Facility
IP
|
$778.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
22282849
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.26 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: SELF PAY |
$622.40
|
| Rate for Payer: Aetna POS, PPO, HMO |
$700.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$132.26
|
| Rate for Payer: Amerigroup Medicare |
$132.26
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$132.26
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$132.26
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$202.28
|
| Rate for Payer: Copperpoint |
$218.23
|
| Rate for Payer: Humana Medicare |
$132.26
|
| Rate for Payer: Veterans (Triwest) |
$132.26
|
|
|
26010 DNG FING ABSJ SIMPLE
|
Facility
OP
|
$778.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
22282849
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.26 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$700.20
|
| Rate for Payer: Aetna Medicare |
$217.84
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$132.26
|
| Rate for Payer: Amerigroup Medicare |
$132.26
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$290.58
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$132.26
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$132.26
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$202.28
|
| Rate for Payer: Cigna All Products |
$544.60
|
| Rate for Payer: Copperpoint |
$218.23
|
| Rate for Payer: HealthNet Commercial |
$466.80
|
| Rate for Payer: HealthNet Medicare |
$217.84
|
| Rate for Payer: Humana Medicare |
$132.26
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$622.40
|
| Rate for Payer: Veterans (Triwest) |
$132.26
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$453.57
|
| Rate for Payer: United Healthcare Medicare |
$140.04
|
|
|
26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER).
|
Facility
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
27414134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.85 |
| Max. Negotiated Rate |
$1,354.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,354.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$255.85
|
| Rate for Payer: Amerigroup Medicare |
$255.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$255.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$255.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$391.30
|
| Rate for Payer: Copperpoint |
$422.15
|
| Rate for Payer: Humana Medicare |
$255.85
|
| Rate for Payer: SELF PAY |
$1,204.00
|
| Rate for Payer: Veterans (Triwest) |
$255.85
|
|
|
26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER).
|
Facility
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
27414134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.85 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$255.85
|
| Rate for Payer: Aetna POS, PPO, HMO |
$1,354.50
|
| Rate for Payer: Aetna Medicare |
$421.40
|
| 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 |
$255.85
|
| Rate for Payer: Amerigroup Medicare |
$255.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$562.12
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$255.85
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$391.30
|
| Rate for Payer: Cigna All Products |
$752.50
|
| Rate for Payer: Copperpoint |
$422.15
|
| Rate for Payer: HealthNet Commercial |
$903.00
|
| Rate for Payer: HealthNet Medicare |
$421.40
|
| Rate for Payer: Humana Medicare |
$255.85
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$1,204.00
|
| Rate for Payer: Veterans (Triwest) |
$255.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$877.41
|
| Rate for Payer: United Healthcare Medicare |
$270.90
|
|
|
26123 REMOVAL OF TISSUE OF PALM AND RELEASE OF FINGER
|
Facility
OP
|
$4,315.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
27407496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.55 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,883.50
|
| Rate for Payer: Aetna Medicare |
$1,208.20
|
| 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 |
$733.55
|
| Rate for Payer: Amerigroup Medicare |
$733.55
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,611.65
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4,104.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$733.55
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$733.55
|
| Rate for Payer: Banner University Family Care Medicaid |
$4,104.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,121.90
|
| Rate for Payer: Cigna All Products |
$2,157.50
|
| Rate for Payer: Copperpoint |
$1,210.36
|
| Rate for Payer: HealthNet Commercial |
$2,589.00
|
| Rate for Payer: HealthNet Medicare |
$1,208.20
|
| Rate for Payer: Humana Medicare |
$733.55
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: SELF PAY |
$3,452.00
|
| Rate for Payer: Veterans (Triwest) |
$733.55
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2,515.64
|
| Rate for Payer: United Healthcare Medicare |
$776.70
|
|
|
26123 REMOVAL OF TISSUE OF PALM AND RELEASE OF FINGER
|
Facility
IP
|
$4,315.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
27407496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.55 |
| Max. Negotiated Rate |
$3,883.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$3,883.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$733.55
|
| Rate for Payer: Amerigroup Medicare |
$733.55
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$733.55
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$733.55
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,121.90
|
| Rate for Payer: Copperpoint |
$1,210.36
|
| Rate for Payer: Humana Medicare |
$733.55
|
| Rate for Payer: SELF PAY |
$3,452.00
|
| Rate for Payer: Veterans (Triwest) |
$733.55
|
|
|
26600 CLD TX FX FING W/OMANIP@
|
Facility
OP
|
$712.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
22282850
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.04 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$640.80
|
| Rate for Payer: Aetna Medicare |
$199.36
|
| 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 |
$121.04
|
| Rate for Payer: Amerigroup Medicare |
$121.04
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$265.93
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$121.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$121.04
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$185.12
|
| Rate for Payer: Cigna All Products |
$498.40
|
| Rate for Payer: Copperpoint |
$199.72
|
| Rate for Payer: HealthNet Commercial |
$427.20
|
| Rate for Payer: HealthNet Medicare |
$199.36
|
| Rate for Payer: Humana Medicare |
$121.04
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$569.60
|
| Rate for Payer: Veterans (Triwest) |
$121.04
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$415.10
|
| Rate for Payer: United Healthcare Medicare |
$128.16
|
|
|
26600 CLD TX FX FING W/OMANIP@
|
Facility
IP
|
$712.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
22282850
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.04 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$640.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$121.04
|
| Rate for Payer: Amerigroup Medicare |
$121.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$121.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$121.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$185.12
|
| Rate for Payer: Copperpoint |
$199.72
|
| Rate for Payer: Humana Medicare |
$121.04
|
| Rate for Payer: SELF PAY |
$569.60
|
| Rate for Payer: Veterans (Triwest) |
$121.04
|
|
|
26605 CLSD TX FX FING W/MAN EA
|
Facility
IP
|
$1,049.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
22282851
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.33 |
| Max. Negotiated Rate |
$944.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$944.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$178.33
|
| Rate for Payer: Amerigroup Medicare |
$178.33
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$178.33
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$178.33
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$272.74
|
| Rate for Payer: Copperpoint |
$294.24
|
| Rate for Payer: Humana Medicare |
$178.33
|
| Rate for Payer: SELF PAY |
$839.20
|
| Rate for Payer: Veterans (Triwest) |
$178.33
|
|
|
26605 CLSD TX FX FING W/MAN EA
|
Facility
OP
|
$1,049.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
22282851
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.33 |
| Max. Negotiated Rate |
$944.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$944.10
|
| Rate for Payer: Aetna Medicare |
$293.72
|
| 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 |
$178.33
|
| Rate for Payer: Amerigroup Medicare |
$178.33
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$391.80
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$178.33
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$178.33
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$272.74
|
| Rate for Payer: Cigna All Products |
$734.30
|
| Rate for Payer: Copperpoint |
$294.24
|
| Rate for Payer: HealthNet Commercial |
$629.40
|
| Rate for Payer: HealthNet Medicare |
$293.72
|
| Rate for Payer: Humana Medicare |
$178.33
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$839.20
|
| Rate for Payer: Veterans (Triwest) |
$178.33
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$611.57
|
| Rate for Payer: United Healthcare Medicare |
$188.82
|
|