|
27550 CLSD TX KNEE DIS W/OANES
|
Facility
|
OP
|
$2,723.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
22282861
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,450.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,450.70
|
| Rate for Payer: Aetna of AZ Medicare |
$762.44
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$435.68
|
| Rate for Payer: Amerigroup Medicare |
$435.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,017.04
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$435.68
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$435.68
|
| Rate for Payer: Bisbee Police All Plans |
$707.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,851.64
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,906.10
|
| Rate for Payer: Copperpoint Commercial |
$673.94
|
| Rate for Payer: Health Net of AZ Commercial |
$1,633.80
|
| Rate for Payer: Health Net of AZ Medicare |
$762.44
|
| Rate for Payer: Humana of AZ Medicare |
$435.68
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$2,178.40
|
| Rate for Payer: TriWest Medicare |
$435.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$490.14
|
|
|
27550 CLSD TX KNEE DIS W/OANES
|
Facility
|
IP
|
$2,723.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
22282861
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$707.98 |
| Max. Negotiated Rate |
$2,450.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,450.70
|
| Rate for Payer: Bisbee Police All Plans |
$707.98
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Self Pay Self Pay |
$2,178.40
|
|
|
27560 CLSD TX PATELLA DIS WOAN
|
Facility
|
IP
|
$1,326.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
22282862
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.76 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,193.40
|
| Rate for Payer: Bisbee Police All Plans |
$344.76
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Self Pay Self Pay |
$1,060.80
|
|
|
27560 CLSD TX PATELLA DIS WOAN
|
Facility
|
OP
|
$1,326.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
22282862
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,193.40
|
| Rate for Payer: Aetna of AZ Medicare |
$371.28
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$212.16
|
| Rate for Payer: Amerigroup Medicare |
$212.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$495.26
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$212.16
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$212.16
|
| Rate for Payer: Bisbee Police All Plans |
$344.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$901.68
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cigna of AZ Commercial |
$928.20
|
| Rate for Payer: Copperpoint Commercial |
$328.19
|
| Rate for Payer: Health Net of AZ Commercial |
$795.60
|
| Rate for Payer: Health Net of AZ Medicare |
$371.28
|
| Rate for Payer: Humana of AZ Medicare |
$212.16
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$1,060.80
|
| Rate for Payer: TriWest Medicare |
$212.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$238.68
|
|
|
27750 CLSD TX FX TIB W/O MANIP
|
Facility
|
OP
|
$1,394.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
22282863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,254.60
|
| Rate for Payer: Aetna of AZ Medicare |
$390.32
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$223.04
|
| Rate for Payer: Amerigroup Medicare |
$223.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$520.66
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$223.04
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$223.04
|
| Rate for Payer: Bisbee Police All Plans |
$362.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$947.92
|
| Rate for Payer: Cash Price |
$1,115.20
|
| Rate for Payer: Cash Price |
$1,115.20
|
| Rate for Payer: Cigna of AZ Commercial |
$975.80
|
| Rate for Payer: Copperpoint Commercial |
$345.01
|
| Rate for Payer: Health Net of AZ Commercial |
$836.40
|
| Rate for Payer: Health Net of AZ Medicare |
$390.32
|
| Rate for Payer: Humana of AZ Medicare |
$223.04
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$1,115.20
|
| Rate for Payer: TriWest Medicare |
$223.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$250.92
|
|
|
27750 CLSD TX FX TIB W/O MANIP
|
Facility
|
IP
|
$1,394.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
22282863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$362.44 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,254.60
|
| Rate for Payer: Bisbee Police All Plans |
$362.44
|
| Rate for Payer: Cash Price |
$1,115.20
|
| Rate for Payer: Self Pay Self Pay |
$1,115.20
|
|
|
27760 CLSD TX FX MMALL WO MANI
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
22282864
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,012.50
|
| Rate for Payer: Aetna of AZ Medicare |
$315.00
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$180.00
|
| Rate for Payer: Amerigroup Medicare |
$180.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$420.19
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$180.00
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$180.00
|
| Rate for Payer: Bisbee Police All Plans |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$765.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna of AZ Commercial |
$787.50
|
| Rate for Payer: Copperpoint Commercial |
$278.44
|
| Rate for Payer: Health Net of AZ Commercial |
$675.00
|
| Rate for Payer: Health Net of AZ Medicare |
$315.00
|
| Rate for Payer: Humana of AZ Medicare |
$180.00
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$900.00
|
| Rate for Payer: TriWest Medicare |
$180.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$202.50
|
|
|
27760 CLSD TX FX MMALL WO MANI
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
22282864
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$1,012.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,012.50
|
| Rate for Payer: Bisbee Police All Plans |
$292.50
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Self Pay Self Pay |
$900.00
|
|
|
27780 CLSD TX FX PRX FIBWO/MAN
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
22282865
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$891.90
|
| Rate for Payer: Aetna of AZ Medicare |
$277.48
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$158.56
|
| Rate for Payer: Amerigroup Medicare |
$158.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$370.14
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$158.56
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$158.56
|
| Rate for Payer: Bisbee Police All Plans |
$257.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$673.88
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Cigna of AZ Commercial |
$693.70
|
| Rate for Payer: Copperpoint Commercial |
$245.27
|
| Rate for Payer: Health Net of AZ Commercial |
$594.60
|
| Rate for Payer: Health Net of AZ Medicare |
$277.48
|
| Rate for Payer: Humana of AZ Medicare |
$158.56
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$792.80
|
| Rate for Payer: TriWest Medicare |
$158.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$178.38
|
|
|
27780 CLSD TX FX PRX FIBWO/MAN
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
22282865
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.66 |
| Max. Negotiated Rate |
$891.90 |
| Rate for Payer: Aetna of AZ Commercial |
$891.90
|
| Rate for Payer: Bisbee Police All Plans |
$257.66
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Self Pay Self Pay |
$792.80
|
|
|
27781 CLSD TX FX PROX FIB W/MA
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
22282866
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.80 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,534.50
|
| Rate for Payer: Aetna of AZ Medicare |
$477.40
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$272.80
|
| Rate for Payer: Amerigroup Medicare |
$272.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$636.82
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$272.80
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$272.80
|
| Rate for Payer: Bisbee Police All Plans |
$443.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,159.40
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,193.50
|
| Rate for Payer: Copperpoint Commercial |
$421.99
|
| Rate for Payer: Health Net of AZ Commercial |
$1,023.00
|
| Rate for Payer: Health Net of AZ Medicare |
$477.40
|
| Rate for Payer: Humana of AZ Medicare |
$272.80
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,364.00
|
| Rate for Payer: TriWest Medicare |
$272.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$306.90
|
|
|
27781 CLSD TX FX PROX FIB W/MA
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
22282866
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$443.30 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,534.50
|
| Rate for Payer: Bisbee Police All Plans |
$443.30
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Self Pay Self Pay |
$1,364.00
|
|
|
27786 CLSD TX FX DIS FIB WO/MA
|
Facility
|
OP
|
$1,076.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
22282867
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$968.40
|
| Rate for Payer: Aetna of AZ Medicare |
$301.28
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$172.16
|
| Rate for Payer: Amerigroup Medicare |
$172.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$401.89
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$172.16
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$172.16
|
| Rate for Payer: Bisbee Police All Plans |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$731.68
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cigna of AZ Commercial |
$753.20
|
| Rate for Payer: Copperpoint Commercial |
$266.31
|
| Rate for Payer: Health Net of AZ Commercial |
$645.60
|
| Rate for Payer: Health Net of AZ Medicare |
$301.28
|
| Rate for Payer: Humana of AZ Medicare |
$172.16
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$860.80
|
| Rate for Payer: TriWest Medicare |
$172.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$193.68
|
|
|
27786 CLSD TX FX DIS FIB WO/MA
|
Facility
|
IP
|
$1,076.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
22282867
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.76 |
| Max. Negotiated Rate |
$968.40 |
| Rate for Payer: Aetna of AZ Commercial |
$968.40
|
| Rate for Payer: Bisbee Police All Plans |
$279.76
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Self Pay Self Pay |
$860.80
|
|
|
27788 CLSD TX FX DISTFIB W/M
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
22282868
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$381.42 |
| Max. Negotiated Rate |
$1,320.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,320.30
|
| Rate for Payer: Bisbee Police All Plans |
$381.42
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Self Pay Self Pay |
$1,173.60
|
|
|
27788 CLSD TX FX DISTFIB W/M
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
22282868
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,320.30
|
| Rate for Payer: Aetna of AZ Medicare |
$410.76
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$234.72
|
| Rate for Payer: Amerigroup Medicare |
$234.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$547.92
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$234.72
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$234.72
|
| Rate for Payer: Bisbee Police All Plans |
$381.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$997.56
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,026.90
|
| Rate for Payer: Copperpoint Commercial |
$363.08
|
| Rate for Payer: Health Net of AZ Commercial |
$880.20
|
| Rate for Payer: Health Net of AZ Medicare |
$410.76
|
| Rate for Payer: Humana of AZ Medicare |
$234.72
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$1,173.60
|
| Rate for Payer: TriWest Medicare |
$234.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$264.06
|
|
|
27808 CLD TX FX BIMALL AKL WOM
|
Facility
|
IP
|
$1,288.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
22282869
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$334.88 |
| Max. Negotiated Rate |
$1,159.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,159.20
|
| Rate for Payer: Bisbee Police All Plans |
$334.88
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Self Pay Self Pay |
$1,030.40
|
|
|
27808 CLD TX FX BIMALL AKL WOM
|
Facility
|
OP
|
$1,288.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
22282869
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,159.20
|
| Rate for Payer: Aetna of AZ Medicare |
$360.64
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$206.08
|
| Rate for Payer: Amerigroup Medicare |
$206.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$481.07
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$206.08
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$206.08
|
| Rate for Payer: Bisbee Police All Plans |
$334.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$875.84
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cigna of AZ Commercial |
$901.60
|
| Rate for Payer: Copperpoint Commercial |
$318.78
|
| Rate for Payer: Health Net of AZ Commercial |
$772.80
|
| Rate for Payer: Health Net of AZ Medicare |
$360.64
|
| Rate for Payer: Humana of AZ Medicare |
$206.08
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$1,030.40
|
| Rate for Payer: TriWest Medicare |
$206.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$231.84
|
|
|
27810 CLSD TXFXBIMALL ANKLN/MN
|
Facility
|
OP
|
$2,881.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
22282870
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$460.96 |
| Max. Negotiated Rate |
$2,592.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,592.90
|
| Rate for Payer: Aetna of AZ Medicare |
$806.68
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$460.96
|
| Rate for Payer: Amerigroup Medicare |
$460.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,076.05
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$460.96
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$460.96
|
| Rate for Payer: Bisbee Police All Plans |
$749.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,959.08
|
| Rate for Payer: Cash Price |
$2,304.80
|
| Rate for Payer: Cash Price |
$2,304.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,016.70
|
| Rate for Payer: Copperpoint Commercial |
$713.05
|
| Rate for Payer: Health Net of AZ Commercial |
$1,728.60
|
| Rate for Payer: Health Net of AZ Medicare |
$806.68
|
| Rate for Payer: Humana of AZ Medicare |
$460.96
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$2,304.80
|
| Rate for Payer: TriWest Medicare |
$460.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$518.58
|
|
|
27810 CLSD TXFXBIMALL ANKLN/MN
|
Facility
|
IP
|
$2,881.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
22282870
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$749.06 |
| Max. Negotiated Rate |
$2,592.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,592.90
|
| Rate for Payer: Bisbee Police All Plans |
$749.06
|
| Rate for Payer: Cash Price |
$2,304.80
|
| Rate for Payer: Self Pay Self Pay |
$2,304.80
|
|
|
27840 CLSD TX AKLE DIS W/O ANE
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
22282871
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.49 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,507.50
|
| Rate for Payer: Aetna of AZ Medicare |
$469.00
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$268.00
|
| Rate for Payer: Amerigroup Medicare |
$268.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$625.61
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$268.00
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$268.00
|
| Rate for Payer: Bisbee Police All Plans |
$435.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,139.00
|
| Rate for Payer: Cash Price |
$1,340.00
|
| Rate for Payer: Cash Price |
$1,340.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,172.50
|
| Rate for Payer: Copperpoint Commercial |
$414.56
|
| Rate for Payer: Health Net of AZ Commercial |
$1,005.00
|
| Rate for Payer: Health Net of AZ Medicare |
$469.00
|
| Rate for Payer: Humana of AZ Medicare |
$268.00
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$1,340.00
|
| Rate for Payer: TriWest Medicare |
$268.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$301.50
|
|
|
27840 CLSD TX AKLE DIS W/O ANE
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
22282871
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.50 |
| Max. Negotiated Rate |
$1,507.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,507.50
|
| Rate for Payer: Bisbee Police All Plans |
$435.50
|
| Rate for Payer: Cash Price |
$1,340.00
|
| Rate for Payer: Self Pay Self Pay |
$1,340.00
|
|
|
28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PH
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
CPT 28108
|
| Hospital Charge Code |
27410736
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$402.74 |
| Max. Negotiated Rate |
$1,394.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,394.10
|
| Rate for Payer: Bisbee Police All Plans |
$402.74
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Self Pay Self Pay |
$1,239.20
|
|
|
28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PH
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
CPT 28108
|
| Hospital Charge Code |
27410736
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,394.10
|
| Rate for Payer: Aetna of AZ Medicare |
$433.72
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$247.84
|
| Rate for Payer: Amerigroup Medicare |
$247.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$578.55
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$247.84
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$247.84
|
| Rate for Payer: Bisbee Police All Plans |
$402.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,053.32
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cigna of AZ Commercial |
$774.50
|
| Rate for Payer: Copperpoint Commercial |
$383.38
|
| Rate for Payer: Health Net of AZ Commercial |
$929.40
|
| Rate for Payer: Health Net of AZ Medicare |
$433.72
|
| Rate for Payer: Humana of AZ Medicare |
$247.84
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,239.20
|
| Rate for Payer: TriWest Medicare |
$247.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$278.82
|
|
|
28490 CLSD TX FX GR TOE W/O MA
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
22282872
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.12 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$411.30
|
| Rate for Payer: Aetna of AZ Medicare |
$127.96
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$73.12
|
| Rate for Payer: Amerigroup Medicare |
$73.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$170.69
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$73.12
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$73.12
|
| Rate for Payer: Bisbee Police All Plans |
$118.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$310.76
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cigna of AZ Commercial |
$319.90
|
| Rate for Payer: Copperpoint Commercial |
$113.11
|
| Rate for Payer: Health Net of AZ Commercial |
$274.20
|
| Rate for Payer: Health Net of AZ Medicare |
$127.96
|
| Rate for Payer: Humana of AZ Medicare |
$73.12
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$365.60
|
| Rate for Payer: TriWest Medicare |
$73.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$82.26
|
|
