|
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 |
$103.95 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$103.95
|
| Rate for Payer: Amerigroup Medicare |
$103.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$258.84
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$103.95
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$103.95
|
| 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 |
$103.95
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$554.40
|
| Rate for Payer: TriWest Medicare |
$103.95
|
| 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
|
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
|
|
|
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 |
$220.80 |
| 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 |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$220.80
|
| Rate for Payer: Amerigroup Medicare |
$220.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$549.79
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$220.80
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$220.80
|
| 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 |
$220.80
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$1,177.60
|
| Rate for Payer: TriWest Medicare |
$220.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$264.96
|
|
|
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 |
$97.50 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$97.50
|
| Rate for Payer: Amerigroup Medicare |
$97.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$242.78
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$97.50
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$97.50
|
| 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 |
$97.50
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$520.00
|
| Rate for Payer: TriWest Medicare |
$97.50
|
| 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
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
22282858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$865.80
|
| Rate for Payer: Aetna of AZ Medicare |
$269.36
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$144.30
|
| Rate for Payer: Amerigroup Medicare |
$144.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$359.31
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$144.30
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$144.30
|
| Rate for Payer: Bisbee Police All Plans |
$250.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$654.16
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cigna of AZ Commercial |
$673.40
|
| Rate for Payer: Copperpoint Commercial |
$238.10
|
| Rate for Payer: Health Net of AZ Commercial |
$577.20
|
| Rate for Payer: Health Net of AZ Medicare |
$269.36
|
| Rate for Payer: Humana of AZ Medicare |
$144.30
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$769.60
|
| Rate for Payer: TriWest Medicare |
$144.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$173.16
|
|
|
26770 CLD TX IPHAL JT DIS N/AN
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
22282858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$865.80 |
| Rate for Payer: Aetna of AZ Commercial |
$865.80
|
| Rate for Payer: Bisbee Police All Plans |
$250.12
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Self Pay Self Pay |
$769.60
|
|
|
27200 CLSD TX COCCYX FX
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 27200
|
| Hospital Charge Code |
22282859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.30 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$105.30
|
| Rate for Payer: Amerigroup Medicare |
$105.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$262.20
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$105.30
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$105.30
|
| 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 |
$173.74
|
| 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 |
$105.30
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$561.60
|
| Rate for Payer: TriWest Medicare |
$105.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$126.36
|
|
|
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
|
|
|
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 |
$287.10 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$287.10
|
| Rate for Payer: Amerigroup Medicare |
$287.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$714.88
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$287.10
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$287.10
|
| 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 |
$473.72
|
| 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 |
$287.10
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$1,531.20
|
| Rate for Payer: TriWest Medicare |
$287.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$344.52
|
|
|
27550 CLSD TX KNEE DIS W/OANES
|
Facility
|
IP
|
$2,017.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
22282861
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$524.42 |
| Max. Negotiated Rate |
$1,815.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,815.30
|
| Rate for Payer: Bisbee Police All Plans |
$524.42
|
| Rate for Payer: Cash Price |
$1,613.60
|
| Rate for Payer: Self Pay Self Pay |
$1,613.60
|
|
|
27550 CLSD TX KNEE DIS W/OANES
|
Facility
|
OP
|
$2,017.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
22282861
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.98 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,815.30
|
| Rate for Payer: Aetna of AZ Medicare |
$564.76
|
| Rate for Payer: AHCCCS Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$302.55
|
| Rate for Payer: Amerigroup Medicare |
$302.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$753.35
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$302.55
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$302.55
|
| Rate for Payer: Bisbee Police All Plans |
$524.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,371.56
|
| Rate for Payer: Cash Price |
$1,613.60
|
| Rate for Payer: Cash Price |
$1,613.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,411.90
|
| Rate for Payer: Copperpoint Commercial |
$499.21
|
| Rate for Payer: Health Net of AZ Commercial |
$1,210.20
|
| Rate for Payer: Health Net of AZ Medicare |
$564.76
|
| Rate for Payer: Humana of AZ Medicare |
$302.55
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$1,613.60
|
| Rate for Payer: TriWest Medicare |
$302.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$363.06
|
|
|
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 |
$198.90 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$198.90
|
| Rate for Payer: Amerigroup Medicare |
$198.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$495.26
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$198.90
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$198.90
|
| 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 |
$328.18
|
| 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 |
$198.90
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$1,060.80
|
| Rate for Payer: TriWest Medicare |
$198.90
|
| 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
|
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
|
|
|
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 |
$209.10 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$209.10
|
| Rate for Payer: Amerigroup Medicare |
$209.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$520.66
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$209.10
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$209.10
|
| 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 |
$345.02
|
| 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 |
$209.10
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$1,115.20
|
| Rate for Payer: TriWest Medicare |
$209.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$250.92
|
|
|
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 |
$168.75 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$168.75
|
| Rate for Payer: Amerigroup Medicare |
$168.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$420.19
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$168.75
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$168.75
|
| 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 |
$168.75
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$900.00
|
| Rate for Payer: TriWest Medicare |
$168.75
|
| 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 |
$148.65 |
| 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 |
$298.98
|
| Rate for Payer: Allwell Medicaid |
$298.98
|
| Rate for Payer: Allwell Medicare |
$148.65
|
| Rate for Payer: Amerigroup Medicare |
$148.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$370.14
|
| Rate for Payer: AZCH Complete Medicaid |
$298.98
|
| Rate for Payer: AZCH Complete Medicare |
$148.65
|
| Rate for Payer: Banner UC Health Medicaid |
$298.98
|
| Rate for Payer: Banner UC Health Medicare |
$148.65
|
| 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 |
$148.65
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Self Pay Self Pay |
$792.80
|
| Rate for Payer: TriWest Medicare |
$148.65
|
| 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 |
$255.75 |
| 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 |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$255.75
|
| Rate for Payer: Amerigroup Medicare |
$255.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$636.82
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$255.75
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$255.75
|
| 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 |
$255.75
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$1,364.00
|
| Rate for Payer: TriWest Medicare |
$255.75
|
| 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
|
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
|
|
