|
26700 CLD TX DIS HAND BN WMANP
|
Facility
OP
|
$1,084.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
22282852
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$975.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$975.60
|
| Rate for Payer: Aetna Medicare |
$303.52
|
| 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 |
$184.28
|
| Rate for Payer: Amerigroup Medicare |
$184.28
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$404.87
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$184.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$184.28
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$281.84
|
| Rate for Payer: Cigna All Products |
$758.80
|
| Rate for Payer: Copperpoint |
$304.06
|
| Rate for Payer: HealthNet Commercial |
$650.40
|
| Rate for Payer: HealthNet Medicare |
$303.52
|
| Rate for Payer: Humana Medicare |
$184.28
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$867.20
|
| Rate for Payer: Veterans (Triwest) |
$184.28
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$631.97
|
| Rate for Payer: United Healthcare Medicare |
$195.12
|
|
|
26700 CLD TX DIS HAND BN WMANP
|
Facility
IP
|
$1,084.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
22282852
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$975.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$975.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$184.28
|
| Rate for Payer: Amerigroup Medicare |
$184.28
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$184.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$184.28
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$281.84
|
| Rate for Payer: Copperpoint |
$304.06
|
| Rate for Payer: Humana Medicare |
$184.28
|
| Rate for Payer: SELF PAY |
$867.20
|
| Rate for Payer: Veterans (Triwest) |
$184.28
|
|
|
26720 CLSD TX FX PHAL W/O MANI
|
Facility
IP
|
$533.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
22282853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.61 |
| Max. Negotiated Rate |
$479.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$479.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$90.61
|
| Rate for Payer: Amerigroup Medicare |
$90.61
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$90.61
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$90.61
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$138.58
|
| Rate for Payer: Copperpoint |
$149.51
|
| Rate for Payer: Humana Medicare |
$90.61
|
| Rate for Payer: SELF PAY |
$426.40
|
| Rate for Payer: Veterans (Triwest) |
$90.61
|
|
|
26720 CLSD TX FX PHAL W/O MANI
|
Facility
OP
|
$533.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
22282853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.61 |
| Max. Negotiated Rate |
$479.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$479.70
|
| Rate for Payer: Aetna Medicare |
$149.24
|
| 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 |
$90.61
|
| Rate for Payer: Amerigroup Medicare |
$90.61
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$199.08
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$90.61
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$90.61
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$138.58
|
| Rate for Payer: Cigna All Products |
$373.10
|
| Rate for Payer: Copperpoint |
$149.51
|
| Rate for Payer: HealthNet Commercial |
$319.80
|
| Rate for Payer: HealthNet Medicare |
$149.24
|
| Rate for Payer: Humana Medicare |
$90.61
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$426.40
|
| Rate for Payer: Veterans (Triwest) |
$90.61
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$310.74
|
| Rate for Payer: United Healthcare Medicare |
$95.94
|
|
|
26725 CLSD TX FX PHAL W/MANIP
|
Facility
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
22282854
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.59 |
| Max. Negotiated Rate |
$924.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$924.30
|
| Rate for Payer: Aetna Medicare |
$287.56
|
| 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 |
$174.59
|
| Rate for Payer: Amerigroup Medicare |
$174.59
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$383.58
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$174.59
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$174.59
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$267.02
|
| Rate for Payer: Cigna All Products |
$718.90
|
| Rate for Payer: Copperpoint |
$288.07
|
| Rate for Payer: HealthNet Commercial |
$616.20
|
| Rate for Payer: HealthNet Medicare |
$287.56
|
| Rate for Payer: Humana Medicare |
$174.59
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$821.60
|
| Rate for Payer: Veterans (Triwest) |
$174.59
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$598.74
|
| Rate for Payer: United Healthcare Medicare |
$184.86
|
|
|
26725 CLSD TX FX PHAL W/MANIP
|
Facility
IP
|
$1,027.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
22282854
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.59 |
| Max. Negotiated Rate |
$924.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$924.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$174.59
|
| Rate for Payer: Amerigroup Medicare |
$174.59
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$174.59
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$174.59
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$267.02
|
| Rate for Payer: Copperpoint |
$288.07
|
| Rate for Payer: Humana Medicare |
$174.59
|
| Rate for Payer: SELF PAY |
$821.60
|
| Rate for Payer: Veterans (Triwest) |
$174.59
|
|
|
26740 CLSD TX ARTCLR FX W/OMAN
|
Facility
IP
|
$660.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
22282855
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$594.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$112.20
|
| Rate for Payer: Amerigroup Medicare |
$112.20
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$112.20
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$112.20
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$171.60
|
| Rate for Payer: Copperpoint |
$185.13
|
| Rate for Payer: Humana Medicare |
$112.20
|
| Rate for Payer: SELF PAY |
$528.00
|
| Rate for Payer: Veterans (Triwest) |
$112.20
|
|
|
26740 CLSD TX ARTCLR FX W/OMAN
|
Facility
OP
|
$660.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
22282855
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$594.00
|
| Rate for Payer: Aetna Medicare |
$184.80
|
| 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 |
$112.20
|
| Rate for Payer: Amerigroup Medicare |
$112.20
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$246.51
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$112.20
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$112.20
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$171.60
|
| Rate for Payer: Cigna All Products |
$462.00
|
| Rate for Payer: Copperpoint |
$185.13
|
| Rate for Payer: HealthNet Commercial |
$396.00
|
| Rate for Payer: HealthNet Medicare |
$184.80
|
| Rate for Payer: Humana Medicare |
$112.20
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$528.00
|
| Rate for Payer: Veterans (Triwest) |
$112.20
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$384.78
|
| Rate for Payer: United Healthcare Medicare |
$118.80
|
|
|
26742 CLSD TX ART FX W/MAN ECH
|
Facility
OP
|
$1,402.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
22282856
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.34 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,261.80
|
| Rate for Payer: Aetna Medicare |
$392.56
|
| 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 |
$238.34
|
| Rate for Payer: Amerigroup Medicare |
$238.34
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$523.65
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$238.34
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$238.34
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$364.52
|
| Rate for Payer: Cigna All Products |
$981.40
|
| Rate for Payer: Copperpoint |
$393.26
|
| Rate for Payer: HealthNet Commercial |
$841.20
|
| Rate for Payer: HealthNet Medicare |
$392.56
|
| Rate for Payer: Humana Medicare |
$238.34
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$1,121.60
|
| Rate for Payer: Veterans (Triwest) |
$238.34
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$817.37
|
| Rate for Payer: United Healthcare Medicare |
$252.36
|
|
|
26742 CLSD TX ART FX W/MAN ECH
|
Facility
IP
|
$1,402.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
22282856
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.34 |
| Max. Negotiated Rate |
$1,261.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,261.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$238.34
|
| Rate for Payer: Amerigroup Medicare |
$238.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$238.34
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$238.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$364.52
|
| Rate for Payer: Copperpoint |
$393.26
|
| Rate for Payer: Humana Medicare |
$238.34
|
| Rate for Payer: SELF PAY |
$1,121.60
|
| Rate for Payer: Veterans (Triwest) |
$238.34
|
|
|
26750 CLD TX METATARSAL
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
22282857
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.23 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$105.23
|
| Rate for Payer: Aetna POS, PPO, HMO |
$557.10
|
| Rate for Payer: Aetna Medicare |
$173.32
|
| 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 |
$105.23
|
| Rate for Payer: Amerigroup Medicare |
$105.23
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$231.20
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$105.23
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$160.94
|
| Rate for Payer: Cigna All Products |
$433.30
|
| Rate for Payer: Copperpoint |
$173.63
|
| Rate for Payer: HealthNet Commercial |
$371.40
|
| Rate for Payer: HealthNet Medicare |
$173.32
|
| Rate for Payer: Humana Medicare |
$105.23
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$495.20
|
| Rate for Payer: Veterans (Triwest) |
$105.23
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$360.88
|
| Rate for Payer: United Healthcare Medicare |
$111.42
|
|
|
26750 CLD TX METATARSAL
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
22282857
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.23 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$557.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$105.23
|
| Rate for Payer: Amerigroup Medicare |
$105.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$105.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$105.23
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$160.94
|
| Rate for Payer: Copperpoint |
$173.63
|
| Rate for Payer: Humana Medicare |
$105.23
|
| Rate for Payer: SELF PAY |
$495.20
|
| Rate for Payer: Veterans (Triwest) |
$105.23
|
|
|
26770 CLD TX IPHAL JT DIS N/AN
|
Facility
IP
|
$916.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
22282858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.72 |
| Max. Negotiated Rate |
$824.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$824.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$155.72
|
| Rate for Payer: Amerigroup Medicare |
$155.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$155.72
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$155.72
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$598.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$238.16
|
| Rate for Payer: Copperpoint |
$256.94
|
| Rate for Payer: Humana Medicare |
$155.72
|
| Rate for Payer: SELF PAY |
$732.80
|
| Rate for Payer: Veterans (Triwest) |
$155.72
|
|
|
26770 CLD TX IPHAL JT DIS N/AN
|
Facility
OP
|
$916.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
22282858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.72 |
| Max. Negotiated Rate |
$824.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$824.40
|
| Rate for Payer: Aetna Medicare |
$256.48
|
| 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 |
$155.72
|
| Rate for Payer: Amerigroup Medicare |
$155.72
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$342.13
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$155.72
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$155.72
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$598.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$238.16
|
| Rate for Payer: Cigna All Products |
$641.20
|
| Rate for Payer: Copperpoint |
$256.94
|
| Rate for Payer: HealthNet Commercial |
$549.60
|
| Rate for Payer: HealthNet Medicare |
$256.48
|
| Rate for Payer: Humana Medicare |
$155.72
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$732.80
|
| Rate for Payer: Veterans (Triwest) |
$155.72
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$534.03
|
| Rate for Payer: United Healthcare Medicare |
$164.88
|
|
|
27200 CLSD TX COCCYX FX
|
Facility
OP
|
$669.00
|
|
|
Service Code
|
CPT 27200
|
| Hospital Charge Code |
22282859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.73 |
| Max. Negotiated Rate |
$602.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$602.10
|
| Rate for Payer: Aetna Medicare |
$187.32
|
| 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 |
$113.73
|
| Rate for Payer: Amerigroup Medicare |
$113.73
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$249.87
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$113.73
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$113.73
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$173.94
|
| Rate for Payer: Cigna All Products |
$468.30
|
| Rate for Payer: Copperpoint |
$187.65
|
| Rate for Payer: HealthNet Commercial |
$401.40
|
| Rate for Payer: HealthNet Medicare |
$187.32
|
| Rate for Payer: Humana Medicare |
$113.73
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$535.20
|
| Rate for Payer: Veterans (Triwest) |
$113.73
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$390.03
|
| Rate for Payer: United Healthcare Medicare |
$120.42
|
|
|
27200 CLSD TX COCCYX FX
|
Facility
IP
|
$669.00
|
|
|
Service Code
|
CPT 27200
|
| Hospital Charge Code |
22282859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.73 |
| Max. Negotiated Rate |
$602.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$602.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$113.73
|
| Rate for Payer: Amerigroup Medicare |
$113.73
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$113.73
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$113.73
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$173.94
|
| Rate for Payer: Copperpoint |
$187.65
|
| Rate for Payer: Humana Medicare |
$113.73
|
| Rate for Payer: SELF PAY |
$535.20
|
| Rate for Payer: Veterans (Triwest) |
$113.73
|
|
|
27246 CLSD TX FX GR TROCH WO/M
|
Facility
OP
|
$1,823.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
22282860
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.98 |
| Max. Negotiated Rate |
$1,640.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,640.70
|
| Rate for Payer: Aetna Medicare |
$510.44
|
| 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 |
$309.91
|
| Rate for Payer: Amerigroup Medicare |
$309.91
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$680.89
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$309.91
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$309.91
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$473.98
|
| Rate for Payer: Cigna All Products |
$1,276.10
|
| Rate for Payer: Copperpoint |
$511.35
|
| Rate for Payer: HealthNet Commercial |
$1,093.80
|
| Rate for Payer: HealthNet Medicare |
$510.44
|
| Rate for Payer: Humana Medicare |
$309.91
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$1,458.40
|
| Rate for Payer: Veterans (Triwest) |
$309.91
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,062.81
|
| Rate for Payer: United Healthcare Medicare |
$328.14
|
|
|
27246 CLSD TX FX GR TROCH WO/M
|
Facility
IP
|
$1,823.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
22282860
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.91 |
| Max. Negotiated Rate |
$1,640.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,640.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$309.91
|
| Rate for Payer: Amerigroup Medicare |
$309.91
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$309.91
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$309.91
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$473.98
|
| Rate for Payer: Copperpoint |
$511.35
|
| Rate for Payer: Humana Medicare |
$309.91
|
| Rate for Payer: SELF PAY |
$1,458.40
|
| Rate for Payer: Veterans (Triwest) |
$309.91
|
|
|
27550 CLSD TX KNEE DIS W/OANES
|
Facility
OP
|
$1,921.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
22282861
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.98 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: City of Bisbee Police Bisbee Police |
$499.46
|
| Rate for Payer: Aetna POS, PPO, HMO |
$1,728.90
|
| Rate for Payer: Aetna Medicare |
$537.88
|
| 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 |
$326.57
|
| Rate for Payer: Amerigroup Medicare |
$326.57
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$717.49
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$326.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$326.57
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: Cigna All Products |
$1,344.70
|
| Rate for Payer: Copperpoint |
$538.84
|
| Rate for Payer: HealthNet Commercial |
$1,152.60
|
| Rate for Payer: HealthNet Medicare |
$537.88
|
| Rate for Payer: Humana Medicare |
$326.57
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$1,536.80
|
| Rate for Payer: Veterans (Triwest) |
$326.57
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,119.94
|
| Rate for Payer: United Healthcare Medicare |
$345.78
|
|
|
27550 CLSD TX KNEE DIS W/OANES
|
Facility
IP
|
$1,921.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
22282861
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$326.57 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,728.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$326.57
|
| Rate for Payer: Amerigroup Medicare |
$326.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$326.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$326.57
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$499.46
|
| Rate for Payer: Copperpoint |
$538.84
|
| Rate for Payer: Humana Medicare |
$326.57
|
| Rate for Payer: SELF PAY |
$1,536.80
|
| Rate for Payer: Veterans (Triwest) |
$326.57
|
|
|
27560 CLSD TX PATELLA DIS WOAN
|
Facility
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
22282862
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.71 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,136.70
|
| Rate for Payer: Aetna Medicare |
$353.64
|
| 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 |
$214.71
|
| Rate for Payer: Amerigroup Medicare |
$214.71
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$471.73
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$214.71
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$214.71
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$328.38
|
| Rate for Payer: Cigna All Products |
$884.10
|
| Rate for Payer: Copperpoint |
$354.27
|
| Rate for Payer: HealthNet Commercial |
$757.80
|
| Rate for Payer: HealthNet Medicare |
$353.64
|
| Rate for Payer: Humana Medicare |
$214.71
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$1,010.40
|
| Rate for Payer: Veterans (Triwest) |
$214.71
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$736.33
|
| Rate for Payer: United Healthcare Medicare |
$227.34
|
|
|
27560 CLSD TX PATELLA DIS WOAN
|
Facility
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
22282862
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.71 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,136.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$214.71
|
| Rate for Payer: Amerigroup Medicare |
$214.71
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$214.71
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$214.71
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$328.38
|
| Rate for Payer: Copperpoint |
$354.27
|
| Rate for Payer: Humana Medicare |
$214.71
|
| Rate for Payer: SELF PAY |
$1,010.40
|
| Rate for Payer: Veterans (Triwest) |
$214.71
|
|
|
27750 CLSD TX FX TIB W/O MANIP
|
Facility
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
22282863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.76 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,195.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$225.76
|
| Rate for Payer: Amerigroup Medicare |
$225.76
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$225.76
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$225.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$345.28
|
| Rate for Payer: Copperpoint |
$372.50
|
| Rate for Payer: Humana Medicare |
$225.76
|
| Rate for Payer: SELF PAY |
$1,062.40
|
| Rate for Payer: Veterans (Triwest) |
$225.76
|
|
|
27750 CLSD TX FX TIB W/O MANIP
|
Facility
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
22282863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.76 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,195.20
|
| Rate for Payer: Aetna Medicare |
$371.84
|
| 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 |
$225.76
|
| Rate for Payer: Amerigroup Medicare |
$225.76
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$496.01
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$225.76
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$225.76
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$345.28
|
| Rate for Payer: Cigna All Products |
$929.60
|
| Rate for Payer: Copperpoint |
$372.50
|
| Rate for Payer: HealthNet Commercial |
$796.80
|
| Rate for Payer: HealthNet Medicare |
$371.84
|
| Rate for Payer: Humana Medicare |
$225.76
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$1,062.40
|
| Rate for Payer: Veterans (Triwest) |
$225.76
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$774.22
|
| Rate for Payer: United Healthcare Medicare |
$239.04
|
|
|
27760 CLSD TX FX MMALL WO MANI
|
Facility
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
22282864
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.07 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$963.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$182.07
|
| Rate for Payer: Amerigroup Medicare |
$182.07
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$182.07
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$182.07
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$278.46
|
| Rate for Payer: Copperpoint |
$300.42
|
| Rate for Payer: Humana Medicare |
$182.07
|
| Rate for Payer: SELF PAY |
$856.80
|
| Rate for Payer: Veterans (Triwest) |
$182.07
|
|