|
Excision of Cervical Stump
|
Facility
|
OP
|
$4,321.00
|
|
|
Service Code
|
CPT 57540
|
| Hospital Charge Code |
27291793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3,888.90 |
| Rate for Payer: Aetna of AZ Commercial |
$3,888.90
|
| Rate for Payer: Aetna of AZ Medicare |
$1,209.88
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$648.15
|
| Rate for Payer: Amerigroup Medicare |
$648.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,613.89
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$648.15
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$648.15
|
| Rate for Payer: Bisbee Police All Plans |
$1,123.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,938.28
|
| Rate for Payer: Cash Price |
$3,456.80
|
| Rate for Payer: Cash Price |
$3,456.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,160.50
|
| Rate for Payer: Copperpoint Commercial |
$1,069.45
|
| Rate for Payer: Health Net of AZ Commercial |
$2,592.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,209.88
|
| Rate for Payer: Humana of AZ Medicare |
$648.15
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$3,456.80
|
| Rate for Payer: TriWest Medicare |
$648.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$777.78
|
|
|
Excision of Cervical Stump
|
Facility
|
IP
|
$4,321.00
|
|
|
Service Code
|
CPT 57540
|
| Hospital Charge Code |
27291793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,123.46 |
| Max. Negotiated Rate |
$3,888.90 |
| Rate for Payer: Aetna of AZ Commercial |
$3,888.90
|
| Rate for Payer: Bisbee Police All Plans |
$1,123.46
|
| Rate for Payer: Cash Price |
$3,456.80
|
| Rate for Payer: Self Pay Self Pay |
$3,456.80
|
|
|
Excision of Cervical Stump (vaginal)
|
Facility
|
OP
|
$2,336.00
|
|
|
Service Code
|
CPT 57550
|
| Hospital Charge Code |
27281897
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$6,393.84 |
| Rate for Payer: Aetna of AZ Commercial |
$2,102.40
|
| Rate for Payer: Aetna of AZ Medicare |
$654.08
|
| Rate for Payer: AHCCCS Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicare |
$350.40
|
| Rate for Payer: Amerigroup Medicare |
$350.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$872.50
|
| Rate for Payer: AZCH Complete Medicaid |
$6,393.84
|
| Rate for Payer: AZCH Complete Medicare |
$350.40
|
| Rate for Payer: Banner UC Health Medicaid |
$6,393.84
|
| Rate for Payer: Banner UC Health Medicare |
$350.40
|
| Rate for Payer: Bisbee Police All Plans |
$607.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,588.48
|
| Rate for Payer: Cash Price |
$1,868.80
|
| Rate for Payer: Cash Price |
$1,868.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,168.00
|
| Rate for Payer: Copperpoint Commercial |
$578.16
|
| Rate for Payer: Health Net of AZ Commercial |
$1,401.60
|
| Rate for Payer: Health Net of AZ Medicare |
$654.08
|
| Rate for Payer: Humana of AZ Medicare |
$350.40
|
| Rate for Payer: Mercy Care Medicaid |
$6,393.84
|
| Rate for Payer: Self Pay Self Pay |
$1,868.80
|
| Rate for Payer: TriWest Medicare |
$350.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$420.48
|
|
|
Excision of Cervical Stump (vaginal)
|
Facility
|
IP
|
$2,336.00
|
|
|
Service Code
|
CPT 57550
|
| Hospital Charge Code |
27281897
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$607.36 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,102.40
|
| Rate for Payer: Bisbee Police All Plans |
$607.36
|
| Rate for Payer: Cash Price |
$1,868.80
|
| Rate for Payer: Self Pay Self Pay |
$1,868.80
|
|
|
Excision of Cervical Stump with AP repair
|
Facility
|
OP
|
$3,371.00
|
|
|
Service Code
|
CPT 57555
|
| Hospital Charge Code |
27281898
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$505.65 |
| Max. Negotiated Rate |
$6,393.84 |
| Rate for Payer: Aetna of AZ Commercial |
$3,033.90
|
| Rate for Payer: Aetna of AZ Medicare |
$943.88
|
| Rate for Payer: AHCCCS Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicare |
$505.65
|
| Rate for Payer: Amerigroup Medicare |
$505.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,259.07
|
| Rate for Payer: AZCH Complete Medicaid |
$6,393.84
|
| Rate for Payer: AZCH Complete Medicare |
$505.65
|
| Rate for Payer: Banner UC Health Medicaid |
$6,393.84
|
| Rate for Payer: Banner UC Health Medicare |
$505.65
|
| Rate for Payer: Bisbee Police All Plans |
$876.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,292.28
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,685.50
|
| Rate for Payer: Copperpoint Commercial |
$834.32
|
| Rate for Payer: Health Net of AZ Commercial |
$2,022.60
|
| Rate for Payer: Health Net of AZ Medicare |
$943.88
|
| Rate for Payer: Humana of AZ Medicare |
$505.65
|
| Rate for Payer: Mercy Care Medicaid |
$6,393.84
|
| Rate for Payer: Self Pay Self Pay |
$2,696.80
|
| Rate for Payer: TriWest Medicare |
$505.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$606.78
|
|
|
Excision of Cervical Stump with AP repair
|
Facility
|
IP
|
$3,371.00
|
|
|
Service Code
|
CPT 57555
|
| Hospital Charge Code |
27281898
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$3,033.90 |
| Rate for Payer: Aetna of AZ Commercial |
$3,033.90
|
| Rate for Payer: Bisbee Police All Plans |
$876.46
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Self Pay Self Pay |
$2,696.80
|
|
|
Excision of Cervical Stump with enterocele repair
|
Facility
|
IP
|
$3,192.00
|
|
|
Service Code
|
CPT 57556
|
| Hospital Charge Code |
27291802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$829.92 |
| Max. Negotiated Rate |
$2,872.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,872.80
|
| Rate for Payer: Bisbee Police All Plans |
$829.92
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Self Pay Self Pay |
$2,553.60
|
|
|
Excision of Cervical Stump with enterocele repair
|
Facility
|
OP
|
$3,192.00
|
|
|
Service Code
|
CPT 57556
|
| Hospital Charge Code |
27291802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$6,393.84 |
| Rate for Payer: Aetna of AZ Commercial |
$2,872.80
|
| Rate for Payer: Aetna of AZ Medicare |
$893.76
|
| Rate for Payer: AHCCCS Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicare |
$478.80
|
| Rate for Payer: Amerigroup Medicare |
$478.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,192.21
|
| Rate for Payer: AZCH Complete Medicaid |
$6,393.84
|
| Rate for Payer: AZCH Complete Medicare |
$478.80
|
| Rate for Payer: Banner UC Health Medicaid |
$6,393.84
|
| Rate for Payer: Banner UC Health Medicare |
$478.80
|
| Rate for Payer: Bisbee Police All Plans |
$829.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,170.56
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,596.00
|
| Rate for Payer: Copperpoint Commercial |
$790.02
|
| Rate for Payer: Health Net of AZ Commercial |
$1,915.20
|
| Rate for Payer: Health Net of AZ Medicare |
$893.76
|
| Rate for Payer: Humana of AZ Medicare |
$478.80
|
| Rate for Payer: Mercy Care Medicaid |
$6,393.84
|
| Rate for Payer: Self Pay Self Pay |
$2,553.60
|
| Rate for Payer: TriWest Medicare |
$478.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4,540.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$574.56
|
|
|
EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY)
|
Facility
|
IP
|
$1,502.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
24043267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$390.52 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,351.80
|
| Rate for Payer: Bisbee Police All Plans |
$390.52
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Self Pay Self Pay |
$1,201.60
|
|
|
EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY)
|
Facility
|
OP
|
$1,502.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
24043267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$225.30 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,351.80
|
| Rate for Payer: Aetna of AZ Medicare |
$420.56
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$225.30
|
| Rate for Payer: Amerigroup Medicare |
$225.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$561.00
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$225.30
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$225.30
|
| Rate for Payer: Bisbee Police All Plans |
$390.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,021.36
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Cigna of AZ Commercial |
$751.00
|
| Rate for Payer: Copperpoint Commercial |
$371.74
|
| Rate for Payer: Health Net of AZ Commercial |
$901.20
|
| Rate for Payer: Health Net of AZ Medicare |
$420.56
|
| Rate for Payer: Humana of AZ Medicare |
$225.30
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$1,201.60
|
| Rate for Payer: TriWest Medicare |
$225.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$270.36
|
|
|
EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY) - 28092
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 28092
|
| Hospital Charge Code |
24043310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$198.30 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,189.80
|
| Rate for Payer: Aetna of AZ Medicare |
$370.16
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$198.30
|
| Rate for Payer: Amerigroup Medicare |
$198.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$493.77
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$198.30
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$198.30
|
| Rate for Payer: Bisbee Police All Plans |
$343.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$898.96
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cigna of AZ Commercial |
$661.00
|
| Rate for Payer: Copperpoint Commercial |
$327.20
|
| Rate for Payer: Health Net of AZ Commercial |
$793.20
|
| Rate for Payer: Health Net of AZ Medicare |
$370.16
|
| Rate for Payer: Humana of AZ Medicare |
$198.30
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$1,057.60
|
| Rate for Payer: TriWest Medicare |
$198.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$237.96
|
|
|
EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY) - 28092
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 28092
|
| Hospital Charge Code |
24043310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.72 |
| Max. Negotiated Rate |
$1,189.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,189.80
|
| Rate for Payer: Bisbee Police All Plans |
$343.72
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Self Pay Self Pay |
$1,057.60
|
|
|
Excision of vaginal septum
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
19665350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$3,803.66 |
| Rate for Payer: Aetna of AZ Commercial |
$796.50
|
| Rate for Payer: Aetna of AZ Medicare |
$247.80
|
| Rate for Payer: AHCCCS Medicaid |
$3,803.66
|
| Rate for Payer: Allwell Medicaid |
$3,803.66
|
| Rate for Payer: Allwell Medicare |
$132.75
|
| Rate for Payer: Amerigroup Medicare |
$132.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$330.55
|
| Rate for Payer: AZCH Complete Medicaid |
$3,803.66
|
| Rate for Payer: AZCH Complete Medicare |
$132.75
|
| Rate for Payer: Banner UC Health Medicaid |
$3,803.66
|
| Rate for Payer: Banner UC Health Medicare |
$132.75
|
| Rate for Payer: Bisbee Police All Plans |
$230.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$601.80
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna of AZ Commercial |
$442.50
|
| Rate for Payer: Copperpoint Commercial |
$219.04
|
| Rate for Payer: Health Net of AZ Commercial |
$531.00
|
| Rate for Payer: Health Net of AZ Medicare |
$247.80
|
| Rate for Payer: Humana of AZ Medicare |
$132.75
|
| Rate for Payer: Mercy Care Medicaid |
$3,803.66
|
| Rate for Payer: Self Pay Self Pay |
$708.00
|
| Rate for Payer: TriWest Medicare |
$132.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$159.30
|
|
|
Excision of vaginal septum
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
19665350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$796.50 |
| Rate for Payer: Aetna of AZ Commercial |
$796.50
|
| Rate for Payer: Bisbee Police All Plans |
$230.10
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Self Pay Self Pay |
$708.00
|
|
|
EXCISION TUMOR SOFT TISSUE OF FOOT OR TOE SUBCUTANEOUS; 1.5 CM OR GREATER - Tech
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT 28039
|
| Hospital Charge Code |
24043329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$252.30 |
| Max. Negotiated Rate |
$3,436.52 |
| Rate for Payer: Aetna of AZ Commercial |
$1,513.80
|
| Rate for Payer: Aetna of AZ Medicare |
$470.96
|
| Rate for Payer: AHCCCS Medicaid |
$3,436.52
|
| Rate for Payer: Allwell Medicaid |
$3,436.52
|
| Rate for Payer: Allwell Medicare |
$252.30
|
| Rate for Payer: Amerigroup Medicare |
$252.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$628.23
|
| Rate for Payer: AZCH Complete Medicaid |
$3,436.52
|
| Rate for Payer: AZCH Complete Medicare |
$252.30
|
| Rate for Payer: Banner UC Health Medicaid |
$3,436.52
|
| Rate for Payer: Banner UC Health Medicare |
$252.30
|
| Rate for Payer: Bisbee Police All Plans |
$437.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,143.76
|
| Rate for Payer: Cash Price |
$1,345.60
|
| Rate for Payer: Cash Price |
$1,345.60
|
| Rate for Payer: Cigna of AZ Commercial |
$841.00
|
| Rate for Payer: Copperpoint Commercial |
$416.30
|
| Rate for Payer: Health Net of AZ Commercial |
$1,009.20
|
| Rate for Payer: Health Net of AZ Medicare |
$470.96
|
| Rate for Payer: Humana of AZ Medicare |
$252.30
|
| Rate for Payer: Mercy Care Medicaid |
$3,436.52
|
| Rate for Payer: Self Pay Self Pay |
$1,345.60
|
| Rate for Payer: TriWest Medicare |
$252.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$302.76
|
|
|
EXCISION TUMOR SOFT TISSUE OF FOOT OR TOE SUBCUTANEOUS; 1.5 CM OR GREATER - Tech
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT 28039
|
| Hospital Charge Code |
24043329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$437.32 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,513.80
|
| Rate for Payer: Bisbee Police All Plans |
$437.32
|
| Rate for Payer: Cash Price |
$1,345.60
|
| Rate for Payer: Self Pay Self Pay |
$1,345.60
|
|
|
EXCISION TUMOR SOFT TISSUE OF FOOT OR TOE SUBCUTANEOUS; LESS THAN 1.5 CM
|
Facility
|
IP
|
$1,283.00
|
|
|
Service Code
|
CPT 28043
|
| Hospital Charge Code |
24043330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$333.58 |
| Max. Negotiated Rate |
$1,154.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,154.70
|
| Rate for Payer: Bisbee Police All Plans |
$333.58
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Self Pay Self Pay |
$1,026.40
|
|
|
EXCISION TUMOR SOFT TISSUE OF FOOT OR TOE SUBCUTANEOUS; LESS THAN 1.5 CM
|
Facility
|
OP
|
$1,283.00
|
|
|
Service Code
|
CPT 28043
|
| Hospital Charge Code |
24043330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$192.45 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,154.70
|
| Rate for Payer: Aetna of AZ Medicare |
$359.24
|
| Rate for Payer: AHCCCS Medicaid |
$2,040.16
|
| Rate for Payer: Allwell Medicaid |
$2,040.16
|
| Rate for Payer: Allwell Medicare |
$192.45
|
| Rate for Payer: Amerigroup Medicare |
$192.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$479.20
|
| Rate for Payer: AZCH Complete Medicaid |
$2,040.16
|
| Rate for Payer: AZCH Complete Medicare |
$192.45
|
| Rate for Payer: Banner UC Health Medicaid |
$2,040.16
|
| Rate for Payer: Banner UC Health Medicare |
$192.45
|
| Rate for Payer: Bisbee Police All Plans |
$333.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$872.44
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cigna of AZ Commercial |
$641.50
|
| Rate for Payer: Copperpoint Commercial |
$317.54
|
| Rate for Payer: Health Net of AZ Commercial |
$769.80
|
| Rate for Payer: Health Net of AZ Medicare |
$359.24
|
| Rate for Payer: Humana of AZ Medicare |
$192.45
|
| Rate for Payer: Mercy Care Medicaid |
$2,040.16
|
| Rate for Payer: Self Pay Self Pay |
$1,026.40
|
| Rate for Payer: TriWest Medicare |
$192.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$230.94
|
|
|
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTRE
|
Facility
|
OP
|
$4,947.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
22596866
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$742.05 |
| Max. Negotiated Rate |
$4,452.30 |
| Rate for Payer: Aetna of AZ Commercial |
$4,452.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,385.16
|
| Rate for Payer: AHCCCS Medicaid |
$901.86
|
| Rate for Payer: Allwell Medicaid |
$901.86
|
| Rate for Payer: Allwell Medicare |
$742.05
|
| Rate for Payer: Amerigroup Medicare |
$742.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,847.70
|
| Rate for Payer: AZCH Complete Medicaid |
$901.86
|
| Rate for Payer: AZCH Complete Medicare |
$742.05
|
| Rate for Payer: Banner UC Health Medicaid |
$901.86
|
| Rate for Payer: Banner UC Health Medicare |
$742.05
|
| Rate for Payer: Bisbee Police All Plans |
$1,286.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,363.96
|
| Rate for Payer: Cash Price |
$3,957.60
|
| Rate for Payer: Cash Price |
$3,957.60
|
| Rate for Payer: Cigna of AZ Commercial |
$3,462.90
|
| Rate for Payer: Copperpoint Commercial |
$1,224.38
|
| Rate for Payer: Health Net of AZ Commercial |
$2,968.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,385.16
|
| Rate for Payer: Humana of AZ Medicare |
$742.05
|
| Rate for Payer: Mercy Care Medicaid |
$901.86
|
| Rate for Payer: Self Pay Self Pay |
$3,957.60
|
| Rate for Payer: TriWest Medicare |
$742.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$890.46
|
|
|
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTRE
|
Facility
|
IP
|
$4,947.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
22596866
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,286.22 |
| Max. Negotiated Rate |
$4,452.30 |
| Rate for Payer: Aetna of AZ Commercial |
$4,452.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,286.22
|
| Rate for Payer: Cash Price |
$3,957.60
|
| Rate for Payer: Self Pay Self Pay |
$3,957.60
|
|
|
EXTENSION SET MALE ADAPTER SMART SITE
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
22355723
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna of AZ Commercial |
$7.20
|
| Rate for Payer: Bisbee Police All Plans |
$2.08
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Self Pay Self Pay |
$6.40
|
|
|
EXTENSION SET MALE ADAPTER SMART SITE
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
22355723
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna of AZ Commercial |
$7.20
|
| Rate for Payer: Aetna of AZ Medicare |
$2.24
|
| Rate for Payer: Allwell Medicare |
$1.20
|
| Rate for Payer: Amerigroup Medicare |
$1.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.99
|
| Rate for Payer: AZCH Complete Medicare |
$1.20
|
| Rate for Payer: Banner UC Health Medicare |
$1.20
|
| Rate for Payer: Bisbee Police All Plans |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5.44
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cigna of AZ Commercial |
$5.60
|
| Rate for Payer: Copperpoint Commercial |
$1.98
|
| Rate for Payer: Health Net of AZ Commercial |
$4.80
|
| Rate for Payer: Health Net of AZ Medicare |
$2.24
|
| Rate for Payer: Humana of AZ Medicare |
$1.20
|
| Rate for Payer: Self Pay Self Pay |
$6.40
|
| Rate for Payer: TriWest Medicare |
$1.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.44
|
|
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$13,096.54
|
|
|
Service Code
|
APR-DRG 9111
|
| Hospital Charge Code |
APRDRG9111
|
| Min. Negotiated Rate |
$13,096.54 |
| Max. Negotiated Rate |
$13,096.54 |
| Rate for Payer: AHCCCS Medicaid |
$13,096.54
|
| Rate for Payer: Allwell Medicaid |
$13,096.54
|
| Rate for Payer: AZCH Complete Medicaid |
$13,096.54
|
| Rate for Payer: Banner UC Health Medicaid |
$13,096.54
|
| Rate for Payer: Mercy Care Medicaid |
$13,096.54
|
|
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$49,192.69
|
|
|
Service Code
|
APR-DRG 9114
|
| Hospital Charge Code |
APRDRG9114
|
| Min. Negotiated Rate |
$49,192.69 |
| Max. Negotiated Rate |
$49,192.69 |
| Rate for Payer: AHCCCS Medicaid |
$49,192.69
|
| Rate for Payer: Allwell Medicaid |
$49,192.69
|
| Rate for Payer: AZCH Complete Medicaid |
$49,192.69
|
| Rate for Payer: Banner UC Health Medicaid |
$49,192.69
|
| Rate for Payer: Mercy Care Medicaid |
$49,192.69
|
|
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$20,800.72
|
|
|
Service Code
|
APR-DRG 9113
|
| Hospital Charge Code |
APRDRG9112
|
| Min. Negotiated Rate |
$20,800.72 |
| Max. Negotiated Rate |
$20,800.72 |
| Rate for Payer: AHCCCS Medicaid |
$20,800.72
|
| Rate for Payer: Allwell Medicaid |
$20,800.72
|
| Rate for Payer: AZCH Complete Medicaid |
$20,800.72
|
| Rate for Payer: Banner UC Health Medicaid |
$20,800.72
|
| Rate for Payer: Mercy Care Medicaid |
$20,800.72
|
|
