|
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
|
|
|
27780 CLSD TX FX PRX FIBWO/MAN
|
Facility
IP
|
$944.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
22282865
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.48 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$849.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$160.48
|
| Rate for Payer: Amerigroup Medicare |
$160.48
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$160.48
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$160.48
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$245.44
|
| Rate for Payer: Copperpoint |
$264.79
|
| Rate for Payer: Humana Medicare |
$160.48
|
| Rate for Payer: SELF PAY |
$755.20
|
| Rate for Payer: Veterans (Triwest) |
$160.48
|
|
|
27780 CLSD TX FX PRX FIBWO/MAN
|
Facility
OP
|
$944.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
22282865
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.48 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: SELF PAY |
$755.20
|
| Rate for Payer: Aetna POS, PPO, HMO |
$849.60
|
| Rate for Payer: Aetna Medicare |
$264.32
|
| 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 |
$160.48
|
| Rate for Payer: Amerigroup Medicare |
$160.48
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$352.58
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$160.48
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$160.48
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$245.44
|
| Rate for Payer: Cigna All Products |
$660.80
|
| Rate for Payer: Copperpoint |
$264.79
|
| Rate for Payer: HealthNet Commercial |
$566.40
|
| Rate for Payer: HealthNet Medicare |
$264.32
|
| Rate for Payer: Humana Medicare |
$160.48
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: Veterans (Triwest) |
$160.48
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$550.35
|
| Rate for Payer: United Healthcare Medicare |
$169.92
|
|
|
27781 CLSD TX FX PROX FIB W/MA
|
Facility
IP
|
$1,624.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
22282866
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.08 |
| Max. Negotiated Rate |
$1,461.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,461.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$276.08
|
| Rate for Payer: Amerigroup Medicare |
$276.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$276.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$276.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$422.24
|
| Rate for Payer: Copperpoint |
$455.53
|
| Rate for Payer: Humana Medicare |
$276.08
|
| Rate for Payer: SELF PAY |
$1,299.20
|
| Rate for Payer: Veterans (Triwest) |
$276.08
|
|
|
27781 CLSD TX FX PROX FIB W/MA
|
Facility
OP
|
$1,624.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
22282866
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.08 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,461.60
|
| Rate for Payer: Aetna Medicare |
$454.72
|
| 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 |
$276.08
|
| Rate for Payer: Amerigroup Medicare |
$276.08
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$606.56
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$276.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$276.08
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$422.24
|
| Rate for Payer: Cigna All Products |
$1,136.80
|
| Rate for Payer: Copperpoint |
$455.53
|
| Rate for Payer: HealthNet Commercial |
$974.40
|
| Rate for Payer: HealthNet Medicare |
$454.72
|
| Rate for Payer: Humana Medicare |
$276.08
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$1,299.20
|
| Rate for Payer: Veterans (Triwest) |
$276.08
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$946.79
|
| Rate for Payer: United Healthcare Medicare |
$292.32
|
|
|
27786 CLSD TX FX DIS FIB WO/MA
|
Facility
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
22282867
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$922.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$174.25
|
| Rate for Payer: Amerigroup Medicare |
$174.25
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$174.25
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$174.25
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$266.50
|
| Rate for Payer: Copperpoint |
$287.51
|
| Rate for Payer: Humana Medicare |
$174.25
|
| Rate for Payer: SELF PAY |
$820.00
|
| Rate for Payer: Veterans (Triwest) |
$174.25
|
|
|
27786 CLSD TX FX DIS FIB WO/MA
|
Facility
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
22282867
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$922.50
|
| Rate for Payer: Aetna Medicare |
$287.00
|
| 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 |
$174.25
|
| Rate for Payer: Amerigroup Medicare |
$174.25
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$382.84
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$174.25
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$174.25
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$266.50
|
| Rate for Payer: Cigna All Products |
$717.50
|
| Rate for Payer: Copperpoint |
$287.51
|
| Rate for Payer: HealthNet Commercial |
$615.00
|
| Rate for Payer: HealthNet Medicare |
$287.00
|
| Rate for Payer: Humana Medicare |
$174.25
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$820.00
|
| Rate for Payer: Veterans (Triwest) |
$174.25
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$597.57
|
| Rate for Payer: United Healthcare Medicare |
$184.50
|
|
|
27788 CLSD TX FX DISTFIB W/M
|
Facility
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
22282868
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$1,323.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,323.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$249.90
|
| Rate for Payer: Amerigroup Medicare |
$249.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$249.90
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$249.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$382.20
|
| Rate for Payer: Copperpoint |
$412.34
|
| Rate for Payer: Humana Medicare |
$249.90
|
| Rate for Payer: SELF PAY |
$1,176.00
|
| Rate for Payer: Veterans (Triwest) |
$249.90
|
|
|
27788 CLSD TX FX DISTFIB W/M
|
Facility
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
22282868
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$1,323.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,323.00
|
| Rate for Payer: Aetna Medicare |
$411.60
|
| 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 |
$249.90
|
| Rate for Payer: Amerigroup Medicare |
$249.90
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$549.04
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$249.90
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$249.90
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$382.20
|
| Rate for Payer: Cigna All Products |
$1,029.00
|
| Rate for Payer: Copperpoint |
$412.34
|
| Rate for Payer: HealthNet Commercial |
$882.00
|
| Rate for Payer: HealthNet Medicare |
$411.60
|
| Rate for Payer: Humana Medicare |
$249.90
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$1,176.00
|
| Rate for Payer: Veterans (Triwest) |
$249.90
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$857.01
|
| Rate for Payer: United Healthcare Medicare |
$264.60
|
|
|
27808 CLD TX FX BIMALL AKL WOM
|
Facility
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
22282869
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.59 |
| Max. Negotiated Rate |
$1,104.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,104.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$208.59
|
| Rate for Payer: Amerigroup Medicare |
$208.59
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$208.59
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$208.59
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$319.02
|
| Rate for Payer: Copperpoint |
$344.17
|
| Rate for Payer: Humana Medicare |
$208.59
|
| Rate for Payer: SELF PAY |
$981.60
|
| Rate for Payer: Veterans (Triwest) |
$208.59
|
|
|
27808 CLD TX FX BIMALL AKL WOM
|
Facility
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
22282869
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.59 |
| Max. Negotiated Rate |
$1,104.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,104.30
|
| Rate for Payer: Aetna Medicare |
$343.56
|
| 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 |
$208.59
|
| Rate for Payer: Amerigroup Medicare |
$208.59
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$458.28
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$208.59
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$208.59
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$319.02
|
| Rate for Payer: Cigna All Products |
$858.90
|
| Rate for Payer: Copperpoint |
$344.17
|
| Rate for Payer: HealthNet Commercial |
$736.20
|
| Rate for Payer: HealthNet Medicare |
$343.56
|
| Rate for Payer: Humana Medicare |
$208.59
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$981.60
|
| Rate for Payer: Veterans (Triwest) |
$208.59
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$715.34
|
| Rate for Payer: United Healthcare Medicare |
$220.86
|
|
|
27810 CLSD TXFXBIMALL ANKLN/MN
|
Facility
OP
|
$2,032.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
22282870
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.44 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,828.80
|
| Rate for Payer: Aetna Medicare |
$568.96
|
| 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 |
$345.44
|
| Rate for Payer: Amerigroup Medicare |
$345.44
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$758.95
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$345.44
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$345.44
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$528.32
|
| Rate for Payer: Cigna All Products |
$1,422.40
|
| Rate for Payer: Copperpoint |
$569.98
|
| Rate for Payer: HealthNet Commercial |
$1,219.20
|
| Rate for Payer: HealthNet Medicare |
$568.96
|
| Rate for Payer: Humana Medicare |
$345.44
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$1,625.60
|
| Rate for Payer: Veterans (Triwest) |
$345.44
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,184.66
|
| Rate for Payer: United Healthcare Medicare |
$365.76
|
|
|
27810 CLSD TXFXBIMALL ANKLN/MN
|
Facility
IP
|
$2,032.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
22282870
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.44 |
| Max. Negotiated Rate |
$1,828.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,828.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$345.44
|
| Rate for Payer: Amerigroup Medicare |
$345.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$345.44
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$345.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$528.32
|
| Rate for Payer: Copperpoint |
$569.98
|
| Rate for Payer: Humana Medicare |
$345.44
|
| Rate for Payer: SELF PAY |
$1,625.60
|
| Rate for Payer: Veterans (Triwest) |
$345.44
|
|
|
27840 CLSD TX AKLE DIS W/O ANE
|
Facility
OP
|
$1,595.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
22282871
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$1,435.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,435.50
|
| Rate for Payer: Aetna Medicare |
$446.60
|
| 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 |
$271.15
|
| Rate for Payer: Amerigroup Medicare |
$271.15
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$595.73
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$271.15
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$271.15
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$414.70
|
| Rate for Payer: Cigna All Products |
$1,116.50
|
| Rate for Payer: Copperpoint |
$447.40
|
| Rate for Payer: HealthNet Commercial |
$957.00
|
| Rate for Payer: HealthNet Medicare |
$446.60
|
| Rate for Payer: Humana Medicare |
$271.15
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$1,276.00
|
| Rate for Payer: Veterans (Triwest) |
$271.15
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$929.88
|
| Rate for Payer: United Healthcare Medicare |
$287.10
|
|
|
27840 CLSD TX AKLE DIS W/O ANE
|
Facility
IP
|
$1,595.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
22282871
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$1,435.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,435.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$271.15
|
| Rate for Payer: Amerigroup Medicare |
$271.15
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$271.15
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$271.15
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$414.70
|
| Rate for Payer: Copperpoint |
$447.40
|
| Rate for Payer: Humana Medicare |
$271.15
|
| Rate for Payer: SELF PAY |
$1,276.00
|
| Rate for Payer: Veterans (Triwest) |
$271.15
|
|
|
28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PH
|
Facility
IP
|
$1,475.00
|
|
|
Service Code
|
CPT 28108
|
| Hospital Charge Code |
27410736
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$250.75 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,327.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$250.75
|
| Rate for Payer: Amerigroup Medicare |
$250.75
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$250.75
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$250.75
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$383.50
|
| Rate for Payer: Copperpoint |
$413.74
|
| Rate for Payer: Humana Medicare |
$250.75
|
| Rate for Payer: SELF PAY |
$1,180.00
|
| Rate for Payer: Veterans (Triwest) |
$250.75
|
|
|
28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PH
|
Facility
OP
|
$1,475.00
|
|
|
Service Code
|
CPT 28108
|
| Hospital Charge Code |
27410736
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$250.75 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,327.50
|
| Rate for Payer: Aetna Medicare |
$413.00
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,018.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$250.75
|
| Rate for Payer: Amerigroup Medicare |
$250.75
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$550.91
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,018.90
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$250.75
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$250.75
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,018.90
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$383.50
|
| Rate for Payer: Cigna All Products |
$737.50
|
| Rate for Payer: Copperpoint |
$413.74
|
| Rate for Payer: HealthNet Commercial |
$885.00
|
| Rate for Payer: HealthNet Medicare |
$413.00
|
| Rate for Payer: Humana Medicare |
$250.75
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: SELF PAY |
$1,180.00
|
| Rate for Payer: Veterans (Triwest) |
$250.75
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$859.92
|
| Rate for Payer: United Healthcare Medicare |
$265.50
|
|
|
28490 CLSD TX FX GR TOE W/O MA
|
Facility
IP
|
$435.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
22282872
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$391.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$73.95
|
| Rate for Payer: Amerigroup Medicare |
$73.95
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$73.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$73.95
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$113.10
|
| Rate for Payer: Copperpoint |
$122.02
|
| Rate for Payer: Humana Medicare |
$73.95
|
| Rate for Payer: SELF PAY |
$348.00
|
| Rate for Payer: Veterans (Triwest) |
$73.95
|
|
|
28490 CLSD TX FX GR TOE W/O MA
|
Facility
OP
|
$435.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
22282872
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$391.50
|
| Rate for Payer: Aetna Medicare |
$121.80
|
| 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 |
$73.95
|
| Rate for Payer: Amerigroup Medicare |
$73.95
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$162.47
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$73.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$73.95
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$113.10
|
| Rate for Payer: Cigna All Products |
$304.50
|
| Rate for Payer: Copperpoint |
$122.02
|
| Rate for Payer: HealthNet Commercial |
$261.00
|
| Rate for Payer: HealthNet Medicare |
$121.80
|
| Rate for Payer: Humana Medicare |
$73.95
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$348.00
|
| Rate for Payer: Veterans (Triwest) |
$73.95
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$253.60
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
|
|
28495 CLSD TX FX GR TOE W/MANI
|
Facility
OP
|
$552.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
22282873
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$496.80
|
| Rate for Payer: Aetna Medicare |
$154.56
|
| 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 |
$93.84
|
| Rate for Payer: Amerigroup Medicare |
$93.84
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$206.17
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$93.84
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$93.84
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$143.52
|
| Rate for Payer: Cigna All Products |
$386.40
|
| Rate for Payer: Copperpoint |
$154.84
|
| Rate for Payer: HealthNet Commercial |
$331.20
|
| Rate for Payer: HealthNet Medicare |
$154.56
|
| Rate for Payer: Humana Medicare |
$93.84
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$441.60
|
| Rate for Payer: Veterans (Triwest) |
$93.84
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$321.82
|
| Rate for Payer: United Healthcare Medicare |
$99.36
|
|
|
28495 CLSD TX FX GR TOE W/MANI
|
Facility
IP
|
$552.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
22282873
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$496.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$93.84
|
| Rate for Payer: Amerigroup Medicare |
$93.84
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$93.84
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$93.84
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$143.52
|
| Rate for Payer: Copperpoint |
$154.84
|
| Rate for Payer: Humana Medicare |
$93.84
|
| Rate for Payer: SELF PAY |
$441.60
|
| Rate for Payer: Veterans (Triwest) |
$93.84
|
|
|
28660 REDUCTION DISLOCATED TOE
|
Facility
OP
|
$378.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
22282874
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$340.20
|
| Rate for Payer: Aetna Medicare |
$105.84
|
| 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 |
$64.26
|
| Rate for Payer: Amerigroup Medicare |
$64.26
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$141.18
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$298.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$64.26
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$64.26
|
| Rate for Payer: Banner University Family Care Medicaid |
$298.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$98.28
|
| Rate for Payer: Cigna All Products |
$264.60
|
| Rate for Payer: Copperpoint |
$106.03
|
| Rate for Payer: HealthNet Commercial |
$226.80
|
| Rate for Payer: HealthNet Medicare |
$105.84
|
| Rate for Payer: Humana Medicare |
$64.26
|
| Rate for Payer: Mercy Care Medicaid |
$298.98
|
| Rate for Payer: SELF PAY |
$302.40
|
| Rate for Payer: Veterans (Triwest) |
$64.26
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$220.37
|
| Rate for Payer: United Healthcare Medicare |
$68.04
|
|
|
28660 REDUCTION DISLOCATED TOE
|
Facility
IP
|
$378.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
22282874
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: SELF PAY |
$302.40
|
| Rate for Payer: Aetna POS, PPO, HMO |
$340.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$64.26
|
| Rate for Payer: Amerigroup Medicare |
$64.26
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$64.26
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$64.26
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$98.28
|
| Rate for Payer: Copperpoint |
$106.03
|
| Rate for Payer: Humana Medicare |
$64.26
|
| Rate for Payer: Veterans (Triwest) |
$64.26
|
|
|
29105 APL LNG ARM SPLNT
|
Facility
OP
|
$191.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
22282875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$204.72 |
| Rate for Payer: Aetna POS, PPO, HMO |
$171.90
|
| Rate for Payer: Aetna Medicare |
$53.48
|
| Rate for Payer: AHCCCS Medicaid |
$204.72
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$204.72
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$32.47
|
| Rate for Payer: Amerigroup Medicare |
$32.47
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$71.34
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$204.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$32.47
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$32.47
|
| Rate for Payer: Banner University Family Care Medicaid |
$204.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$49.66
|
| Rate for Payer: Cigna All Products |
$133.70
|
| Rate for Payer: Copperpoint |
$53.58
|
| Rate for Payer: HealthNet Commercial |
$114.60
|
| Rate for Payer: HealthNet Medicare |
$53.48
|
| Rate for Payer: Humana Medicare |
$32.47
|
| Rate for Payer: Mercy Care Medicaid |
$204.72
|
| Rate for Payer: SELF PAY |
$152.80
|
| Rate for Payer: Veterans (Triwest) |
$32.47
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$111.35
|
| Rate for Payer: United Healthcare Medicare |
$34.38
|
|
|
29105 APL LNG ARM SPLNT
|
Facility
IP
|
$191.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
22282875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$171.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$32.47
|
| Rate for Payer: Amerigroup Medicare |
$32.47
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$32.47
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$32.47
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$49.66
|
| Rate for Payer: Copperpoint |
$53.58
|
| Rate for Payer: Humana Medicare |
$32.47
|
| Rate for Payer: SELF PAY |
$152.80
|
| Rate for Payer: Veterans (Triwest) |
$32.47
|
|