|
29580 STRAPPING UNNA BOOT
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
22282891
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of AZ Commercial |
$153.00
|
| Rate for Payer: Bisbee Police All Plans |
$44.20
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Self Pay Self Pay |
$136.00
|
|
|
29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL
|
Facility
|
OP
|
$2,951.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
23206694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$442.65 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$2,655.90
|
| Rate for Payer: Aetna of AZ Medicare |
$826.28
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$442.65
|
| Rate for Payer: Amerigroup Medicare |
$442.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,102.20
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$442.65
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$442.65
|
| Rate for Payer: Bisbee Police All Plans |
$767.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,006.68
|
| Rate for Payer: Cash Price |
$2,360.80
|
| Rate for Payer: Cash Price |
$2,360.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,475.50
|
| Rate for Payer: Copperpoint Commercial |
$730.37
|
| Rate for Payer: Health Net of AZ Commercial |
$1,770.60
|
| Rate for Payer: Health Net of AZ Medicare |
$826.28
|
| Rate for Payer: Humana of AZ Medicare |
$442.65
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$2,360.80
|
| Rate for Payer: TriWest Medicare |
$442.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$531.18
|
|
|
29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL
|
Facility
|
IP
|
$2,951.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
23206694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$767.26 |
| Max. Negotiated Rate |
$2,655.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,655.90
|
| Rate for Payer: Bisbee Police All Plans |
$767.26
|
| Rate for Payer: Cash Price |
$2,360.80
|
| Rate for Payer: Self Pay Self Pay |
$2,360.80
|
|
|
2 AND 2.5 CANNULATED DRILL 1.65MM
|
Facility
|
IP
|
$969.00
|
|
| Hospital Charge Code |
27341822
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$251.94 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna of AZ Commercial |
$872.10
|
| Rate for Payer: Bisbee Police All Plans |
$251.94
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Self Pay Self Pay |
$775.20
|
|
|
2 AND 2.5 CANNULATED DRILL 1.65MM
|
Facility
|
OP
|
$969.00
|
|
| Hospital Charge Code |
27341822
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna of AZ Commercial |
$872.10
|
| Rate for Payer: Aetna of AZ Medicare |
$271.32
|
| Rate for Payer: Allwell Medicare |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$361.92
|
| Rate for Payer: AZCH Complete Medicare |
$145.35
|
| Rate for Payer: Banner UC Health Medicare |
$145.35
|
| Rate for Payer: Bisbee Police All Plans |
$251.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$658.92
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna of AZ Commercial |
$678.30
|
| Rate for Payer: Copperpoint Commercial |
$239.83
|
| Rate for Payer: Health Net of AZ Commercial |
$581.40
|
| Rate for Payer: Health Net of AZ Medicare |
$271.32
|
| Rate for Payer: Humana of AZ Medicare |
$145.35
|
| Rate for Payer: Self Pay Self Pay |
$775.20
|
| Rate for Payer: TriWest Medicare |
$145.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$564.93
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$174.42
|
|
|
30300 RMV FB NOSE
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
22282892
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$259.20
|
| Rate for Payer: Aetna of AZ Medicare |
$80.64
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$43.20
|
| Rate for Payer: Amerigroup Medicare |
$43.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$107.57
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$43.20
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$43.20
|
| Rate for Payer: Bisbee Police All Plans |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$195.84
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna of AZ Commercial |
$201.60
|
| Rate for Payer: Copperpoint Commercial |
$71.28
|
| Rate for Payer: Health Net of AZ Commercial |
$172.80
|
| Rate for Payer: Health Net of AZ Medicare |
$80.64
|
| Rate for Payer: Humana of AZ Medicare |
$43.20
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$230.40
|
| Rate for Payer: TriWest Medicare |
$43.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$51.84
|
|
|
30300 RMV FB NOSE
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
22282892
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.88 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of AZ Commercial |
$259.20
|
| Rate for Payer: Bisbee Police All Plans |
$74.88
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Self Pay Self Pay |
$230.40
|
|
|
30901 TX EPISTAXIS ANT SIMPLE
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
22282893
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Aetna of AZ Commercial |
$454.50
|
| Rate for Payer: Bisbee Police All Plans |
$131.30
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Self Pay Self Pay |
$404.00
|
|
|
30901 TX EPISTAXIS ANT SIMPLE
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
22282893
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$454.50
|
| Rate for Payer: Aetna of AZ Medicare |
$141.40
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$75.75
|
| Rate for Payer: Amerigroup Medicare |
$75.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$188.62
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$75.75
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$75.75
|
| Rate for Payer: Bisbee Police All Plans |
$131.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$343.40
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cigna of AZ Commercial |
$353.50
|
| Rate for Payer: Copperpoint Commercial |
$124.99
|
| Rate for Payer: Health Net of AZ Commercial |
$303.00
|
| Rate for Payer: Health Net of AZ Medicare |
$141.40
|
| Rate for Payer: Humana of AZ Medicare |
$75.75
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$404.00
|
| Rate for Payer: TriWest Medicare |
$75.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$90.90
|
|
|
30903 TX EPISTAXIS ANT COMPLEX
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
22282894
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.42 |
| Max. Negotiated Rate |
$870.30 |
| Rate for Payer: Aetna of AZ Commercial |
$870.30
|
| Rate for Payer: Bisbee Police All Plans |
$251.42
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Self Pay Self Pay |
$773.60
|
|
|
30903 TX EPISTAXIS ANT COMPLEX
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
22282894
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$870.30
|
| Rate for Payer: Aetna of AZ Medicare |
$270.76
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$145.05
|
| Rate for Payer: Amerigroup Medicare |
$145.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$361.17
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$145.05
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$145.05
|
| Rate for Payer: Bisbee Police All Plans |
$251.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$657.56
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cigna of AZ Commercial |
$676.90
|
| Rate for Payer: Copperpoint Commercial |
$239.33
|
| Rate for Payer: Health Net of AZ Commercial |
$580.20
|
| Rate for Payer: Health Net of AZ Medicare |
$270.76
|
| Rate for Payer: Humana of AZ Medicare |
$145.05
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$773.60
|
| Rate for Payer: TriWest Medicare |
$145.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$174.06
|
|
|
30905 TX EPISTAXIS POST SIMPLE
|
Facility
|
OP
|
$1,203.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
22282895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.32 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,082.70
|
| Rate for Payer: Aetna of AZ Medicare |
$336.84
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$180.45
|
| Rate for Payer: Amerigroup Medicare |
$180.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$449.32
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$180.45
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$180.45
|
| Rate for Payer: Bisbee Police All Plans |
$312.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$818.04
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cigna of AZ Commercial |
$842.10
|
| Rate for Payer: Copperpoint Commercial |
$297.74
|
| Rate for Payer: Health Net of AZ Commercial |
$721.80
|
| Rate for Payer: Health Net of AZ Medicare |
$336.84
|
| Rate for Payer: Humana of AZ Medicare |
$180.45
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$962.40
|
| Rate for Payer: TriWest Medicare |
$180.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$216.54
|
|
|
30905 TX EPISTAXIS POST SIMPLE
|
Facility
|
IP
|
$1,203.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
22282895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$312.78 |
| Max. Negotiated Rate |
$1,082.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,082.70
|
| Rate for Payer: Bisbee Police All Plans |
$312.78
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Self Pay Self Pay |
$962.40
|
|
|
30906 TX EPISTAXIS POST COMPLEX
|
Facility
|
IP
|
$1,341.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
22282896
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.66 |
| Max. Negotiated Rate |
$1,206.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,206.90
|
| Rate for Payer: Bisbee Police All Plans |
$348.66
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Self Pay Self Pay |
$1,072.80
|
|
|
30906 TX EPISTAXIS POST COMPLEX
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
22282896
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.15 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,206.90
|
| Rate for Payer: Aetna of AZ Medicare |
$375.48
|
| Rate for Payer: AHCCCS Medicaid |
$306.82
|
| Rate for Payer: Allwell Medicaid |
$306.82
|
| Rate for Payer: Allwell Medicare |
$201.15
|
| Rate for Payer: Amerigroup Medicare |
$201.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$500.86
|
| Rate for Payer: AZCH Complete Medicaid |
$306.82
|
| Rate for Payer: AZCH Complete Medicare |
$201.15
|
| Rate for Payer: Banner UC Health Medicaid |
$306.82
|
| Rate for Payer: Banner UC Health Medicare |
$201.15
|
| Rate for Payer: Bisbee Police All Plans |
$348.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$911.88
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Cigna of AZ Commercial |
$938.70
|
| Rate for Payer: Copperpoint Commercial |
$331.90
|
| Rate for Payer: Health Net of AZ Commercial |
$804.60
|
| Rate for Payer: Health Net of AZ Medicare |
$375.48
|
| Rate for Payer: Humana of AZ Medicare |
$201.15
|
| Rate for Payer: Mercy Care Medicaid |
$306.82
|
| Rate for Payer: Self Pay Self Pay |
$1,072.80
|
| Rate for Payer: TriWest Medicare |
$201.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$241.38
|
|
|
3-0 Chromic Gut FS-1
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
22926446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna of AZ Commercial |
$19.80
|
| Rate for Payer: Bisbee Police All Plans |
$5.72
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Self Pay Self Pay |
$17.60
|
|
|
3-0 Chromic Gut FS-1
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
22926446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna of AZ Commercial |
$19.80
|
| Rate for Payer: Aetna of AZ Medicare |
$6.16
|
| Rate for Payer: Allwell Medicare |
$3.30
|
| Rate for Payer: Amerigroup Medicare |
$3.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$8.22
|
| Rate for Payer: AZCH Complete Medicare |
$3.30
|
| Rate for Payer: Banner UC Health Medicare |
$3.30
|
| Rate for Payer: Bisbee Police All Plans |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$14.96
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cigna of AZ Commercial |
$15.40
|
| Rate for Payer: Copperpoint Commercial |
$5.44
|
| Rate for Payer: Health Net of AZ Commercial |
$13.20
|
| Rate for Payer: Health Net of AZ Medicare |
$6.16
|
| Rate for Payer: Humana of AZ Medicare |
$3.30
|
| Rate for Payer: Self Pay Self Pay |
$17.60
|
| Rate for Payer: TriWest Medicare |
$3.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$12.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.96
|
|
|
3-0 Chromic Gut FS-2
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
22926445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of AZ Commercial |
$18.90
|
| Rate for Payer: Bisbee Police All Plans |
$5.46
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Self Pay Self Pay |
$16.80
|
|
|
3-0 Chromic Gut FS-2
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
22926445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of AZ Commercial |
$18.90
|
| Rate for Payer: Aetna of AZ Medicare |
$5.88
|
| Rate for Payer: Allwell Medicare |
$3.15
|
| Rate for Payer: Amerigroup Medicare |
$3.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$7.84
|
| Rate for Payer: AZCH Complete Medicare |
$3.15
|
| Rate for Payer: Banner UC Health Medicare |
$3.15
|
| Rate for Payer: Bisbee Police All Plans |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna of AZ Commercial |
$14.70
|
| Rate for Payer: Copperpoint Commercial |
$5.20
|
| Rate for Payer: Health Net of AZ Commercial |
$12.60
|
| Rate for Payer: Health Net of AZ Medicare |
$5.88
|
| Rate for Payer: Humana of AZ Medicare |
$3.15
|
| Rate for Payer: Self Pay Self Pay |
$16.80
|
| Rate for Payer: TriWest Medicare |
$3.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$12.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.78
|
|
|
3-0 Prolene FS-1
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
22926432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of AZ Commercial |
$16.20
|
| Rate for Payer: Aetna of AZ Medicare |
$5.04
|
| Rate for Payer: Allwell Medicare |
$2.70
|
| Rate for Payer: Amerigroup Medicare |
$2.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$6.72
|
| Rate for Payer: AZCH Complete Medicare |
$2.70
|
| Rate for Payer: Banner UC Health Medicare |
$2.70
|
| Rate for Payer: Bisbee Police All Plans |
$4.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$12.24
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of AZ Commercial |
$12.60
|
| Rate for Payer: Copperpoint Commercial |
$4.46
|
| Rate for Payer: Health Net of AZ Commercial |
$10.80
|
| Rate for Payer: Health Net of AZ Medicare |
$5.04
|
| Rate for Payer: Humana of AZ Medicare |
$2.70
|
| Rate for Payer: Self Pay Self Pay |
$14.40
|
| Rate for Payer: TriWest Medicare |
$2.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$10.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.24
|
|
|
3-0 Prolene FS-1
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
22926432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of AZ Commercial |
$16.20
|
| Rate for Payer: Bisbee Police All Plans |
$4.68
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Self Pay Self Pay |
$14.40
|
|
|
3-0 Vicryl Plus MH Violet Braided
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
22926429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of AZ Commercial |
$11.70
|
| Rate for Payer: Aetna of AZ Medicare |
$3.64
|
| Rate for Payer: Allwell Medicare |
$1.95
|
| Rate for Payer: Amerigroup Medicare |
$1.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4.86
|
| Rate for Payer: AZCH Complete Medicare |
$1.95
|
| Rate for Payer: Banner UC Health Medicare |
$1.95
|
| Rate for Payer: Bisbee Police All Plans |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$8.84
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cigna of AZ Commercial |
$9.10
|
| Rate for Payer: Copperpoint Commercial |
$3.22
|
| Rate for Payer: Health Net of AZ Commercial |
$7.80
|
| Rate for Payer: Health Net of AZ Medicare |
$3.64
|
| Rate for Payer: Humana of AZ Medicare |
$1.95
|
| Rate for Payer: Self Pay Self Pay |
$10.40
|
| Rate for Payer: TriWest Medicare |
$1.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$7.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.34
|
|
|
3-0 Vicryl Plus MH Violet Braided
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
22926429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of AZ Commercial |
$11.70
|
| Rate for Payer: Bisbee Police All Plans |
$3.38
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Self Pay Self Pay |
$10.40
|
|
|
31500 INTUB ET
|
Facility
|
IP
|
$1,146.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
22282897
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.96 |
| Max. Negotiated Rate |
$1,031.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,031.40
|
| Rate for Payer: Bisbee Police All Plans |
$297.96
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Self Pay Self Pay |
$916.80
|
|
|
31500 INTUB ET
|
Facility
|
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
22282897
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.90 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,031.40
|
| Rate for Payer: Aetna of AZ Medicare |
$320.88
|
| Rate for Payer: AHCCCS Medicaid |
$306.82
|
| Rate for Payer: Allwell Medicaid |
$306.82
|
| Rate for Payer: Allwell Medicare |
$171.90
|
| Rate for Payer: Amerigroup Medicare |
$171.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$428.03
|
| Rate for Payer: AZCH Complete Medicaid |
$306.82
|
| Rate for Payer: AZCH Complete Medicare |
$171.90
|
| Rate for Payer: Banner UC Health Medicaid |
$306.82
|
| Rate for Payer: Banner UC Health Medicare |
$171.90
|
| Rate for Payer: Bisbee Police All Plans |
$297.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$779.28
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cigna of AZ Commercial |
$802.20
|
| Rate for Payer: Copperpoint Commercial |
$283.64
|
| Rate for Payer: Health Net of AZ Commercial |
$687.60
|
| Rate for Payer: Health Net of AZ Medicare |
$320.88
|
| Rate for Payer: Humana of AZ Medicare |
$171.90
|
| Rate for Payer: Mercy Care Medicaid |
$306.82
|
| Rate for Payer: Self Pay Self Pay |
$916.80
|
| Rate for Payer: TriWest Medicare |
$171.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$206.28
|
|
