|
29520 STRAPPING HIP
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
22282887
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$118.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$22.44
|
| Rate for Payer: Amerigroup Medicare |
$22.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$22.44
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$22.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$34.32
|
| Rate for Payer: Copperpoint |
$37.03
|
| Rate for Payer: Humana Medicare |
$22.44
|
| Rate for Payer: SELF PAY |
$105.60
|
| Rate for Payer: Veterans (Triwest) |
$22.44
|
|
|
29530 STRAPPING KNEE
|
Facility
OP
|
$169.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
22282888
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$162.32 |
| Rate for Payer: Aetna POS, PPO, HMO |
$152.10
|
| Rate for Payer: Aetna Medicare |
$47.32
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$28.73
|
| Rate for Payer: Amerigroup Medicare |
$28.73
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$63.12
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$162.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$28.73
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$28.73
|
| Rate for Payer: Banner University Family Care Medicaid |
$162.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$43.94
|
| Rate for Payer: Cigna All Products |
$118.30
|
| Rate for Payer: Copperpoint |
$47.40
|
| Rate for Payer: HealthNet Commercial |
$101.40
|
| Rate for Payer: HealthNet Medicare |
$47.32
|
| Rate for Payer: Humana Medicare |
$28.73
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: SELF PAY |
$135.20
|
| Rate for Payer: Veterans (Triwest) |
$28.73
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$98.53
|
| Rate for Payer: United Healthcare Medicare |
$30.42
|
|
|
29530 STRAPPING KNEE
|
Facility
IP
|
$169.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
22282888
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$152.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$28.73
|
| Rate for Payer: Amerigroup Medicare |
$28.73
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$28.73
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$28.73
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$43.94
|
| Rate for Payer: Copperpoint |
$47.40
|
| Rate for Payer: Humana Medicare |
$28.73
|
| Rate for Payer: SELF PAY |
$135.20
|
| Rate for Payer: Veterans (Triwest) |
$28.73
|
|
|
29540 STRAPPING ANKLE
|
Facility
OP
|
$138.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
22282889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$204.72 |
| Rate for Payer: Aetna POS, PPO, HMO |
$124.20
|
| Rate for Payer: Aetna Medicare |
$38.64
|
| 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 |
$23.46
|
| Rate for Payer: Amerigroup Medicare |
$23.46
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$51.54
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$204.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.46
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.46
|
| Rate for Payer: Banner University Family Care Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$89.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$35.88
|
| Rate for Payer: Cigna All Products |
$96.60
|
| Rate for Payer: Copperpoint |
$38.71
|
| Rate for Payer: HealthNet Commercial |
$82.80
|
| Rate for Payer: HealthNet Medicare |
$38.64
|
| Rate for Payer: Humana Medicare |
$23.46
|
| Rate for Payer: Mercy Care Medicaid |
$204.72
|
| Rate for Payer: SELF PAY |
$110.40
|
| Rate for Payer: Veterans (Triwest) |
$23.46
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$80.45
|
| Rate for Payer: United Healthcare Medicare |
$24.84
|
|
|
29540 STRAPPING ANKLE
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
22282889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$124.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$23.46
|
| Rate for Payer: Amerigroup Medicare |
$23.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.46
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$89.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$35.88
|
| Rate for Payer: Copperpoint |
$38.71
|
| Rate for Payer: Humana Medicare |
$23.46
|
| Rate for Payer: SELF PAY |
$110.40
|
| Rate for Payer: Veterans (Triwest) |
$23.46
|
|
|
29550 STRAPPING TOES
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
22282890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$115.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$21.76
|
| Rate for Payer: Amerigroup Medicare |
$21.76
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$21.76
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$21.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$33.28
|
| Rate for Payer: Copperpoint |
$35.90
|
| Rate for Payer: Humana Medicare |
$21.76
|
| Rate for Payer: SELF PAY |
$102.40
|
| Rate for Payer: Veterans (Triwest) |
$21.76
|
|
|
29550 STRAPPING TOES
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
22282890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$115.20
|
| Rate for Payer: Aetna Medicare |
$35.84
|
| Rate for Payer: AHCCCS Medicaid |
$80.70
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$80.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$21.76
|
| Rate for Payer: Amerigroup Medicare |
$21.76
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$47.81
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$80.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$21.76
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$21.76
|
| Rate for Payer: Banner University Family Care Medicaid |
$80.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$33.28
|
| Rate for Payer: Cigna All Products |
$89.60
|
| Rate for Payer: Copperpoint |
$35.90
|
| Rate for Payer: HealthNet Commercial |
$76.80
|
| Rate for Payer: HealthNet Medicare |
$35.84
|
| Rate for Payer: Humana Medicare |
$21.76
|
| Rate for Payer: Mercy Care Medicaid |
$80.70
|
| Rate for Payer: SELF PAY |
$102.40
|
| Rate for Payer: Veterans (Triwest) |
$21.76
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$74.62
|
| Rate for Payer: United Healthcare Medicare |
$23.04
|
|
|
29580 STRAPPING UNNA BOOT
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
22282891
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.54 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$145.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$27.54
|
| Rate for Payer: Amerigroup Medicare |
$27.54
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$27.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$27.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$42.12
|
| Rate for Payer: Copperpoint |
$45.44
|
| Rate for Payer: Humana Medicare |
$27.54
|
| Rate for Payer: SELF PAY |
$129.60
|
| Rate for Payer: Veterans (Triwest) |
$27.54
|
|
|
29580 STRAPPING UNNA BOOT
|
Facility
OP
|
$162.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
22282891
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.54 |
| Max. Negotiated Rate |
$204.72 |
| Rate for Payer: Aetna POS, PPO, HMO |
$145.80
|
| Rate for Payer: Aetna Medicare |
$45.36
|
| 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 |
$27.54
|
| Rate for Payer: Amerigroup Medicare |
$27.54
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$60.51
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$204.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$27.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$27.54
|
| Rate for Payer: Banner University Family Care Medicaid |
$204.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$42.12
|
| Rate for Payer: Cigna All Products |
$113.40
|
| Rate for Payer: Copperpoint |
$45.44
|
| Rate for Payer: HealthNet Commercial |
$97.20
|
| Rate for Payer: HealthNet Medicare |
$45.36
|
| Rate for Payer: Humana Medicare |
$27.54
|
| Rate for Payer: Mercy Care Medicaid |
$204.72
|
| Rate for Payer: SELF PAY |
$129.60
|
| Rate for Payer: Veterans (Triwest) |
$27.54
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$94.45
|
| Rate for Payer: United Healthcare Medicare |
$29.16
|
|
|
29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL
|
Facility
OP
|
$2,810.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
23206694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$477.70 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,529.00
|
| Rate for Payer: Aetna Medicare |
$786.80
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4,104.08
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$477.70
|
| Rate for Payer: Amerigroup Medicare |
$477.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,049.54
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4,104.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$477.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$477.70
|
| Rate for Payer: Banner University Family Care Medicaid |
$4,104.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$730.60
|
| Rate for Payer: Cigna All Products |
$1,405.00
|
| Rate for Payer: Copperpoint |
$788.21
|
| Rate for Payer: HealthNet Commercial |
$1,686.00
|
| Rate for Payer: HealthNet Medicare |
$786.80
|
| Rate for Payer: Humana Medicare |
$477.70
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: SELF PAY |
$2,248.00
|
| Rate for Payer: Veterans (Triwest) |
$477.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,638.23
|
| Rate for Payer: United Healthcare Medicare |
$505.80
|
|
|
29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL
|
Facility
IP
|
$2,810.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
23206694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$477.70 |
| Max. Negotiated Rate |
$2,529.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,529.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$477.70
|
| Rate for Payer: Amerigroup Medicare |
$477.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$477.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$477.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$730.60
|
| Rate for Payer: Copperpoint |
$788.21
|
| Rate for Payer: Humana Medicare |
$477.70
|
| Rate for Payer: SELF PAY |
$2,248.00
|
| Rate for Payer: Veterans (Triwest) |
$477.70
|
|
|
30300 RMV FB NOSE
|
Facility
OP
|
$274.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
22282892
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$246.60
|
| Rate for Payer: Aetna Medicare |
$76.72
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$46.58
|
| Rate for Payer: Amerigroup Medicare |
$46.58
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$102.34
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$162.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$46.58
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$46.58
|
| Rate for Payer: Banner University Family Care Medicaid |
$162.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$71.24
|
| Rate for Payer: Cigna All Products |
$191.80
|
| Rate for Payer: Copperpoint |
$76.86
|
| Rate for Payer: HealthNet Commercial |
$164.40
|
| Rate for Payer: HealthNet Medicare |
$76.72
|
| Rate for Payer: Humana Medicare |
$46.58
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: SELF PAY |
$219.20
|
| Rate for Payer: Veterans (Triwest) |
$46.58
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$159.74
|
| Rate for Payer: United Healthcare Medicare |
$49.32
|
|
|
30300 RMV FB NOSE
|
Facility
IP
|
$274.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
22282892
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$246.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$46.58
|
| Rate for Payer: Amerigroup Medicare |
$46.58
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$46.58
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$46.58
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$71.24
|
| Rate for Payer: Copperpoint |
$76.86
|
| Rate for Payer: Humana Medicare |
$46.58
|
| Rate for Payer: SELF PAY |
$219.20
|
| Rate for Payer: Veterans (Triwest) |
$46.58
|
|
|
30901 TX EPISTAXIS ANT SIMPLE
|
Facility
OP
|
$481.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
22282893
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.77 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$432.90
|
| Rate for Payer: Aetna Medicare |
$134.68
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$81.77
|
| Rate for Payer: Amerigroup Medicare |
$81.77
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$179.65
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$162.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$81.77
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$81.77
|
| Rate for Payer: Banner University Family Care Medicaid |
$162.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$125.06
|
| Rate for Payer: Cigna All Products |
$336.70
|
| Rate for Payer: Copperpoint |
$134.92
|
| Rate for Payer: HealthNet Commercial |
$288.60
|
| Rate for Payer: HealthNet Medicare |
$134.68
|
| Rate for Payer: Humana Medicare |
$81.77
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: SELF PAY |
$384.80
|
| Rate for Payer: Veterans (Triwest) |
$81.77
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$280.42
|
| Rate for Payer: United Healthcare Medicare |
$86.58
|
|
|
30901 TX EPISTAXIS ANT SIMPLE
|
Facility
IP
|
$481.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
22282893
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.77 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Humana Medicare |
$81.77
|
| Rate for Payer: SELF PAY |
$384.80
|
| Rate for Payer: Aetna POS, PPO, HMO |
$432.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$81.77
|
| Rate for Payer: Amerigroup Medicare |
$81.77
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$81.77
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$81.77
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$125.06
|
| Rate for Payer: Copperpoint |
$134.92
|
| Rate for Payer: Veterans (Triwest) |
$81.77
|
|
|
30903 TX EPISTAXIS ANT COMPLEX
|
Facility
OP
|
$921.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
22282894
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.57 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$828.90
|
| Rate for Payer: Aetna Medicare |
$257.88
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$156.57
|
| Rate for Payer: Amerigroup Medicare |
$156.57
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$343.99
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$162.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$156.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$156.57
|
| Rate for Payer: Banner University Family Care Medicaid |
$162.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$239.46
|
| Rate for Payer: Cigna All Products |
$644.70
|
| Rate for Payer: Copperpoint |
$258.34
|
| Rate for Payer: HealthNet Commercial |
$552.60
|
| Rate for Payer: HealthNet Medicare |
$257.88
|
| Rate for Payer: Humana Medicare |
$156.57
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: SELF PAY |
$736.80
|
| Rate for Payer: Veterans (Triwest) |
$156.57
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$536.94
|
| Rate for Payer: United Healthcare Medicare |
$165.78
|
|
|
30903 TX EPISTAXIS ANT COMPLEX
|
Facility
IP
|
$921.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
22282894
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.57 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$828.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$156.57
|
| Rate for Payer: Amerigroup Medicare |
$156.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$156.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$156.57
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$239.46
|
| Rate for Payer: Copperpoint |
$258.34
|
| Rate for Payer: Humana Medicare |
$156.57
|
| Rate for Payer: SELF PAY |
$736.80
|
| Rate for Payer: Veterans (Triwest) |
$156.57
|
|
|
30905 TX EPISTAXIS POST SIMPLE
|
Facility
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
22282895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.32 |
| Max. Negotiated Rate |
$1,031.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,031.40
|
| Rate for Payer: Aetna Medicare |
$320.88
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$194.82
|
| Rate for Payer: Amerigroup Medicare |
$194.82
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$428.03
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$162.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$194.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$194.82
|
| Rate for Payer: Banner University Family Care Medicaid |
$162.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$297.96
|
| Rate for Payer: Cigna All Products |
$802.20
|
| Rate for Payer: Copperpoint |
$321.45
|
| Rate for Payer: HealthNet Commercial |
$687.60
|
| Rate for Payer: HealthNet Medicare |
$320.88
|
| Rate for Payer: Humana Medicare |
$194.82
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: SELF PAY |
$916.80
|
| Rate for Payer: Veterans (Triwest) |
$194.82
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$668.12
|
| Rate for Payer: United Healthcare Medicare |
$206.28
|
|
|
30905 TX EPISTAXIS POST SIMPLE
|
Facility
IP
|
$1,146.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
22282895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.82 |
| Max. Negotiated Rate |
$1,031.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,031.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$194.82
|
| Rate for Payer: Amerigroup Medicare |
$194.82
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$194.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$194.82
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$297.96
|
| Rate for Payer: Copperpoint |
$321.45
|
| Rate for Payer: Humana Medicare |
$194.82
|
| Rate for Payer: SELF PAY |
$916.80
|
| Rate for Payer: Veterans (Triwest) |
$194.82
|
|
|
30906 TX EPISTAXIS POST COMPLEX
|
Facility
IP
|
$1,277.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
22282896
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.09 |
| Max. Negotiated Rate |
$1,149.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,149.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$217.09
|
| Rate for Payer: Amerigroup Medicare |
$217.09
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$217.09
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$217.09
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$332.02
|
| Rate for Payer: Copperpoint |
$358.20
|
| Rate for Payer: Humana Medicare |
$217.09
|
| Rate for Payer: SELF PAY |
$1,021.60
|
| Rate for Payer: Veterans (Triwest) |
$217.09
|
|
|
30906 TX EPISTAXIS POST COMPLEX
|
Facility
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
22282896
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.09 |
| Max. Negotiated Rate |
$1,149.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,149.30
|
| Rate for Payer: Aetna Medicare |
$357.56
|
| Rate for Payer: AHCCCS Medicaid |
$306.82
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$306.82
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$217.09
|
| Rate for Payer: Amerigroup Medicare |
$217.09
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$476.96
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$306.82
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$217.09
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$217.09
|
| Rate for Payer: Banner University Family Care Medicaid |
$306.82
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$332.02
|
| Rate for Payer: Cigna All Products |
$893.90
|
| Rate for Payer: Copperpoint |
$358.20
|
| Rate for Payer: HealthNet Commercial |
$766.20
|
| Rate for Payer: HealthNet Medicare |
$357.56
|
| Rate for Payer: Humana Medicare |
$217.09
|
| Rate for Payer: Mercy Care Medicaid |
$306.82
|
| Rate for Payer: SELF PAY |
$1,021.60
|
| Rate for Payer: Veterans (Triwest) |
$217.09
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$744.49
|
| Rate for Payer: United Healthcare Medicare |
$229.86
|
|
|
3-0 Chromic Gut FS-1
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
22926446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$18.90
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.57
|
| Rate for Payer: Amerigroup Medicare |
$3.57
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$7.84
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.57
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$5.46
|
| Rate for Payer: Cigna All Products |
$14.70
|
| Rate for Payer: Copperpoint |
$5.89
|
| Rate for Payer: HealthNet Commercial |
$12.60
|
| Rate for Payer: HealthNet Medicare |
$5.88
|
| Rate for Payer: Humana Medicare |
$3.57
|
| Rate for Payer: SELF PAY |
$16.80
|
| Rate for Payer: Veterans (Triwest) |
$3.57
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$12.24
|
| Rate for Payer: United Healthcare Medicare |
$3.78
|
|
|
3-0 Chromic Gut FS-1
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
22926446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$18.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.57
|
| Rate for Payer: Amerigroup Medicare |
$3.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.57
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$5.46
|
| Rate for Payer: Copperpoint |
$5.89
|
| Rate for Payer: Humana Medicare |
$3.57
|
| Rate for Payer: SELF PAY |
$16.80
|
| Rate for Payer: Veterans (Triwest) |
$3.57
|
|
|
3-0 Chromic Gut FS-2
|
Facility
IP
|
$20.00
|
|
| Hospital Charge Code |
22926445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$18.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.40
|
| Rate for Payer: Amerigroup Medicare |
$3.40
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.40
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$5.20
|
| Rate for Payer: Copperpoint |
$5.61
|
| Rate for Payer: Humana Medicare |
$3.40
|
| Rate for Payer: SELF PAY |
$16.00
|
| Rate for Payer: Veterans (Triwest) |
$3.40
|
|
|
3-0 Chromic Gut FS-2
|
Facility
OP
|
$20.00
|
|
| Hospital Charge Code |
22926445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$18.00
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$3.40
|
| Rate for Payer: Amerigroup Medicare |
$3.40
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$7.47
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$3.40
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$3.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$5.20
|
| Rate for Payer: Cigna All Products |
$14.00
|
| Rate for Payer: Copperpoint |
$5.61
|
| Rate for Payer: HealthNet Commercial |
$12.00
|
| Rate for Payer: HealthNet Medicare |
$5.60
|
| Rate for Payer: Humana Medicare |
$3.40
|
| Rate for Payer: SELF PAY |
$16.00
|
| Rate for Payer: Veterans (Triwest) |
$3.40
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$11.66
|
| Rate for Payer: United Healthcare Medicare |
$3.60
|
|