|
PT IONTOPHORESIS @ 15 MIN
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
692258
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$64.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$84.27
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Cigna All Products |
$120.40
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: HealthNet Commercial |
$103.20
|
| Rate for Payer: HealthNet Medicare |
$48.16
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$30.96
|
|
|
PT IONTOPHORESIS @ 15 MIN
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
692258
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$84.27
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
|
|
PT MASSAGE 15 MIN
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
692251
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$64.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Cigna All Products |
$120.40
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: HealthNet Commercial |
$103.20
|
| Rate for Payer: HealthNet Medicare |
$48.16
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$30.96
|
|
|
PT MASSAGE 15 MIN
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
692251
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
|
|
PT Mobility Goal Status G-8979 CM At least 80% but less than 100% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8979 GP
|
| Hospital Charge Code |
6035332
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Cigna All Products |
$3.50
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: HealthNet Commercial |
$3.00
|
| Rate for Payer: HealthNet Medicare |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
|
|
PT Mobility Goal Status G-8979 CM At least 80% but less than 100% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8979 GP
|
| Hospital Charge Code |
6035332
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
|
|
PT Mobility Goal Status G-8979 CN 100% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8979 GP
|
| Hospital Charge Code |
6035331
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
|
|
PT Mobility Goal Status G-8979 CN 100% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8979 GP
|
| Hospital Charge Code |
6035331
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Cigna All Products |
$3.50
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: HealthNet Commercial |
$3.00
|
| Rate for Payer: HealthNet Medicare |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
|
|
PT NEURO RE-ED EACH 15MIN
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
692238
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$97.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
|
|
PT NEURO RE-ED EACH 15MIN
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
692238
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$64.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$97.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Cigna All Products |
$120.40
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: HealthNet Commercial |
$103.20
|
| Rate for Payer: HealthNet Medicare |
$48.16
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$30.96
|
|
|
PT ORTHO FITTRNG EACH 15
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
692243
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$64.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Cigna All Products |
$120.40
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: HealthNet Commercial |
$103.20
|
| Rate for Payer: HealthNet Medicare |
$48.16
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$30.96
|
|
|
PT ORTHO FITTRNG EACH 15
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
692243
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
|
|
PT ORTHO/PROS CKOUT @ 15 MIN
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97762 GP
|
| Hospital Charge Code |
2781053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
|
|
PT ORTHO/PROS CKOUT @ 15 MIN
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97762 GP
|
| Hospital Charge Code |
2781053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$154.80
|
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$29.24
|
| Rate for Payer: Amerigroup Medicare |
$29.24
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$64.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$29.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$29.24
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$44.72
|
| Rate for Payer: Cigna All Products |
$120.40
|
| Rate for Payer: Copperpoint |
$48.25
|
| Rate for Payer: HealthNet Commercial |
$103.20
|
| Rate for Payer: HealthNet Medicare |
$48.16
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: SELF PAY |
$137.60
|
| Rate for Payer: Veterans (Triwest) |
$29.24
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$30.96
|
|
|
PT Other Primary Goal Status G-8991 CH 0% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035358
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
|
|
PT Other Primary Goal Status G-8991 CH 0% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035358
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Cigna All Products |
$3.50
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: HealthNet Commercial |
$3.00
|
| Rate for Payer: HealthNet Medicare |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CI At least 1% but less than 20% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035357
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Cigna All Products |
$3.50
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: HealthNet Commercial |
$3.00
|
| Rate for Payer: HealthNet Medicare |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CI At least 1% but less than 20% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035357
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
|
|
PT Other Primary Goal Status G-8991 CJ At least 20% but less than 40% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
|
|
PT Other Primary Goal Status G-8991 CJ At least 20% but less than 40% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Cigna All Products |
$3.50
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: HealthNet Commercial |
$3.00
|
| Rate for Payer: HealthNet Medicare |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CK At least 40% but less than 60% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035355
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Cigna All Products |
$3.50
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: HealthNet Commercial |
$3.00
|
| Rate for Payer: HealthNet Medicare |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CK At least 40% but less than 60% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035355
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
|
|
PT Other Primary Goal Status G-8991 CL At least 60% but less than 80% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035354
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
|
|
PT Other Primary Goal Status G-8991 CL At least 60% but less than 80% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035354
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Cigna All Products |
$3.50
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: HealthNet Commercial |
$3.00
|
| Rate for Payer: HealthNet Medicare |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CM At least 80% but less than 100% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035353
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$4.50
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$0.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$0.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1.30
|
| Rate for Payer: Cigna All Products |
$3.50
|
| Rate for Payer: Copperpoint |
$1.40
|
| Rate for Payer: HealthNet Commercial |
$3.00
|
| Rate for Payer: HealthNet Medicare |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: SELF PAY |
$4.00
|
| Rate for Payer: Veterans (Triwest) |
$0.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
|