|
PT Other Primary Goal Status G-8991 CM At least 80% but less than 100% impaired
|
Facility
IP
|
$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: 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 CN 100% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035352
|
|
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 CN 100% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035352
|
|
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 PARAFIN BATH
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
1230143
|
|
Hospital Revenue Code
|
424
|
| 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 PARAFIN BATH
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
1230143
|
|
Hospital Revenue Code
|
424
|
| 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 PROSTHETIC TRN @15 MIN
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
692241
|
|
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 PROSTHETIC TRN @15 MIN
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
692241
|
|
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 RE-EVAL
|
Facility
IP
|
$341.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
22528957
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$57.97 |
| Max. Negotiated Rate |
$306.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$306.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$57.97
|
| Rate for Payer: Amerigroup Medicare |
$57.97
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$57.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$57.97
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$88.66
|
| Rate for Payer: Copperpoint |
$95.65
|
| Rate for Payer: Humana Medicare |
$57.97
|
| Rate for Payer: SELF PAY |
$272.80
|
| Rate for Payer: Veterans (Triwest) |
$57.97
|
|
|
PT RE-EVAL
|
Facility
OP
|
$341.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
22528957
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$57.97 |
| Max. Negotiated Rate |
$306.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$306.90
|
| Rate for Payer: Aetna Medicare |
$95.48
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$57.97
|
| Rate for Payer: Amerigroup Medicare |
$57.97
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$127.36
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$57.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$57.97
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$88.66
|
| Rate for Payer: Cigna All Products |
$238.70
|
| Rate for Payer: Copperpoint |
$95.65
|
| Rate for Payer: HealthNet Commercial |
$204.60
|
| Rate for Payer: HealthNet Medicare |
$95.48
|
| Rate for Payer: Humana Medicare |
$57.97
|
| Rate for Payer: SELF PAY |
$272.80
|
| Rate for Payer: Veterans (Triwest) |
$57.97
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$198.80
|
| Rate for Payer: United Healthcare Medicare |
$61.38
|
|
|
PT RE-EVALUATION 31 TO 60 MIN
|
Facility
OP
|
$664.00
|
|
| Hospital Charge Code |
22528958
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$597.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$597.60
|
| Rate for Payer: Aetna Medicare |
$185.92
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$112.88
|
| Rate for Payer: Amerigroup Medicare |
$112.88
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$248.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$112.88
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$112.88
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$172.64
|
| Rate for Payer: Cigna All Products |
$464.80
|
| Rate for Payer: Copperpoint |
$186.25
|
| Rate for Payer: HealthNet Commercial |
$398.40
|
| Rate for Payer: HealthNet Medicare |
$185.92
|
| Rate for Payer: Humana Medicare |
$112.88
|
| Rate for Payer: SELF PAY |
$531.20
|
| Rate for Payer: Veterans (Triwest) |
$112.88
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$387.11
|
| Rate for Payer: United Healthcare Medicare |
$119.52
|
|
|
PT RE-EVALUATION 31 TO 60 MIN
|
Facility
IP
|
$664.00
|
|
| Hospital Charge Code |
22528958
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$597.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$597.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$112.88
|
| Rate for Payer: Amerigroup Medicare |
$112.88
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$112.88
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$112.88
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$172.64
|
| Rate for Payer: Copperpoint |
$186.25
|
| Rate for Payer: Humana Medicare |
$112.88
|
| Rate for Payer: SELF PAY |
$531.20
|
| Rate for Payer: Veterans (Triwest) |
$112.88
|
|
|
PT Self-Care Current Status G-8987 CH 0% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035383
|
|
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 Self-Care Current Status G-8987 CH 0% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035383
|
|
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 Self-Care Current Status G-8987 CI At least 1% but less than 20% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035382
|
|
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 Self-Care Current Status G-8987 CI At least 1% but less than 20% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035382
|
|
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 Self-Care Current Status G-8987 CJ At least 20% but less than 40% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035381
|
|
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 Self-Care Current Status G-8987 CJ At least 20% but less than 40% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035381
|
|
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 Self-Care Current Status G-8987 CK At least 40% but less than 60% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035380
|
|
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 Self-Care Current Status G-8987 CK At least 40% but less than 60% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035380
|
|
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 Self-Care Current Status G-8987 CL At least 60% but less than 80% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035379
|
|
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 Self-Care Current Status G-8987 CL At least 60% but less than 80% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035379
|
|
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 Self-Care Current Status G-8987 CM At least 80% but less than 100% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035378
|
|
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 Self-Care Current Status G-8987 CM At least 80% but less than 100% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035378
|
|
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 Self-Care Current Status G-8987 CN 100% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035377
|
|
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 Self-Care Current Status G-8987 CN 100% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8987 GP
|
| Hospital Charge Code |
6035377
|
|
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
|
|