|
PT Self-Care Goal Status G-8988 CH 0% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035397
|
|
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 Goal Status G-8988 CH 0% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035397
|
|
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 Goal Status G-8988 CI At least 1% but less than 20% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035396
|
|
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 Goal Status G-8988 CI At least 1% but less than 20% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035396
|
|
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 Goal Status G-8988 CJ At least 20% but less than 40% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035395
|
|
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 Goal Status G-8988 CJ At least 20% but less than 40% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035395
|
|
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 Goal Status G-8988 CK At least 40% but less than 60% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035394
|
|
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 Goal Status G-8988 CK At least 40% but less than 60% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035394
|
|
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 Goal Status G-8988 CL At least 60% but less than 80% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035393
|
|
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 Goal Status G-8988 CL At least 60% but less than 80% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035393
|
|
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 Goal Status G-8988 CM At least 80% but less than 100% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035392
|
|
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 Goal Status G-8988 CM At least 80% but less than 100% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035392
|
|
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 Goal Status G-8988 CN 100% impaired
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035391
|
|
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 Goal Status G-8988 CN 100% impaired
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035391
|
|
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/HOME MGT TRG EACH 15
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
8772924
|
|
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 |
$112.20
|
| 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 SELF CARE/HOME MGT TRG EACH 15
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
8772924
|
|
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 |
$112.20
|
| 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
|
|
|
PTT
|
Facility
OP
|
$141.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
22481500
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$126.90
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: AHCCCS Medicaid |
$6.01
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$6.01
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$23.97
|
| Rate for Payer: Amerigroup Medicare |
$23.97
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$52.66
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$6.01
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.97
|
| Rate for Payer: Banner University Family Care Medicaid |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$91.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.66
|
| Rate for Payer: Cigna All Products |
$91.65
|
| Rate for Payer: Copperpoint |
$39.55
|
| Rate for Payer: HealthNet Commercial |
$84.60
|
| Rate for Payer: HealthNet Medicare |
$39.48
|
| Rate for Payer: Humana Medicare |
$23.97
|
| Rate for Payer: Mercy Care Medicaid |
$6.01
|
| Rate for Payer: SELF PAY |
$112.80
|
| Rate for Payer: Veterans (Triwest) |
$23.97
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$82.20
|
| Rate for Payer: United Healthcare Medicare |
$25.38
|
|
|
PTT
|
Facility
IP
|
$141.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
22481500
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$126.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$23.97
|
| Rate for Payer: Amerigroup Medicare |
$23.97
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$91.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.66
|
| Rate for Payer: Copperpoint |
$39.55
|
| Rate for Payer: Humana Medicare |
$23.97
|
| Rate for Payer: SELF PAY |
$112.80
|
| Rate for Payer: Veterans (Triwest) |
$23.97
|
|
|
PTT DED
|
Facility
OP
|
$141.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
24151823
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$126.90
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: AHCCCS Medicaid |
$6.01
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$6.01
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$23.97
|
| Rate for Payer: Amerigroup Medicare |
$23.97
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$52.66
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$6.01
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.97
|
| Rate for Payer: Banner University Family Care Medicaid |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$91.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.66
|
| Rate for Payer: Cigna All Products |
$91.65
|
| Rate for Payer: Copperpoint |
$39.55
|
| Rate for Payer: HealthNet Commercial |
$84.60
|
| Rate for Payer: HealthNet Medicare |
$39.48
|
| Rate for Payer: Humana Medicare |
$23.97
|
| Rate for Payer: Mercy Care Medicaid |
$6.01
|
| Rate for Payer: SELF PAY |
$112.80
|
| Rate for Payer: Veterans (Triwest) |
$23.97
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$82.20
|
| Rate for Payer: United Healthcare Medicare |
$25.38
|
|
|
PTT DED
|
Facility
IP
|
$141.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
24151823
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$126.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$23.97
|
| Rate for Payer: Amerigroup Medicare |
$23.97
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$91.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.66
|
| Rate for Payer: Copperpoint |
$39.55
|
| Rate for Payer: Humana Medicare |
$23.97
|
| Rate for Payer: SELF PAY |
$112.80
|
| Rate for Payer: Veterans (Triwest) |
$23.97
|
|
|
PT T E N S APPLICATION
|
Facility
IP
|
$664.00
|
|
|
Service Code
|
CPT 64550 GP
|
| Hospital Charge Code |
1272337
|
|
Hospital Revenue Code
|
420
|
| 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 T E N S APPLICATION
|
Facility
OP
|
$664.00
|
|
|
Service Code
|
CPT 64550 GP
|
| Hospital Charge Code |
1272337
|
|
Hospital Revenue Code
|
420
|
| 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 THERAPEUTIC EX @15 MIN
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
692217
|
|
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 |
$100.00
|
| 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 THERAPEUTIC EX @15 MIN
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
692217
|
|
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 |
$100.00
|
| 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 (Thromborel-S) LC
|
Facility
OP
|
$141.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
22311162
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$126.90
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: AHCCCS Medicaid |
$6.01
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$6.01
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$23.97
|
| Rate for Payer: Amerigroup Medicare |
$23.97
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$52.66
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$6.01
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.97
|
| Rate for Payer: Banner University Family Care Medicaid |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$91.17
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.66
|
| Rate for Payer: Cigna All Products |
$91.65
|
| Rate for Payer: Copperpoint |
$39.55
|
| Rate for Payer: HealthNet Commercial |
$84.60
|
| Rate for Payer: HealthNet Medicare |
$39.48
|
| Rate for Payer: Humana Medicare |
$23.97
|
| Rate for Payer: Mercy Care Medicaid |
$6.01
|
| Rate for Payer: SELF PAY |
$112.80
|
| Rate for Payer: Veterans (Triwest) |
$23.97
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$82.20
|
| Rate for Payer: United Healthcare Medicare |
$25.38
|
|