|
.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
|
|
|
PT TRACTION MECH 1 OR MORE AREAS
|
Facility
IP
|
$511.00
|
|
|
Service Code
|
CPT 97012 GP
|
| Hospital Charge Code |
1230088
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.87 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$459.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$86.87
|
| Rate for Payer: Amerigroup Medicare |
$86.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$86.87
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$86.87
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$132.86
|
| Rate for Payer: Copperpoint |
$143.34
|
| Rate for Payer: Humana Medicare |
$86.87
|
| Rate for Payer: SELF PAY |
$408.80
|
| Rate for Payer: Veterans (Triwest) |
$86.87
|
|
|
PT TRACTION MECH 1 OR MORE AREAS
|
Facility
OP
|
$511.00
|
|
|
Service Code
|
CPT 97012 GP
|
| Hospital Charge Code |
1230088
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.87 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$459.90
|
| Rate for Payer: Aetna Medicare |
$143.08
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$86.87
|
| Rate for Payer: Amerigroup Medicare |
$86.87
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$190.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$86.87
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$86.87
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$132.86
|
| Rate for Payer: Cigna All Products |
$357.70
|
| Rate for Payer: Copperpoint |
$143.34
|
| Rate for Payer: HealthNet Commercial |
$306.60
|
| Rate for Payer: HealthNet Medicare |
$143.08
|
| Rate for Payer: Humana Medicare |
$86.87
|
| Rate for Payer: SELF PAY |
$408.80
|
| Rate for Payer: Veterans (Triwest) |
$86.87
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$297.91
|
| Rate for Payer: United Healthcare Medicare |
$91.98
|
|
|
.PTT SUB
|
Facility
IP
|
$96.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
22481450
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$86.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.32
|
| Rate for Payer: Amerigroup Medicare |
$16.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.32
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$24.96
|
| Rate for Payer: Copperpoint |
$26.93
|
| Rate for Payer: Humana Medicare |
$16.32
|
| Rate for Payer: SELF PAY |
$76.80
|
| Rate for Payer: Veterans (Triwest) |
$16.32
|
|
|
.PTT SUB
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
22481450
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$86.40
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: AHCCCS Medicaid |
$6.47
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$6.47
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.32
|
| Rate for Payer: Amerigroup Medicare |
$16.32
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$35.86
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$6.47
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.32
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.32
|
| Rate for Payer: Banner University Family Care Medicaid |
$6.47
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$24.96
|
| Rate for Payer: Cigna All Products |
$62.40
|
| Rate for Payer: Copperpoint |
$26.93
|
| Rate for Payer: HealthNet Commercial |
$57.60
|
| Rate for Payer: HealthNet Medicare |
$26.88
|
| Rate for Payer: Humana Medicare |
$16.32
|
| Rate for Payer: Mercy Care Medicaid |
$6.47
|
| Rate for Payer: SELF PAY |
$76.80
|
| Rate for Payer: Veterans (Triwest) |
$16.32
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$55.97
|
| Rate for Payer: United Healthcare Medicare |
$17.28
|
|
|
PT ULTRASOUND EACH 15 MIN
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
692237
|
|
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 |
$85.27
|
| 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 ULTRASOUND EACH 15 MIN
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
692237
|
|
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 |
$85.27
|
| 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 UNLISTED THER PROCDUR
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 97139 GP
|
| Hospital Charge Code |
20731357
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$35.10
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.63
|
| Rate for Payer: Amerigroup Medicare |
$6.63
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$14.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.63
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.63
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.14
|
| Rate for Payer: Cigna All Products |
$27.30
|
| Rate for Payer: Copperpoint |
$10.94
|
| Rate for Payer: HealthNet Commercial |
$23.40
|
| Rate for Payer: HealthNet Medicare |
$10.92
|
| Rate for Payer: Humana Medicare |
$6.63
|
| Rate for Payer: SELF PAY |
$31.20
|
| Rate for Payer: Veterans (Triwest) |
$6.63
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$22.74
|
| Rate for Payer: United Healthcare Medicare |
$7.02
|
|
|
PT UNLISTED THER PROCDUR
|
Facility
IP
|
$39.00
|
|
|
Service Code
|
CPT 97139 GP
|
| Hospital Charge Code |
20731357
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$35.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.63
|
| Rate for Payer: Amerigroup Medicare |
$6.63
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.63
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.63
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$10.14
|
| Rate for Payer: Copperpoint |
$10.94
|
| Rate for Payer: Humana Medicare |
$6.63
|
| Rate for Payer: SELF PAY |
$31.20
|
| Rate for Payer: Veterans (Triwest) |
$6.63
|
|
|
PT VASOPNEUMATIC DEVICE
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 97016 GP
|
| Hospital Charge Code |
11428383
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$93.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.68
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.68
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.68
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.04
|
| Rate for Payer: Copperpoint |
$29.17
|
| Rate for Payer: Humana Medicare |
$17.68
|
| Rate for Payer: SELF PAY |
$83.20
|
| Rate for Payer: Veterans (Triwest) |
$17.68
|
|
|
PT VASOPNEUMATIC DEVICE
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 97016 GP
|
| Hospital Charge Code |
11428383
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$93.60
|
| Rate for Payer: Aetna Medicare |
$29.12
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$17.68
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$38.84
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$17.68
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$17.68
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.04
|
| Rate for Payer: Cigna All Products |
$72.80
|
| Rate for Payer: Copperpoint |
$29.17
|
| Rate for Payer: HealthNet Commercial |
$62.40
|
| Rate for Payer: HealthNet Medicare |
$29.12
|
| Rate for Payer: Humana Medicare |
$17.68
|
| Rate for Payer: SELF PAY |
$83.20
|
| Rate for Payer: Veterans (Triwest) |
$17.68
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$60.63
|
| Rate for Payer: United Healthcare Medicare |
$18.72
|
|
|
PT WHEELCHAIR MGT/PROP EACH 15
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
692240
|
|
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 WHEELCHAIR MGT/PROP EACH 15
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
692240
|
|
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 WOUND CARE GREATER THAN 20 CM
|
Facility
IP
|
$664.00
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
2619686
|
|
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 WOUND CARE GREATER THAN 20 CM
|
Facility
OP
|
$664.00
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
2619686
|
|
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: AHCCCS Medicaid |
$206.28
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$206.28
|
| 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 Medicaid |
$206.28
|
| 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: Banner University Family Care Medicaid |
$206.28
|
| 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: Mercy Care Medicaid |
$206.28
|
| 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 WOUND CARE LESS THAN 20 CM
|
Facility
OP
|
$341.00
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
2734847
|
|
Hospital Revenue Code
|
420
|
| 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: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$260.34
|
| 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 Medicaid |
$260.34
|
| 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: Banner University Family Care Medicaid |
$260.34
|
| 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: Mercy Care Medicaid |
$260.34
|
| 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 WOUND CARE LESS THAN 20 CM
|
Facility
IP
|
$341.00
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
2734847
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
Pulmonary Embolism
|
Facility
IP
|
$7,455.18
|
|
|
Service Code
|
APRDRG 1343
|
| Hospital Charge Code |
APRDRG1343
|
| Min. Negotiated Rate |
$7,455.18 |
| Max. Negotiated Rate |
$7,455.18 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$7,455.18
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$7,455.18
|
| Rate for Payer: Banner University Family Care Medicaid |
$7,455.18
|
| Rate for Payer: Mercy Care Medicaid |
$7,455.18
|
|
|
Pulmonary Embolism
|
Facility
IP
|
$5,001.68
|
|
|
Service Code
|
APRDRG 1342
|
| Hospital Charge Code |
APRDRG1342
|
| Min. Negotiated Rate |
$5,001.68 |
| Max. Negotiated Rate |
$5,001.68 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$5,001.68
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$5,001.68
|
| Rate for Payer: Banner University Family Care Medicaid |
$5,001.68
|
| Rate for Payer: Mercy Care Medicaid |
$5,001.68
|
|
|
Pulmonary Embolism
|
Facility
IP
|
$3,769.32
|
|
|
Service Code
|
APRDRG 1341
|
| Hospital Charge Code |
APRDRG1341
|
| Min. Negotiated Rate |
$3,769.32 |
| Max. Negotiated Rate |
$3,769.32 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3,769.32
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3,769.32
|
| Rate for Payer: Banner University Family Care Medicaid |
$3,769.32
|
| Rate for Payer: Mercy Care Medicaid |
$3,769.32
|
|
|
Pulmonary Embolism
|
Facility
IP
|
$11,397.75
|
|
|
Service Code
|
APRDRG 1344
|
| Hospital Charge Code |
APRDRG1344
|
| Min. Negotiated Rate |
$11,397.75 |
| Max. Negotiated Rate |
$11,397.75 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$11,397.75
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$11,397.75
|
| Rate for Payer: Banner University Family Care Medicaid |
$11,397.75
|
| Rate for Payer: Mercy Care Medicaid |
$11,397.75
|
|
|
Pulmonary Function Test
|
Facility
IP
|
$855.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
23591076
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$769.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.35
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$145.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$558.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$222.30
|
| Rate for Payer: Copperpoint |
$239.83
|
| Rate for Payer: Humana Medicare |
$145.35
|
| Rate for Payer: SELF PAY |
$684.00
|
| Rate for Payer: Veterans (Triwest) |
$145.35
|
|
|
Pulmonary Function Test
|
Facility
OP
|
$855.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
23591076
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$769.50
|
| Rate for Payer: Aetna Medicare |
$239.40
|
| Rate for Payer: AHCCCS Medicaid |
$383.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$383.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.35
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$319.34
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$383.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$145.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$145.35
|
| Rate for Payer: Banner University Family Care Medicaid |
$383.46
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$558.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$222.30
|
| Rate for Payer: Cigna All Products |
$598.50
|
| Rate for Payer: Copperpoint |
$239.83
|
| Rate for Payer: HealthNet Commercial |
$513.00
|
| Rate for Payer: HealthNet Medicare |
$239.40
|
| Rate for Payer: Humana Medicare |
$145.35
|
| Rate for Payer: Mercy Care Medicaid |
$383.46
|
| Rate for Payer: SELF PAY |
$684.00
|
| Rate for Payer: Veterans (Triwest) |
$145.35
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$498.46
|
| Rate for Payer: United Healthcare Medicare |
$153.90
|
|
|
Pulmonary Stress Test 6 Minute Walk
|
Facility
OP
|
$286.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
22409369
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$48.62 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$257.40
|
| Rate for Payer: Aetna Medicare |
$80.08
|
| 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 |
$48.62
|
| Rate for Payer: Amerigroup Medicare |
$48.62
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$106.82
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$162.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$48.62
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$48.62
|
| Rate for Payer: Banner University Family Care Medicaid |
$162.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$74.36
|
| Rate for Payer: Cigna All Products |
$200.20
|
| Rate for Payer: Copperpoint |
$80.22
|
| Rate for Payer: HealthNet Commercial |
$171.60
|
| Rate for Payer: HealthNet Medicare |
$80.08
|
| Rate for Payer: Humana Medicare |
$48.62
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: SELF PAY |
$228.80
|
| Rate for Payer: Veterans (Triwest) |
$48.62
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$166.74
|
| Rate for Payer: United Healthcare Medicare |
$51.48
|
|
|
Pulmonary Stress Test 6 Minute Walk
|
Facility
IP
|
$286.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
22409369
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$48.62 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$257.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$48.62
|
| Rate for Payer: Amerigroup Medicare |
$48.62
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$48.62
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$48.62
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$74.36
|
| Rate for Payer: Copperpoint |
$80.22
|
| Rate for Payer: Humana Medicare |
$48.62
|
| Rate for Payer: SELF PAY |
$228.80
|
| Rate for Payer: Veterans (Triwest) |
$48.62
|
|