|
PURAPLY MZ 100MG
|
Facility
OP
|
$1,657.50
|
|
| Hospital Charge Code |
27570615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$281.78 |
| Max. Negotiated Rate |
$1,491.75 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,491.75
|
| Rate for Payer: Aetna Medicare |
$464.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$281.78
|
| Rate for Payer: Amerigroup Medicare |
$281.78
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$619.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$281.78
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$281.78
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$430.95
|
| Rate for Payer: Cigna All Products |
$1,160.25
|
| Rate for Payer: Copperpoint |
$464.93
|
| Rate for Payer: HealthNet Commercial |
$994.50
|
| Rate for Payer: HealthNet Medicare |
$464.10
|
| Rate for Payer: Humana Medicare |
$281.78
|
| Rate for Payer: SELF PAY |
$1,326.00
|
| Rate for Payer: Veterans (Triwest) |
$281.78
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$966.32
|
| Rate for Payer: United Healthcare Medicare |
$298.35
|
|
|
PURAPLY MZ 500MG
|
Facility
IP
|
$7,540.00
|
|
| Hospital Charge Code |
27570616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,281.80 |
| Max. Negotiated Rate |
$6,786.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$6,786.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1,281.80
|
| Rate for Payer: Amerigroup Medicare |
$1,281.80
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1,281.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1,281.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,960.40
|
| Rate for Payer: Copperpoint |
$2,114.97
|
| Rate for Payer: Humana Medicare |
$1,281.80
|
| Rate for Payer: SELF PAY |
$6,032.00
|
| Rate for Payer: Veterans (Triwest) |
$1,281.80
|
|
|
PURAPLY MZ 500MG
|
Facility
OP
|
$7,540.00
|
|
| Hospital Charge Code |
27570616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,281.80 |
| Max. Negotiated Rate |
$6,786.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$6,786.00
|
| Rate for Payer: Aetna Medicare |
$2,111.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1,281.80
|
| Rate for Payer: Amerigroup Medicare |
$1,281.80
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$2,816.19
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1,281.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1,281.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$1,960.40
|
| Rate for Payer: Cigna All Products |
$5,278.00
|
| Rate for Payer: Copperpoint |
$2,114.97
|
| Rate for Payer: HealthNet Commercial |
$4,524.00
|
| Rate for Payer: HealthNet Medicare |
$2,111.20
|
| Rate for Payer: Humana Medicare |
$1,281.80
|
| Rate for Payer: SELF PAY |
$6,032.00
|
| Rate for Payer: Veterans (Triwest) |
$1,281.80
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$4,395.82
|
| Rate for Payer: United Healthcare Medicare |
$1,357.20
|
|
|
PuraPly XT
|
Facility
OP
|
$11,232.00
|
|
|
Service Code
|
CPT Q4197
|
| Hospital Charge Code |
24363414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,909.44 |
| Max. Negotiated Rate |
$10,108.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$10,108.80
|
| Rate for Payer: Aetna Medicare |
$3,144.96
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1,909.44
|
| Rate for Payer: Amerigroup Medicare |
$1,909.44
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$4,195.15
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1,909.44
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1,909.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2,920.32
|
| Rate for Payer: Cigna All Products |
$7,862.40
|
| Rate for Payer: Copperpoint |
$3,150.58
|
| Rate for Payer: HealthNet Commercial |
$6,739.20
|
| Rate for Payer: HealthNet Medicare |
$3,144.96
|
| Rate for Payer: Humana Medicare |
$1,909.44
|
| Rate for Payer: SELF PAY |
$8,985.60
|
| Rate for Payer: Veterans (Triwest) |
$1,909.44
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$6,548.26
|
| Rate for Payer: United Healthcare Medicare |
$2,021.76
|
|
|
PuraPly XT
|
Facility
IP
|
$11,232.00
|
|
|
Service Code
|
CPT Q4197
|
| Hospital Charge Code |
24363414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,909.44 |
| Max. Negotiated Rate |
$10,108.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$10,108.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$1,909.44
|
| Rate for Payer: Amerigroup Medicare |
$1,909.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$1,909.44
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$1,909.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$2,920.32
|
| Rate for Payer: Copperpoint |
$3,150.58
|
| Rate for Payer: Humana Medicare |
$1,909.44
|
| Rate for Payer: SELF PAY |
$8,985.60
|
| Rate for Payer: Veterans (Triwest) |
$1,909.44
|
|
|
PUREWICK FEMALE EXTERNAL CATHETER
|
Facility
OP
|
$67.15
|
|
| Hospital Charge Code |
27437084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$60.44 |
| Rate for Payer: Aetna POS, PPO, HMO |
$60.44
|
| Rate for Payer: Aetna Medicare |
$18.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.42
|
| Rate for Payer: Amerigroup Medicare |
$11.42
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$25.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.42
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$17.46
|
| Rate for Payer: Cigna All Products |
$47.01
|
| Rate for Payer: Copperpoint |
$18.84
|
| Rate for Payer: HealthNet Commercial |
$40.29
|
| Rate for Payer: HealthNet Medicare |
$18.80
|
| Rate for Payer: Humana Medicare |
$11.42
|
| Rate for Payer: SELF PAY |
$53.72
|
| Rate for Payer: Veterans (Triwest) |
$11.42
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$12.09
|
|
|
PUREWICK FEMALE EXTERNAL CATHETER
|
Facility
IP
|
$67.15
|
|
| Hospital Charge Code |
27437084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$60.44 |
| Rate for Payer: Aetna POS, PPO, HMO |
$60.44
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.42
|
| Rate for Payer: Amerigroup Medicare |
$11.42
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.42
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.42
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$17.46
|
| Rate for Payer: Copperpoint |
$18.84
|
| Rate for Payer: Humana Medicare |
$11.42
|
| Rate for Payer: SELF PAY |
$53.72
|
| Rate for Payer: Veterans (Triwest) |
$11.42
|
|
|
PURPLE INTRAOSSEOUS MODULE PEDS
|
Facility
IP
|
$345.00
|
|
| Hospital Charge Code |
23175125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: SELF PAY |
$276.00
|
| Rate for Payer: Aetna POS, PPO, HMO |
$310.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$58.65
|
| Rate for Payer: Amerigroup Medicare |
$58.65
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$58.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$58.65
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$89.70
|
| Rate for Payer: Copperpoint |
$96.77
|
| Rate for Payer: Humana Medicare |
$58.65
|
| Rate for Payer: Veterans (Triwest) |
$58.65
|
|
|
PURPLE INTRAOSSEOUS MODULE PEDS
|
Facility
OP
|
$345.00
|
|
| Hospital Charge Code |
23175125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$310.50
|
| Rate for Payer: Aetna Medicare |
$96.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$58.65
|
| Rate for Payer: Amerigroup Medicare |
$58.65
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$128.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$58.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$58.65
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$89.70
|
| Rate for Payer: Cigna All Products |
$241.50
|
| Rate for Payer: Copperpoint |
$96.77
|
| Rate for Payer: HealthNet Commercial |
$207.00
|
| Rate for Payer: HealthNet Medicare |
$96.60
|
| Rate for Payer: Humana Medicare |
$58.65
|
| Rate for Payer: SELF PAY |
$276.00
|
| Rate for Payer: Veterans (Triwest) |
$58.65
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$201.13
|
| Rate for Payer: United Healthcare Medicare |
$62.10
|
|
|
PURPLE INTUBATION MODULE PEDS
|
Facility
IP
|
$288.00
|
|
| Hospital Charge Code |
23175713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$259.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$48.96
|
| Rate for Payer: Amerigroup Medicare |
$48.96
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$48.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$48.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$74.88
|
| Rate for Payer: Copperpoint |
$80.78
|
| Rate for Payer: Humana Medicare |
$48.96
|
| Rate for Payer: SELF PAY |
$230.40
|
| Rate for Payer: Veterans (Triwest) |
$48.96
|
|
|
PURPLE INTUBATION MODULE PEDS
|
Facility
OP
|
$288.00
|
|
| Hospital Charge Code |
23175713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$259.20
|
| Rate for Payer: Aetna Medicare |
$80.64
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$48.96
|
| Rate for Payer: Amerigroup Medicare |
$48.96
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$107.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$48.96
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$48.96
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$74.88
|
| Rate for Payer: Cigna All Products |
$201.60
|
| Rate for Payer: Copperpoint |
$80.78
|
| Rate for Payer: HealthNet Commercial |
$172.80
|
| Rate for Payer: HealthNet Medicare |
$80.64
|
| Rate for Payer: Humana Medicare |
$48.96
|
| Rate for Payer: SELF PAY |
$230.40
|
| Rate for Payer: Veterans (Triwest) |
$48.96
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$167.90
|
| Rate for Payer: United Healthcare Medicare |
$51.84
|
|
|
PURPLE IV DELIVERY MODULE PEDS
|
Facility
OP
|
$276.00
|
|
| Hospital Charge Code |
23175706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$248.40
|
| Rate for Payer: Aetna Medicare |
$77.28
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$46.92
|
| Rate for Payer: Amerigroup Medicare |
$46.92
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$103.09
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$46.92
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$46.92
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$71.76
|
| Rate for Payer: Cigna All Products |
$193.20
|
| Rate for Payer: Copperpoint |
$77.42
|
| Rate for Payer: HealthNet Commercial |
$165.60
|
| Rate for Payer: HealthNet Medicare |
$77.28
|
| Rate for Payer: Humana Medicare |
$46.92
|
| Rate for Payer: SELF PAY |
$220.80
|
| Rate for Payer: Veterans (Triwest) |
$46.92
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$160.91
|
| Rate for Payer: United Healthcare Medicare |
$49.68
|
|
|
PURPLE IV DELIVERY MODULE PEDS
|
Facility
IP
|
$276.00
|
|
| Hospital Charge Code |
23175706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$248.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$46.92
|
| Rate for Payer: Amerigroup Medicare |
$46.92
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$46.92
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$46.92
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$71.76
|
| Rate for Payer: Copperpoint |
$77.42
|
| Rate for Payer: Humana Medicare |
$46.92
|
| Rate for Payer: SELF PAY |
$220.80
|
| Rate for Payer: Veterans (Triwest) |
$46.92
|
|
|
PURPLE OXYGEN DELIVERY MODULE PEDS
|
Facility
IP
|
$115.00
|
|
| Hospital Charge Code |
23175699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$103.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$19.55
|
| Rate for Payer: Amerigroup Medicare |
$19.55
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$19.55
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$19.55
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$29.90
|
| Rate for Payer: Copperpoint |
$32.26
|
| Rate for Payer: Humana Medicare |
$19.55
|
| Rate for Payer: SELF PAY |
$92.00
|
| Rate for Payer: Veterans (Triwest) |
$19.55
|
|
|
PURPLE OXYGEN DELIVERY MODULE PEDS
|
Facility
OP
|
$115.00
|
|
| Hospital Charge Code |
23175699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: SELF PAY |
$92.00
|
| Rate for Payer: Aetna POS, PPO, HMO |
$103.50
|
| Rate for Payer: Aetna Medicare |
$32.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$19.55
|
| Rate for Payer: Amerigroup Medicare |
$19.55
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$42.95
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$19.55
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$19.55
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$29.90
|
| Rate for Payer: Cigna All Products |
$80.50
|
| Rate for Payer: Copperpoint |
$32.26
|
| Rate for Payer: HealthNet Commercial |
$69.00
|
| Rate for Payer: HealthNet Medicare |
$32.20
|
| Rate for Payer: Humana Medicare |
$19.55
|
| Rate for Payer: Veterans (Triwest) |
$19.55
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$67.05
|
| Rate for Payer: United Healthcare Medicare |
$20.70
|
|
|
Q3014 TELEHEALTH BURN SITE FACILITY FEE
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22282946
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$55.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.54
|
| Rate for Payer: Amerigroup Medicare |
$10.54
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.12
|
| Rate for Payer: Copperpoint |
$17.39
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: SELF PAY |
$49.60
|
| Rate for Payer: Veterans (Triwest) |
$10.54
|
|
|
Q3014 TELEHEALTH BURN SITE FACILITY FEE
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22282946
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$55.80
|
| Rate for Payer: Aetna Medicare |
$17.36
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.54
|
| Rate for Payer: Amerigroup Medicare |
$10.54
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$23.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.12
|
| Rate for Payer: Cigna All Products |
$43.40
|
| Rate for Payer: Copperpoint |
$17.39
|
| Rate for Payer: HealthNet Commercial |
$37.20
|
| Rate for Payer: HealthNet Medicare |
$17.36
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: SELF PAY |
$49.60
|
| Rate for Payer: Veterans (Triwest) |
$10.54
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$36.15
|
| Rate for Payer: United Healthcare Medicare |
$11.16
|
|
|
Q3014 TELEHEALTH CARDIO SITE FACILITY FEE
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22282944
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$55.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.54
|
| Rate for Payer: Amerigroup Medicare |
$10.54
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.12
|
| Rate for Payer: Copperpoint |
$17.39
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: SELF PAY |
$49.60
|
| Rate for Payer: Veterans (Triwest) |
$10.54
|
|
|
Q3014 TELEHEALTH CARDIO SITE FACILITY FEE
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22282944
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$55.80
|
| Rate for Payer: Aetna Medicare |
$17.36
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.54
|
| Rate for Payer: Amerigroup Medicare |
$10.54
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$23.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.12
|
| Rate for Payer: Cigna All Products |
$43.40
|
| Rate for Payer: Copperpoint |
$17.39
|
| Rate for Payer: HealthNet Commercial |
$37.20
|
| Rate for Payer: HealthNet Medicare |
$17.36
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: SELF PAY |
$49.60
|
| Rate for Payer: Veterans (Triwest) |
$10.54
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$36.15
|
| Rate for Payer: United Healthcare Medicare |
$11.16
|
|
|
Q3014 TELEHEALTH NEURO SITE FACILITY FEE
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22282943
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$55.80
|
| Rate for Payer: Aetna Medicare |
$17.36
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.54
|
| Rate for Payer: Amerigroup Medicare |
$10.54
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$23.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.12
|
| Rate for Payer: Cigna All Products |
$43.40
|
| Rate for Payer: Copperpoint |
$17.39
|
| Rate for Payer: HealthNet Commercial |
$37.20
|
| Rate for Payer: HealthNet Medicare |
$17.36
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: SELF PAY |
$49.60
|
| Rate for Payer: Veterans (Triwest) |
$10.54
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$36.15
|
| Rate for Payer: United Healthcare Medicare |
$11.16
|
|
|
Q3014 TELEHEALTH NEURO SITE FACILITY FEE
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22282943
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$55.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.54
|
| Rate for Payer: Amerigroup Medicare |
$10.54
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.12
|
| Rate for Payer: Copperpoint |
$17.39
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: SELF PAY |
$49.60
|
| Rate for Payer: Veterans (Triwest) |
$10.54
|
|
|
Q3014 TELEHEALTH PEDIATRICS SITE FACILITY FEE
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22282947
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$55.80
|
| Rate for Payer: Aetna Medicare |
$17.36
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.54
|
| Rate for Payer: Amerigroup Medicare |
$10.54
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$23.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.12
|
| Rate for Payer: Cigna All Products |
$43.40
|
| Rate for Payer: Copperpoint |
$17.39
|
| Rate for Payer: HealthNet Commercial |
$37.20
|
| Rate for Payer: HealthNet Medicare |
$17.36
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: SELF PAY |
$49.60
|
| Rate for Payer: Veterans (Triwest) |
$10.54
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$36.15
|
| Rate for Payer: United Healthcare Medicare |
$11.16
|
|
|
Q3014 TELEHEALTH PEDIATRICS SITE FACILITY FEE
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22282947
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$55.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.54
|
| Rate for Payer: Amerigroup Medicare |
$10.54
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.12
|
| Rate for Payer: Copperpoint |
$17.39
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: SELF PAY |
$49.60
|
| Rate for Payer: Veterans (Triwest) |
$10.54
|
|
|
Q3014 TELEHEALTH PULMON SITE FACILITY FEE
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22282945
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$55.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.54
|
| Rate for Payer: Amerigroup Medicare |
$10.54
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.12
|
| Rate for Payer: Copperpoint |
$17.39
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: SELF PAY |
$49.60
|
| Rate for Payer: Veterans (Triwest) |
$10.54
|
|
|
Q3014 TELEHEALTH PULMON SITE FACILITY FEE
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22282945
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$55.80
|
| Rate for Payer: Aetna Medicare |
$17.36
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$10.54
|
| Rate for Payer: Amerigroup Medicare |
$10.54
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$23.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$10.54
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$10.54
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.12
|
| Rate for Payer: Cigna All Products |
$43.40
|
| Rate for Payer: Copperpoint |
$17.39
|
| Rate for Payer: HealthNet Commercial |
$37.20
|
| Rate for Payer: HealthNet Medicare |
$17.36
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: SELF PAY |
$49.60
|
| Rate for Payer: Veterans (Triwest) |
$10.54
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$36.15
|
| Rate for Payer: United Healthcare Medicare |
$11.16
|
|