|
Rehabilitation
|
Facility
IP
|
$9,792.25
|
|
|
Service Code
|
APRDRG 8602
|
| Hospital Charge Code |
APRDRG8602
|
| Min. Negotiated Rate |
$9,792.25 |
| Max. Negotiated Rate |
$9,792.25 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$9,792.25
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$9,792.25
|
| Rate for Payer: Banner University Family Care Medicaid |
$9,792.25
|
| Rate for Payer: Mercy Care Medicaid |
$9,792.25
|
|
|
RELEASE TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
|
Facility
OP
|
$1,654.00
|
|
|
Service Code
|
CPT 28035
|
| Hospital Charge Code |
24043317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.18 |
| Max. Negotiated Rate |
$2,543.86 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,488.60
|
| Rate for Payer: Aetna Medicare |
$463.12
|
| Rate for Payer: AHCCCS Medicaid |
$2,543.86
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,543.86
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$281.18
|
| Rate for Payer: Amerigroup Medicare |
$281.18
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$617.77
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,543.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$281.18
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$281.18
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,543.86
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$430.04
|
| Rate for Payer: Cigna All Products |
$827.00
|
| Rate for Payer: Copperpoint |
$463.95
|
| Rate for Payer: HealthNet Commercial |
$992.40
|
| Rate for Payer: HealthNet Medicare |
$463.12
|
| Rate for Payer: Humana Medicare |
$281.18
|
| Rate for Payer: Mercy Care Medicaid |
$2,543.86
|
| Rate for Payer: SELF PAY |
$1,323.20
|
| Rate for Payer: Veterans (Triwest) |
$281.18
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$964.28
|
| Rate for Payer: United Healthcare Medicare |
$297.72
|
|
|
RELEASE TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
|
Facility
IP
|
$1,654.00
|
|
|
Service Code
|
CPT 28035
|
| Hospital Charge Code |
24043317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.18 |
| Max. Negotiated Rate |
$1,488.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,488.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$281.18
|
| Rate for Payer: Amerigroup Medicare |
$281.18
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$281.18
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$281.18
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$430.04
|
| Rate for Payer: Copperpoint |
$463.95
|
| Rate for Payer: Humana Medicare |
$281.18
|
| Rate for Payer: SELF PAY |
$1,323.20
|
| Rate for Payer: Veterans (Triwest) |
$281.18
|
|
|
REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE P
|
Facility
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 54406
|
| Hospital Charge Code |
23173229
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$246.16 |
| Max. Negotiated Rate |
$4,460.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,303.20
|
| Rate for Payer: Aetna Medicare |
$405.44
|
| Rate for Payer: AHCCCS Medicaid |
$4,460.70
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4,460.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$246.16
|
| Rate for Payer: Amerigroup Medicare |
$246.16
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$540.83
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4,460.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$246.16
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$246.16
|
| Rate for Payer: Banner University Family Care Medicaid |
$4,460.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$376.48
|
| Rate for Payer: Cigna All Products |
$1,013.60
|
| Rate for Payer: Copperpoint |
$406.16
|
| Rate for Payer: HealthNet Commercial |
$868.80
|
| Rate for Payer: HealthNet Medicare |
$405.44
|
| Rate for Payer: Humana Medicare |
$246.16
|
| Rate for Payer: Mercy Care Medicaid |
$4,460.70
|
| Rate for Payer: SELF PAY |
$1,158.40
|
| Rate for Payer: Veterans (Triwest) |
$246.16
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$844.18
|
| Rate for Payer: United Healthcare Medicare |
$260.64
|
|
|
REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE P
|
Facility
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 54406
|
| Hospital Charge Code |
23173229
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$246.16 |
| Max. Negotiated Rate |
$1,303.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,303.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$246.16
|
| Rate for Payer: Amerigroup Medicare |
$246.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$246.16
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$246.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$376.48
|
| Rate for Payer: Copperpoint |
$406.16
|
| Rate for Payer: Humana Medicare |
$246.16
|
| Rate for Payer: SELF PAY |
$1,158.40
|
| Rate for Payer: Veterans (Triwest) |
$246.16
|
|
|
REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE D
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
24049292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$70.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$13.26
|
| Rate for Payer: Amerigroup Medicare |
$13.26
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$13.26
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$13.26
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$20.28
|
| Rate for Payer: Copperpoint |
$21.88
|
| Rate for Payer: Humana Medicare |
$13.26
|
| Rate for Payer: SELF PAY |
$62.40
|
| Rate for Payer: Veterans (Triwest) |
$13.26
|
|
|
REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE D
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
24049292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$260.34 |
| Rate for Payer: Aetna POS, PPO, HMO |
$70.20
|
| Rate for Payer: Aetna Medicare |
$21.84
|
| 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 |
$13.26
|
| Rate for Payer: Amerigroup Medicare |
$13.26
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$29.13
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$13.26
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$13.26
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$20.28
|
| Rate for Payer: Cigna All Products |
$39.00
|
| Rate for Payer: Copperpoint |
$21.88
|
| Rate for Payer: HealthNet Commercial |
$46.80
|
| Rate for Payer: HealthNet Medicare |
$21.84
|
| Rate for Payer: Humana Medicare |
$13.26
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$62.40
|
| Rate for Payer: Veterans (Triwest) |
$13.26
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$45.47
|
| Rate for Payer: United Healthcare Medicare |
$14.04
|
|
|
REMOVAL OF FOREIGN BODY FOOT; SUBCUTANEOUS - Tech
|
Facility
IP
|
$624.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
24043293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$561.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$106.08
|
| Rate for Payer: Amerigroup Medicare |
$106.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$106.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$106.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$162.24
|
| Rate for Payer: Copperpoint |
$175.03
|
| Rate for Payer: Humana Medicare |
$106.08
|
| Rate for Payer: SELF PAY |
$499.20
|
| Rate for Payer: Veterans (Triwest) |
$106.08
|
|
|
REMOVAL OF FOREIGN BODY FOOT; SUBCUTANEOUS - Tech
|
Facility
OP
|
$624.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
24043293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$901.86 |
| Rate for Payer: Aetna POS, PPO, HMO |
$561.60
|
| Rate for Payer: Aetna Medicare |
$174.72
|
| Rate for Payer: AHCCCS Medicaid |
$901.86
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$901.86
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$106.08
|
| Rate for Payer: Amerigroup Medicare |
$106.08
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$233.06
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$901.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$106.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$106.08
|
| Rate for Payer: Banner University Family Care Medicaid |
$901.86
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$162.24
|
| Rate for Payer: Cigna All Products |
$312.00
|
| Rate for Payer: Copperpoint |
$175.03
|
| Rate for Payer: HealthNet Commercial |
$374.40
|
| Rate for Payer: HealthNet Medicare |
$174.72
|
| Rate for Payer: Humana Medicare |
$106.08
|
| Rate for Payer: Mercy Care Medicaid |
$901.86
|
| Rate for Payer: SELF PAY |
$499.20
|
| Rate for Payer: Veterans (Triwest) |
$106.08
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$363.79
|
| Rate for Payer: United Healthcare Medicare |
$112.32
|
|
|
REMOVAL OF IMPLANT; DEEP (EG BURIED WIRE PIN SCREW METAL BAND NAIL ROD OR
|
Facility
IP
|
$1,950.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
24043286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$1,755.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,755.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$331.50
|
| Rate for Payer: Amerigroup Medicare |
$331.50
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$331.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$331.50
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$507.00
|
| Rate for Payer: Copperpoint |
$546.98
|
| Rate for Payer: Humana Medicare |
$331.50
|
| Rate for Payer: SELF PAY |
$1,560.00
|
| Rate for Payer: Veterans (Triwest) |
$331.50
|
|
|
REMOVAL OF IMPLANT; DEEP (EG BURIED WIRE PIN SCREW METAL BAND NAIL ROD OR
|
Facility
OP
|
$1,950.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
24043286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$3,436.52 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,755.00
|
| Rate for Payer: Aetna Medicare |
$546.00
|
| Rate for Payer: AHCCCS Medicaid |
$3,436.52
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3,436.52
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$331.50
|
| Rate for Payer: Amerigroup Medicare |
$331.50
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$728.33
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3,436.52
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$331.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$331.50
|
| Rate for Payer: Banner University Family Care Medicaid |
$3,436.52
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$507.00
|
| Rate for Payer: Cigna All Products |
$975.00
|
| Rate for Payer: Copperpoint |
$546.98
|
| Rate for Payer: HealthNet Commercial |
$1,170.00
|
| Rate for Payer: HealthNet Medicare |
$546.00
|
| Rate for Payer: Humana Medicare |
$331.50
|
| Rate for Payer: Mercy Care Medicaid |
$3,436.52
|
| Rate for Payer: SELF PAY |
$1,560.00
|
| Rate for Payer: Veterans (Triwest) |
$331.50
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,136.85
|
| Rate for Payer: United Healthcare Medicare |
$351.00
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG BURIED WIRE PIN OR ROD) (SEPARATE
|
Facility
IP
|
$676.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
24043316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.92 |
| Max. Negotiated Rate |
$608.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$608.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$114.92
|
| Rate for Payer: Amerigroup Medicare |
$114.92
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$114.92
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$114.92
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$175.76
|
| Rate for Payer: Copperpoint |
$189.62
|
| Rate for Payer: Humana Medicare |
$114.92
|
| Rate for Payer: SELF PAY |
$540.80
|
| Rate for Payer: Veterans (Triwest) |
$114.92
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG BURIED WIRE PIN OR ROD) (SEPARATE
|
Facility
OP
|
$676.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
24043316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.92 |
| Max. Negotiated Rate |
$2,040.16 |
| Rate for Payer: Aetna POS, PPO, HMO |
$608.40
|
| Rate for Payer: Aetna Medicare |
$189.28
|
| Rate for Payer: AHCCCS Medicaid |
$2,040.16
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,040.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$114.92
|
| Rate for Payer: Amerigroup Medicare |
$114.92
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$252.49
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,040.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$114.92
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$114.92
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,040.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$175.76
|
| Rate for Payer: Cigna All Products |
$338.00
|
| Rate for Payer: Copperpoint |
$189.62
|
| Rate for Payer: HealthNet Commercial |
$405.60
|
| Rate for Payer: HealthNet Medicare |
$189.28
|
| Rate for Payer: Humana Medicare |
$114.92
|
| Rate for Payer: Mercy Care Medicaid |
$2,040.16
|
| Rate for Payer: SELF PAY |
$540.80
|
| Rate for Payer: Veterans (Triwest) |
$114.92
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$394.11
|
| Rate for Payer: United Healthcare Medicare |
$121.68
|
|
|
Removal of lead
|
Facility
IP
|
$740.00
|
|
|
Service Code
|
CPT 64585
|
| Hospital Charge Code |
27281907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$666.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$125.80
|
| Rate for Payer: Amerigroup Medicare |
$125.80
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$125.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$125.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$192.40
|
| Rate for Payer: Copperpoint |
$207.57
|
| Rate for Payer: Humana Medicare |
$125.80
|
| Rate for Payer: SELF PAY |
$592.00
|
| Rate for Payer: Veterans (Triwest) |
$125.80
|
|
|
Removal of lead
|
Facility
OP
|
$740.00
|
|
|
Service Code
|
CPT 64585
|
| Hospital Charge Code |
27281907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$4,749.18 |
| Rate for Payer: Aetna POS, PPO, HMO |
$666.00
|
| Rate for Payer: Aetna Medicare |
$207.20
|
| Rate for Payer: AHCCCS Medicaid |
$4,749.18
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4,749.18
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$125.80
|
| Rate for Payer: Amerigroup Medicare |
$125.80
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$276.39
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4,749.18
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$125.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$125.80
|
| Rate for Payer: Banner University Family Care Medicaid |
$4,749.18
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$192.40
|
| Rate for Payer: Cigna All Products |
$370.00
|
| Rate for Payer: Copperpoint |
$207.57
|
| Rate for Payer: HealthNet Commercial |
$444.00
|
| Rate for Payer: HealthNet Medicare |
$207.20
|
| Rate for Payer: Humana Medicare |
$125.80
|
| Rate for Payer: Mercy Care Medicaid |
$4,749.18
|
| Rate for Payer: SELF PAY |
$592.00
|
| Rate for Payer: Veterans (Triwest) |
$125.80
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$431.42
|
| Rate for Payer: United Healthcare Medicare |
$133.20
|
|
|
Removal /revision of generator
|
Facility
OP
|
$655.00
|
|
|
Service Code
|
CPT 64595
|
| Hospital Charge Code |
27267840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$4,749.18 |
| Rate for Payer: City of Bisbee Police Bisbee Police |
$170.30
|
| Rate for Payer: Aetna POS, PPO, HMO |
$589.50
|
| Rate for Payer: Aetna Medicare |
$183.40
|
| Rate for Payer: AHCCCS Medicaid |
$4,749.18
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4,749.18
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$111.35
|
| Rate for Payer: Amerigroup Medicare |
$111.35
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$244.64
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4,749.18
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$111.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$111.35
|
| Rate for Payer: Banner University Family Care Medicaid |
$4,749.18
|
| Rate for Payer: Cigna All Products |
$327.50
|
| Rate for Payer: Copperpoint |
$183.73
|
| Rate for Payer: HealthNet Commercial |
$393.00
|
| Rate for Payer: HealthNet Medicare |
$183.40
|
| Rate for Payer: Humana Medicare |
$111.35
|
| Rate for Payer: Mercy Care Medicaid |
$4,749.18
|
| Rate for Payer: SELF PAY |
$524.00
|
| Rate for Payer: Veterans (Triwest) |
$111.35
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$381.86
|
| Rate for Payer: United Healthcare Medicare |
$117.90
|
|
|
Removal /revision of generator
|
Facility
IP
|
$655.00
|
|
|
Service Code
|
CPT 64595
|
| Hospital Charge Code |
27267840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$589.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$111.35
|
| Rate for Payer: Amerigroup Medicare |
$111.35
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$111.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$111.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$170.30
|
| Rate for Payer: Copperpoint |
$183.73
|
| Rate for Payer: Humana Medicare |
$111.35
|
| Rate for Payer: SELF PAY |
$524.00
|
| Rate for Payer: Veterans (Triwest) |
$111.35
|
|
|
REMOVER STAPLE PRECISE 3M
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
22540633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$13.50
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.55
|
| Rate for Payer: Amerigroup Medicare |
$2.55
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$5.60
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.55
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.55
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.90
|
| Rate for Payer: Cigna All Products |
$10.50
|
| Rate for Payer: Copperpoint |
$4.21
|
| Rate for Payer: HealthNet Commercial |
$9.00
|
| Rate for Payer: HealthNet Medicare |
$4.20
|
| Rate for Payer: Humana Medicare |
$2.55
|
| Rate for Payer: SELF PAY |
$12.00
|
| Rate for Payer: Veterans (Triwest) |
$2.55
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$8.74
|
| Rate for Payer: United Healthcare Medicare |
$2.70
|
|
|
REMOVER STAPLE PRECISE 3M
|
Facility
IP
|
$15.00
|
|
| Hospital Charge Code |
22540633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$13.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.55
|
| Rate for Payer: Amerigroup Medicare |
$2.55
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.55
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.55
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.90
|
| Rate for Payer: Copperpoint |
$4.21
|
| Rate for Payer: Humana Medicare |
$2.55
|
| Rate for Payer: SELF PAY |
$12.00
|
| Rate for Payer: Veterans (Triwest) |
$2.55
|
|
|
REMOVER STAPLE PROXIMATE
|
Facility
OP
|
$35.00
|
|
| Hospital Charge Code |
22355173
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$31.50
|
| Rate for Payer: Aetna Medicare |
$9.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.95
|
| Rate for Payer: Amerigroup Medicare |
$5.95
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$13.07
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.95
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$9.10
|
| Rate for Payer: Cigna All Products |
$24.50
|
| Rate for Payer: Copperpoint |
$9.82
|
| Rate for Payer: HealthNet Commercial |
$21.00
|
| Rate for Payer: HealthNet Medicare |
$9.80
|
| Rate for Payer: Humana Medicare |
$5.95
|
| Rate for Payer: SELF PAY |
$28.00
|
| Rate for Payer: Veterans (Triwest) |
$5.95
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$20.40
|
| Rate for Payer: United Healthcare Medicare |
$6.30
|
|
|
REMOVER STAPLE PROXIMATE
|
Facility
IP
|
$35.00
|
|
| Hospital Charge Code |
22355173
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$31.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$5.95
|
| Rate for Payer: Amerigroup Medicare |
$5.95
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$5.95
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$5.95
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$9.10
|
| Rate for Payer: Copperpoint |
$9.82
|
| Rate for Payer: Humana Medicare |
$5.95
|
| Rate for Payer: SELF PAY |
$28.00
|
| Rate for Payer: Veterans (Triwest) |
$5.95
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
IP
|
$6,833.04
|
|
|
Service Code
|
APRDRG 4441
|
| Hospital Charge Code |
APRDRG4441
|
| Min. Negotiated Rate |
$6,833.04 |
| Max. Negotiated Rate |
$6,833.04 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$6,833.04
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$6,833.04
|
| Rate for Payer: Banner University Family Care Medicaid |
$6,833.04
|
| Rate for Payer: Mercy Care Medicaid |
$6,833.04
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
IP
|
$16,643.52
|
|
|
Service Code
|
APRDRG 4443
|
| Hospital Charge Code |
APRDRG4443
|
| Min. Negotiated Rate |
$16,643.52 |
| Max. Negotiated Rate |
$16,643.52 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$16,643.52
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$16,643.52
|
| Rate for Payer: Banner University Family Care Medicaid |
$16,643.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,643.52
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
IP
|
$10,436.13
|
|
|
Service Code
|
APRDRG 4442
|
| Hospital Charge Code |
APRDRG4442
|
| Min. Negotiated Rate |
$10,436.13 |
| Max. Negotiated Rate |
$10,436.13 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$10,436.13
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$10,436.13
|
| Rate for Payer: Banner University Family Care Medicaid |
$10,436.13
|
| Rate for Payer: Mercy Care Medicaid |
$10,436.13
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
IP
|
$29,825.63
|
|
|
Service Code
|
APRDRG 4444
|
| Hospital Charge Code |
APRDRG4444
|
| Min. Negotiated Rate |
$29,825.63 |
| Max. Negotiated Rate |
$29,825.63 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$29,825.63
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$29,825.63
|
| Rate for Payer: Banner University Family Care Medicaid |
$29,825.63
|
| Rate for Payer: Mercy Care Medicaid |
$29,825.63
|
|