|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$7,529.53
|
|
|
Service Code
|
APR-DRG 2282
|
| Hospital Charge Code |
APRDRG2281
|
| Min. Negotiated Rate |
$7,529.53 |
| Max. Negotiated Rate |
$7,529.53 |
| Rate for Payer: AHCCCS Medicaid |
$7,529.53
|
| Rate for Payer: Allwell Medicaid |
$7,529.53
|
| Rate for Payer: AZCH Complete Medicaid |
$7,529.53
|
| Rate for Payer: Banner UC Health Medicaid |
$7,529.53
|
| Rate for Payer: Mercy Care Medicaid |
$7,529.53
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$5,855.99
|
|
|
Service Code
|
APR-DRG 2281
|
| Hospital Charge Code |
APRDRG2282
|
| Min. Negotiated Rate |
$5,855.99 |
| Max. Negotiated Rate |
$5,855.99 |
| Rate for Payer: AHCCCS Medicaid |
$5,855.99
|
| Rate for Payer: Allwell Medicaid |
$5,855.99
|
| Rate for Payer: AZCH Complete Medicaid |
$5,855.99
|
| Rate for Payer: Banner UC Health Medicaid |
$5,855.99
|
| Rate for Payer: Mercy Care Medicaid |
$5,855.99
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$21,389.19
|
|
|
Service Code
|
APR-DRG 2284
|
| Hospital Charge Code |
APRDRG2282
|
| Min. Negotiated Rate |
$21,389.19 |
| Max. Negotiated Rate |
$21,389.19 |
| Rate for Payer: AHCCCS Medicaid |
$21,389.19
|
| Rate for Payer: Allwell Medicaid |
$21,389.19
|
| Rate for Payer: AZCH Complete Medicaid |
$21,389.19
|
| Rate for Payer: Banner UC Health Medicaid |
$21,389.19
|
| Rate for Payer: Mercy Care Medicaid |
$21,389.19
|
|
|
INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANC
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
24049524
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$56.68 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna of AZ Commercial |
$196.20
|
| Rate for Payer: Bisbee Police All Plans |
$56.68
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Self Pay Self Pay |
$174.40
|
|
|
INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANC
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
24049524
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$196.20
|
| Rate for Payer: Aetna of AZ Medicare |
$61.04
|
| Rate for Payer: AHCCCS Medicaid |
$920.16
|
| Rate for Payer: Allwell Medicaid |
$920.16
|
| Rate for Payer: Allwell Medicare |
$32.70
|
| Rate for Payer: Amerigroup Medicare |
$32.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$81.42
|
| Rate for Payer: AZCH Complete Medicaid |
$920.16
|
| Rate for Payer: AZCH Complete Medicare |
$32.70
|
| Rate for Payer: Banner UC Health Medicaid |
$920.16
|
| Rate for Payer: Banner UC Health Medicare |
$32.70
|
| Rate for Payer: Bisbee Police All Plans |
$56.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$148.24
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cigna of AZ Commercial |
$109.00
|
| Rate for Payer: Copperpoint Commercial |
$53.96
|
| Rate for Payer: Health Net of AZ Commercial |
$130.80
|
| Rate for Payer: Health Net of AZ Medicare |
$61.04
|
| Rate for Payer: Humana of AZ Medicare |
$32.70
|
| Rate for Payer: Mercy Care Medicaid |
$920.16
|
| Rate for Payer: Self Pay Self Pay |
$174.40
|
| Rate for Payer: TriWest Medicare |
$32.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$39.24
|
|
|
INJECTION OF LOCAL ANESTHETIC FOR ABDOMINAL WALL PAIN CONTRO
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 64486 59
|
| Hospital Charge Code |
22282744
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of AZ Commercial |
$340.20
|
| Rate for Payer: Bisbee Police All Plans |
$98.28
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Self Pay Self Pay |
$302.40
|
|
|
INJECTION OF LOCAL ANESTHETIC FOR ABDOMINAL WALL PAIN CONTRO
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 64486 59
|
| Hospital Charge Code |
22282744
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of AZ Commercial |
$340.20
|
| Rate for Payer: Aetna of AZ Medicare |
$105.84
|
| Rate for Payer: Allwell Medicare |
$56.70
|
| Rate for Payer: Amerigroup Medicare |
$56.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$141.18
|
| Rate for Payer: AZCH Complete Medicare |
$56.70
|
| Rate for Payer: Banner UC Health Medicare |
$56.70
|
| Rate for Payer: Bisbee Police All Plans |
$98.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$257.04
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna of AZ Commercial |
$245.70
|
| Rate for Payer: Copperpoint Commercial |
$93.56
|
| Rate for Payer: Health Net of AZ Commercial |
$226.80
|
| Rate for Payer: Health Net of AZ Medicare |
$105.84
|
| Rate for Payer: Humana of AZ Medicare |
$56.70
|
| Rate for Payer: Self Pay Self Pay |
$302.40
|
| Rate for Payer: TriWest Medicare |
$56.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$220.37
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$68.04
|
|
|
INJECTION OF LOCAL ANESTHETIC FOR ABDOMINAL WALL PAIN CONTRO
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 64488 59
|
| Hospital Charge Code |
22282748
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$87.62 |
| Max. Negotiated Rate |
$303.30 |
| Rate for Payer: Aetna of AZ Commercial |
$303.30
|
| Rate for Payer: Bisbee Police All Plans |
$87.62
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Self Pay Self Pay |
$269.60
|
|
|
INJECTION OF LOCAL ANESTHETIC FOR ABDOMINAL WALL PAIN CONTRO
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 64488 59
|
| Hospital Charge Code |
22282748
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$50.55 |
| Max. Negotiated Rate |
$303.30 |
| Rate for Payer: Aetna of AZ Commercial |
$303.30
|
| Rate for Payer: Aetna of AZ Medicare |
$94.36
|
| Rate for Payer: Allwell Medicare |
$50.55
|
| Rate for Payer: Amerigroup Medicare |
$50.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$125.87
|
| Rate for Payer: AZCH Complete Medicare |
$50.55
|
| Rate for Payer: Banner UC Health Medicare |
$50.55
|
| Rate for Payer: Bisbee Police All Plans |
$87.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$229.16
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cigna of AZ Commercial |
$219.05
|
| Rate for Payer: Copperpoint Commercial |
$83.41
|
| Rate for Payer: Health Net of AZ Commercial |
$202.20
|
| Rate for Payer: Health Net of AZ Medicare |
$94.36
|
| Rate for Payer: Humana of AZ Medicare |
$50.55
|
| Rate for Payer: Self Pay Self Pay |
$269.60
|
| Rate for Payer: TriWest Medicare |
$50.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$196.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$60.66
|
|
|
INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO NERVE OF F
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
24049522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$153.00
|
| Rate for Payer: Aetna of AZ Medicare |
$47.60
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicare |
$25.50
|
| Rate for Payer: Amerigroup Medicare |
$25.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$63.50
|
| Rate for Payer: AZCH Complete Medicaid |
$378.70
|
| Rate for Payer: AZCH Complete Medicare |
$25.50
|
| Rate for Payer: Banner UC Health Medicaid |
$378.70
|
| Rate for Payer: Banner UC Health Medicare |
$25.50
|
| Rate for Payer: Bisbee Police All Plans |
$44.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$115.60
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna of AZ Commercial |
$85.00
|
| Rate for Payer: Copperpoint Commercial |
$42.08
|
| Rate for Payer: Health Net of AZ Commercial |
$102.00
|
| Rate for Payer: Health Net of AZ Medicare |
$47.60
|
| Rate for Payer: Humana of AZ Medicare |
$25.50
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: Self Pay Self Pay |
$136.00
|
| Rate for Payer: TriWest Medicare |
$25.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.60
|
|
|
INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO NERVE OF F
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
24049522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of AZ Commercial |
$153.00
|
| Rate for Payer: Bisbee Police All Plans |
$44.20
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Self Pay Self Pay |
$136.00
|
|
|
INJECTIONS OF TENDON SHEATH, LIGAMENT, OR MUSCLE MEMBRANE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
24049521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$171.90
|
| Rate for Payer: Aetna of AZ Medicare |
$53.48
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicare |
$28.65
|
| Rate for Payer: Amerigroup Medicare |
$28.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$71.34
|
| Rate for Payer: AZCH Complete Medicaid |
$378.70
|
| Rate for Payer: AZCH Complete Medicare |
$28.65
|
| Rate for Payer: Banner UC Health Medicaid |
$378.70
|
| Rate for Payer: Banner UC Health Medicare |
$28.65
|
| Rate for Payer: Bisbee Police All Plans |
$49.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$129.88
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cigna of AZ Commercial |
$95.50
|
| Rate for Payer: Copperpoint Commercial |
$47.27
|
| Rate for Payer: Health Net of AZ Commercial |
$114.60
|
| Rate for Payer: Health Net of AZ Medicare |
$53.48
|
| Rate for Payer: Humana of AZ Medicare |
$28.65
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: Self Pay Self Pay |
$152.80
|
| Rate for Payer: TriWest Medicare |
$28.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$34.38
|
|
|
INJECTIONS OF TENDON SHEATH, LIGAMENT, OR MUSCLE MEMBRANE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
24049521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of AZ Commercial |
$171.90
|
| Rate for Payer: Bisbee Police All Plans |
$49.66
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Self Pay Self Pay |
$152.80
|
|
|
INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
22760242
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$497.70
|
| Rate for Payer: Aetna of AZ Medicare |
$154.84
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$82.95
|
| Rate for Payer: Amerigroup Medicare |
$82.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$206.55
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$82.95
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$82.95
|
| Rate for Payer: Bisbee Police All Plans |
$143.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$376.04
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cigna of AZ Commercial |
$387.10
|
| Rate for Payer: Copperpoint Commercial |
$136.87
|
| Rate for Payer: Health Net of AZ Commercial |
$331.80
|
| Rate for Payer: Health Net of AZ Medicare |
$154.84
|
| Rate for Payer: Humana of AZ Medicare |
$82.95
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$442.40
|
| Rate for Payer: TriWest Medicare |
$82.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$99.54
|
|
|
INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
22760242
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$143.78 |
| Max. Negotiated Rate |
$497.70 |
| Rate for Payer: Aetna of AZ Commercial |
$497.70
|
| Rate for Payer: Bisbee Police All Plans |
$143.78
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Self Pay Self Pay |
$442.40
|
|
|
INSERTION OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
22760243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$792.90
|
| Rate for Payer: Aetna of AZ Medicare |
$246.68
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$132.15
|
| Rate for Payer: Amerigroup Medicare |
$132.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$329.05
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$132.15
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$132.15
|
| Rate for Payer: Bisbee Police All Plans |
$229.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$599.08
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cigna of AZ Commercial |
$440.50
|
| Rate for Payer: Copperpoint Commercial |
$218.05
|
| Rate for Payer: Health Net of AZ Commercial |
$528.60
|
| Rate for Payer: Health Net of AZ Medicare |
$246.68
|
| Rate for Payer: Humana of AZ Medicare |
$132.15
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$704.80
|
| Rate for Payer: TriWest Medicare |
$132.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$158.58
|
|
|
INSERTION OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
22760243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$229.06 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of AZ Commercial |
$792.90
|
| Rate for Payer: Bisbee Police All Plans |
$229.06
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Self Pay Self Pay |
$704.80
|
|
|
INSERTION OF PESSARY INTRAVAGINAL SUPPORT DEVICE
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
22951058
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$531.90
|
| Rate for Payer: Aetna of AZ Medicare |
$165.48
|
| Rate for Payer: AHCCCS Medicaid |
$246.96
|
| Rate for Payer: Allwell Medicaid |
$246.96
|
| Rate for Payer: Allwell Medicare |
$88.65
|
| Rate for Payer: Amerigroup Medicare |
$88.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$220.74
|
| Rate for Payer: AZCH Complete Medicaid |
$246.96
|
| Rate for Payer: AZCH Complete Medicare |
$88.65
|
| Rate for Payer: Banner UC Health Medicaid |
$246.96
|
| Rate for Payer: Banner UC Health Medicare |
$88.65
|
| Rate for Payer: Bisbee Police All Plans |
$153.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$401.88
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cigna of AZ Commercial |
$413.70
|
| Rate for Payer: Copperpoint Commercial |
$146.27
|
| Rate for Payer: Health Net of AZ Commercial |
$354.60
|
| Rate for Payer: Health Net of AZ Medicare |
$165.48
|
| Rate for Payer: Humana of AZ Medicare |
$88.65
|
| Rate for Payer: Mercy Care Medicaid |
$246.96
|
| Rate for Payer: Self Pay Self Pay |
$472.80
|
| Rate for Payer: TriWest Medicare |
$88.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$106.38
|
|
|
INSERTION OF PESSARY INTRAVAGINAL SUPPORT DEVICE
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
22951058
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$153.66 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of AZ Commercial |
$531.90
|
| Rate for Payer: Bisbee Police All Plans |
$153.66
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Self Pay Self Pay |
$472.80
|
|
|
Insertion of Portacath additional minutes
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 00532
|
| Hospital Charge Code |
23968401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Aetna of AZ Medicare |
$2.52
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicare |
$1.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.36
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$1.35
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$1.35
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of AZ Commercial |
$5.85
|
| Rate for Payer: Copperpoint Commercial |
$2.23
|
| Rate for Payer: Health Net of AZ Commercial |
$5.40
|
| Rate for Payer: Health Net of AZ Medicare |
$2.52
|
| Rate for Payer: Humana of AZ Medicare |
$1.35
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
| Rate for Payer: TriWest Medicare |
$1.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.62
|
|
|
Insertion of Portacath additional minutes
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 00532
|
| Hospital Charge Code |
23968401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
|
|
INSERTION OF STENT IN URETER USING AN ENDOSCOPE
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
27807900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.52 |
| Max. Negotiated Rate |
$721.80 |
| Rate for Payer: Aetna of AZ Commercial |
$721.80
|
| Rate for Payer: Bisbee Police All Plans |
$208.52
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Self Pay Self Pay |
$641.60
|
|
|
INSERTION OF STENT IN URETER USING AN ENDOSCOPE
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
27807900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$120.30 |
| Max. Negotiated Rate |
$4,460.70 |
| Rate for Payer: Aetna of AZ Commercial |
$721.80
|
| Rate for Payer: Aetna of AZ Medicare |
$224.56
|
| Rate for Payer: AHCCCS Medicaid |
$4,460.70
|
| Rate for Payer: Allwell Medicaid |
$4,460.70
|
| Rate for Payer: Allwell Medicare |
$120.30
|
| Rate for Payer: Amerigroup Medicare |
$120.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$299.55
|
| Rate for Payer: AZCH Complete Medicaid |
$4,460.70
|
| Rate for Payer: AZCH Complete Medicare |
$120.30
|
| Rate for Payer: Banner UC Health Medicaid |
$4,460.70
|
| Rate for Payer: Banner UC Health Medicare |
$120.30
|
| Rate for Payer: Bisbee Police All Plans |
$208.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$545.36
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cigna of AZ Commercial |
$401.00
|
| Rate for Payer: Copperpoint Commercial |
$198.50
|
| Rate for Payer: Health Net of AZ Commercial |
$481.20
|
| Rate for Payer: Health Net of AZ Medicare |
$224.56
|
| Rate for Payer: Humana of AZ Medicare |
$120.30
|
| Rate for Payer: Mercy Care Medicaid |
$4,460.70
|
| Rate for Payer: Self Pay Self Pay |
$641.60
|
| Rate for Payer: TriWest Medicare |
$120.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$144.36
|
|
|
INSERTION OF STOMACH TUBE USING AN EDOCS
|
Facility
|
OP
|
$6,347.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
23599034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$952.05 |
| Max. Negotiated Rate |
$5,712.30 |
| Rate for Payer: Aetna of AZ Commercial |
$5,712.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,777.16
|
| Rate for Payer: AHCCCS Medicaid |
$2,356.28
|
| Rate for Payer: Allwell Medicaid |
$2,356.28
|
| Rate for Payer: Allwell Medicare |
$952.05
|
| Rate for Payer: Amerigroup Medicare |
$952.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,370.60
|
| Rate for Payer: AZCH Complete Medicaid |
$2,356.28
|
| Rate for Payer: AZCH Complete Medicare |
$952.05
|
| Rate for Payer: Banner UC Health Medicaid |
$2,356.28
|
| Rate for Payer: Banner UC Health Medicare |
$952.05
|
| Rate for Payer: Bisbee Police All Plans |
$1,650.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4,315.96
|
| Rate for Payer: Cash Price |
$5,077.60
|
| Rate for Payer: Cash Price |
$5,077.60
|
| Rate for Payer: Cigna of AZ Commercial |
$4,442.90
|
| Rate for Payer: Copperpoint Commercial |
$1,570.88
|
| Rate for Payer: Health Net of AZ Commercial |
$3,808.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,777.16
|
| Rate for Payer: Humana of AZ Medicare |
$952.05
|
| Rate for Payer: Mercy Care Medicaid |
$2,356.28
|
| Rate for Payer: Self Pay Self Pay |
$5,077.60
|
| Rate for Payer: TriWest Medicare |
$952.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,142.46
|
|
|
INSERTION OF STOMACH TUBE USING AN EDOCS
|
Facility
|
IP
|
$6,347.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
23599034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,650.22 |
| Max. Negotiated Rate |
$5,712.30 |
| Rate for Payer: Aetna of AZ Commercial |
$5,712.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,650.22
|
| Rate for Payer: Cash Price |
$5,077.60
|
| Rate for Payer: Self Pay Self Pay |
$5,077.60
|
|
