|
INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO RIB NERVE
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
27927130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$273.60
|
| Rate for Payer: Aetna of AZ Medicare |
$85.12
|
| Rate for Payer: AHCCCS Medicaid |
$460.08
|
| Rate for Payer: Allwell Medicaid |
$460.08
|
| Rate for Payer: Allwell Medicare |
$48.64
|
| Rate for Payer: Amerigroup Medicare |
$48.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$113.54
|
| Rate for Payer: AZCH Complete Medicaid |
$460.08
|
| Rate for Payer: AZCH Complete Medicare |
$48.64
|
| Rate for Payer: Banner UC Health Medicaid |
$460.08
|
| Rate for Payer: Banner UC Health Medicare |
$48.64
|
| Rate for Payer: Bisbee Police All Plans |
$79.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$206.72
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cigna of AZ Commercial |
$152.00
|
| Rate for Payer: Copperpoint Commercial |
$75.24
|
| Rate for Payer: Health Net of AZ Commercial |
$182.40
|
| Rate for Payer: Health Net of AZ Medicare |
$85.12
|
| Rate for Payer: Humana of AZ Medicare |
$48.64
|
| Rate for Payer: Mercy Care Medicaid |
$460.08
|
| Rate for Payer: Self Pay Self Pay |
$243.20
|
| Rate for Payer: TriWest Medicare |
$48.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$54.72
|
|
|
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
|
$337.00
|
|
|
Service Code
|
CPT 64488 59
|
| Hospital Charge Code |
22282748
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$303.30
|
| Rate for Payer: Aetna of AZ Medicare |
$94.36
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$53.92
|
| Rate for Payer: Amerigroup Medicare |
$53.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$125.87
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$53.92
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$53.92
|
| 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: 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 |
$53.92
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$269.60
|
| Rate for Payer: TriWest Medicare |
$53.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$60.66
|
|
|
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
|
$378.00
|
|
|
Service Code
|
CPT 64486 59
|
| Hospital Charge Code |
22282744
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$340.20
|
| Rate for Payer: Aetna of AZ Medicare |
$105.84
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$60.48
|
| Rate for Payer: Amerigroup Medicare |
$60.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$141.18
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$60.48
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$60.48
|
| 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: 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 |
$60.48
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$302.40
|
| Rate for Payer: TriWest Medicare |
$60.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$68.04
|
|
|
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 |
$27.20 |
| 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 |
$189.35
|
| Rate for Payer: Allwell Medicaid |
$189.35
|
| Rate for Payer: Allwell Medicare |
$27.20
|
| Rate for Payer: Amerigroup Medicare |
$27.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$63.49
|
| Rate for Payer: AZCH Complete Medicaid |
$189.35
|
| Rate for Payer: AZCH Complete Medicare |
$27.20
|
| Rate for Payer: Banner UC Health Medicaid |
$189.35
|
| Rate for Payer: Banner UC Health Medicare |
$27.20
|
| 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 |
$27.20
|
| Rate for Payer: Mercy Care Medicaid |
$189.35
|
| Rate for Payer: Self Pay Self Pay |
$136.00
|
| Rate for Payer: TriWest Medicare |
$27.20
|
| 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
|
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
|
|
|
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 |
$30.56 |
| 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 |
$189.35
|
| Rate for Payer: Allwell Medicaid |
$189.35
|
| Rate for Payer: Allwell Medicare |
$30.56
|
| Rate for Payer: Amerigroup Medicare |
$30.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$71.34
|
| Rate for Payer: AZCH Complete Medicaid |
$189.35
|
| Rate for Payer: AZCH Complete Medicare |
$30.56
|
| Rate for Payer: Banner UC Health Medicaid |
$189.35
|
| Rate for Payer: Banner UC Health Medicare |
$30.56
|
| 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 |
$30.56
|
| Rate for Payer: Mercy Care Medicaid |
$189.35
|
| Rate for Payer: Self Pay Self Pay |
$152.80
|
| Rate for Payer: TriWest Medicare |
$30.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$34.38
|
|
|
INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
IP
|
$346.75
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
22760242
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$312.07 |
| Rate for Payer: Aetna of AZ Commercial |
$312.07
|
| Rate for Payer: Bisbee Police All Plans |
$90.16
|
| Rate for Payer: Cash Price |
$277.40
|
| Rate for Payer: Self Pay Self Pay |
$277.40
|
|
|
INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$346.75
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
22760242
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$312.07
|
| Rate for Payer: Aetna of AZ Medicare |
$97.09
|
| Rate for Payer: Allwell Medicare |
$55.48
|
| Rate for Payer: Amerigroup Medicare |
$55.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$129.51
|
| Rate for Payer: AZCH Complete Medicare |
$55.48
|
| Rate for Payer: Banner UC Health Medicare |
$55.48
|
| Rate for Payer: Bisbee Police All Plans |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$235.79
|
| Rate for Payer: Cash Price |
$277.40
|
| Rate for Payer: Cash Price |
$277.40
|
| Rate for Payer: Cigna of AZ Commercial |
$242.72
|
| Rate for Payer: Copperpoint Commercial |
$85.82
|
| Rate for Payer: Health Net of AZ Commercial |
$208.05
|
| Rate for Payer: Health Net of AZ Medicare |
$97.09
|
| Rate for Payer: Humana of AZ Medicare |
$55.48
|
| Rate for Payer: Self Pay Self Pay |
$277.40
|
| Rate for Payer: TriWest Medicare |
$55.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$62.41
|
|
|
INSERTION OF INDWELLING TUBE FOR DRAINAGE OF LUNG FLUID Tech
|
Facility
|
IP
|
$1,051.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
27927131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$273.26 |
| Max. Negotiated Rate |
$945.90 |
| Rate for Payer: Aetna of AZ Commercial |
$945.90
|
| Rate for Payer: Bisbee Police All Plans |
$273.26
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Self Pay Self Pay |
$840.80
|
|
|
INSERTION OF INDWELLING TUBE FOR DRAINAGE OF LUNG FLUID Tech
|
Facility
|
OP
|
$1,051.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
27927131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$168.16 |
| Max. Negotiated Rate |
$3,914.00 |
| Rate for Payer: Aetna of AZ Commercial |
$945.90
|
| Rate for Payer: Aetna of AZ Medicare |
$294.28
|
| Rate for Payer: AHCCCS Medicaid |
$2,307.97
|
| Rate for Payer: Allwell Medicaid |
$2,307.97
|
| Rate for Payer: Allwell Medicare |
$168.16
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$392.55
|
| Rate for Payer: AZCH Complete Medicaid |
$2,307.97
|
| Rate for Payer: AZCH Complete Medicare |
$168.16
|
| Rate for Payer: Banner UC Health Medicaid |
$2,307.97
|
| Rate for Payer: Banner UC Health Medicare |
$168.16
|
| Rate for Payer: Bisbee Police All Plans |
$273.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$714.68
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cigna of AZ Commercial |
$525.50
|
| Rate for Payer: Copperpoint Commercial |
$260.12
|
| Rate for Payer: Health Net of AZ Commercial |
$630.60
|
| Rate for Payer: Health Net of AZ Medicare |
$294.28
|
| Rate for Payer: Humana of AZ Medicare |
$168.16
|
| Rate for Payer: Mercy Care Medicaid |
$2,307.97
|
| Rate for Payer: Self Pay Self Pay |
$840.80
|
| Rate for Payer: TriWest Medicare |
$168.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$189.18
|
|
|
INSERTION OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
22760243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$105.76 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$594.90
|
| Rate for Payer: Aetna of AZ Medicare |
$185.08
|
| Rate for Payer: Allwell Medicare |
$105.76
|
| Rate for Payer: Amerigroup Medicare |
$105.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$246.88
|
| Rate for Payer: AZCH Complete Medicare |
$105.76
|
| Rate for Payer: Banner UC Health Medicare |
$105.76
|
| Rate for Payer: Bisbee Police All Plans |
$171.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$449.48
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cigna of AZ Commercial |
$330.50
|
| Rate for Payer: Copperpoint Commercial |
$163.60
|
| Rate for Payer: Health Net of AZ Commercial |
$396.60
|
| Rate for Payer: Health Net of AZ Medicare |
$185.08
|
| Rate for Payer: Humana of AZ Medicare |
$105.76
|
| Rate for Payer: Self Pay Self Pay |
$528.80
|
| Rate for Payer: TriWest Medicare |
$105.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$118.98
|
|
|
INSERTION OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
22760243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$171.86 |
| Max. Negotiated Rate |
$594.90 |
| Rate for Payer: Aetna of AZ Commercial |
$594.90
|
| Rate for Payer: Bisbee Police All Plans |
$171.86
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Self Pay Self Pay |
$528.80
|
|
|
INSERTION OF PESSARY INTRAVAGINAL SUPPORT DEVICE
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
22951058
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$341.10
|
| Rate for Payer: Aetna of AZ Medicare |
$106.12
|
| Rate for Payer: AHCCCS Medicaid |
$123.48
|
| Rate for Payer: Allwell Medicaid |
$123.48
|
| Rate for Payer: Allwell Medicare |
$60.64
|
| Rate for Payer: Amerigroup Medicare |
$60.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$141.56
|
| Rate for Payer: AZCH Complete Medicaid |
$123.48
|
| Rate for Payer: AZCH Complete Medicare |
$60.64
|
| Rate for Payer: Banner UC Health Medicaid |
$123.48
|
| Rate for Payer: Banner UC Health Medicare |
$60.64
|
| Rate for Payer: Bisbee Police All Plans |
$98.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$257.72
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cigna of AZ Commercial |
$265.30
|
| Rate for Payer: Copperpoint Commercial |
$93.80
|
| Rate for Payer: Health Net of AZ Commercial |
$227.40
|
| Rate for Payer: Health Net of AZ Medicare |
$106.12
|
| Rate for Payer: Humana of AZ Medicare |
$60.64
|
| Rate for Payer: Mercy Care Medicaid |
$123.48
|
| Rate for Payer: Self Pay Self Pay |
$303.20
|
| Rate for Payer: TriWest Medicare |
$60.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$68.22
|
|
|
INSERTION OF PESSARY INTRAVAGINAL SUPPORT DEVICE
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
22951058
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Aetna of AZ Commercial |
$341.10
|
| Rate for Payer: Bisbee Police All Plans |
$98.54
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Self Pay Self Pay |
$303.20
|
|
|
Insertion of Portacath additional minutes
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 00532
|
| Hospital Charge Code |
23968401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.44 |
| 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: Allwell Medicare |
$1.44
|
| Rate for Payer: Amerigroup Medicare |
$1.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.36
|
| Rate for Payer: AZCH Complete Medicare |
$1.44
|
| Rate for Payer: Banner UC Health Medicare |
$1.44
|
| 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: 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 |
$1.44
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
| Rate for Payer: TriWest Medicare |
$1.44
|
| 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 SACRAL NERVE NEUROSTIMULATOR ELECTRODE ARRAY
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
28068478
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$254.08 |
| Max. Negotiated Rate |
$4,466.49 |
| Rate for Payer: Aetna of AZ Commercial |
$1,429.20
|
| Rate for Payer: Aetna of AZ Medicare |
$444.64
|
| Rate for Payer: AHCCCS Medicaid |
$4,466.49
|
| Rate for Payer: Allwell Medicaid |
$4,466.49
|
| Rate for Payer: Allwell Medicare |
$254.08
|
| Rate for Payer: Amerigroup Medicare |
$254.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$593.12
|
| Rate for Payer: AZCH Complete Medicaid |
$4,466.49
|
| Rate for Payer: AZCH Complete Medicare |
$254.08
|
| Rate for Payer: Banner UC Health Medicaid |
$4,466.49
|
| Rate for Payer: Banner UC Health Medicare |
$254.08
|
| Rate for Payer: Bisbee Police All Plans |
$412.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,079.84
|
| Rate for Payer: Cash Price |
$1,270.40
|
| Rate for Payer: Cash Price |
$1,270.40
|
| Rate for Payer: Cigna of AZ Commercial |
$794.00
|
| Rate for Payer: Copperpoint Commercial |
$393.03
|
| Rate for Payer: Health Net of AZ Commercial |
$952.80
|
| Rate for Payer: Health Net of AZ Medicare |
$444.64
|
| Rate for Payer: Humana of AZ Medicare |
$254.08
|
| Rate for Payer: Mercy Care Medicaid |
$4,466.49
|
| Rate for Payer: Self Pay Self Pay |
$1,270.40
|
| Rate for Payer: TriWest Medicare |
$254.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$925.80
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$285.84
|
|
|
INSERTION OF SACRAL NERVE NEUROSTIMULATOR ELECTRODE ARRAY
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
28068478
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$412.88 |
| Max. Negotiated Rate |
$1,429.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,429.20
|
| Rate for Payer: Bisbee Police All Plans |
$412.88
|
| Rate for Payer: Cash Price |
$1,270.40
|
| Rate for Payer: Self Pay Self Pay |
$1,270.40
|
|
|
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 |
$128.32 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$721.80
|
| Rate for Payer: Aetna of AZ Medicare |
$224.56
|
| Rate for Payer: AHCCCS Medicaid |
$2,230.35
|
| Rate for Payer: Allwell Medicaid |
$2,230.35
|
| Rate for Payer: Allwell Medicare |
$128.32
|
| Rate for Payer: Amerigroup Medicare |
$128.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$299.55
|
| Rate for Payer: AZCH Complete Medicaid |
$2,230.35
|
| Rate for Payer: AZCH Complete Medicare |
$128.32
|
| Rate for Payer: Banner UC Health Medicaid |
$2,230.35
|
| Rate for Payer: Banner UC Health Medicare |
$128.32
|
| 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 |
$128.32
|
| Rate for Payer: Mercy Care Medicaid |
$2,230.35
|
| Rate for Payer: Self Pay Self Pay |
$641.60
|
| Rate for Payer: TriWest Medicare |
$128.32
|
| 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
|
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
|
|
|
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 |
$1,015.52 |
| 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 |
$1,178.14
|
| Rate for Payer: Allwell Medicaid |
$1,178.14
|
| Rate for Payer: Allwell Medicare |
$1,015.52
|
| Rate for Payer: Amerigroup Medicare |
$1,015.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,370.60
|
| Rate for Payer: AZCH Complete Medicaid |
$1,178.14
|
| Rate for Payer: AZCH Complete Medicare |
$1,015.52
|
| Rate for Payer: Banner UC Health Medicaid |
$1,178.14
|
| Rate for Payer: Banner UC Health Medicare |
$1,015.52
|
| 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 |
$1,015.52
|
| Rate for Payer: Mercy Care Medicaid |
$1,178.14
|
| Rate for Payer: Self Pay Self Pay |
$5,077.60
|
| Rate for Payer: TriWest Medicare |
$1,015.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,142.46
|
|
