|
56420 INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSCESS
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
23008151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.10 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$624.60
|
| Rate for Payer: Aetna of AZ Medicare |
$194.32
|
| Rate for Payer: AHCCCS Medicaid |
$246.96
|
| Rate for Payer: Allwell Medicaid |
$246.96
|
| Rate for Payer: Allwell Medicare |
$104.10
|
| Rate for Payer: Amerigroup Medicare |
$104.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$259.21
|
| Rate for Payer: AZCH Complete Medicaid |
$246.96
|
| Rate for Payer: AZCH Complete Medicare |
$104.10
|
| Rate for Payer: Banner UC Health Medicaid |
$246.96
|
| Rate for Payer: Banner UC Health Medicare |
$104.10
|
| Rate for Payer: Bisbee Police All Plans |
$180.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$471.92
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cigna of AZ Commercial |
$485.80
|
| Rate for Payer: Copperpoint Commercial |
$171.76
|
| Rate for Payer: Health Net of AZ Commercial |
$416.40
|
| Rate for Payer: Health Net of AZ Medicare |
$194.32
|
| Rate for Payer: Humana of AZ Medicare |
$104.10
|
| Rate for Payer: Mercy Care Medicaid |
$246.96
|
| Rate for Payer: Self Pay Self Pay |
$555.20
|
| Rate for Payer: TriWest Medicare |
$104.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$124.92
|
|
|
5-HIAA,Quant.,24 Hr Urine LC
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
2084298
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Aetna of AZ Commercial |
$232.20
|
| Rate for Payer: Bisbee Police All Plans |
$67.08
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Self Pay Self Pay |
$206.40
|
|
|
5-HIAA,Quant.,24 Hr Urine LC
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
2084298
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Aetna of AZ Commercial |
$232.20
|
| Rate for Payer: Aetna of AZ Medicare |
$72.24
|
| Rate for Payer: AHCCCS Medicaid |
$12.90
|
| Rate for Payer: Allwell Medicaid |
$12.90
|
| Rate for Payer: Allwell Medicare |
$38.70
|
| Rate for Payer: Amerigroup Medicare |
$38.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$96.36
|
| Rate for Payer: AZCH Complete Medicaid |
$12.90
|
| Rate for Payer: AZCH Complete Medicare |
$38.70
|
| Rate for Payer: Banner UC Health Medicaid |
$12.90
|
| Rate for Payer: Banner UC Health Medicare |
$38.70
|
| Rate for Payer: Bisbee Police All Plans |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$175.44
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna of AZ Commercial |
$167.70
|
| Rate for Payer: Copperpoint Commercial |
$63.86
|
| Rate for Payer: Health Net of AZ Commercial |
$154.80
|
| Rate for Payer: Health Net of AZ Medicare |
$72.24
|
| Rate for Payer: Humana of AZ Medicare |
$38.70
|
| Rate for Payer: Mercy Care Medicaid |
$12.90
|
| Rate for Payer: Self Pay Self Pay |
$206.40
|
| Rate for Payer: TriWest Medicare |
$38.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$150.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$46.44
|
|
|
62270 LUMBAR SPINAL TAP
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
22282923
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.62 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Aetna of AZ Commercial |
$663.30
|
| Rate for Payer: Bisbee Police All Plans |
$191.62
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Self Pay Self Pay |
$589.60
|
|
|
62270 LUMBAR SPINAL TAP
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
22282923
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.55 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$663.30
|
| Rate for Payer: Aetna of AZ Medicare |
$206.36
|
| Rate for Payer: AHCCCS Medicaid |
$920.16
|
| Rate for Payer: Allwell Medicaid |
$920.16
|
| Rate for Payer: Allwell Medicare |
$110.55
|
| Rate for Payer: Amerigroup Medicare |
$110.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$275.27
|
| Rate for Payer: AZCH Complete Medicaid |
$920.16
|
| Rate for Payer: AZCH Complete Medicare |
$110.55
|
| Rate for Payer: Banner UC Health Medicaid |
$920.16
|
| Rate for Payer: Banner UC Health Medicare |
$110.55
|
| Rate for Payer: Bisbee Police All Plans |
$191.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$501.16
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cigna of AZ Commercial |
$515.90
|
| Rate for Payer: Copperpoint Commercial |
$182.41
|
| Rate for Payer: Health Net of AZ Commercial |
$442.20
|
| Rate for Payer: Health Net of AZ Medicare |
$206.36
|
| Rate for Payer: Humana of AZ Medicare |
$110.55
|
| Rate for Payer: Mercy Care Medicaid |
$920.16
|
| Rate for Payer: Self Pay Self Pay |
$589.60
|
| Rate for Payer: TriWest Medicare |
$110.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$132.66
|
|
|
64405 Injection, Anesthetic agent; Facial Nerve
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
22704948
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.35 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$494.10
|
| Rate for Payer: Aetna of AZ Medicare |
$153.72
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicare |
$82.35
|
| Rate for Payer: Amerigroup Medicare |
$82.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$205.05
|
| Rate for Payer: AZCH Complete Medicaid |
$378.70
|
| Rate for Payer: AZCH Complete Medicare |
$82.35
|
| Rate for Payer: Banner UC Health Medicaid |
$378.70
|
| Rate for Payer: Banner UC Health Medicare |
$82.35
|
| Rate for Payer: Bisbee Police All Plans |
$142.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$373.32
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna of AZ Commercial |
$384.30
|
| Rate for Payer: Copperpoint Commercial |
$135.88
|
| Rate for Payer: Health Net of AZ Commercial |
$329.40
|
| Rate for Payer: Health Net of AZ Medicare |
$153.72
|
| Rate for Payer: Humana of AZ Medicare |
$82.35
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: Self Pay Self Pay |
$439.20
|
| Rate for Payer: TriWest Medicare |
$82.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$98.82
|
|
|
64405 Injection, Anesthetic agent; Facial Nerve
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
22704948
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.74 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Aetna of AZ Commercial |
$494.10
|
| Rate for Payer: Bisbee Police All Plans |
$142.74
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Self Pay Self Pay |
$439.20
|
|
|
64430 INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO PUDE
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
27410735
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$77.74 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna of AZ Commercial |
$269.10
|
| Rate for Payer: Bisbee Police All Plans |
$77.74
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Self Pay Self Pay |
$239.20
|
|
|
64430 INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO PUDE
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
27410735
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$269.10
|
| Rate for Payer: Aetna of AZ Medicare |
$83.72
|
| Rate for Payer: AHCCCS Medicaid |
$1,192.56
|
| Rate for Payer: Allwell Medicaid |
$1,192.56
|
| Rate for Payer: Allwell Medicare |
$44.85
|
| Rate for Payer: Amerigroup Medicare |
$44.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$111.68
|
| Rate for Payer: AZCH Complete Medicaid |
$1,192.56
|
| Rate for Payer: AZCH Complete Medicare |
$44.85
|
| Rate for Payer: Banner UC Health Medicaid |
$1,192.56
|
| Rate for Payer: Banner UC Health Medicare |
$44.85
|
| Rate for Payer: Bisbee Police All Plans |
$77.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$203.32
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cigna of AZ Commercial |
$149.50
|
| Rate for Payer: Copperpoint Commercial |
$74.00
|
| Rate for Payer: Health Net of AZ Commercial |
$179.40
|
| Rate for Payer: Health Net of AZ Medicare |
$83.72
|
| Rate for Payer: Humana of AZ Medicare |
$44.85
|
| Rate for Payer: Mercy Care Medicaid |
$1,192.56
|
| Rate for Payer: Self Pay Self Pay |
$239.20
|
| Rate for Payer: TriWest Medicare |
$44.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$53.82
|
|
|
64455 INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO NERV
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
22986169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.04 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna of AZ Commercial |
$993.60
|
| Rate for Payer: Bisbee Police All Plans |
$287.04
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Self Pay Self Pay |
$883.20
|
|
|
64455 INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO NERV
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
22986169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$993.60
|
| Rate for Payer: Aetna of AZ Medicare |
$309.12
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicare |
$165.60
|
| Rate for Payer: Amerigroup Medicare |
$165.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$412.34
|
| Rate for Payer: AZCH Complete Medicaid |
$378.70
|
| Rate for Payer: AZCH Complete Medicare |
$165.60
|
| Rate for Payer: Banner UC Health Medicaid |
$378.70
|
| Rate for Payer: Banner UC Health Medicare |
$165.60
|
| Rate for Payer: Bisbee Police All Plans |
$287.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$750.72
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna of AZ Commercial |
$772.80
|
| Rate for Payer: Copperpoint Commercial |
$273.24
|
| Rate for Payer: Health Net of AZ Commercial |
$662.40
|
| Rate for Payer: Health Net of AZ Medicare |
$309.12
|
| Rate for Payer: Humana of AZ Medicare |
$165.60
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: Self Pay Self Pay |
$883.20
|
| Rate for Payer: TriWest Medicare |
$165.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$198.72
|
|
|
64566 POSTERIOR TIBIAL NEUROSTIMULATION, PERCUTANEOUS NEEDLE
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
27414132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$151.20
|
| Rate for Payer: Aetna of AZ Medicare |
$47.04
|
| Rate for Payer: AHCCCS Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicaid |
$378.70
|
| Rate for Payer: Allwell Medicare |
$25.20
|
| Rate for Payer: Amerigroup Medicare |
$25.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$62.75
|
| Rate for Payer: AZCH Complete Medicaid |
$378.70
|
| Rate for Payer: AZCH Complete Medicare |
$25.20
|
| Rate for Payer: Banner UC Health Medicaid |
$378.70
|
| Rate for Payer: Banner UC Health Medicare |
$25.20
|
| Rate for Payer: Bisbee Police All Plans |
$43.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$114.24
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna of AZ Commercial |
$84.00
|
| Rate for Payer: Copperpoint Commercial |
$41.58
|
| Rate for Payer: Health Net of AZ Commercial |
$100.80
|
| Rate for Payer: Health Net of AZ Medicare |
$47.04
|
| Rate for Payer: Humana of AZ Medicare |
$25.20
|
| Rate for Payer: Mercy Care Medicaid |
$378.70
|
| Rate for Payer: Self Pay Self Pay |
$134.40
|
| Rate for Payer: TriWest Medicare |
$25.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.24
|
|
|
64566 POSTERIOR TIBIAL NEUROSTIMULATION, PERCUTANEOUS NEEDLE
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
27414132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna of AZ Commercial |
$151.20
|
| Rate for Payer: Bisbee Police All Plans |
$43.68
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Self Pay Self Pay |
$134.40
|
|
|
65205 REMOVE FB EXT EYE SUPERT
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
22282924
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.52 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of AZ Commercial |
$181.80
|
| Rate for Payer: Bisbee Police All Plans |
$52.52
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Self Pay Self Pay |
$161.60
|
|
|
65205 REMOVE FB EXT EYE SUPERT
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
22282924
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$181.80
|
| Rate for Payer: Aetna of AZ Medicare |
$56.56
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$30.30
|
| Rate for Payer: Amerigroup Medicare |
$30.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$75.45
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$30.30
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$30.30
|
| Rate for Payer: Bisbee Police All Plans |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cigna of AZ Commercial |
$141.40
|
| Rate for Payer: Copperpoint Commercial |
$50.00
|
| Rate for Payer: Health Net of AZ Commercial |
$121.20
|
| Rate for Payer: Health Net of AZ Medicare |
$56.56
|
| Rate for Payer: Humana of AZ Medicare |
$30.30
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$161.60
|
| Rate for Payer: TriWest Medicare |
$30.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$36.36
|
|
|
65210 REMOVE FB EXT EYE ENBEDD
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
22282925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$209.70 |
| Rate for Payer: Aetna of AZ Commercial |
$209.70
|
| Rate for Payer: Bisbee Police All Plans |
$60.58
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Self Pay Self Pay |
$186.40
|
|
|
65210 REMOVE FB EXT EYE ENBEDD
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
22282925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$209.70
|
| Rate for Payer: Aetna of AZ Medicare |
$65.24
|
| Rate for Payer: AHCCCS Medicaid |
$391.82
|
| Rate for Payer: Allwell Medicaid |
$391.82
|
| Rate for Payer: Allwell Medicare |
$34.95
|
| Rate for Payer: Amerigroup Medicare |
$34.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$87.03
|
| Rate for Payer: AZCH Complete Medicaid |
$391.82
|
| Rate for Payer: AZCH Complete Medicare |
$34.95
|
| Rate for Payer: Banner UC Health Medicaid |
$391.82
|
| Rate for Payer: Banner UC Health Medicare |
$34.95
|
| Rate for Payer: Bisbee Police All Plans |
$60.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$158.44
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cigna of AZ Commercial |
$163.10
|
| Rate for Payer: Copperpoint Commercial |
$57.67
|
| Rate for Payer: Health Net of AZ Commercial |
$139.80
|
| Rate for Payer: Health Net of AZ Medicare |
$65.24
|
| Rate for Payer: Humana of AZ Medicare |
$34.95
|
| Rate for Payer: Mercy Care Medicaid |
$391.82
|
| Rate for Payer: Self Pay Self Pay |
$186.40
|
| Rate for Payer: TriWest Medicare |
$34.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.94
|
|
|
65235 REMOVE FB INTRAOCULAR
|
Facility
|
OP
|
$2,337.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
22282926
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.55 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,103.30
|
| Rate for Payer: Aetna of AZ Medicare |
$654.36
|
| Rate for Payer: AHCCCS Medicaid |
$3,014.78
|
| Rate for Payer: Allwell Medicaid |
$3,014.78
|
| Rate for Payer: Allwell Medicare |
$350.55
|
| Rate for Payer: Amerigroup Medicare |
$350.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$872.87
|
| Rate for Payer: AZCH Complete Medicaid |
$3,014.78
|
| Rate for Payer: AZCH Complete Medicare |
$350.55
|
| Rate for Payer: Banner UC Health Medicaid |
$3,014.78
|
| Rate for Payer: Banner UC Health Medicare |
$350.55
|
| Rate for Payer: Bisbee Police All Plans |
$607.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,589.16
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,635.90
|
| Rate for Payer: Copperpoint Commercial |
$578.41
|
| Rate for Payer: Health Net of AZ Commercial |
$1,402.20
|
| Rate for Payer: Health Net of AZ Medicare |
$654.36
|
| Rate for Payer: Humana of AZ Medicare |
$350.55
|
| Rate for Payer: Mercy Care Medicaid |
$3,014.78
|
| Rate for Payer: Self Pay Self Pay |
$1,869.60
|
| Rate for Payer: TriWest Medicare |
$350.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$420.66
|
|
|
65235 REMOVE FB INTRAOCULAR
|
Facility
|
IP
|
$2,337.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
22282926
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$607.62 |
| Max. Negotiated Rate |
$2,103.30 |
| Rate for Payer: Aetna of AZ Commercial |
$2,103.30
|
| Rate for Payer: Bisbee Police All Plans |
$607.62
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Self Pay Self Pay |
$1,869.60
|
|
|
6.6 POST REAMER
|
Facility
|
OP
|
$964.00
|
|
| Hospital Charge Code |
22354197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.60 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Aetna of AZ Commercial |
$867.60
|
| Rate for Payer: Aetna of AZ Medicare |
$269.92
|
| Rate for Payer: Allwell Medicare |
$144.60
|
| Rate for Payer: Amerigroup Medicare |
$144.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$360.05
|
| Rate for Payer: AZCH Complete Medicare |
$144.60
|
| Rate for Payer: Banner UC Health Medicare |
$144.60
|
| Rate for Payer: Bisbee Police All Plans |
$250.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$655.52
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cigna of AZ Commercial |
$674.80
|
| Rate for Payer: Copperpoint Commercial |
$238.59
|
| Rate for Payer: Health Net of AZ Commercial |
$578.40
|
| Rate for Payer: Health Net of AZ Medicare |
$269.92
|
| Rate for Payer: Humana of AZ Medicare |
$144.60
|
| Rate for Payer: Self Pay Self Pay |
$771.20
|
| Rate for Payer: TriWest Medicare |
$144.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$562.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$173.52
|
|
|
6.6 POST REAMER
|
Facility
|
IP
|
$964.00
|
|
| Hospital Charge Code |
22354197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$250.64 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Aetna of AZ Commercial |
$867.60
|
| Rate for Payer: Bisbee Police All Plans |
$250.64
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Self Pay Self Pay |
$771.20
|
|
|
6.6 x 20MM POST
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$988.00 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,420.00
|
| Rate for Payer: Bisbee Police All Plans |
$988.00
|
| Rate for Payer: Cash Price |
$3,040.00
|
| Rate for Payer: Self Pay Self Pay |
$3,040.00
|
|
|
6.6 x 20MM POST
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
22354199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,420.00
|
| Rate for Payer: Aetna of AZ Medicare |
$1,064.00
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$570.00
|
| Rate for Payer: Amerigroup Medicare |
$570.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,419.30
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$570.00
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$570.00
|
| Rate for Payer: Bisbee Police All Plans |
$988.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,584.00
|
| Rate for Payer: Cash Price |
$3,040.00
|
| Rate for Payer: Cash Price |
$3,040.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,660.00
|
| Rate for Payer: Copperpoint Commercial |
$940.50
|
| Rate for Payer: Health Net of AZ Commercial |
$2,280.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,064.00
|
| Rate for Payer: Humana of AZ Medicare |
$570.00
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$3,040.00
|
| Rate for Payer: TriWest Medicare |
$570.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,215.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$684.00
|
|
|
69200 REMOVE FB EXT EAR
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
22282927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Aetna of AZ Medicare |
$71.40
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$38.25
|
| Rate for Payer: Amerigroup Medicare |
$38.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$95.24
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$38.25
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$38.25
|
| Rate for Payer: Bisbee Police All Plans |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna of AZ Commercial |
$178.50
|
| Rate for Payer: Copperpoint Commercial |
$63.11
|
| Rate for Payer: Health Net of AZ Commercial |
$153.00
|
| Rate for Payer: Health Net of AZ Medicare |
$71.40
|
| Rate for Payer: Humana of AZ Medicare |
$38.25
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$204.00
|
| Rate for Payer: TriWest Medicare |
$38.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$45.90
|
|
|
69200 REMOVE FB EXT EAR
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
22282927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Bisbee Police All Plans |
$66.30
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Self Pay Self Pay |
$204.00
|
|
