|
92520 STUDY OF VOICE BOX FUNCTION
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT 92520
|
| Hospital Charge Code |
27728009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna of AZ Commercial |
$197.10
|
| Rate for Payer: Aetna of AZ Medicare |
$61.32
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$32.85
|
| Rate for Payer: Amerigroup Medicare |
$32.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$81.80
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$32.85
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$32.85
|
| Rate for Payer: Bisbee Police All Plans |
$56.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$148.92
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna of AZ Commercial |
$153.30
|
| Rate for Payer: Copperpoint Commercial |
$54.20
|
| Rate for Payer: Health Net of AZ Commercial |
$131.40
|
| Rate for Payer: Health Net of AZ Medicare |
$61.32
|
| Rate for Payer: Humana of AZ Medicare |
$32.85
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$175.20
|
| Rate for Payer: TriWest Medicare |
$32.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$127.68
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$39.42
|
|
|
92520 STUDY OF VOICE BOX FUNCTION
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT 92520
|
| Hospital Charge Code |
27728009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna of AZ Commercial |
$197.10
|
| Rate for Payer: Bisbee Police All Plans |
$56.94
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Self Pay Self Pay |
$175.20
|
|
|
92521 EVALUATION OF SPEECH CONTINUITY, SMOOTHNESS, RATE, AND
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
27726435
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna of AZ Commercial |
$662.40
|
| Rate for Payer: Bisbee Police All Plans |
$191.36
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Self Pay Self Pay |
$588.80
|
|
|
92521 EVALUATION OF SPEECH CONTINUITY, SMOOTHNESS, RATE, AND
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
27726435
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna of AZ Commercial |
$662.40
|
| Rate for Payer: Aetna of AZ Medicare |
$206.08
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$110.40
|
| Rate for Payer: Amerigroup Medicare |
$110.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$274.90
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$110.40
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$110.40
|
| Rate for Payer: Bisbee Police All Plans |
$191.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$500.48
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cigna of AZ Commercial |
$515.20
|
| Rate for Payer: Copperpoint Commercial |
$182.16
|
| Rate for Payer: Health Net of AZ Commercial |
$441.60
|
| Rate for Payer: Health Net of AZ Medicare |
$206.08
|
| Rate for Payer: Humana of AZ Medicare |
$110.40
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$588.80
|
| Rate for Payer: TriWest Medicare |
$110.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$429.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$132.48
|
|
|
92522 EVALUATION OF SPEECH SOUND PRODUCTION (EG, ARTICULATIO
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
27728007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Aetna of AZ Commercial |
$553.50
|
| Rate for Payer: Aetna of AZ Medicare |
$172.20
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$92.25
|
| Rate for Payer: Amerigroup Medicare |
$92.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$229.70
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$92.25
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$92.25
|
| Rate for Payer: Bisbee Police All Plans |
$159.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$418.20
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna of AZ Commercial |
$430.50
|
| Rate for Payer: Copperpoint Commercial |
$152.21
|
| Rate for Payer: Health Net of AZ Commercial |
$369.00
|
| Rate for Payer: Health Net of AZ Medicare |
$172.20
|
| Rate for Payer: Humana of AZ Medicare |
$92.25
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$492.00
|
| Rate for Payer: TriWest Medicare |
$92.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$358.54
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$110.70
|
|
|
92522 EVALUATION OF SPEECH SOUND PRODUCTION (EG, ARTICULATIO
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
27728007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Aetna of AZ Commercial |
$553.50
|
| Rate for Payer: Bisbee Police All Plans |
$159.90
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Self Pay Self Pay |
$492.00
|
|
|
92523 EVALUATION OF SPEECH SOUND PRODUCTION WITH EVAL OF LAN
|
Facility
|
OP
|
$1,262.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
27728008
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1,135.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,135.80
|
| Rate for Payer: Aetna of AZ Medicare |
$353.36
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$189.30
|
| Rate for Payer: Amerigroup Medicare |
$189.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$471.36
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$189.30
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$189.30
|
| Rate for Payer: Bisbee Police All Plans |
$328.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$858.16
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cigna of AZ Commercial |
$883.40
|
| Rate for Payer: Copperpoint Commercial |
$312.34
|
| Rate for Payer: Health Net of AZ Commercial |
$757.20
|
| Rate for Payer: Health Net of AZ Medicare |
$353.36
|
| Rate for Payer: Humana of AZ Medicare |
$189.30
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$1,009.60
|
| Rate for Payer: TriWest Medicare |
$189.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$735.75
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$227.16
|
|
|
92523 EVALUATION OF SPEECH SOUND PRODUCTION WITH EVAL OF LAN
|
Facility
|
IP
|
$1,262.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
27728008
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$328.12 |
| Max. Negotiated Rate |
$1,135.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,135.80
|
| Rate for Payer: Bisbee Police All Plans |
$328.12
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Self Pay Self Pay |
$1,009.60
|
|
|
92524 ANALYSIS OF VOICE AND RESONANCE PRODUCTION
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
27724316
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$158.08 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna of AZ Commercial |
$547.20
|
| Rate for Payer: Bisbee Police All Plans |
$158.08
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Self Pay Self Pay |
$486.40
|
|
|
92524 ANALYSIS OF VOICE AND RESONANCE PRODUCTION
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
27724316
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna of AZ Commercial |
$547.20
|
| Rate for Payer: Aetna of AZ Medicare |
$170.24
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$91.20
|
| Rate for Payer: Amerigroup Medicare |
$91.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$227.09
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$91.20
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$91.20
|
| Rate for Payer: Bisbee Police All Plans |
$158.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$413.44
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cigna of AZ Commercial |
$425.60
|
| Rate for Payer: Copperpoint Commercial |
$150.48
|
| Rate for Payer: Health Net of AZ Commercial |
$364.80
|
| Rate for Payer: Health Net of AZ Medicare |
$170.24
|
| Rate for Payer: Humana of AZ Medicare |
$91.20
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$486.40
|
| Rate for Payer: TriWest Medicare |
$91.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$354.46
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$109.44
|
|
|
92526 TREATMENT OF SWALLOWING AND FEEDING DISORDER
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
27724313
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Aetna of AZ Commercial |
$422.10
|
| Rate for Payer: Aetna of AZ Medicare |
$131.32
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$70.35
|
| Rate for Payer: Amerigroup Medicare |
$70.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$175.17
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$70.35
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$70.35
|
| Rate for Payer: Bisbee Police All Plans |
$121.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$318.92
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Cigna of AZ Commercial |
$328.30
|
| Rate for Payer: Copperpoint Commercial |
$116.08
|
| Rate for Payer: Health Net of AZ Commercial |
$281.40
|
| Rate for Payer: Health Net of AZ Medicare |
$131.32
|
| Rate for Payer: Humana of AZ Medicare |
$70.35
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$375.20
|
| Rate for Payer: TriWest Medicare |
$70.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$273.43
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$84.42
|
|
|
92526 TREATMENT OF SWALLOWING AND FEEDING DISORDER
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
27724313
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$121.94 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Aetna of AZ Commercial |
$422.10
|
| Rate for Payer: Bisbee Police All Plans |
$121.94
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Self Pay Self Pay |
$375.20
|
|
|
92610 EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION.
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
27724315
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$101.14 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of AZ Commercial |
$350.10
|
| Rate for Payer: Bisbee Police All Plans |
$101.14
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Self Pay Self Pay |
$311.20
|
|
|
92610 EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION.
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
27724315
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of AZ Commercial |
$350.10
|
| Rate for Payer: Aetna of AZ Medicare |
$108.92
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$58.35
|
| Rate for Payer: Amerigroup Medicare |
$58.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$145.29
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$58.35
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$58.35
|
| Rate for Payer: Bisbee Police All Plans |
$101.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$264.52
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Cigna of AZ Commercial |
$272.30
|
| Rate for Payer: Copperpoint Commercial |
$96.28
|
| Rate for Payer: Health Net of AZ Commercial |
$233.40
|
| Rate for Payer: Health Net of AZ Medicare |
$108.92
|
| Rate for Payer: Humana of AZ Medicare |
$58.35
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$311.20
|
| Rate for Payer: TriWest Medicare |
$58.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$226.79
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$70.02
|
|
|
92950 ER - CPR
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
22282930
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.80 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,197.00
|
| Rate for Payer: Bisbee Police All Plans |
$345.80
|
| Rate for Payer: Cash Price |
$1,064.00
|
| Rate for Payer: Self Pay Self Pay |
$1,064.00
|
|
|
92950 ER - CPR
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
22282930
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,197.00
|
| Rate for Payer: Aetna of AZ Medicare |
$372.40
|
| Rate for Payer: AHCCCS Medicaid |
$383.46
|
| Rate for Payer: Allwell Medicaid |
$383.46
|
| Rate for Payer: Allwell Medicare |
$199.50
|
| Rate for Payer: Amerigroup Medicare |
$199.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$496.76
|
| Rate for Payer: AZCH Complete Medicaid |
$383.46
|
| Rate for Payer: AZCH Complete Medicare |
$199.50
|
| Rate for Payer: Banner UC Health Medicaid |
$383.46
|
| Rate for Payer: Banner UC Health Medicare |
$199.50
|
| Rate for Payer: Bisbee Police All Plans |
$345.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$904.40
|
| Rate for Payer: Cash Price |
$1,064.00
|
| Rate for Payer: Cash Price |
$1,064.00
|
| Rate for Payer: Cigna of AZ Commercial |
$931.00
|
| Rate for Payer: Copperpoint Commercial |
$329.18
|
| Rate for Payer: Health Net of AZ Commercial |
$798.00
|
| Rate for Payer: Health Net of AZ Medicare |
$372.40
|
| Rate for Payer: Humana of AZ Medicare |
$199.50
|
| Rate for Payer: Mercy Care Medicaid |
$383.46
|
| Rate for Payer: Self Pay Self Pay |
$1,064.00
|
| Rate for Payer: TriWest Medicare |
$199.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$775.39
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$239.40
|
|
|
93225-Holter Monitor Hookup
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
24384246
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$162.32 |
| Rate for Payer: Aetna of AZ Commercial |
$94.50
|
| Rate for Payer: Aetna of AZ Medicare |
$29.40
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$15.75
|
| Rate for Payer: Amerigroup Medicare |
$15.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$39.22
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$15.75
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$15.75
|
| Rate for Payer: Bisbee Police All Plans |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna of AZ Commercial |
$73.50
|
| Rate for Payer: Copperpoint Commercial |
$25.99
|
| Rate for Payer: Health Net of AZ Commercial |
$63.00
|
| Rate for Payer: Health Net of AZ Medicare |
$29.40
|
| Rate for Payer: Humana of AZ Medicare |
$15.75
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$84.00
|
| Rate for Payer: TriWest Medicare |
$15.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$61.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.90
|
|
|
93225-Holter Monitor Hookup
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
24384246
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of AZ Commercial |
$94.50
|
| Rate for Payer: Bisbee Police All Plans |
$27.30
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Self Pay Self Pay |
$84.00
|
|
|
93270- Event Monitor Hookup
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
24384245
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna of AZ Commercial |
$42.30
|
| Rate for Payer: Aetna of AZ Medicare |
$13.16
|
| Rate for Payer: AHCCCS Medicaid |
$53.86
|
| Rate for Payer: Allwell Medicaid |
$53.86
|
| Rate for Payer: Allwell Medicare |
$7.05
|
| Rate for Payer: Amerigroup Medicare |
$7.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$17.55
|
| Rate for Payer: AZCH Complete Medicaid |
$53.86
|
| Rate for Payer: AZCH Complete Medicare |
$7.05
|
| Rate for Payer: Banner UC Health Medicaid |
$53.86
|
| Rate for Payer: Banner UC Health Medicare |
$7.05
|
| Rate for Payer: Bisbee Police All Plans |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$31.96
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cigna of AZ Commercial |
$32.90
|
| Rate for Payer: Copperpoint Commercial |
$11.63
|
| Rate for Payer: Health Net of AZ Commercial |
$28.20
|
| Rate for Payer: Health Net of AZ Medicare |
$13.16
|
| Rate for Payer: Humana of AZ Medicare |
$7.05
|
| Rate for Payer: Mercy Care Medicaid |
$53.86
|
| Rate for Payer: Self Pay Self Pay |
$37.60
|
| Rate for Payer: TriWest Medicare |
$7.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$27.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.46
|
|
|
93270- Event Monitor Hookup
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
24384245
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of AZ Commercial |
$42.30
|
| Rate for Payer: Bisbee Police All Plans |
$12.22
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Self Pay Self Pay |
$37.60
|
|
|
93308 Echocardiography, transthoracic, real-time w/image doc
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
27410734
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$140.66 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Aetna of AZ Commercial |
$486.90
|
| Rate for Payer: Bisbee Police All Plans |
$140.66
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Self Pay Self Pay |
$432.80
|
|
|
93308 Echocardiography, transthoracic, real-time w/image doc
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
27410734
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Aetna of AZ Commercial |
$486.90
|
| Rate for Payer: Aetna of AZ Medicare |
$151.48
|
| Rate for Payer: AHCCCS Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicaid |
$333.68
|
| Rate for Payer: Allwell Medicare |
$81.15
|
| Rate for Payer: Amerigroup Medicare |
$81.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$202.06
|
| Rate for Payer: AZCH Complete Medicaid |
$333.68
|
| Rate for Payer: AZCH Complete Medicare |
$81.15
|
| Rate for Payer: Banner UC Health Medicaid |
$333.68
|
| Rate for Payer: Banner UC Health Medicare |
$81.15
|
| Rate for Payer: Bisbee Police All Plans |
$140.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$367.88
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cigna of AZ Commercial |
$378.70
|
| Rate for Payer: Copperpoint Commercial |
$133.90
|
| Rate for Payer: Health Net of AZ Commercial |
$324.60
|
| Rate for Payer: Health Net of AZ Medicare |
$151.48
|
| Rate for Payer: Humana of AZ Medicare |
$81.15
|
| Rate for Payer: Mercy Care Medicaid |
$333.68
|
| Rate for Payer: Self Pay Self Pay |
$432.80
|
| Rate for Payer: TriWest Medicare |
$81.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$315.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$97.38
|
|
|
94010 PFT
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
23897245
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$233.48 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Aetna of AZ Commercial |
$808.20
|
| Rate for Payer: Bisbee Police All Plans |
$233.48
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Self Pay Self Pay |
$718.40
|
|
|
94010 PFT
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
23897245
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$134.70 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Aetna of AZ Commercial |
$808.20
|
| Rate for Payer: Aetna of AZ Medicare |
$251.44
|
| Rate for Payer: AHCCCS Medicaid |
$202.34
|
| Rate for Payer: Allwell Medicaid |
$202.34
|
| Rate for Payer: Allwell Medicare |
$134.70
|
| Rate for Payer: Amerigroup Medicare |
$134.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$335.40
|
| Rate for Payer: AZCH Complete Medicaid |
$202.34
|
| Rate for Payer: AZCH Complete Medicare |
$134.70
|
| Rate for Payer: Banner UC Health Medicaid |
$202.34
|
| Rate for Payer: Banner UC Health Medicare |
$134.70
|
| Rate for Payer: Bisbee Police All Plans |
$233.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$610.64
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cigna of AZ Commercial |
$628.60
|
| Rate for Payer: Copperpoint Commercial |
$222.26
|
| Rate for Payer: Health Net of AZ Commercial |
$538.80
|
| Rate for Payer: Health Net of AZ Medicare |
$251.44
|
| Rate for Payer: Humana of AZ Medicare |
$134.70
|
| Rate for Payer: Mercy Care Medicaid |
$202.34
|
| Rate for Payer: Self Pay Self Pay |
$718.40
|
| Rate for Payer: TriWest Medicare |
$134.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$523.53
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$161.64
|
|
|
96105 ASSESSMENT OF APHASIA WITH INTERPRETATION AND REPORT P
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
27728005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna of AZ Commercial |
$486.00
|
| Rate for Payer: Aetna of AZ Medicare |
$151.20
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$81.00
|
| Rate for Payer: Amerigroup Medicare |
$81.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$201.69
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$81.00
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$81.00
|
| Rate for Payer: Bisbee Police All Plans |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$367.20
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna of AZ Commercial |
$378.00
|
| Rate for Payer: Copperpoint Commercial |
$133.65
|
| Rate for Payer: Health Net of AZ Commercial |
$324.00
|
| Rate for Payer: Health Net of AZ Medicare |
$151.20
|
| Rate for Payer: Humana of AZ Medicare |
$81.00
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$432.00
|
| Rate for Payer: TriWest Medicare |
$81.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$314.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$97.20
|
|
