|
00840 ANES INTRAPERITONEAL LOWER ABDOMEN BASE CHG AND 1ST MI
|
Facility
OP
|
$723.00
|
|
|
Service Code
|
CPT 00840
|
| Hospital Charge Code |
22406138
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$650.70 |
| Rate for Payer: Aetna of AZ Commercial |
$650.70
|
| Rate for Payer: Aetna of AZ Medicare |
$202.44
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$108.45
|
| Rate for Payer: Amerigroup Medicare |
$108.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$270.04
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$108.45
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$108.45
|
| Rate for Payer: Bisbee Police All Plans |
$187.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$491.64
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna of AZ Commercial |
$506.10
|
| Rate for Payer: Copperpoint Commercial |
$178.94
|
| Rate for Payer: Health Net of AZ Commercial |
$433.80
|
| Rate for Payer: Health Net of AZ Medicare |
$202.44
|
| Rate for Payer: Humana of AZ Medicare |
$108.45
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$578.40
|
| Rate for Payer: TriWest Medicare |
$108.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$421.51
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$130.14
|
|
|
00840 ANES INTRAPERITONEAL LOWER ABDOMEN BASE CHG AND 1ST MI
|
Facility
IP
|
$723.00
|
|
|
Service Code
|
CPT 00840
|
| Hospital Charge Code |
22406138
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$187.98 |
| Max. Negotiated Rate |
$650.70 |
| Rate for Payer: Aetna of AZ Commercial |
$650.70
|
| Rate for Payer: Bisbee Police All Plans |
$187.98
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Self Pay Self Pay |
$578.40
|
|
|
00851 ANES TUBAL LIGATION TRASECTION ADDITIONAL MINUTES
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 00851
|
| Hospital Charge Code |
22406142
|
|
Hospital Revenue Code
|
964
|
| 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 |
$6.30
|
| 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
|
|
|
00851 ANES TUBAL LIGATION TRASECTION ADDITIONAL MINUTES
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 00851
|
| Hospital Charge Code |
22406142
|
|
Hospital Revenue Code
|
964
|
| 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
|
|
|
00851 ANES TUBAL LIGATION TRASECTION BASE CHARGE AND 1ST MIN
|
Facility
OP
|
$723.00
|
|
|
Service Code
|
CPT 00851
|
| Hospital Charge Code |
22406141
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$650.70 |
| Rate for Payer: Aetna of AZ Commercial |
$650.70
|
| Rate for Payer: Aetna of AZ Medicare |
$202.44
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$108.45
|
| Rate for Payer: Amerigroup Medicare |
$108.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$270.04
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$108.45
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$108.45
|
| Rate for Payer: Bisbee Police All Plans |
$187.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$491.64
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna of AZ Commercial |
$506.10
|
| Rate for Payer: Copperpoint Commercial |
$178.94
|
| Rate for Payer: Health Net of AZ Commercial |
$433.80
|
| Rate for Payer: Health Net of AZ Medicare |
$202.44
|
| Rate for Payer: Humana of AZ Medicare |
$108.45
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$578.40
|
| Rate for Payer: TriWest Medicare |
$108.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$421.51
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$130.14
|
|
|
00851 ANES TUBAL LIGATION TRASECTION BASE CHARGE AND 1ST MIN
|
Facility
IP
|
$723.00
|
|
|
Service Code
|
CPT 00851
|
| Hospital Charge Code |
22406141
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$187.98 |
| Max. Negotiated Rate |
$650.70 |
| Rate for Payer: Aetna of AZ Commercial |
$650.70
|
| Rate for Payer: Bisbee Police All Plans |
$187.98
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Self Pay Self Pay |
$578.40
|
|
|
00860 ANES LOWER ABDOMEN ADDITIONAL MINUTES
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 00860
|
| Hospital Charge Code |
22406210
|
|
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
|
|
|
00860 ANES LOWER ABDOMEN ADDITIONAL MINUTES
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 00860
|
| Hospital Charge Code |
22406210
|
|
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
|
|
|
00860 ANES LOWER ABDOMEN ADDTNL 0:30 CHARGE
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 00860
|
| Hospital Charge Code |
22406213
|
|
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
|
|
|
00860 ANES LOWER ABDOMEN ADDTNL 0:30 CHARGE
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 00860
|
| Hospital Charge Code |
22406213
|
|
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
|
|
|
00860 ANES LOWER ABDOMEN BASE CHARGE AND 1ST MINUTE
|
Facility
IP
|
$490.00
|
|
|
Service Code
|
CPT 00860
|
| Hospital Charge Code |
22406208
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of AZ Commercial |
$441.00
|
| Rate for Payer: Bisbee Police All Plans |
$127.40
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Self Pay Self Pay |
$392.00
|
|
|
00860 ANES LOWER ABDOMEN BASE CHARGE AND 1ST MINUTE
|
Facility
OP
|
$490.00
|
|
|
Service Code
|
CPT 00860
|
| Hospital Charge Code |
22406208
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of AZ Commercial |
$441.00
|
| Rate for Payer: Aetna of AZ Medicare |
$137.20
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$73.50
|
| Rate for Payer: Amerigroup Medicare |
$73.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$183.02
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$73.50
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$73.50
|
| Rate for Payer: Bisbee Police All Plans |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$333.20
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna of AZ Commercial |
$343.00
|
| Rate for Payer: Copperpoint Commercial |
$121.28
|
| Rate for Payer: Health Net of AZ Commercial |
$294.00
|
| Rate for Payer: Health Net of AZ Medicare |
$137.20
|
| Rate for Payer: Humana of AZ Medicare |
$73.50
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$392.00
|
| Rate for Payer: TriWest Medicare |
$73.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$285.67
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$88.20
|
|
|
00902 ANES ANORECTAL PROCEDURE ADDITIONAL MINUTES
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 00902
|
| Hospital Charge Code |
22406144
|
|
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
|
|
|
00902 ANES ANORECTAL PROCEDURE ADDITIONAL MINUTES
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 00902
|
| Hospital Charge Code |
22406144
|
|
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
|
|
|
00902 ANES ANORECTAL PROCEDURE ADDTNL 0:30 CHARGE
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 00902
|
| Hospital Charge Code |
22406145
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of AZ Commercial |
$268.20
|
| Rate for Payer: Aetna of AZ Medicare |
$83.44
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$44.70
|
| Rate for Payer: Amerigroup Medicare |
$44.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$111.30
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$44.70
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$44.70
|
| Rate for Payer: Bisbee Police All Plans |
$77.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$202.64
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cigna of AZ Commercial |
$193.70
|
| Rate for Payer: Copperpoint Commercial |
$73.76
|
| Rate for Payer: Health Net of AZ Commercial |
$178.80
|
| Rate for Payer: Health Net of AZ Medicare |
$83.44
|
| Rate for Payer: Humana of AZ Medicare |
$44.70
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$238.40
|
| Rate for Payer: TriWest Medicare |
$44.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$173.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$53.64
|
|
|
00902 ANES ANORECTAL PROCEDURE ADDTNL 0:30 CHARGE
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 00902
|
| Hospital Charge Code |
22406145
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$77.48 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of AZ Commercial |
$268.20
|
| Rate for Payer: Bisbee Police All Plans |
$77.48
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Self Pay Self Pay |
$238.40
|
|
|
00902 ANES ANORECTAL PROCEDURE BASE CHARGE AND 1ST MINUTE
|
Facility
OP
|
$490.00
|
|
|
Service Code
|
CPT 00902
|
| Hospital Charge Code |
22406143
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of AZ Commercial |
$441.00
|
| Rate for Payer: Aetna of AZ Medicare |
$137.20
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$73.50
|
| Rate for Payer: Amerigroup Medicare |
$73.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$183.02
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$73.50
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$73.50
|
| Rate for Payer: Bisbee Police All Plans |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$333.20
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna of AZ Commercial |
$343.00
|
| Rate for Payer: Copperpoint Commercial |
$121.28
|
| Rate for Payer: Health Net of AZ Commercial |
$294.00
|
| Rate for Payer: Health Net of AZ Medicare |
$137.20
|
| Rate for Payer: Humana of AZ Medicare |
$73.50
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$392.00
|
| Rate for Payer: TriWest Medicare |
$73.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$285.67
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$88.20
|
|
|
00902 ANES ANORECTAL PROCEDURE BASE CHARGE AND 1ST MINUTE
|
Facility
IP
|
$490.00
|
|
|
Service Code
|
CPT 00902
|
| Hospital Charge Code |
22406143
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of AZ Commercial |
$441.00
|
| Rate for Payer: Bisbee Police All Plans |
$127.40
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Self Pay Self Pay |
$392.00
|
|
|
00908 ANESTHESIA FOR; PERINEAL PROSTATECTOMY
|
Facility
OP
|
$591.00
|
|
|
Service Code
|
CPT 00908
|
| Hospital Charge Code |
23084417
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of AZ Commercial |
$531.90
|
| Rate for Payer: Aetna of AZ Medicare |
$165.48
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| 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 |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$88.65
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| 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 |
$384.15
|
| 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 |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$472.80
|
| Rate for Payer: TriWest Medicare |
$88.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$344.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$106.38
|
|
|
00908 ANESTHESIA FOR; PERINEAL PROSTATECTOMY
|
Facility
IP
|
$591.00
|
|
|
Service Code
|
CPT 00908
|
| Hospital Charge Code |
23084417
|
|
Hospital Revenue Code
|
370
|
| 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
|
|
|
00908 ANESTHESIA FOR; PERINEAL PROSTATECTOMY 1ST 0:30
|
Facility
OP
|
$591.00
|
|
|
Service Code
|
CPT 00908
|
| Hospital Charge Code |
23084423
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of AZ Commercial |
$531.90
|
| Rate for Payer: Aetna of AZ Medicare |
$165.48
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| 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 |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$88.65
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| 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 |
$384.15
|
| 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 |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$472.80
|
| Rate for Payer: TriWest Medicare |
$88.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$344.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$106.38
|
|
|
00908 ANESTHESIA FOR; PERINEAL PROSTATECTOMY 1ST 0:30
|
Facility
IP
|
$591.00
|
|
|
Service Code
|
CPT 00908
|
| Hospital Charge Code |
23084423
|
|
Hospital Revenue Code
|
370
|
| 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
|
|
|
00908 ANESTHESIA FOR; PERINEAL PROSTATECTOMY ADDTNL 0:30
|
Facility
OP
|
$591.00
|
|
|
Service Code
|
CPT 00908
|
| Hospital Charge Code |
23084424
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of AZ Commercial |
$531.90
|
| Rate for Payer: Aetna of AZ Medicare |
$165.48
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| 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 |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$88.65
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| 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 |
$384.15
|
| 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 |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$472.80
|
| Rate for Payer: TriWest Medicare |
$88.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$344.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$106.38
|
|
|
00908 ANESTHESIA FOR; PERINEAL PROSTATECTOMY ADDTNL 0:30
|
Facility
IP
|
$591.00
|
|
|
Service Code
|
CPT 00908
|
| Hospital Charge Code |
23084424
|
|
Hospital Revenue Code
|
370
|
| 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
|
|
|
00910 ANES TRANSURETHRAL PROCEDURE ADDITONAL MINS
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 00910
|
| Hospital Charge Code |
22406147
|
|
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
|
|
