|
97112 PT Neuromuscular reeducation (Timed per 15 mins)
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
23955336
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Aetna of AZ Medicare |
$50.68
|
| Rate for Payer: Allwell Medicare |
$27.15
|
| Rate for Payer: Amerigroup Medicare |
$27.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$27.15
|
| Rate for Payer: Banner UC Health Medicare |
$27.15
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$123.08
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna of AZ Commercial |
$126.70
|
| Rate for Payer: Copperpoint Commercial |
$44.80
|
| Rate for Payer: Health Net of AZ Commercial |
$108.60
|
| Rate for Payer: Health Net of AZ Medicare |
$50.68
|
| Rate for Payer: Humana of AZ Medicare |
$27.15
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$27.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
97116 PT Gait training therapy (Timed per 15 mins)
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
23955337
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Aetna of AZ Medicare |
$50.68
|
| Rate for Payer: Allwell Medicare |
$27.15
|
| Rate for Payer: Amerigroup Medicare |
$27.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$27.15
|
| Rate for Payer: Banner UC Health Medicare |
$27.15
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$123.08
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna of AZ Commercial |
$126.70
|
| Rate for Payer: Copperpoint Commercial |
$44.80
|
| Rate for Payer: Health Net of AZ Commercial |
$108.60
|
| Rate for Payer: Health Net of AZ Medicare |
$50.68
|
| Rate for Payer: Humana of AZ Medicare |
$27.15
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$27.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
97116 PT Gait training therapy (Timed per 15 mins)
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
23955337
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
|
|
97129 THERAPY PROCEDURE FOR A RANGE OF MENTAL PROCESSES, INI
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
27728004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of AZ Commercial |
$110.70
|
| Rate for Payer: Aetna of AZ Medicare |
$34.44
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$18.45
|
| Rate for Payer: Amerigroup Medicare |
$18.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$45.94
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$18.45
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$18.45
|
| Rate for Payer: Bisbee Police All Plans |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$83.64
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna of AZ Commercial |
$86.10
|
| Rate for Payer: Copperpoint Commercial |
$30.44
|
| Rate for Payer: Health Net of AZ Commercial |
$73.80
|
| Rate for Payer: Health Net of AZ Medicare |
$34.44
|
| Rate for Payer: Humana of AZ Medicare |
$18.45
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$98.40
|
| Rate for Payer: TriWest Medicare |
$18.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$71.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$22.14
|
|
|
97129 THERAPY PROCEDURE FOR A RANGE OF MENTAL PROCESSES, INI
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
27728004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of AZ Commercial |
$110.70
|
| Rate for Payer: Bisbee Police All Plans |
$31.98
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Self Pay Self Pay |
$98.40
|
|
|
97130 THERAPY PROCEDURE FOR A RANGE OF MENTAL PROCESSES, EAC
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
27724314
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Aetna of AZ Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$18.00
|
| Rate for Payer: Amerigroup Medicare |
$18.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$18.00
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of AZ Commercial |
$84.00
|
| Rate for Payer: Copperpoint Commercial |
$29.70
|
| Rate for Payer: Health Net of AZ Commercial |
$72.00
|
| Rate for Payer: Health Net of AZ Medicare |
$33.60
|
| Rate for Payer: Humana of AZ Medicare |
$18.00
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$18.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.60
|
|
|
97130 THERAPY PROCEDURE FOR A RANGE OF MENTAL PROCESSES, EAC
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
27724314
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
|
|
97530 THERAPEUTIC ACTIVITY (ea. 15 mins) CHARGE
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
15989382
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Aetna of AZ Medicare |
$50.68
|
| Rate for Payer: Allwell Medicare |
$27.15
|
| Rate for Payer: Amerigroup Medicare |
$27.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$27.15
|
| Rate for Payer: Banner UC Health Medicare |
$27.15
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$123.08
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna of AZ Commercial |
$126.70
|
| Rate for Payer: Copperpoint Commercial |
$44.80
|
| Rate for Payer: Health Net of AZ Commercial |
$108.60
|
| Rate for Payer: Health Net of AZ Medicare |
$50.68
|
| Rate for Payer: Humana of AZ Medicare |
$27.15
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$27.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
97530 THERAPEUTIC ACTIVITY (ea. 15 mins) CHARGE
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
15989382
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
|
|
97537 COMMUNITY/WORK REINTEGRATION TRAINING CHARGE
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
22856918
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
|
|
97537 COMMUNITY/WORK REINTEGRATION TRAINING CHARGE
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
22856918
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Aetna of AZ Medicare |
$50.68
|
| Rate for Payer: Allwell Medicare |
$27.15
|
| Rate for Payer: Amerigroup Medicare |
$27.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$27.15
|
| Rate for Payer: Banner UC Health Medicare |
$27.15
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$123.08
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna of AZ Commercial |
$126.70
|
| Rate for Payer: Copperpoint Commercial |
$44.80
|
| Rate for Payer: Health Net of AZ Commercial |
$108.60
|
| Rate for Payer: Health Net of AZ Medicare |
$50.68
|
| Rate for Payer: Humana of AZ Medicare |
$27.15
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$27.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
97542 Wheelchair Management ea 15 Min
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
23818480
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Aetna of AZ Medicare |
$50.68
|
| Rate for Payer: Allwell Medicare |
$27.15
|
| Rate for Payer: Amerigroup Medicare |
$27.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$27.15
|
| Rate for Payer: Banner UC Health Medicare |
$27.15
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$123.08
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna of AZ Commercial |
$126.70
|
| Rate for Payer: Copperpoint Commercial |
$44.80
|
| Rate for Payer: Health Net of AZ Commercial |
$108.60
|
| Rate for Payer: Health Net of AZ Medicare |
$50.68
|
| Rate for Payer: Humana of AZ Medicare |
$27.15
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$27.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
97542 Wheelchair Management ea 15 Min
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
23818480
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
|
|
97606 NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED D
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
24053047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$501.46 |
| Rate for Payer: Aetna of AZ Commercial |
$123.30
|
| Rate for Payer: Aetna of AZ Medicare |
$38.36
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicare |
$20.55
|
| Rate for Payer: Amerigroup Medicare |
$20.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$51.17
|
| Rate for Payer: AZCH Complete Medicaid |
$501.46
|
| Rate for Payer: AZCH Complete Medicare |
$20.55
|
| Rate for Payer: Banner UC Health Medicaid |
$501.46
|
| Rate for Payer: Banner UC Health Medicare |
$20.55
|
| Rate for Payer: Bisbee Police All Plans |
$35.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$93.16
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cigna of AZ Commercial |
$68.50
|
| Rate for Payer: Copperpoint Commercial |
$33.91
|
| Rate for Payer: Health Net of AZ Commercial |
$82.20
|
| Rate for Payer: Health Net of AZ Medicare |
$38.36
|
| Rate for Payer: Humana of AZ Medicare |
$20.55
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: Self Pay Self Pay |
$109.60
|
| Rate for Payer: TriWest Medicare |
$20.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$79.87
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$24.66
|
|
|
97606 NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED D
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
24053047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of AZ Commercial |
$123.30
|
| Rate for Payer: Bisbee Police All Plans |
$35.62
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Self Pay Self Pay |
$109.60
|
|
|
99144 ANES 1ST 0:30 CHARGE
|
Facility
|
OP
|
$622.00
|
|
| Hospital Charge Code |
22406220
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$93.30 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna of AZ Commercial |
$559.80
|
| Rate for Payer: Aetna of AZ Medicare |
$174.16
|
| Rate for Payer: Allwell Medicare |
$93.30
|
| Rate for Payer: Amerigroup Medicare |
$93.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$232.32
|
| Rate for Payer: AZCH Complete Medicare |
$93.30
|
| Rate for Payer: Banner UC Health Medicare |
$93.30
|
| Rate for Payer: Bisbee Police All Plans |
$161.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$422.96
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cigna of AZ Commercial |
$404.30
|
| Rate for Payer: Copperpoint Commercial |
$153.94
|
| Rate for Payer: Health Net of AZ Commercial |
$373.20
|
| Rate for Payer: Health Net of AZ Medicare |
$174.16
|
| Rate for Payer: Humana of AZ Medicare |
$93.30
|
| Rate for Payer: Self Pay Self Pay |
$497.60
|
| Rate for Payer: TriWest Medicare |
$93.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$362.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$111.96
|
|
|
99144 ANES 1ST 0:30 CHARGE
|
Facility
|
IP
|
$622.00
|
|
| Hospital Charge Code |
22406220
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna of AZ Commercial |
$559.80
|
| Rate for Payer: Bisbee Police All Plans |
$161.72
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Self Pay Self Pay |
$497.60
|
|
|
99144 ANES ADDTNL 0:30 CHARGE
|
Facility
|
OP
|
$622.00
|
|
| Hospital Charge Code |
22406221
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$93.30 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna of AZ Commercial |
$559.80
|
| Rate for Payer: Aetna of AZ Medicare |
$174.16
|
| Rate for Payer: Allwell Medicare |
$93.30
|
| Rate for Payer: Amerigroup Medicare |
$93.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$232.32
|
| Rate for Payer: AZCH Complete Medicare |
$93.30
|
| Rate for Payer: Banner UC Health Medicare |
$93.30
|
| Rate for Payer: Bisbee Police All Plans |
$161.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$422.96
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cigna of AZ Commercial |
$404.30
|
| Rate for Payer: Copperpoint Commercial |
$153.94
|
| Rate for Payer: Health Net of AZ Commercial |
$373.20
|
| Rate for Payer: Health Net of AZ Medicare |
$174.16
|
| Rate for Payer: Humana of AZ Medicare |
$93.30
|
| Rate for Payer: Self Pay Self Pay |
$497.60
|
| Rate for Payer: TriWest Medicare |
$93.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$362.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$111.96
|
|
|
99144 ANES ADDTNL 0:30 CHARGE
|
Facility
|
IP
|
$622.00
|
|
| Hospital Charge Code |
22406221
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna of AZ Commercial |
$559.80
|
| Rate for Payer: Bisbee Police All Plans |
$161.72
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Self Pay Self Pay |
$497.60
|
|
|
99281 - ED Level 1
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
22283175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$439.00 |
| Rate for Payer: Aetna of AZ Commercial |
$373.50
|
| Rate for Payer: Aetna of AZ Medicare |
$116.20
|
| Rate for Payer: AHCCCS Medicaid |
$109.08
|
| Rate for Payer: Allwell Medicaid |
$109.08
|
| Rate for Payer: Allwell Medicare |
$62.25
|
| Rate for Payer: Amerigroup Medicare |
$62.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$155.00
|
| Rate for Payer: AZCH Complete Medicaid |
$109.08
|
| Rate for Payer: AZCH Complete Medicare |
$62.25
|
| Rate for Payer: Banner UC Health Medicaid |
$109.08
|
| Rate for Payer: Banner UC Health Medicare |
$62.25
|
| Rate for Payer: Bisbee Police All Plans |
$107.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$282.20
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cigna of AZ Commercial |
$290.50
|
| Rate for Payer: Copperpoint Commercial |
$102.71
|
| Rate for Payer: Health Net of AZ Commercial |
$249.00
|
| Rate for Payer: Health Net of AZ Medicare |
$116.20
|
| Rate for Payer: Humana of AZ Medicare |
$62.25
|
| Rate for Payer: Mercy Care Medicaid |
$109.08
|
| Rate for Payer: Self Pay Self Pay |
$332.00
|
| Rate for Payer: TriWest Medicare |
$62.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$439.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$74.70
|
|
|
99281 - ED Level 1
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
22283175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$373.50 |
| Rate for Payer: Aetna of AZ Commercial |
$373.50
|
| Rate for Payer: Bisbee Police All Plans |
$107.90
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Self Pay Self Pay |
$332.00
|
|
|
99282 - ED Level 2
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
22283176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.72 |
| Max. Negotiated Rate |
$739.80 |
| Rate for Payer: Aetna of AZ Commercial |
$739.80
|
| Rate for Payer: Bisbee Police All Plans |
$213.72
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Self Pay Self Pay |
$657.60
|
|
|
99282 - ED Level 2
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
22283176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.30 |
| Max. Negotiated Rate |
$739.80 |
| Rate for Payer: Aetna of AZ Commercial |
$739.80
|
| Rate for Payer: Aetna of AZ Medicare |
$230.16
|
| Rate for Payer: AHCCCS Medicaid |
$177.74
|
| Rate for Payer: Allwell Medicaid |
$177.74
|
| Rate for Payer: Allwell Medicare |
$123.30
|
| Rate for Payer: Amerigroup Medicare |
$123.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$307.02
|
| Rate for Payer: AZCH Complete Medicaid |
$177.74
|
| Rate for Payer: AZCH Complete Medicare |
$123.30
|
| Rate for Payer: Banner UC Health Medicaid |
$177.74
|
| Rate for Payer: Banner UC Health Medicare |
$123.30
|
| Rate for Payer: Bisbee Police All Plans |
$213.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$558.96
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna of AZ Commercial |
$575.40
|
| Rate for Payer: Copperpoint Commercial |
$203.44
|
| Rate for Payer: Health Net of AZ Commercial |
$493.20
|
| Rate for Payer: Health Net of AZ Medicare |
$230.16
|
| Rate for Payer: Humana of AZ Medicare |
$123.30
|
| Rate for Payer: Mercy Care Medicaid |
$177.74
|
| Rate for Payer: Self Pay Self Pay |
$657.60
|
| Rate for Payer: TriWest Medicare |
$123.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$602.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$147.96
|
|
|
99283 - ED Level 3
|
Facility
|
OP
|
$1,460.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
22283177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,314.00
|
| Rate for Payer: Aetna of AZ Medicare |
$408.80
|
| Rate for Payer: AHCCCS Medicaid |
$276.48
|
| Rate for Payer: Allwell Medicaid |
$276.48
|
| Rate for Payer: Allwell Medicare |
$219.00
|
| Rate for Payer: Amerigroup Medicare |
$219.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$545.31
|
| Rate for Payer: AZCH Complete Medicaid |
$276.48
|
| Rate for Payer: AZCH Complete Medicare |
$219.00
|
| Rate for Payer: Banner UC Health Medicaid |
$276.48
|
| Rate for Payer: Banner UC Health Medicare |
$219.00
|
| Rate for Payer: Bisbee Police All Plans |
$379.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$992.80
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,022.00
|
| Rate for Payer: Copperpoint Commercial |
$361.35
|
| Rate for Payer: Health Net of AZ Commercial |
$876.00
|
| Rate for Payer: Health Net of AZ Medicare |
$408.80
|
| Rate for Payer: Humana of AZ Medicare |
$219.00
|
| Rate for Payer: Mercy Care Medicaid |
$276.48
|
| Rate for Payer: Self Pay Self Pay |
$1,168.00
|
| Rate for Payer: TriWest Medicare |
$219.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$863.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$262.80
|
|
|
99283 - ED Level 3
|
Facility
|
IP
|
$1,460.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
22283177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$379.60 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,314.00
|
| Rate for Payer: Bisbee Police All Plans |
$379.60
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Self Pay Self Pay |
$1,168.00
|
|
