|
96372 - Subq/IM Injection
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
22283167
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
96372 - Subq/IM Injection
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
22283167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.28 |
| 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 |
$44.93
|
| Rate for Payer: Allwell Medicaid |
$44.93
|
| Rate for Payer: Allwell Medicare |
$41.28
|
| Rate for Payer: Amerigroup Medicare |
$41.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$96.36
|
| Rate for Payer: AZCH Complete Medicaid |
$44.93
|
| Rate for Payer: AZCH Complete Medicare |
$41.28
|
| Rate for Payer: Banner UC Health Medicaid |
$44.93
|
| Rate for Payer: Banner UC Health Medicare |
$41.28
|
| 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 |
$180.60
|
| Rate for Payer: Copperpoint Commercial |
$63.85
|
| 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 |
$41.28
|
| Rate for Payer: Mercy Care Medicaid |
$44.93
|
| Rate for Payer: Self Pay Self Pay |
$206.40
|
| Rate for Payer: TriWest Medicare |
$41.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$150.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$46.44
|
|
|
96372 THERAPTIC PROPHALACTIC I
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
22282936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna of AZ Commercial |
$220.50
|
| Rate for Payer: Bisbee Police All Plans |
$63.70
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Self Pay Self Pay |
$196.00
|
|
|
96372 THERAPTIC PROPHALACTIC I
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
22282936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna of AZ Commercial |
$220.50
|
| Rate for Payer: Aetna of AZ Medicare |
$68.60
|
| Rate for Payer: AHCCCS Medicaid |
$44.93
|
| Rate for Payer: Allwell Medicaid |
$44.93
|
| Rate for Payer: Allwell Medicare |
$39.20
|
| Rate for Payer: Amerigroup Medicare |
$39.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$91.51
|
| Rate for Payer: AZCH Complete Medicaid |
$44.93
|
| Rate for Payer: AZCH Complete Medicare |
$39.20
|
| Rate for Payer: Banner UC Health Medicaid |
$44.93
|
| Rate for Payer: Banner UC Health Medicare |
$39.20
|
| Rate for Payer: Bisbee Police All Plans |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$166.60
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cigna of AZ Commercial |
$171.50
|
| Rate for Payer: Copperpoint Commercial |
$60.64
|
| Rate for Payer: Health Net of AZ Commercial |
$147.00
|
| Rate for Payer: Health Net of AZ Medicare |
$68.60
|
| Rate for Payer: Humana of AZ Medicare |
$39.20
|
| Rate for Payer: Mercy Care Medicaid |
$44.93
|
| Rate for Payer: Self Pay Self Pay |
$196.00
|
| Rate for Payer: TriWest Medicare |
$39.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$142.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$44.10
|
|
|
96373 - Intra-Arterial injection
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 96373
|
| Hospital Charge Code |
22283168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
|
|
96373 - Intra-Arterial injection
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 96373
|
| Hospital Charge Code |
22283168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.88 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Aetna of AZ Medicare |
$75.04
|
| Rate for Payer: AHCCCS Medicaid |
$147.54
|
| Rate for Payer: Allwell Medicaid |
$147.54
|
| Rate for Payer: Allwell Medicare |
$42.88
|
| Rate for Payer: Amerigroup Medicare |
$42.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$100.10
|
| Rate for Payer: AZCH Complete Medicaid |
$147.54
|
| Rate for Payer: AZCH Complete Medicare |
$42.88
|
| Rate for Payer: Banner UC Health Medicaid |
$147.54
|
| Rate for Payer: Banner UC Health Medicare |
$42.88
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$182.24
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cigna of AZ Commercial |
$187.60
|
| Rate for Payer: Copperpoint Commercial |
$66.33
|
| Rate for Payer: Health Net of AZ Commercial |
$160.80
|
| Rate for Payer: Health Net of AZ Medicare |
$75.04
|
| Rate for Payer: Humana of AZ Medicare |
$42.88
|
| Rate for Payer: Mercy Care Medicaid |
$147.54
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
| Rate for Payer: TriWest Medicare |
$42.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$156.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.24
|
|
|
96374 INTRAVENOUS PUSH ADMINISTRATI
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
22282938
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.92 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Aetna of AZ Commercial |
$325.80
|
| Rate for Payer: Aetna of AZ Medicare |
$101.36
|
| Rate for Payer: AHCCCS Medicaid |
$77.79
|
| Rate for Payer: Allwell Medicaid |
$77.79
|
| Rate for Payer: Allwell Medicare |
$57.92
|
| Rate for Payer: Amerigroup Medicare |
$57.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$135.21
|
| Rate for Payer: AZCH Complete Medicaid |
$77.79
|
| Rate for Payer: AZCH Complete Medicare |
$57.92
|
| Rate for Payer: Banner UC Health Medicaid |
$77.79
|
| Rate for Payer: Banner UC Health Medicare |
$57.92
|
| Rate for Payer: Bisbee Police All Plans |
$94.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$246.16
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cigna of AZ Commercial |
$253.40
|
| Rate for Payer: Copperpoint Commercial |
$89.59
|
| Rate for Payer: Health Net of AZ Commercial |
$217.20
|
| Rate for Payer: Health Net of AZ Medicare |
$101.36
|
| Rate for Payer: Humana of AZ Medicare |
$57.92
|
| Rate for Payer: Mercy Care Medicaid |
$77.79
|
| Rate for Payer: Self Pay Self Pay |
$289.60
|
| Rate for Payer: TriWest Medicare |
$57.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$211.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$65.16
|
|
|
96374 INTRAVENOUS PUSH ADMINISTRATI
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
22282938
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.12 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Aetna of AZ Commercial |
$325.80
|
| Rate for Payer: Bisbee Police All Plans |
$94.12
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Self Pay Self Pay |
$289.60
|
|
|
96374 - IV Injection, single/initial
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
22283169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
|
|
96374 - IV Injection, single/initial
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
22283169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.88 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Aetna of AZ Medicare |
$75.04
|
| Rate for Payer: AHCCCS Medicaid |
$77.79
|
| Rate for Payer: Allwell Medicaid |
$77.79
|
| Rate for Payer: Allwell Medicare |
$42.88
|
| Rate for Payer: Amerigroup Medicare |
$42.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$100.10
|
| Rate for Payer: AZCH Complete Medicaid |
$77.79
|
| Rate for Payer: AZCH Complete Medicare |
$42.88
|
| Rate for Payer: Banner UC Health Medicaid |
$77.79
|
| Rate for Payer: Banner UC Health Medicare |
$42.88
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$182.24
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cigna of AZ Commercial |
$187.60
|
| Rate for Payer: Copperpoint Commercial |
$66.33
|
| Rate for Payer: Health Net of AZ Commercial |
$160.80
|
| Rate for Payer: Health Net of AZ Medicare |
$75.04
|
| Rate for Payer: Humana of AZ Medicare |
$42.88
|
| Rate for Payer: Mercy Care Medicaid |
$77.79
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
| Rate for Payer: TriWest Medicare |
$42.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$156.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.24
|
|
|
97032-Attended Estem
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
27373775
|
|
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
|
|
|
97032-Attended Estem
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
27373775
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.96 |
| 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 |
$28.96
|
| Rate for Payer: Amerigroup Medicare |
$28.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$28.96
|
| Rate for Payer: Banner UC Health Medicare |
$28.96
|
| 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 |
$28.96
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$28.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
97110 Therapeutic Exercise Charges
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
24237124
|
|
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
|
|
|
97110 Therapeutic Exercise Charges
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
24237124
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.96 |
| 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 |
$28.96
|
| Rate for Payer: Amerigroup Medicare |
$28.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$28.96
|
| Rate for Payer: Banner UC Health Medicare |
$28.96
|
| 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 |
$28.96
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$28.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
97112 PT Neuromuscular reeducation (Timed per 15 mins)
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
23955336
|
|
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
|
|
|
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 |
$28.96 |
| 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 |
$28.96
|
| Rate for Payer: Amerigroup Medicare |
$28.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$28.96
|
| Rate for Payer: Banner UC Health Medicare |
$28.96
|
| 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 |
$28.96
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$28.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
97129 THERAPY PROCEDURE FOR A RANGE OF MENTAL PROCESSES, INI
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 97129 GN
|
| Hospital Charge Code |
27728004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$19.68 |
| 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: Allwell Medicare |
$19.68
|
| Rate for Payer: Amerigroup Medicare |
$19.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$45.94
|
| Rate for Payer: AZCH Complete Medicare |
$19.68
|
| Rate for Payer: Banner UC Health Medicare |
$19.68
|
| 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: 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 |
$19.68
|
| Rate for Payer: Self Pay Self Pay |
$98.40
|
| Rate for Payer: TriWest Medicare |
$19.68
|
| 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 GN
|
| 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 GN
|
| Hospital Charge Code |
27724314
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$19.20 |
| 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: Allwell Medicare |
$19.20
|
| Rate for Payer: Amerigroup Medicare |
$19.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicare |
$19.20
|
| Rate for Payer: Banner UC Health Medicare |
$19.20
|
| 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: 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 |
$19.20
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$19.20
|
| 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 GN
|
| 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 |
$28.96 |
| 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 |
$28.96
|
| Rate for Payer: Amerigroup Medicare |
$28.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$28.96
|
| Rate for Payer: Banner UC Health Medicare |
$28.96
|
| 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 |
$28.96
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$28.96
|
| 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
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
22856918
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.96 |
| 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 |
$28.96
|
| Rate for Payer: Amerigroup Medicare |
$28.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$28.96
|
| Rate for Payer: Banner UC Health Medicare |
$28.96
|
| 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 |
$28.96
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$28.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
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
|
|
|
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
|
|
