|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$9,085.23
|
|
|
Service Code
|
APR-DRG 3443
|
| Hospital Charge Code |
APRDRG3444
|
| Min. Negotiated Rate |
$9,085.23 |
| Max. Negotiated Rate |
$9,085.23 |
| Rate for Payer: AHCCCS Medicaid |
$9,085.23
|
| Rate for Payer: Allwell Medicaid |
$9,085.23
|
| Rate for Payer: AZCH Complete Medicaid |
$9,085.23
|
| Rate for Payer: Banner UC Health Medicaid |
$9,085.23
|
| Rate for Payer: Mercy Care Medicaid |
$9,085.23
|
|
|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$15,890.22
|
|
|
Service Code
|
APR-DRG 3444
|
| Hospital Charge Code |
APRDRG3444
|
| Min. Negotiated Rate |
$15,890.22 |
| Max. Negotiated Rate |
$15,890.22 |
| Rate for Payer: AHCCCS Medicaid |
$15,890.22
|
| Rate for Payer: Allwell Medicaid |
$15,890.22
|
| Rate for Payer: AZCH Complete Medicaid |
$15,890.22
|
| Rate for Payer: Banner UC Health Medicaid |
$15,890.22
|
| Rate for Payer: Mercy Care Medicaid |
$15,890.22
|
|
|
OSTEOSET RESORBABLE MINI BEAD FAST
|
Facility
|
OP
|
$2,293.00
|
|
| Hospital Charge Code |
22354275
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$343.95 |
| Max. Negotiated Rate |
$2,063.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,063.70
|
| Rate for Payer: Aetna of AZ Medicare |
$642.04
|
| Rate for Payer: Allwell Medicare |
$343.95
|
| Rate for Payer: Amerigroup Medicare |
$343.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$856.44
|
| Rate for Payer: AZCH Complete Medicare |
$343.95
|
| Rate for Payer: Banner UC Health Medicare |
$343.95
|
| Rate for Payer: Bisbee Police All Plans |
$596.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,559.24
|
| Rate for Payer: Cash Price |
$1,834.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,605.10
|
| Rate for Payer: Copperpoint Commercial |
$567.52
|
| Rate for Payer: Health Net of AZ Commercial |
$1,375.80
|
| Rate for Payer: Health Net of AZ Medicare |
$642.04
|
| Rate for Payer: Humana of AZ Medicare |
$343.95
|
| Rate for Payer: Self Pay Self Pay |
$1,834.40
|
| Rate for Payer: TriWest Medicare |
$343.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,336.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$412.74
|
|
|
OSTEOSET RESORBABLE MINI BEAD FAST
|
Facility
|
IP
|
$2,293.00
|
|
| Hospital Charge Code |
22354275
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$596.18 |
| Max. Negotiated Rate |
$2,063.70 |
| Rate for Payer: Aetna of AZ Commercial |
$2,063.70
|
| Rate for Payer: Bisbee Police All Plans |
$596.18
|
| Rate for Payer: Cash Price |
$1,834.40
|
| Rate for Payer: Self Pay Self Pay |
$1,834.40
|
|
|
OSTEOTOMY WITH OR WITHOUT LENGTHENING SHORTENING OR ANGULAR CORRECTION
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
CPT 28306
|
| Hospital Charge Code |
24043263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$511.16 |
| Max. Negotiated Rate |
$1,769.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,769.40
|
| Rate for Payer: Bisbee Police All Plans |
$511.16
|
| Rate for Payer: Cash Price |
$1,572.80
|
| Rate for Payer: Self Pay Self Pay |
$1,572.80
|
|
|
OSTEOTOMY WITH OR WITHOUT LENGTHENING SHORTENING OR ANGULAR CORRECTION
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
CPT 28306
|
| Hospital Charge Code |
24043263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$294.90 |
| Max. Negotiated Rate |
$9,084.18 |
| Rate for Payer: Aetna of AZ Commercial |
$1,769.40
|
| Rate for Payer: Aetna of AZ Medicare |
$550.48
|
| Rate for Payer: AHCCCS Medicaid |
$9,084.18
|
| Rate for Payer: Allwell Medicaid |
$9,084.18
|
| Rate for Payer: Allwell Medicare |
$294.90
|
| Rate for Payer: Amerigroup Medicare |
$294.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$734.30
|
| Rate for Payer: AZCH Complete Medicaid |
$9,084.18
|
| Rate for Payer: AZCH Complete Medicare |
$294.90
|
| Rate for Payer: Banner UC Health Medicaid |
$9,084.18
|
| Rate for Payer: Banner UC Health Medicare |
$294.90
|
| Rate for Payer: Bisbee Police All Plans |
$511.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,336.88
|
| Rate for Payer: Cash Price |
$1,572.80
|
| Rate for Payer: Cash Price |
$1,572.80
|
| Rate for Payer: Cigna of AZ Commercial |
$983.00
|
| Rate for Payer: Copperpoint Commercial |
$486.58
|
| Rate for Payer: Health Net of AZ Commercial |
$1,179.60
|
| Rate for Payer: Health Net of AZ Medicare |
$550.48
|
| Rate for Payer: Humana of AZ Medicare |
$294.90
|
| Rate for Payer: Mercy Care Medicaid |
$9,084.18
|
| Rate for Payer: Self Pay Self Pay |
$1,572.80
|
| Rate for Payer: TriWest Medicare |
$294.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$353.88
|
|
|
OSTEOTOMY WITH OR WITHOUT LENGTHENING SHORTENING OR ANGULAR CORRECTION - 28308
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
CPT 28308
|
| Hospital Charge Code |
24043264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$481.26 |
| Max. Negotiated Rate |
$1,665.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,665.90
|
| Rate for Payer: Bisbee Police All Plans |
$481.26
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Self Pay Self Pay |
$1,480.80
|
|
|
OSTEOTOMY WITH OR WITHOUT LENGTHENING SHORTENING OR ANGULAR CORRECTION - 28308
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
CPT 28308
|
| Hospital Charge Code |
24043264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$277.65 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,665.90
|
| Rate for Payer: Aetna of AZ Medicare |
$518.28
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$277.65
|
| Rate for Payer: Amerigroup Medicare |
$277.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$691.35
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$277.65
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$277.65
|
| Rate for Payer: Bisbee Police All Plans |
$481.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,258.68
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cigna of AZ Commercial |
$925.50
|
| Rate for Payer: Copperpoint Commercial |
$458.12
|
| Rate for Payer: Health Net of AZ Commercial |
$1,110.60
|
| Rate for Payer: Health Net of AZ Medicare |
$518.28
|
| Rate for Payer: Humana of AZ Medicare |
$277.65
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,480.80
|
| Rate for Payer: TriWest Medicare |
$277.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$333.18
|
|
|
OSTOMY BELT ADJUSTABLE
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
22354246
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna of AZ Commercial |
$60.30
|
| Rate for Payer: Bisbee Police All Plans |
$17.42
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Self Pay Self Pay |
$53.60
|
|
|
OSTOMY BELT ADJUSTABLE
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
22354246
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna of AZ Commercial |
$60.30
|
| Rate for Payer: Aetna of AZ Medicare |
$18.76
|
| Rate for Payer: AHCCCS Medicaid |
$13.24
|
| Rate for Payer: Allwell Medicaid |
$13.24
|
| Rate for Payer: Allwell Medicare |
$10.05
|
| Rate for Payer: Amerigroup Medicare |
$10.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$25.02
|
| Rate for Payer: AZCH Complete Medicaid |
$13.24
|
| Rate for Payer: AZCH Complete Medicare |
$10.05
|
| Rate for Payer: Banner UC Health Medicaid |
$13.24
|
| Rate for Payer: Banner UC Health Medicare |
$10.05
|
| Rate for Payer: Bisbee Police All Plans |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$45.56
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cigna of AZ Commercial |
$46.90
|
| Rate for Payer: Copperpoint Commercial |
$16.58
|
| Rate for Payer: Health Net of AZ Commercial |
$40.20
|
| Rate for Payer: Health Net of AZ Medicare |
$18.76
|
| Rate for Payer: Humana of AZ Medicare |
$10.05
|
| Rate for Payer: Mercy Care Medicaid |
$13.24
|
| Rate for Payer: Self Pay Self Pay |
$53.60
|
| Rate for Payer: TriWest Medicare |
$10.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$39.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.06
|
|
|
OT COGNITIVE TRAIN @ 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
691289
|
|
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
|
|
|
OT COGNITIVE TRAIN @ 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
11473411
|
|
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
|
|
|
OT COGNITIVE TRAIN @ 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
11473411
|
|
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
|
|
|
OT COGNITIVE TRAIN @ 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97532 GO
|
| Hospital Charge Code |
691289
|
|
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
|
|
|
OT COMMUNITY/WORK TRAIN @ 15 MIN
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
11473418
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna of AZ Commercial |
$165.60
|
| Rate for Payer: Bisbee Police All Plans |
$47.84
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Self Pay Self Pay |
$147.20
|
|
|
OT COMMUNITY/WORK TRAIN @ 15 MIN
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
691287
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna of AZ Commercial |
$154.80
|
| Rate for Payer: Bisbee Police All Plans |
$44.72
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Self Pay Self Pay |
$137.60
|
|
|
OT COMMUNITY/WORK TRAIN @ 15 MIN
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
691287
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna of AZ Commercial |
$154.80
|
| Rate for Payer: Aetna of AZ Medicare |
$48.16
|
| Rate for Payer: Allwell Medicare |
$25.80
|
| Rate for Payer: Amerigroup Medicare |
$25.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$64.24
|
| Rate for Payer: AZCH Complete Medicare |
$25.80
|
| Rate for Payer: Banner UC Health Medicare |
$25.80
|
| Rate for Payer: Bisbee Police All Plans |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$116.96
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cigna of AZ Commercial |
$120.40
|
| Rate for Payer: Copperpoint Commercial |
$42.57
|
| Rate for Payer: Health Net of AZ Commercial |
$103.20
|
| Rate for Payer: Health Net of AZ Medicare |
$48.16
|
| Rate for Payer: Humana of AZ Medicare |
$25.80
|
| Rate for Payer: Self Pay Self Pay |
$137.60
|
| Rate for Payer: TriWest Medicare |
$25.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$100.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.96
|
|
|
OT COMMUNITY/WORK TRAIN @ 15 MIN
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
11473418
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna of AZ Commercial |
$165.60
|
| Rate for Payer: Aetna of AZ Medicare |
$51.52
|
| Rate for Payer: Allwell Medicare |
$27.60
|
| Rate for Payer: Amerigroup Medicare |
$27.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$68.72
|
| Rate for Payer: AZCH Complete Medicare |
$27.60
|
| Rate for Payer: Banner UC Health Medicare |
$27.60
|
| Rate for Payer: Bisbee Police All Plans |
$47.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$125.12
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cigna of AZ Commercial |
$128.80
|
| Rate for Payer: Copperpoint Commercial |
$45.54
|
| Rate for Payer: Health Net of AZ Commercial |
$110.40
|
| Rate for Payer: Health Net of AZ Medicare |
$51.52
|
| Rate for Payer: Humana of AZ Medicare |
$27.60
|
| Rate for Payer: Self Pay Self Pay |
$147.20
|
| Rate for Payer: TriWest Medicare |
$27.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$107.27
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$33.12
|
|
|
OT CONTRAST BATH EA 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
22056771
|
|
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
|
|
|
OT CONTRAST BATH EA 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
22056771
|
|
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
|
|
|
OT ELECT STIM MANUAL @ 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
691324
|
|
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
|
|
|
OT ELECT STIM MANUAL @ 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
691324
|
|
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
|
|
|
OT E-STIM W US - EACH 15
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
8865394
|
|
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
|
|
|
OT E-STIM W US - EACH 15
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
8865394
|
|
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
|
|
|
OT EVAL 30 MIN
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
22528841
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Aetna of AZ Commercial |
$322.20
|
| Rate for Payer: Aetna of AZ Medicare |
$100.24
|
| Rate for Payer: Allwell Medicare |
$53.70
|
| Rate for Payer: Amerigroup Medicare |
$53.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$133.71
|
| Rate for Payer: AZCH Complete Medicare |
$53.70
|
| Rate for Payer: Banner UC Health Medicare |
$53.70
|
| Rate for Payer: Bisbee Police All Plans |
$93.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$243.44
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cigna of AZ Commercial |
$250.60
|
| Rate for Payer: Copperpoint Commercial |
$88.60
|
| Rate for Payer: Health Net of AZ Commercial |
$214.80
|
| Rate for Payer: Health Net of AZ Medicare |
$100.24
|
| Rate for Payer: Humana of AZ Medicare |
$53.70
|
| Rate for Payer: Self Pay Self Pay |
$286.40
|
| Rate for Payer: TriWest Medicare |
$53.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$208.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$64.44
|
|
