|
pantoprazole 40 mg Tab [CQCH]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 51079005120
|
| Hospital Charge Code |
105935743
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of AZ Commercial |
$0.14
|
| Rate for Payer: Aetna of AZ Medicare |
$0.04
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.06
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of AZ Commercial |
$0.10
|
| Rate for Payer: Copperpoint Commercial |
$0.04
|
| Rate for Payer: Health Net of AZ Commercial |
$0.09
|
| Rate for Payer: Health Net of AZ Medicare |
$0.04
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.12
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
|
pantoprazole 40 mg Tab [CQCH]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 51079005120
|
| Hospital Charge Code |
105935743
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of AZ Commercial |
$0.14
|
| Rate for Payer: Bisbee Police All Plans |
$0.04
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Self Pay Self Pay |
$0.12
|
|
|
Parasite ID, Worm LC
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
22311201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Aetna of AZ Medicare |
$23.52
|
| Rate for Payer: AHCCCS Medicaid |
$4.31
|
| Rate for Payer: Allwell Medicaid |
$4.31
|
| Rate for Payer: Allwell Medicare |
$12.60
|
| Rate for Payer: Amerigroup Medicare |
$12.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$31.37
|
| Rate for Payer: AZCH Complete Medicaid |
$4.31
|
| Rate for Payer: AZCH Complete Medicare |
$12.60
|
| Rate for Payer: Banner UC Health Medicaid |
$4.31
|
| Rate for Payer: Banner UC Health Medicare |
$12.60
|
| Rate for Payer: Bisbee Police All Plans |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$57.12
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna of AZ Commercial |
$54.60
|
| Rate for Payer: Copperpoint Commercial |
$20.79
|
| Rate for Payer: Health Net of AZ Commercial |
$50.40
|
| Rate for Payer: Health Net of AZ Medicare |
$23.52
|
| Rate for Payer: Humana of AZ Medicare |
$12.60
|
| Rate for Payer: Mercy Care Medicaid |
$4.31
|
| Rate for Payer: Self Pay Self Pay |
$67.20
|
| Rate for Payer: TriWest Medicare |
$12.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$48.97
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.12
|
|
|
Parasite ID, Worm LC
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
22311201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Bisbee Police All Plans |
$21.84
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Self Pay Self Pay |
$67.20
|
|
|
.Parasite ID, Worm Result LC
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
22311160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of AZ Commercial |
$72.00
|
| Rate for Payer: Aetna of AZ Medicare |
$22.40
|
| Rate for Payer: AHCCCS Medicaid |
$4.31
|
| Rate for Payer: Allwell Medicaid |
$4.31
|
| Rate for Payer: Allwell Medicare |
$12.00
|
| Rate for Payer: Amerigroup Medicare |
$12.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$29.88
|
| Rate for Payer: AZCH Complete Medicaid |
$4.31
|
| Rate for Payer: AZCH Complete Medicare |
$12.00
|
| Rate for Payer: Banner UC Health Medicaid |
$4.31
|
| Rate for Payer: Banner UC Health Medicare |
$12.00
|
| Rate for Payer: Bisbee Police All Plans |
$20.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$54.40
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna of AZ Commercial |
$52.00
|
| Rate for Payer: Copperpoint Commercial |
$19.80
|
| Rate for Payer: Health Net of AZ Commercial |
$48.00
|
| Rate for Payer: Health Net of AZ Medicare |
$22.40
|
| Rate for Payer: Humana of AZ Medicare |
$12.00
|
| Rate for Payer: Mercy Care Medicaid |
$4.31
|
| Rate for Payer: Self Pay Self Pay |
$64.00
|
| Rate for Payer: TriWest Medicare |
$12.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$46.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.40
|
|
|
.Parasite ID, Worm Result LC
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
22311160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of AZ Commercial |
$72.00
|
| Rate for Payer: Bisbee Police All Plans |
$20.80
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Self Pay Self Pay |
$64.00
|
|
|
Paravaginal repair abdominal or vaginal
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
CPT 57284
|
| Hospital Charge Code |
27267806
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$648.00 |
| Max. Negotiated Rate |
$6,393.84 |
| Rate for Payer: Aetna of AZ Commercial |
$3,888.00
|
| Rate for Payer: Aetna of AZ Medicare |
$1,209.60
|
| Rate for Payer: AHCCCS Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicaid |
$6,393.84
|
| Rate for Payer: Allwell Medicare |
$648.00
|
| Rate for Payer: Amerigroup Medicare |
$648.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,613.52
|
| Rate for Payer: AZCH Complete Medicaid |
$6,393.84
|
| Rate for Payer: AZCH Complete Medicare |
$648.00
|
| Rate for Payer: Banner UC Health Medicaid |
$6,393.84
|
| Rate for Payer: Banner UC Health Medicare |
$648.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,123.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,937.60
|
| Rate for Payer: Cash Price |
$3,456.00
|
| Rate for Payer: Cash Price |
$3,456.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,160.00
|
| Rate for Payer: Copperpoint Commercial |
$1,069.20
|
| Rate for Payer: Health Net of AZ Commercial |
$2,592.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,209.60
|
| Rate for Payer: Humana of AZ Medicare |
$648.00
|
| Rate for Payer: Mercy Care Medicaid |
$6,393.84
|
| Rate for Payer: Self Pay Self Pay |
$3,456.00
|
| Rate for Payer: TriWest Medicare |
$648.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4,540.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$777.60
|
|
|
Paravaginal repair abdominal or vaginal
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
CPT 57284
|
| Hospital Charge Code |
27267806
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$3,888.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,888.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,123.20
|
| Rate for Payer: Cash Price |
$3,456.00
|
| Rate for Payer: Self Pay Self Pay |
$3,456.00
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
24049516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Aetna of AZ Medicare |
$21.56
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$11.55
|
| Rate for Payer: Amerigroup Medicare |
$11.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$28.76
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$11.55
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$11.55
|
| Rate for Payer: Bisbee Police All Plans |
$20.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$52.36
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cigna of AZ Commercial |
$38.50
|
| Rate for Payer: Copperpoint Commercial |
$19.06
|
| Rate for Payer: Health Net of AZ Commercial |
$46.20
|
| Rate for Payer: Health Net of AZ Medicare |
$21.56
|
| Rate for Payer: Humana of AZ Medicare |
$11.55
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$61.60
|
| Rate for Payer: TriWest Medicare |
$11.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.86
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
24049517
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Bisbee Police All Plans |
$28.34
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Self Pay Self Pay |
$87.20
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
24049518
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Bisbee Police All Plans |
$38.48
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Self Pay Self Pay |
$118.40
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
24049518
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Aetna of AZ Medicare |
$41.44
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$22.20
|
| Rate for Payer: Amerigroup Medicare |
$22.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.28
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$22.20
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$22.20
|
| Rate for Payer: Bisbee Police All Plans |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$100.64
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cigna of AZ Commercial |
$74.00
|
| Rate for Payer: Copperpoint Commercial |
$36.63
|
| Rate for Payer: Health Net of AZ Commercial |
$88.80
|
| Rate for Payer: Health Net of AZ Medicare |
$41.44
|
| Rate for Payer: Humana of AZ Medicare |
$22.20
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$118.40
|
| Rate for Payer: TriWest Medicare |
$22.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.64
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
24049516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Bisbee Police All Plans |
$20.02
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Self Pay Self Pay |
$61.60
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
24049517
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Aetna of AZ Medicare |
$30.52
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$16.35
|
| Rate for Payer: Amerigroup Medicare |
$16.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$40.71
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$16.35
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$16.35
|
| Rate for Payer: Bisbee Police All Plans |
$28.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$74.12
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cigna of AZ Commercial |
$54.50
|
| Rate for Payer: Copperpoint Commercial |
$26.98
|
| Rate for Payer: Health Net of AZ Commercial |
$65.40
|
| Rate for Payer: Health Net of AZ Medicare |
$30.52
|
| Rate for Payer: Humana of AZ Medicare |
$16.35
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$87.20
|
| Rate for Payer: TriWest Medicare |
$16.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.62
|
|
|
PARoxetine 20 mg Tab [CQCH]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 904567761
|
| Hospital Charge Code |
105935810
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of AZ Commercial |
$0.13
|
| Rate for Payer: Bisbee Police All Plans |
$0.04
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Self Pay Self Pay |
$0.11
|
|
|
PARoxetine 20 mg Tab [CQCH]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 904567761
|
| Hospital Charge Code |
105935810
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of AZ Commercial |
$0.13
|
| Rate for Payer: Aetna of AZ Medicare |
$0.04
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.05
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of AZ Commercial |
$0.09
|
| Rate for Payer: Copperpoint Commercial |
$0.03
|
| Rate for Payer: Health Net of AZ Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Medicare |
$0.04
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.11
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION OR DIAPHYSECTOMY) BONE��
|
Facility
|
IP
|
$4,040.00
|
|
|
Service Code
|
CPT 27640
|
| Hospital Charge Code |
24043287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,050.40 |
| Max. Negotiated Rate |
$3,636.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,636.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,050.40
|
| Rate for Payer: Cash Price |
$3,232.00
|
| Rate for Payer: Self Pay Self Pay |
$3,232.00
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION OR DIAPHYSECTOMY) BONE��
|
Facility
|
OP
|
$4,040.00
|
|
|
Service Code
|
CPT 27640
|
| Hospital Charge Code |
24043287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$3,636.00
|
| Rate for Payer: Aetna of AZ Medicare |
$1,131.20
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$606.00
|
| Rate for Payer: Amerigroup Medicare |
$606.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,508.94
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$606.00
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$606.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,050.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,747.20
|
| Rate for Payer: Cash Price |
$3,232.00
|
| Rate for Payer: Cash Price |
$3,232.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,020.00
|
| Rate for Payer: Copperpoint Commercial |
$999.90
|
| Rate for Payer: Health Net of AZ Commercial |
$2,424.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,131.20
|
| Rate for Payer: Humana of AZ Medicare |
$606.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$3,232.00
|
| Rate for Payer: TriWest Medicare |
$606.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$727.20
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY
|
Facility
|
OP
|
$2,146.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
24043291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.90 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,931.40
|
| Rate for Payer: Aetna of AZ Medicare |
$600.88
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$321.90
|
| Rate for Payer: Amerigroup Medicare |
$321.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$801.53
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$321.90
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$321.90
|
| Rate for Payer: Bisbee Police All Plans |
$557.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,459.28
|
| Rate for Payer: Cash Price |
$1,716.80
|
| Rate for Payer: Cash Price |
$1,716.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,073.00
|
| Rate for Payer: Copperpoint Commercial |
$531.14
|
| Rate for Payer: Health Net of AZ Commercial |
$1,287.60
|
| Rate for Payer: Health Net of AZ Medicare |
$600.88
|
| Rate for Payer: Humana of AZ Medicare |
$321.90
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,716.80
|
| Rate for Payer: TriWest Medicare |
$321.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$386.28
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY
|
Facility
|
IP
|
$2,146.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
24043291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$557.96 |
| Max. Negotiated Rate |
$1,931.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,931.40
|
| Rate for Payer: Bisbee Police All Plans |
$557.96
|
| Rate for Payer: Cash Price |
$1,716.80
|
| Rate for Payer: Self Pay Self Pay |
$1,716.80
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY - 28124
|
Facility
|
OP
|
$1,622.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
24043292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$243.30 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,459.80
|
| Rate for Payer: Aetna of AZ Medicare |
$454.16
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$243.30
|
| Rate for Payer: Amerigroup Medicare |
$243.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$605.82
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$243.30
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$243.30
|
| Rate for Payer: Bisbee Police All Plans |
$421.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,102.96
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cigna of AZ Commercial |
$811.00
|
| Rate for Payer: Copperpoint Commercial |
$401.44
|
| Rate for Payer: Health Net of AZ Commercial |
$973.20
|
| Rate for Payer: Health Net of AZ Medicare |
$454.16
|
| Rate for Payer: Humana of AZ Medicare |
$243.30
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,297.60
|
| Rate for Payer: TriWest Medicare |
$243.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$291.96
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY - 28124
|
Facility
|
IP
|
$1,622.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
24043292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$421.72 |
| Max. Negotiated Rate |
$1,459.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,459.80
|
| Rate for Payer: Bisbee Police All Plans |
$421.72
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Self Pay Self Pay |
$1,297.60
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY - Tech
|
Facility
|
OP
|
$2,309.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
24043309
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$346.35 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$2,078.10
|
| Rate for Payer: Aetna of AZ Medicare |
$646.52
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$346.35
|
| Rate for Payer: Amerigroup Medicare |
$346.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$862.41
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$346.35
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$346.35
|
| Rate for Payer: Bisbee Police All Plans |
$600.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,570.12
|
| Rate for Payer: Cash Price |
$1,847.20
|
| Rate for Payer: Cash Price |
$1,847.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,154.50
|
| Rate for Payer: Copperpoint Commercial |
$571.48
|
| Rate for Payer: Health Net of AZ Commercial |
$1,385.40
|
| Rate for Payer: Health Net of AZ Medicare |
$646.52
|
| Rate for Payer: Humana of AZ Medicare |
$346.35
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,847.20
|
| Rate for Payer: TriWest Medicare |
$346.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$415.62
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY - Tech
|
Facility
|
IP
|
$2,309.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
24043309
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$600.34 |
| Max. Negotiated Rate |
$2,078.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,078.10
|
| Rate for Payer: Bisbee Police All Plans |
$600.34
|
| Rate for Payer: Cash Price |
$1,847.20
|
| Rate for Payer: Self Pay Self Pay |
$1,847.20
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$3,100.89
|
|
|
Service Code
|
APR-DRG 8441
|
| Hospital Charge Code |
APRDRG8442
|
| Min. Negotiated Rate |
$3,100.89 |
| Max. Negotiated Rate |
$3,100.89 |
| Rate for Payer: AHCCCS Medicaid |
$3,100.89
|
| Rate for Payer: Allwell Medicaid |
$3,100.89
|
| Rate for Payer: AZCH Complete Medicaid |
$3,100.89
|
| Rate for Payer: Banner UC Health Medicaid |
$3,100.89
|
| Rate for Payer: Mercy Care Medicaid |
$3,100.89
|
|
