|
90845 Psychoanalysis CQCH
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 90845
|
| Hospital Charge Code |
24089999
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of AZ Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$184.00
|
|
|
90845 Psychoanalysis CQCH
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 90845
|
| Hospital Charge Code |
24089999
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$274.63 |
| Rate for Payer: Aetna of AZ Commercial |
$207.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$36.80
|
| Rate for Payer: Banner UC Health Medicare |
$36.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$36.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$36.80
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna of AZ Commercial |
$161.00
|
| Rate for Payer: Devoted Health Medicare |
$41.40
|
| Rate for Payer: Humana of AZ Medicare |
$36.80
|
| Rate for Payer: Mercy Care Medicaid |
$12.78
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12.78
|
| Rate for Payer: Seven Corners Travel Insurance |
$274.63
|
| Rate for Payer: Southwest Service Administrators UFCW |
$156.40
|
| Rate for Payer: TriWest Medicare |
$36.80
|
| Rate for Payer: United Healthcare Commercial |
$131.56
|
| Rate for Payer: United Healthcare Medicare |
$36.80
|
| Rate for Payer: Veterans Affairs TRICARE |
$36.43
|
|
|
90846 FAMILY PSYCHOTHERAPY 50 Mins
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
23919271
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$607.50 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna of AZ Commercial |
$607.50
|
| Rate for Payer: Cash Price |
$540.00
|
|
|
90846 FAMILY PSYCHOTHERAPY 50 Mins
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
23919271
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna of AZ Commercial |
$607.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$108.00
|
| Rate for Payer: Banner UC Health Medicare |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$108.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$108.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna of AZ Commercial |
$472.50
|
| Rate for Payer: Devoted Health Medicare |
$121.50
|
| Rate for Payer: Humana of AZ Medicare |
$108.00
|
| Rate for Payer: Mercy Care Medicaid |
$0.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$0.36
|
| Rate for Payer: Seven Corners Travel Insurance |
$274.63
|
| Rate for Payer: Southwest Service Administrators UFCW |
$459.00
|
| Rate for Payer: TriWest Medicare |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$386.10
|
| Rate for Payer: United Healthcare Medicare |
$108.00
|
| Rate for Payer: Veterans Affairs TRICARE |
$106.92
|
|
|
90847 Family psychotherapy Including Patient 50 Mins
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
23919272
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$630.90 |
| Max. Negotiated Rate |
$630.90 |
| Rate for Payer: Aetna of AZ Commercial |
$630.90
|
| Rate for Payer: Cash Price |
$560.80
|
|
|
90847 Family psychotherapy Including Patient 50 Mins
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
23919272
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$630.90 |
| Rate for Payer: Aetna of AZ Commercial |
$630.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$112.16
|
| Rate for Payer: Banner UC Health Medicare |
$112.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$476.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$0.35
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$112.16
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$112.16
|
| Rate for Payer: Cash Price |
$560.80
|
| Rate for Payer: Cash Price |
$560.80
|
| Rate for Payer: Cigna of AZ Commercial |
$490.70
|
| Rate for Payer: Devoted Health Medicare |
$126.18
|
| Rate for Payer: Humana of AZ Medicare |
$112.16
|
| Rate for Payer: Mercy Care Medicaid |
$0.35
|
| Rate for Payer: NaphCare Correctional Healthcare |
$0.35
|
| Rate for Payer: Seven Corners Travel Insurance |
$274.63
|
| Rate for Payer: Southwest Service Administrators UFCW |
$476.68
|
| Rate for Payer: TriWest Medicare |
$112.16
|
| Rate for Payer: United Healthcare Commercial |
$400.97
|
| Rate for Payer: United Healthcare Medicare |
$112.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$111.04
|
|
|
90849 Multiple Family Group Psychotherapy CQCH
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
24090000
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of AZ Commercial |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
|
|
90849 Multiple Family Group Psychotherapy CQCH
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
24090000
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$274.63 |
| Rate for Payer: Aetna of AZ Commercial |
$93.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$16.64
|
| Rate for Payer: Banner UC Health Medicare |
$16.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$16.64
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$16.64
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cigna of AZ Commercial |
$72.80
|
| Rate for Payer: Devoted Health Medicare |
$18.72
|
| Rate for Payer: Humana of AZ Medicare |
$16.64
|
| Rate for Payer: Mercy Care Medicaid |
$8.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8.52
|
| Rate for Payer: Seven Corners Travel Insurance |
$274.63
|
| Rate for Payer: Southwest Service Administrators UFCW |
$70.72
|
| Rate for Payer: TriWest Medicare |
$16.64
|
| Rate for Payer: United Healthcare Commercial |
$59.49
|
| Rate for Payer: United Healthcare Medicare |
$16.64
|
| Rate for Payer: Veterans Affairs TRICARE |
$16.47
|
|
|
90853 Group psychotherapy.
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
23919273
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$149.40 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna of AZ Commercial |
$149.40
|
| Rate for Payer: Cash Price |
$132.80
|
|
|
90853 Group psychotherapy.
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
23919273
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Aetna of AZ Commercial |
$149.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$26.56
|
| Rate for Payer: Banner UC Health Medicare |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$26.56
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$26.56
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cigna of AZ Commercial |
$116.20
|
| Rate for Payer: Devoted Health Medicare |
$29.88
|
| Rate for Payer: Humana of AZ Medicare |
$26.56
|
| Rate for Payer: Mercy Care Medicaid |
$3.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3.90
|
| Rate for Payer: Seven Corners Travel Insurance |
$157.18
|
| Rate for Payer: Southwest Service Administrators UFCW |
$112.88
|
| Rate for Payer: TriWest Medicare |
$26.56
|
| Rate for Payer: United Healthcare Commercial |
$94.95
|
| Rate for Payer: United Healthcare Medicare |
$26.56
|
| Rate for Payer: Veterans Affairs TRICARE |
$26.29
|
|
|
90875 Individual Psychophysiological Therapy Biofeedback Tra
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 90875
|
| Hospital Charge Code |
23919274
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna of AZ Commercial |
$369.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$65.60
|
| Rate for Payer: Banner UC Health Medicare |
$65.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$278.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$65.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$65.60
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cigna of AZ Commercial |
$287.00
|
| Rate for Payer: Devoted Health Medicare |
$73.80
|
| Rate for Payer: Humana of AZ Medicare |
$65.60
|
| Rate for Payer: Mercy Care Medicaid |
$0.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$0.70
|
| Rate for Payer: Southwest Service Administrators UFCW |
$278.80
|
| Rate for Payer: TriWest Medicare |
$65.60
|
| Rate for Payer: United Healthcare Commercial |
$234.52
|
| Rate for Payer: United Healthcare Medicare |
$65.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$64.94
|
|
|
90875 Individual Psychophysiological Therapy Biofeedback Tra
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 90875
|
| Hospital Charge Code |
23919274
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$369.00 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna of AZ Commercial |
$369.00
|
| Rate for Payer: Cash Price |
$328.00
|
|
|
90876 Individual Psychophysiological Therapy Biofeedback Tra
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 90876
|
| Hospital Charge Code |
23919275
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$581.40 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Aetna of AZ Commercial |
$581.40
|
| Rate for Payer: Cash Price |
$516.80
|
|
|
90876 Individual Psychophysiological Therapy Biofeedback Tra
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 90876
|
| Hospital Charge Code |
23919275
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Aetna of AZ Commercial |
$581.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$103.36
|
| Rate for Payer: Banner UC Health Medicare |
$103.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$439.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$103.36
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$103.36
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cigna of AZ Commercial |
$452.20
|
| Rate for Payer: Devoted Health Medicare |
$116.28
|
| Rate for Payer: Humana of AZ Medicare |
$103.36
|
| Rate for Payer: Mercy Care Medicaid |
$11.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11.15
|
| Rate for Payer: Southwest Service Administrators UFCW |
$439.28
|
| Rate for Payer: TriWest Medicare |
$103.36
|
| Rate for Payer: United Healthcare Commercial |
$369.51
|
| Rate for Payer: United Healthcare Medicare |
$103.36
|
| Rate for Payer: Veterans Affairs TRICARE |
$102.33
|
|
|
90887 INTERPRETATION OR EXPLANATION OF RESULTS OF PSYCHIATRI
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 90887
|
| Hospital Charge Code |
23919285
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$455.40 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Aetna of AZ Commercial |
$455.40
|
| Rate for Payer: Cash Price |
$404.80
|
|
|
90887 INTERPRETATION OR EXPLANATION OF RESULTS OF PSYCHIATRI
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT 90887
|
| Hospital Charge Code |
23919285
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Aetna of AZ Commercial |
$455.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$80.96
|
| Rate for Payer: Banner UC Health Medicare |
$80.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$344.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$80.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$80.96
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cigna of AZ Commercial |
$354.20
|
| Rate for Payer: Devoted Health Medicare |
$91.08
|
| Rate for Payer: Humana of AZ Medicare |
$80.96
|
| Rate for Payer: Mercy Care Medicaid |
$14.64
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14.64
|
| Rate for Payer: Southwest Service Administrators UFCW |
$344.08
|
| Rate for Payer: TriWest Medicare |
$80.96
|
| Rate for Payer: United Healthcare Commercial |
$289.43
|
| Rate for Payer: United Healthcare Medicare |
$80.96
|
| Rate for Payer: Veterans Affairs TRICARE |
$80.15
|
|
|
90889 Preparation of Report Of Patient’s Psychiatric Status
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 90889
|
| Hospital Charge Code |
23919278
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$357.30 |
| Max. Negotiated Rate |
$357.30 |
| Rate for Payer: Aetna of AZ Commercial |
$357.30
|
| Rate for Payer: Cash Price |
$317.60
|
|
|
90889 Preparation of Report Of Patient’s Psychiatric Status
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 90889
|
| Hospital Charge Code |
23919278
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$357.30 |
| Rate for Payer: Aetna of AZ Commercial |
$357.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$63.52
|
| Rate for Payer: Banner UC Health Medicare |
$63.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$269.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$63.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$63.52
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Cigna of AZ Commercial |
$277.90
|
| Rate for Payer: Devoted Health Medicare |
$71.46
|
| Rate for Payer: Humana of AZ Medicare |
$63.52
|
| Rate for Payer: Southwest Service Administrators UFCW |
$269.96
|
| Rate for Payer: TriWest Medicare |
$63.52
|
| Rate for Payer: United Healthcare Commercial |
$227.08
|
| Rate for Payer: United Healthcare Medicare |
$63.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$62.88
|
|
|
90901 Biofeedback Training by any Modality
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 90901
|
| Hospital Charge Code |
23919276
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.38 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of AZ Commercial |
$121.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$21.60
|
| Rate for Payer: Banner UC Health Medicare |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$22.31
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$21.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$21.60
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of AZ Commercial |
$94.50
|
| Rate for Payer: Devoted Health Medicare |
$24.30
|
| Rate for Payer: Humana of AZ Medicare |
$21.60
|
| Rate for Payer: Mercy Care Medicaid |
$22.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$22.31
|
| Rate for Payer: Southwest Service Administrators UFCW |
$91.80
|
| Rate for Payer: TriWest Medicare |
$21.60
|
| Rate for Payer: United Healthcare Commercial |
$77.22
|
| Rate for Payer: United Healthcare Medicare |
$21.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$21.38
|
|
|
90901 Biofeedback Training by any Modality
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 90901
|
| Hospital Charge Code |
23919276
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of AZ Commercial |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
|
|
90911 Biofeedback Training ,Perineal Muscles,Anorectal, Uret
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
23919277
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$47.36 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna of AZ Commercial |
$269.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$47.84
|
| Rate for Payer: Banner UC Health Medicare |
$47.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$203.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$47.84
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$47.84
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cigna of AZ Commercial |
$209.30
|
| Rate for Payer: Devoted Health Medicare |
$53.82
|
| Rate for Payer: Humana of AZ Medicare |
$47.84
|
| Rate for Payer: Southwest Service Administrators UFCW |
$203.32
|
| Rate for Payer: TriWest Medicare |
$47.84
|
| Rate for Payer: United Healthcare Commercial |
$171.03
|
| Rate for Payer: United Healthcare Medicare |
$47.84
|
| Rate for Payer: Veterans Affairs TRICARE |
$47.36
|
|
|
90911 Biofeedback Training ,Perineal Muscles,Anorectal, Uret
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
23919277
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$269.10 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna of AZ Commercial |
$269.10
|
| Rate for Payer: Cash Price |
$239.20
|
|
|
90912 Biofeedback initial 15 min
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
23926324
|
|
Hospital Revenue Code
|
2105
|
| Min. Negotiated Rate |
$205.36 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna of AZ Commercial |
$271.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$205.36
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,700.00
|
| Rate for Payer: Devoted Health Medicare |
$1,434.00
|
| Rate for Payer: Southwest Service Administrators UFCW |
$205.36
|
|
|
90912 Biofeedback initial 15 min
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
23926324
|
|
Hospital Revenue Code
|
2105
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Aetna of AZ Commercial |
$271.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$48.32
|
| Rate for Payer: Banner UC Health Medicare |
$48.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$205.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$48.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$48.32
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cigna of AZ Commercial |
$211.40
|
| Rate for Payer: Devoted Health Medicare |
$54.36
|
| Rate for Payer: Humana of AZ Medicare |
$48.32
|
| Rate for Payer: Mercy Care Medicaid |
$38.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$38.71
|
| Rate for Payer: Southwest Service Administrators UFCW |
$205.36
|
| Rate for Payer: TriWest Medicare |
$48.32
|
| Rate for Payer: United Healthcare Commercial |
$172.74
|
| Rate for Payer: United Healthcare Medicare |
$48.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$47.84
|
|
|
90913 Biofeedback additional 15 min
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
23926325
|
|
Hospital Revenue Code
|
2105
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna of AZ Commercial |
$150.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$26.72
|
| Rate for Payer: Banner UC Health Medicare |
$26.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$113.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$26.72
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$26.72
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cigna of AZ Commercial |
$116.90
|
| Rate for Payer: Devoted Health Medicare |
$30.06
|
| Rate for Payer: Humana of AZ Medicare |
$26.72
|
| Rate for Payer: Mercy Care Medicaid |
$8.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8.71
|
| Rate for Payer: Southwest Service Administrators UFCW |
$113.56
|
| Rate for Payer: TriWest Medicare |
$26.72
|
| Rate for Payer: United Healthcare Commercial |
$95.52
|
| Rate for Payer: United Healthcare Medicare |
$26.72
|
| Rate for Payer: Veterans Affairs TRICARE |
$26.45
|
|
