|
PT Other Primary Current Status G-8990 CL At least 60% but less than 80% impaire
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8990 GP
|
| Hospital Charge Code |
6035340
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of AZ Commercial |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.01
|
|
|
PT Other Primary Current Status G-8990 CL At least 60% but less than 80% impaire
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8990 GP
|
| Hospital Charge Code |
6035340
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of AZ Commercial |
$0.01
|
| Rate for Payer: Aetna of AZ Medicare |
$0.00
|
| Rate for Payer: Allwell Medicare |
$0.00
|
| Rate for Payer: Amerigroup Medicare |
$0.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.00
|
| Rate for Payer: AZCH Complete Medicare |
$0.00
|
| Rate for Payer: Banner UC Health Medicare |
$0.00
|
| Rate for Payer: Bisbee Police All Plans |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of AZ Commercial |
$0.01
|
| Rate for Payer: Copperpoint Commercial |
$0.00
|
| Rate for Payer: Health Net of AZ Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Medicare |
$0.00
|
| Rate for Payer: Humana of AZ Medicare |
$0.00
|
| Rate for Payer: Self Pay Self Pay |
$0.01
|
| Rate for Payer: TriWest Medicare |
$0.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.00
|
|
|
PT Other Primary Current Status G-8990 CM At least 80% but less than 100% impair
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8990 GP
|
| Hospital Charge Code |
6035339
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of AZ Commercial |
$0.01
|
| Rate for Payer: Aetna of AZ Medicare |
$0.00
|
| Rate for Payer: Allwell Medicare |
$0.00
|
| Rate for Payer: Amerigroup Medicare |
$0.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.00
|
| Rate for Payer: AZCH Complete Medicare |
$0.00
|
| Rate for Payer: Banner UC Health Medicare |
$0.00
|
| Rate for Payer: Bisbee Police All Plans |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of AZ Commercial |
$0.01
|
| Rate for Payer: Copperpoint Commercial |
$0.00
|
| Rate for Payer: Health Net of AZ Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Medicare |
$0.00
|
| Rate for Payer: Humana of AZ Medicare |
$0.00
|
| Rate for Payer: Self Pay Self Pay |
$0.01
|
| Rate for Payer: TriWest Medicare |
$0.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.00
|
|
|
PT Other Primary Current Status G-8990 CM At least 80% but less than 100% impair
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8990 GP
|
| Hospital Charge Code |
6035339
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of AZ Commercial |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.01
|
|
|
PT Other Primary Current Status G-8990 CN 100% impaired
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8990 GP
|
| Hospital Charge Code |
6035338
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of AZ Commercial |
$0.01
|
| Rate for Payer: Aetna of AZ Medicare |
$0.00
|
| Rate for Payer: Allwell Medicare |
$0.00
|
| Rate for Payer: Amerigroup Medicare |
$0.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.00
|
| Rate for Payer: AZCH Complete Medicare |
$0.00
|
| Rate for Payer: Banner UC Health Medicare |
$0.00
|
| Rate for Payer: Bisbee Police All Plans |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of AZ Commercial |
$0.01
|
| Rate for Payer: Copperpoint Commercial |
$0.00
|
| Rate for Payer: Health Net of AZ Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Medicare |
$0.00
|
| Rate for Payer: Humana of AZ Medicare |
$0.00
|
| Rate for Payer: Self Pay Self Pay |
$0.01
|
| Rate for Payer: TriWest Medicare |
$0.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.00
|
|
|
PT Other Primary Current Status G-8990 CN 100% impaired
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8990 GP
|
| Hospital Charge Code |
6035338
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of AZ Commercial |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.01
|
|
|
PT Other Primary Goal Status G-8991 CH 0% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035358
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1.40
|
| Rate for Payer: Allwell Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.87
|
| Rate for Payer: AZCH Complete Medicare |
$0.80
|
| Rate for Payer: Banner UC Health Medicare |
$0.80
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3.50
|
| Rate for Payer: Copperpoint Commercial |
$1.24
|
| Rate for Payer: Health Net of AZ Commercial |
$3.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1.40
|
| Rate for Payer: Humana of AZ Medicare |
$0.80
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
| Rate for Payer: TriWest Medicare |
$0.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CH 0% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035358
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
|
|
PT Other Primary Goal Status G-8991 CI At least 1% but less than 20% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035357
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
|
|
PT Other Primary Goal Status G-8991 CI At least 1% but less than 20% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035357
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1.40
|
| Rate for Payer: Allwell Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.87
|
| Rate for Payer: AZCH Complete Medicare |
$0.80
|
| Rate for Payer: Banner UC Health Medicare |
$0.80
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3.50
|
| Rate for Payer: Copperpoint Commercial |
$1.24
|
| Rate for Payer: Health Net of AZ Commercial |
$3.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1.40
|
| Rate for Payer: Humana of AZ Medicare |
$0.80
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
| Rate for Payer: TriWest Medicare |
$0.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CJ At least 20% but less than 40% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
|
|
PT Other Primary Goal Status G-8991 CJ At least 20% but less than 40% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1.40
|
| Rate for Payer: Allwell Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.87
|
| Rate for Payer: AZCH Complete Medicare |
$0.80
|
| Rate for Payer: Banner UC Health Medicare |
$0.80
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3.50
|
| Rate for Payer: Copperpoint Commercial |
$1.24
|
| Rate for Payer: Health Net of AZ Commercial |
$3.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1.40
|
| Rate for Payer: Humana of AZ Medicare |
$0.80
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
| Rate for Payer: TriWest Medicare |
$0.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CK At least 40% but less than 60% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035355
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1.40
|
| Rate for Payer: Allwell Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.87
|
| Rate for Payer: AZCH Complete Medicare |
$0.80
|
| Rate for Payer: Banner UC Health Medicare |
$0.80
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3.50
|
| Rate for Payer: Copperpoint Commercial |
$1.24
|
| Rate for Payer: Health Net of AZ Commercial |
$3.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1.40
|
| Rate for Payer: Humana of AZ Medicare |
$0.80
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
| Rate for Payer: TriWest Medicare |
$0.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CK At least 40% but less than 60% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035355
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
|
|
PT Other Primary Goal Status G-8991 CL At least 60% but less than 80% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035354
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1.40
|
| Rate for Payer: Allwell Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.87
|
| Rate for Payer: AZCH Complete Medicare |
$0.80
|
| Rate for Payer: Banner UC Health Medicare |
$0.80
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3.50
|
| Rate for Payer: Copperpoint Commercial |
$1.24
|
| Rate for Payer: Health Net of AZ Commercial |
$3.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1.40
|
| Rate for Payer: Humana of AZ Medicare |
$0.80
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
| Rate for Payer: TriWest Medicare |
$0.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CL At least 60% but less than 80% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035354
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
|
|
PT Other Primary Goal Status G-8991 CM At least 80% but less than 100% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035353
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
|
|
PT Other Primary Goal Status G-8991 CM At least 80% but less than 100% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035353
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1.40
|
| Rate for Payer: Allwell Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.87
|
| Rate for Payer: AZCH Complete Medicare |
$0.80
|
| Rate for Payer: Banner UC Health Medicare |
$0.80
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3.50
|
| Rate for Payer: Copperpoint Commercial |
$1.24
|
| Rate for Payer: Health Net of AZ Commercial |
$3.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1.40
|
| Rate for Payer: Humana of AZ Medicare |
$0.80
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
| Rate for Payer: TriWest Medicare |
$0.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CN 100% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1.40
|
| Rate for Payer: Allwell Medicare |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.87
|
| Rate for Payer: AZCH Complete Medicare |
$0.80
|
| Rate for Payer: Banner UC Health Medicare |
$0.80
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3.50
|
| Rate for Payer: Copperpoint Commercial |
$1.24
|
| Rate for Payer: Health Net of AZ Commercial |
$3.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1.40
|
| Rate for Payer: Humana of AZ Medicare |
$0.80
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
| Rate for Payer: TriWest Medicare |
$0.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.90
|
|
|
PT Other Primary Goal Status G-8991 CN 100% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8991 GP
|
| Hospital Charge Code |
6035352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
|
|
PT PARAFIN BATH
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
1230143
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$27.52 |
| 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 |
$27.52
|
| Rate for Payer: Amerigroup Medicare |
$27.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$64.24
|
| Rate for Payer: AZCH Complete Medicare |
$27.52
|
| Rate for Payer: Banner UC Health Medicare |
$27.52
|
| 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 |
$27.52
|
| Rate for Payer: Self Pay Self Pay |
$137.60
|
| Rate for Payer: TriWest Medicare |
$27.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$100.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.96
|
|
|
PT PARAFIN BATH
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
1230143
|
|
Hospital Revenue Code
|
424
|
| 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
|
|
|
PT PROSTHETIC TRN @15 MIN
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
692241
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.52 |
| 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 |
$27.52
|
| Rate for Payer: Amerigroup Medicare |
$27.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$64.24
|
| Rate for Payer: AZCH Complete Medicare |
$27.52
|
| Rate for Payer: Banner UC Health Medicare |
$27.52
|
| 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 |
$27.52
|
| Rate for Payer: Self Pay Self Pay |
$137.60
|
| Rate for Payer: TriWest Medicare |
$27.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$100.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.96
|
|
|
PT PROSTHETIC TRN @15 MIN
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
692241
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PT RE-EVAL
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
22528957
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$57.28 |
| 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 |
$57.28
|
| Rate for Payer: Amerigroup Medicare |
$57.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$133.71
|
| Rate for Payer: AZCH Complete Medicare |
$57.28
|
| Rate for Payer: Banner UC Health Medicare |
$57.28
|
| 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 |
$88.61
|
| 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 |
$57.28
|
| Rate for Payer: Self Pay Self Pay |
$286.40
|
| Rate for Payer: TriWest Medicare |
$57.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$208.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$64.44
|
|