|
PT Self-Care Discharge Status G-8989 CL At least 60% but less than 80% impaired
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8989 GP
|
| Hospital Charge Code |
6035386
|
|
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 Self-Care Discharge Status G-8989 CL At least 60% but less than 80% impaired
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8989 GP
|
| Hospital Charge Code |
6035386
|
|
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 Self-Care Discharge Status G-8989 CM At least 80% but less than 100% impaired
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8989 GP
|
| Hospital Charge Code |
6035385
|
|
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 Self-Care Discharge Status G-8989 CM At least 80% but less than 100% impaired
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8989 GP
|
| Hospital Charge Code |
6035385
|
|
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 Self-Care Discharge Status G-8989 CN 100% impaired
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8989 GP
|
| Hospital Charge Code |
6035384
|
|
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 Self-Care Discharge Status G-8989 CN 100% impaired
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8989 GP
|
| Hospital Charge Code |
6035384
|
|
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 Self-Care Goal Status G-8988 CH 0% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035397
|
|
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 Self-Care Goal Status G-8988 CH 0% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035397
|
|
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 Self-Care Goal Status G-8988 CI At least 1% but less than 20% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035396
|
|
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 Self-Care Goal Status G-8988 CI At least 1% but less than 20% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035396
|
|
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 Self-Care Goal Status G-8988 CJ At least 20% but less than 40% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035395
|
|
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 Self-Care Goal Status G-8988 CJ At least 20% but less than 40% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035395
|
|
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 Self-Care Goal Status G-8988 CK At least 40% but less than 60% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035394
|
|
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 Self-Care Goal Status G-8988 CK At least 40% but less than 60% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035394
|
|
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 Self-Care Goal Status G-8988 CL At least 60% but less than 80% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035393
|
|
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 Self-Care Goal Status G-8988 CL At least 60% but less than 80% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035393
|
|
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 Self-Care Goal Status G-8988 CM At least 80% but less than 100% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035392
|
|
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 Self-Care Goal Status G-8988 CM At least 80% but less than 100% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035392
|
|
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 Self-Care Goal Status G-8988 CN 100% impaired
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035391
|
|
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 Self-Care Goal Status G-8988 CN 100% impaired
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT G8988 GP
|
| Hospital Charge Code |
6035391
|
|
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 SELF CARE/HOME MGT TRG EACH 15
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
8772924
|
|
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
|
|
|
PT SELF CARE/HOME MGT TRG EACH 15
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
8772924
|
|
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
|
|
|
PTT
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
22481500
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of AZ Commercial |
$126.90
|
| Rate for Payer: Bisbee Police All Plans |
$36.66
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Self Pay Self Pay |
$112.80
|
|
|
PTT
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
22481500
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of AZ Commercial |
$126.90
|
| Rate for Payer: Aetna of AZ Medicare |
$39.48
|
| Rate for Payer: Allwell Medicare |
$22.56
|
| Rate for Payer: Amerigroup Medicare |
$22.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$52.66
|
| Rate for Payer: AZCH Complete Medicare |
$22.56
|
| Rate for Payer: Banner UC Health Medicare |
$22.56
|
| Rate for Payer: Bisbee Police All Plans |
$36.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$95.88
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna of AZ Commercial |
$91.65
|
| Rate for Payer: Copperpoint Commercial |
$34.90
|
| Rate for Payer: Health Net of AZ Commercial |
$84.60
|
| Rate for Payer: Health Net of AZ Medicare |
$39.48
|
| Rate for Payer: Humana of AZ Medicare |
$22.56
|
| Rate for Payer: Self Pay Self Pay |
$112.80
|
| Rate for Payer: TriWest Medicare |
$22.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$82.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.38
|
|
|
PTT DED
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
24151823
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Aetna of AZ Medicare |
$41.44
|
| Rate for Payer: Allwell Medicare |
$23.68
|
| Rate for Payer: Amerigroup Medicare |
$23.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.28
|
| Rate for Payer: AZCH Complete Medicare |
$23.68
|
| Rate for Payer: Banner UC Health Medicare |
$23.68
|
| 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: Cigna of AZ Commercial |
$96.20
|
| 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 |
$23.68
|
| Rate for Payer: Self Pay Self Pay |
$118.40
|
| Rate for Payer: TriWest Medicare |
$23.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$86.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.64
|
|
