|
00955 INTRATHECAL INJECTION
|
Facility
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 00955
|
| Hospital Charge Code |
23361647
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$359.84 |
| Max. Negotiated Rate |
$1,245.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,245.60
|
| Rate for Payer: Bisbee Police All Plans |
$359.84
|
| Rate for Payer: Cash Price |
$1,107.20
|
| Rate for Payer: Self Pay Self Pay |
$1,107.20
|
|
|
01360 ANES OPEN PROC LOWER 1/3 FEMUR ADDITIONAL MINUTES
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 01360
|
| Hospital Charge Code |
22406182
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Aetna of AZ Medicare |
$2.52
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicare |
$1.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.36
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$1.35
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$1.35
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of AZ Commercial |
$5.85
|
| Rate for Payer: Copperpoint Commercial |
$2.23
|
| Rate for Payer: Health Net of AZ Commercial |
$5.40
|
| Rate for Payer: Health Net of AZ Medicare |
$2.52
|
| Rate for Payer: Humana of AZ Medicare |
$1.35
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
| Rate for Payer: TriWest Medicare |
$1.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.62
|
|
|
01360 ANES OPEN PROC LOWER 1/3 FEMUR ADDITIONAL MINUTES
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 01360
|
| Hospital Charge Code |
22406182
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
|
|
01360 ANES OPEN PROC LOWER 1/3 FEMUR ADDNL 30 CHARGE
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 01360
|
| Hospital Charge Code |
22406183
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of AZ Commercial |
$268.20
|
| Rate for Payer: Aetna of AZ Medicare |
$83.44
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$44.70
|
| Rate for Payer: Amerigroup Medicare |
$44.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$111.30
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$44.70
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$44.70
|
| Rate for Payer: Bisbee Police All Plans |
$77.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$202.64
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cigna of AZ Commercial |
$193.70
|
| Rate for Payer: Copperpoint Commercial |
$73.76
|
| Rate for Payer: Health Net of AZ Commercial |
$178.80
|
| Rate for Payer: Health Net of AZ Medicare |
$83.44
|
| Rate for Payer: Humana of AZ Medicare |
$44.70
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$238.40
|
| Rate for Payer: TriWest Medicare |
$44.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$173.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$53.64
|
|
|
01360 ANES OPEN PROC LOWER 1/3 FEMUR ADDNL 30 CHARGE
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 01360
|
| Hospital Charge Code |
22406183
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$77.48 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of AZ Commercial |
$268.20
|
| Rate for Payer: Bisbee Police All Plans |
$77.48
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Self Pay Self Pay |
$238.40
|
|
|
01360 ANES OPEN PROC LOWER 1/3 FEMUR BASE CHARGE AND 1ST MIN
|
Facility
OP
|
$894.00
|
|
|
Service Code
|
CPT 01360
|
| Hospital Charge Code |
22406180
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$804.60 |
| Rate for Payer: Aetna of AZ Commercial |
$804.60
|
| Rate for Payer: Aetna of AZ Medicare |
$250.32
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$134.10
|
| Rate for Payer: Amerigroup Medicare |
$134.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$333.91
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$134.10
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$134.10
|
| Rate for Payer: Bisbee Police All Plans |
$232.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$607.92
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cigna of AZ Commercial |
$625.80
|
| Rate for Payer: Copperpoint Commercial |
$221.26
|
| Rate for Payer: Health Net of AZ Commercial |
$536.40
|
| Rate for Payer: Health Net of AZ Medicare |
$250.32
|
| Rate for Payer: Humana of AZ Medicare |
$134.10
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$715.20
|
| Rate for Payer: TriWest Medicare |
$134.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$521.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$160.92
|
|
|
01360 ANES OPEN PROC LOWER 1/3 FEMUR BASE CHARGE AND 1ST MIN
|
Facility
IP
|
$894.00
|
|
|
Service Code
|
CPT 01360
|
| Hospital Charge Code |
22406180
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$804.60 |
| Rate for Payer: Aetna of AZ Commercial |
$804.60
|
| Rate for Payer: Bisbee Police All Plans |
$232.44
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Self Pay Self Pay |
$715.20
|
|
|
01382 ANES FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JO
|
Facility
OP
|
$591.00
|
|
|
Service Code
|
CPT 01382
|
| Hospital Charge Code |
22889347
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of AZ Commercial |
$531.90
|
| Rate for Payer: Aetna of AZ Medicare |
$165.48
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$88.65
|
| Rate for Payer: Amerigroup Medicare |
$88.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$220.74
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$88.65
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$88.65
|
| Rate for Payer: Bisbee Police All Plans |
$153.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$401.88
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cigna of AZ Commercial |
$384.15
|
| Rate for Payer: Copperpoint Commercial |
$146.27
|
| Rate for Payer: Health Net of AZ Commercial |
$354.60
|
| Rate for Payer: Health Net of AZ Medicare |
$165.48
|
| Rate for Payer: Humana of AZ Medicare |
$88.65
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$472.80
|
| Rate for Payer: TriWest Medicare |
$88.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$344.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$106.38
|
|
|
01382 ANES FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JO
|
Facility
IP
|
$591.00
|
|
|
Service Code
|
CPT 01382
|
| Hospital Charge Code |
22889347
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$153.66 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Aetna of AZ Commercial |
$531.90
|
| Rate for Payer: Bisbee Police All Plans |
$153.66
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Self Pay Self Pay |
$472.80
|
|
|
01462 Anesthesia for all closed procedures on lower leg, ank
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT 01462
|
| Hospital Charge Code |
24062579
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna of AZ Commercial |
$7.20
|
| Rate for Payer: Bisbee Police All Plans |
$2.08
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Self Pay Self Pay |
$6.40
|
|
|
01462 Anesthesia for all closed procedures on lower leg, ank
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT 01462
|
| Hospital Charge Code |
24062579
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna of AZ Commercial |
$7.20
|
| Rate for Payer: Aetna of AZ Medicare |
$2.24
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$1.20
|
| Rate for Payer: Amerigroup Medicare |
$1.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.99
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$1.20
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$1.20
|
| Rate for Payer: Bisbee Police All Plans |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5.44
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cigna of AZ Commercial |
$5.20
|
| Rate for Payer: Copperpoint Commercial |
$1.98
|
| Rate for Payer: Health Net of AZ Commercial |
$4.80
|
| Rate for Payer: Health Net of AZ Medicare |
$2.24
|
| Rate for Payer: Humana of AZ Medicare |
$1.20
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$6.40
|
| Rate for Payer: TriWest Medicare |
$1.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.44
|
|
|
01462 ANESTHESIA LOWER LEG ANKLE FOOT FMC CHARGE
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
CPT 01462
|
| Hospital Charge Code |
22385160
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$515.70 |
| Rate for Payer: Aetna of AZ Commercial |
$515.70
|
| Rate for Payer: Aetna of AZ Medicare |
$160.44
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$85.95
|
| Rate for Payer: Amerigroup Medicare |
$85.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$214.02
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$85.95
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$85.95
|
| Rate for Payer: Bisbee Police All Plans |
$148.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$389.64
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cigna of AZ Commercial |
$401.10
|
| Rate for Payer: Copperpoint Commercial |
$141.82
|
| Rate for Payer: Health Net of AZ Commercial |
$343.80
|
| Rate for Payer: Health Net of AZ Medicare |
$160.44
|
| Rate for Payer: Humana of AZ Medicare |
$85.95
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$458.40
|
| Rate for Payer: TriWest Medicare |
$85.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$334.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$103.14
|
|
|
01462 ANESTHESIA LOWER LEG ANKLE FOOT FMC CHARGE
|
Facility
IP
|
$573.00
|
|
|
Service Code
|
CPT 01462
|
| Hospital Charge Code |
22385160
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$148.98 |
| Max. Negotiated Rate |
$515.70 |
| Rate for Payer: Aetna of AZ Commercial |
$515.70
|
| Rate for Payer: Bisbee Police All Plans |
$148.98
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Self Pay Self Pay |
$458.40
|
|
|
01470 ANES OPEN FOOT ADDITIONAL MINUTES
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 01470
|
| Hospital Charge Code |
22406202
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
|
|
01470 ANES OPEN FOOT ADDITIONAL MINUTES
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 01470
|
| Hospital Charge Code |
22406202
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Aetna of AZ Medicare |
$2.52
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicare |
$1.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.36
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$1.35
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$1.35
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of AZ Commercial |
$5.85
|
| Rate for Payer: Copperpoint Commercial |
$2.23
|
| Rate for Payer: Health Net of AZ Commercial |
$5.40
|
| Rate for Payer: Health Net of AZ Medicare |
$2.52
|
| Rate for Payer: Humana of AZ Medicare |
$1.35
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
| Rate for Payer: TriWest Medicare |
$1.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.62
|
|
|
01470 ANES OPEN FOOT ADDTNL 0:30 CHARGE
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 01470
|
| Hospital Charge Code |
22406205
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
|
|
01470 ANES OPEN FOOT ADDTNL 0:30 CHARGE
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 01470
|
| Hospital Charge Code |
22406205
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Aetna of AZ Medicare |
$2.52
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicare |
$1.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.36
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$1.35
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$1.35
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of AZ Commercial |
$5.85
|
| Rate for Payer: Copperpoint Commercial |
$2.23
|
| Rate for Payer: Health Net of AZ Commercial |
$5.40
|
| Rate for Payer: Health Net of AZ Medicare |
$2.52
|
| Rate for Payer: Humana of AZ Medicare |
$1.35
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
| Rate for Payer: TriWest Medicare |
$1.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.62
|
|
|
01470 ANES OPEN FOOT PROCEDURE BASE CHARGE AND 1ST MINUTE
|
Facility
IP
|
$490.00
|
|
|
Service Code
|
CPT 01470
|
| Hospital Charge Code |
22406199
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of AZ Commercial |
$441.00
|
| Rate for Payer: Bisbee Police All Plans |
$127.40
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Self Pay Self Pay |
$392.00
|
|
|
01470 ANES OPEN FOOT PROCEDURE BASE CHARGE AND 1ST MINUTE
|
Facility
OP
|
$490.00
|
|
|
Service Code
|
CPT 01470
|
| Hospital Charge Code |
22406199
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of AZ Commercial |
$441.00
|
| Rate for Payer: Aetna of AZ Medicare |
$137.20
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$73.50
|
| Rate for Payer: Amerigroup Medicare |
$73.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$183.02
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$73.50
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$73.50
|
| Rate for Payer: Bisbee Police All Plans |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$333.20
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna of AZ Commercial |
$343.00
|
| Rate for Payer: Copperpoint Commercial |
$121.28
|
| Rate for Payer: Health Net of AZ Commercial |
$294.00
|
| Rate for Payer: Health Net of AZ Medicare |
$137.20
|
| Rate for Payer: Humana of AZ Medicare |
$73.50
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$392.00
|
| Rate for Payer: TriWest Medicare |
$73.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$285.67
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$88.20
|
|
|
01710 ANES NERVES;MUSCLE;TENDONS;U ADDTNL 0:30 CHARGE
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 01710
|
| Hospital Charge Code |
22406186
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$77.48 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of AZ Commercial |
$268.20
|
| Rate for Payer: Bisbee Police All Plans |
$77.48
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Self Pay Self Pay |
$238.40
|
|
|
01710 ANES NERVES;MUSCLE;TENDONS;U ADDTNL 0:30 CHARGE
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 01710
|
| Hospital Charge Code |
22406186
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna of AZ Commercial |
$268.20
|
| Rate for Payer: Aetna of AZ Medicare |
$83.44
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$44.70
|
| Rate for Payer: Amerigroup Medicare |
$44.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$111.30
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$44.70
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$44.70
|
| Rate for Payer: Bisbee Police All Plans |
$77.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$202.64
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cigna of AZ Commercial |
$193.70
|
| Rate for Payer: Copperpoint Commercial |
$73.76
|
| Rate for Payer: Health Net of AZ Commercial |
$178.80
|
| Rate for Payer: Health Net of AZ Medicare |
$83.44
|
| Rate for Payer: Humana of AZ Medicare |
$44.70
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$238.40
|
| Rate for Payer: TriWest Medicare |
$44.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$173.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$53.64
|
|
|
01710 ANES NERVES;MUSCLE;TENDONS;U AR ADDITIONAL MINUTES
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 01710
|
| Hospital Charge Code |
22406185
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Aetna of AZ Medicare |
$2.52
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicare |
$1.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.36
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$1.35
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$1.35
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of AZ Commercial |
$5.85
|
| Rate for Payer: Copperpoint Commercial |
$2.23
|
| Rate for Payer: Health Net of AZ Commercial |
$5.40
|
| Rate for Payer: Health Net of AZ Medicare |
$2.52
|
| Rate for Payer: Humana of AZ Medicare |
$1.35
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
| Rate for Payer: TriWest Medicare |
$1.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.62
|
|
|
01710 ANES NERVES;MUSCLE;TENDONS;U AR ADDITIONAL MINUTES
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 01710
|
| Hospital Charge Code |
22406185
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Self Pay Self Pay |
$7.20
|
|
|
01710 ANES NERVES; MUSCLE;TENDONS U ARM BASE CHG AND 1ST MIN
|
Facility
IP
|
$595.00
|
|
|
Service Code
|
CPT 01710
|
| Hospital Charge Code |
22406184
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna of AZ Commercial |
$535.50
|
| Rate for Payer: Bisbee Police All Plans |
$154.70
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Self Pay Self Pay |
$476.00
|
|
|
01710 ANES NERVES; MUSCLE;TENDONS U ARM BASE CHG AND 1ST MIN
|
Facility
OP
|
$595.00
|
|
|
Service Code
|
CPT 01710
|
| Hospital Charge Code |
22406184
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna of AZ Commercial |
$535.50
|
| Rate for Payer: Aetna of AZ Medicare |
$166.60
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$89.25
|
| Rate for Payer: Amerigroup Medicare |
$89.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$222.23
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$89.25
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$89.25
|
| Rate for Payer: Bisbee Police All Plans |
$154.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$404.60
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cigna of AZ Commercial |
$416.50
|
| Rate for Payer: Copperpoint Commercial |
$147.26
|
| Rate for Payer: Health Net of AZ Commercial |
$357.00
|
| Rate for Payer: Health Net of AZ Medicare |
$166.60
|
| Rate for Payer: Humana of AZ Medicare |
$89.25
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$476.00
|
| Rate for Payer: TriWest Medicare |
$89.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$346.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$107.10
|
|
