|
01810 ANES PROCEDURES LOWER ARM ADDITIONAL MINUTES
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 01810
|
| Hospital Charge Code |
22406188
|
|
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
|
|
|
01810 ANES PROCEDURES LOWER ARM ADDITIONAL MINUTES
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 01810
|
| Hospital Charge Code |
22406188
|
|
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
|
|
|
01810 ANES PROCEDURES LOWER ARM ADDTNL 0:30 CHARGE
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 01810
|
| Hospital Charge Code |
22406189
|
|
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
|
|
|
01810 ANES PROCEDURES LOWER ARM ADDTNL 0:30 CHARGE
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 01810
|
| Hospital Charge Code |
22406189
|
|
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
|
|
|
01922 ANES NON INVASIVE IMAG OR RAD THER ADDITONAL MINUTES
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 01922
|
| Hospital Charge Code |
22406191
|
|
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
|
|
|
01922 ANES NON INVASIVE IMAG OR RAD THER ADDITONAL MINUTES
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 01922
|
| Hospital Charge Code |
22406191
|
|
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
|
|
|
01922 ANES NON INVASIVE IMAG OR RAD THER ADDTNL 0:30 CHARGE
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 01922
|
| Hospital Charge Code |
22406192
|
|
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
|
|
|
01922 ANES NON INVASIVE IMAG OR RAD THER ADDTNL 0:30 CHARGE
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 01922
|
| Hospital Charge Code |
22406192
|
|
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
|
|
|
01999 ANES UNLISTED ANESTHESIA PRO ADDTNL 0:30 CHARGE
|
Facility
IP
|
$595.00
|
|
|
Service Code
|
CPT 01999
|
| Hospital Charge Code |
22406197
|
|
Hospital Revenue Code
|
370
|
| 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
|
|
|
01999 ANES UNLISTED ANESTHESIA PRO ADDTNL 0:30 CHARGE
|
Facility
OP
|
$595.00
|
|
|
Service Code
|
CPT 01999
|
| Hospital Charge Code |
22406197
|
|
Hospital Revenue Code
|
370
|
| 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 |
$386.75
|
| 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
|
|
|
01999 ANES UNLISTED ANESTHESIA PROCED ADDITONAL MINUTES
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 01999
|
| Hospital Charge Code |
22406194
|
|
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
|
|
|
01999 ANES UNLISTED ANESTHESIA PROCED ADDITONAL MINUTES
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 01999
|
| Hospital Charge Code |
22406194
|
|
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
|
|
|
01999 ANES UNLISTED ANESTHESIA PROCEDURE BASE CHG AND 1ST MI
|
Facility
IP
|
$490.00
|
|
|
Service Code
|
CPT 01999
|
| Hospital Charge Code |
22406193
|
|
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
|
|
|
01999 ANES UNLISTED ANESTHESIA PROCEDURE BASE CHG AND 1ST MI
|
Facility
OP
|
$490.00
|
|
|
Service Code
|
CPT 01999
|
| Hospital Charge Code |
22406193
|
|
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
|
|
|
0 Ethibond Excel CT-0
|
Facility
OP
|
$85.00
|
|
| Hospital Charge Code |
22926434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of AZ Commercial |
$76.50
|
| Rate for Payer: Aetna of AZ Medicare |
$23.80
|
| Rate for Payer: Allwell Medicare |
$12.75
|
| Rate for Payer: Amerigroup Medicare |
$12.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$31.75
|
| Rate for Payer: AZCH Complete Medicare |
$12.75
|
| Rate for Payer: Banner UC Health Medicare |
$12.75
|
| Rate for Payer: Bisbee Police All Plans |
$22.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$57.80
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna of AZ Commercial |
$59.50
|
| Rate for Payer: Copperpoint Commercial |
$21.04
|
| Rate for Payer: Health Net of AZ Commercial |
$51.00
|
| Rate for Payer: Health Net of AZ Medicare |
$23.80
|
| Rate for Payer: Humana of AZ Medicare |
$12.75
|
| Rate for Payer: Self Pay Self Pay |
$68.00
|
| Rate for Payer: TriWest Medicare |
$12.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$49.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.30
|
|
|
0 Ethibond Excel CT-0
|
Facility
IP
|
$85.00
|
|
| Hospital Charge Code |
22926434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of AZ Commercial |
$76.50
|
| Rate for Payer: Bisbee Police All Plans |
$22.10
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Self Pay Self Pay |
$68.00
|
|
|
0 Ethibond Excel OS-4
|
Facility
IP
|
$18.00
|
|
| Hospital Charge Code |
22926436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of AZ Commercial |
$16.20
|
| Rate for Payer: Bisbee Police All Plans |
$4.68
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Self Pay Self Pay |
$14.40
|
|
|
0 Ethibond Excel OS-4
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
22926436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of AZ Commercial |
$16.20
|
| Rate for Payer: Aetna of AZ Medicare |
$5.04
|
| Rate for Payer: Allwell Medicare |
$2.70
|
| Rate for Payer: Amerigroup Medicare |
$2.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$6.72
|
| Rate for Payer: AZCH Complete Medicare |
$2.70
|
| Rate for Payer: Banner UC Health Medicare |
$2.70
|
| Rate for Payer: Bisbee Police All Plans |
$4.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$12.24
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of AZ Commercial |
$12.60
|
| Rate for Payer: Copperpoint Commercial |
$4.46
|
| Rate for Payer: Health Net of AZ Commercial |
$10.80
|
| Rate for Payer: Health Net of AZ Medicare |
$5.04
|
| Rate for Payer: Humana of AZ Medicare |
$2.70
|
| Rate for Payer: Self Pay Self Pay |
$14.40
|
| Rate for Payer: TriWest Medicare |
$2.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$10.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.24
|
|
|
0 Surgigut GS-23
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
22926443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of AZ Commercial |
$32.40
|
| Rate for Payer: Aetna of AZ Medicare |
$10.08
|
| Rate for Payer: Allwell Medicare |
$5.40
|
| Rate for Payer: Amerigroup Medicare |
$5.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$13.45
|
| Rate for Payer: AZCH Complete Medicare |
$5.40
|
| Rate for Payer: Banner UC Health Medicare |
$5.40
|
| Rate for Payer: Bisbee Police All Plans |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$24.48
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of AZ Commercial |
$25.20
|
| Rate for Payer: Copperpoint Commercial |
$8.91
|
| Rate for Payer: Health Net of AZ Commercial |
$21.60
|
| Rate for Payer: Health Net of AZ Medicare |
$10.08
|
| Rate for Payer: Humana of AZ Medicare |
$5.40
|
| Rate for Payer: Self Pay Self Pay |
$28.80
|
| Rate for Payer: TriWest Medicare |
$5.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$20.99
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.48
|
|
|
0 Surgigut GS-23
|
Facility
IP
|
$36.00
|
|
| Hospital Charge Code |
22926443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of AZ Commercial |
$32.40
|
| Rate for Payer: Bisbee Police All Plans |
$9.36
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Self Pay Self Pay |
$28.80
|
|
|
10060 I D ABSCESS
|
Facility
OP
|
$433.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
22273442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$389.70
|
| Rate for Payer: Aetna of AZ Medicare |
$121.24
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$64.95
|
| Rate for Payer: Amerigroup Medicare |
$64.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$161.73
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$64.95
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$64.95
|
| Rate for Payer: Bisbee Police All Plans |
$112.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$294.44
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cigna of AZ Commercial |
$303.10
|
| Rate for Payer: Copperpoint Commercial |
$107.17
|
| Rate for Payer: Health Net of AZ Commercial |
$259.80
|
| Rate for Payer: Health Net of AZ Medicare |
$121.24
|
| Rate for Payer: Humana of AZ Medicare |
$64.95
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$346.40
|
| Rate for Payer: TriWest Medicare |
$64.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$77.94
|
|
|
10060 I D ABSCESS
|
Facility
IP
|
$433.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
22273442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$389.70 |
| Rate for Payer: Aetna of AZ Commercial |
$389.70
|
| Rate for Payer: Bisbee Police All Plans |
$112.58
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Self Pay Self Pay |
$346.40
|
|
|
10120 INCS REM FOB SUB CUT S
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
22282760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$387.90
|
| Rate for Payer: Aetna of AZ Medicare |
$120.68
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicare |
$64.65
|
| Rate for Payer: Amerigroup Medicare |
$64.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$160.98
|
| Rate for Payer: AZCH Complete Medicaid |
$501.46
|
| Rate for Payer: AZCH Complete Medicare |
$64.65
|
| Rate for Payer: Banner UC Health Medicaid |
$501.46
|
| Rate for Payer: Banner UC Health Medicare |
$64.65
|
| Rate for Payer: Bisbee Police All Plans |
$112.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$293.08
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cigna of AZ Commercial |
$301.70
|
| Rate for Payer: Copperpoint Commercial |
$106.67
|
| Rate for Payer: Health Net of AZ Commercial |
$258.60
|
| Rate for Payer: Health Net of AZ Medicare |
$120.68
|
| Rate for Payer: Humana of AZ Medicare |
$64.65
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: Self Pay Self Pay |
$344.80
|
| Rate for Payer: TriWest Medicare |
$64.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$77.58
|
|
|
10120 INCS REM FOB SUB CUT S
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
22282760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Aetna of AZ Commercial |
$387.90
|
| Rate for Payer: Bisbee Police All Plans |
$112.06
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Self Pay Self Pay |
$344.80
|
|
|
10140 ID HMTMA SRMA TLD COLEC
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
22282761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$387.90
|
| Rate for Payer: Aetna of AZ Medicare |
$120.68
|
| Rate for Payer: AHCCCS Medicaid |
$2,040.16
|
| Rate for Payer: Allwell Medicaid |
$2,040.16
|
| Rate for Payer: Allwell Medicare |
$64.65
|
| Rate for Payer: Amerigroup Medicare |
$64.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$160.98
|
| Rate for Payer: AZCH Complete Medicaid |
$2,040.16
|
| Rate for Payer: AZCH Complete Medicare |
$64.65
|
| Rate for Payer: Banner UC Health Medicaid |
$2,040.16
|
| Rate for Payer: Banner UC Health Medicare |
$64.65
|
| Rate for Payer: Bisbee Police All Plans |
$112.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$293.08
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cigna of AZ Commercial |
$301.70
|
| Rate for Payer: Copperpoint Commercial |
$106.67
|
| Rate for Payer: Health Net of AZ Commercial |
$258.60
|
| Rate for Payer: Health Net of AZ Medicare |
$120.68
|
| Rate for Payer: Humana of AZ Medicare |
$64.65
|
| Rate for Payer: Mercy Care Medicaid |
$2,040.16
|
| Rate for Payer: Self Pay Self Pay |
$344.80
|
| Rate for Payer: TriWest Medicare |
$64.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$77.58
|
|
