|
11760 RPR NAIL BED
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
22282766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.46 |
| Max. Negotiated Rate |
$603.90 |
| Rate for Payer: Aetna of AZ Commercial |
$603.90
|
| Rate for Payer: Bisbee Police All Plans |
$174.46
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Self Pay Self Pay |
$536.80
|
|
|
12001 REPAIR SMPLE WND 2.5CM OR LESS
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
22282767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$535.50
|
| Rate for Payer: Aetna of AZ Medicare |
$166.60
|
| Rate for Payer: AHCCCS Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicare |
$95.20
|
| Rate for Payer: Amerigroup Medicare |
$95.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$222.23
|
| Rate for Payer: AZCH Complete Medicaid |
$130.17
|
| Rate for Payer: AZCH Complete Medicare |
$95.20
|
| Rate for Payer: Banner UC Health Medicaid |
$130.17
|
| Rate for Payer: Banner UC Health Medicare |
$95.20
|
| 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 |
$95.20
|
| Rate for Payer: Mercy Care Medicaid |
$130.17
|
| Rate for Payer: Self Pay Self Pay |
$476.00
|
| Rate for Payer: TriWest Medicare |
$95.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$107.10
|
|
|
12001 REPAIR SMPLE WND 2.5CM OR LESS
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
22282767
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
12002 REPAIR SMPLE WND 2.6CM -7.5CM
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
22282768
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.98 |
| Max. Negotiated Rate |
$695.70 |
| Rate for Payer: Aetna of AZ Commercial |
$695.70
|
| Rate for Payer: Bisbee Police All Plans |
$200.98
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Self Pay Self Pay |
$618.40
|
|
|
12002 REPAIR SMPLE WND 2.6CM -7.5CM
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
22282768
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.68 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$695.70
|
| Rate for Payer: Aetna of AZ Medicare |
$216.44
|
| Rate for Payer: AHCCCS Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicare |
$123.68
|
| Rate for Payer: Amerigroup Medicare |
$123.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$288.72
|
| Rate for Payer: AZCH Complete Medicaid |
$130.17
|
| Rate for Payer: AZCH Complete Medicare |
$123.68
|
| Rate for Payer: Banner UC Health Medicaid |
$130.17
|
| Rate for Payer: Banner UC Health Medicare |
$123.68
|
| Rate for Payer: Bisbee Police All Plans |
$200.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$525.64
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cigna of AZ Commercial |
$541.10
|
| Rate for Payer: Copperpoint Commercial |
$191.32
|
| Rate for Payer: Health Net of AZ Commercial |
$463.80
|
| Rate for Payer: Health Net of AZ Medicare |
$216.44
|
| Rate for Payer: Humana of AZ Medicare |
$123.68
|
| Rate for Payer: Mercy Care Medicaid |
$130.17
|
| Rate for Payer: Self Pay Self Pay |
$618.40
|
| Rate for Payer: TriWest Medicare |
$123.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$139.14
|
|
|
12004 REPAIR SMPLE WND 7.5CM - 12.5CM
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
22282769
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$853.20
|
| Rate for Payer: Aetna of AZ Medicare |
$265.44
|
| Rate for Payer: AHCCCS Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicare |
$151.68
|
| Rate for Payer: Amerigroup Medicare |
$151.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$354.08
|
| Rate for Payer: AZCH Complete Medicaid |
$130.17
|
| Rate for Payer: AZCH Complete Medicare |
$151.68
|
| Rate for Payer: Banner UC Health Medicaid |
$130.17
|
| Rate for Payer: Banner UC Health Medicare |
$151.68
|
| Rate for Payer: Bisbee Police All Plans |
$246.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$644.64
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cigna of AZ Commercial |
$663.60
|
| Rate for Payer: Copperpoint Commercial |
$234.63
|
| Rate for Payer: Health Net of AZ Commercial |
$568.80
|
| Rate for Payer: Health Net of AZ Medicare |
$265.44
|
| Rate for Payer: Humana of AZ Medicare |
$151.68
|
| Rate for Payer: Mercy Care Medicaid |
$130.17
|
| Rate for Payer: Self Pay Self Pay |
$758.40
|
| Rate for Payer: TriWest Medicare |
$151.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$170.64
|
|
|
12004 REPAIR SMPLE WND 7.5CM - 12.5CM
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
22282769
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$853.20 |
| Rate for Payer: Aetna of AZ Commercial |
$853.20
|
| Rate for Payer: Bisbee Police All Plans |
$246.48
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Self Pay Self Pay |
$758.40
|
|
|
12005 SUPSCLP NK XNXTR 12.6-20
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
22282770
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.32 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$856.80
|
| Rate for Payer: Aetna of AZ Medicare |
$266.56
|
| Rate for Payer: AHCCCS Medicaid |
$250.73
|
| Rate for Payer: Allwell Medicaid |
$250.73
|
| Rate for Payer: Allwell Medicare |
$152.32
|
| Rate for Payer: Amerigroup Medicare |
$152.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$355.57
|
| Rate for Payer: AZCH Complete Medicaid |
$250.73
|
| Rate for Payer: AZCH Complete Medicare |
$152.32
|
| Rate for Payer: Banner UC Health Medicaid |
$250.73
|
| Rate for Payer: Banner UC Health Medicare |
$152.32
|
| Rate for Payer: Bisbee Police All Plans |
$247.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$647.36
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cigna of AZ Commercial |
$666.40
|
| Rate for Payer: Copperpoint Commercial |
$235.62
|
| Rate for Payer: Health Net of AZ Commercial |
$571.20
|
| Rate for Payer: Health Net of AZ Medicare |
$266.56
|
| Rate for Payer: Humana of AZ Medicare |
$152.32
|
| Rate for Payer: Mercy Care Medicaid |
$250.73
|
| Rate for Payer: Self Pay Self Pay |
$761.60
|
| Rate for Payer: TriWest Medicare |
$152.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$171.36
|
|
|
12005 SUPSCLP NK XNXTR 12.6-20
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
22282770
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.52 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: Aetna of AZ Commercial |
$856.80
|
| Rate for Payer: Bisbee Police All Plans |
$247.52
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Self Pay Self Pay |
$761.60
|
|
|
12006 SUP SCPNKXGNXTR 20.1-30
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
22282771
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.60 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,044.00
|
| Rate for Payer: Bisbee Police All Plans |
$301.60
|
| Rate for Payer: Cash Price |
$928.00
|
| Rate for Payer: Self Pay Self Pay |
$928.00
|
|
|
12006 SUP SCPNKXGNXTR 20.1-30
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
22282771
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,044.00
|
| Rate for Payer: Aetna of AZ Medicare |
$324.80
|
| Rate for Payer: AHCCCS Medicaid |
$250.73
|
| Rate for Payer: Allwell Medicaid |
$250.73
|
| Rate for Payer: Allwell Medicare |
$185.60
|
| Rate for Payer: Amerigroup Medicare |
$185.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$433.26
|
| Rate for Payer: AZCH Complete Medicaid |
$250.73
|
| Rate for Payer: AZCH Complete Medicare |
$185.60
|
| Rate for Payer: Banner UC Health Medicaid |
$250.73
|
| Rate for Payer: Banner UC Health Medicare |
$185.60
|
| Rate for Payer: Bisbee Police All Plans |
$301.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$788.80
|
| Rate for Payer: Cash Price |
$928.00
|
| Rate for Payer: Cash Price |
$928.00
|
| Rate for Payer: Cigna of AZ Commercial |
$812.00
|
| Rate for Payer: Copperpoint Commercial |
$287.10
|
| Rate for Payer: Health Net of AZ Commercial |
$696.00
|
| Rate for Payer: Health Net of AZ Medicare |
$324.80
|
| Rate for Payer: Humana of AZ Medicare |
$185.60
|
| Rate for Payer: Mercy Care Medicaid |
$250.73
|
| Rate for Payer: Self Pay Self Pay |
$928.00
|
| Rate for Payer: TriWest Medicare |
$185.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$208.80
|
|
|
12007 SUP SCLP NK XGN XTR >30
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
22282772
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,153.80
|
| Rate for Payer: Aetna of AZ Medicare |
$358.96
|
| Rate for Payer: AHCCCS Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicare |
$205.12
|
| Rate for Payer: Amerigroup Medicare |
$205.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$478.83
|
| Rate for Payer: AZCH Complete Medicaid |
$130.17
|
| Rate for Payer: AZCH Complete Medicare |
$205.12
|
| Rate for Payer: Banner UC Health Medicaid |
$130.17
|
| Rate for Payer: Banner UC Health Medicare |
$205.12
|
| Rate for Payer: Bisbee Police All Plans |
$333.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$871.76
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cigna of AZ Commercial |
$897.40
|
| Rate for Payer: Copperpoint Commercial |
$317.30
|
| Rate for Payer: Health Net of AZ Commercial |
$769.20
|
| Rate for Payer: Health Net of AZ Medicare |
$358.96
|
| Rate for Payer: Humana of AZ Medicare |
$205.12
|
| Rate for Payer: Mercy Care Medicaid |
$130.17
|
| Rate for Payer: Self Pay Self Pay |
$1,025.60
|
| Rate for Payer: TriWest Medicare |
$205.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$230.76
|
|
|
12007 SUP SCLP NK XGN XTR >30
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
22282772
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.32 |
| Max. Negotiated Rate |
$1,153.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,153.80
|
| Rate for Payer: Bisbee Police All Plans |
$333.32
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Self Pay Self Pay |
$1,025.60
|
|
|
12011 SPL FACE MUC MEMB 2.5
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
22282773
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$655.20
|
| Rate for Payer: Aetna of AZ Medicare |
$203.84
|
| Rate for Payer: AHCCCS Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicare |
$116.48
|
| Rate for Payer: Amerigroup Medicare |
$116.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$271.91
|
| Rate for Payer: AZCH Complete Medicaid |
$130.17
|
| Rate for Payer: AZCH Complete Medicare |
$116.48
|
| Rate for Payer: Banner UC Health Medicaid |
$130.17
|
| Rate for Payer: Banner UC Health Medicare |
$116.48
|
| Rate for Payer: Bisbee Police All Plans |
$189.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$495.04
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cigna of AZ Commercial |
$509.60
|
| Rate for Payer: Copperpoint Commercial |
$180.18
|
| Rate for Payer: Health Net of AZ Commercial |
$436.80
|
| Rate for Payer: Health Net of AZ Medicare |
$203.84
|
| Rate for Payer: Humana of AZ Medicare |
$116.48
|
| Rate for Payer: Mercy Care Medicaid |
$130.17
|
| Rate for Payer: Self Pay Self Pay |
$582.40
|
| Rate for Payer: TriWest Medicare |
$116.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$131.04
|
|
|
12011 SPL FACE MUC MEMB 2.5
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
22282773
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.28 |
| Max. Negotiated Rate |
$655.20 |
| Rate for Payer: Aetna of AZ Commercial |
$655.20
|
| Rate for Payer: Bisbee Police All Plans |
$189.28
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Self Pay Self Pay |
$582.40
|
|
|
12013 SPL FACE MUCMEMB 2.6-5.0
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
22282774
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.44 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Aetna of AZ Commercial |
$759.60
|
| Rate for Payer: Bisbee Police All Plans |
$219.44
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Self Pay Self Pay |
$675.20
|
|
|
12013 SPL FACE MUCMEMB 2.6-5.0
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
22282774
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$759.60
|
| Rate for Payer: Aetna of AZ Medicare |
$236.32
|
| Rate for Payer: AHCCCS Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicare |
$135.04
|
| Rate for Payer: Amerigroup Medicare |
$135.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$315.23
|
| Rate for Payer: AZCH Complete Medicaid |
$130.17
|
| Rate for Payer: AZCH Complete Medicare |
$135.04
|
| Rate for Payer: Banner UC Health Medicaid |
$130.17
|
| Rate for Payer: Banner UC Health Medicare |
$135.04
|
| Rate for Payer: Bisbee Police All Plans |
$219.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$573.92
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cigna of AZ Commercial |
$590.80
|
| Rate for Payer: Copperpoint Commercial |
$208.89
|
| Rate for Payer: Health Net of AZ Commercial |
$506.40
|
| Rate for Payer: Health Net of AZ Medicare |
$236.32
|
| Rate for Payer: Humana of AZ Medicare |
$135.04
|
| Rate for Payer: Mercy Care Medicaid |
$130.17
|
| Rate for Payer: Self Pay Self Pay |
$675.20
|
| Rate for Payer: TriWest Medicare |
$135.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$151.92
|
|
|
12014 SPL FACE MUC MEM 5.1-7.5
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
22282775
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna of AZ Commercial |
$923.40
|
| Rate for Payer: Bisbee Police All Plans |
$266.76
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Self Pay Self Pay |
$820.80
|
|
|
12014 SPL FACE MUC MEM 5.1-7.5
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
22282775
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$923.40
|
| Rate for Payer: Aetna of AZ Medicare |
$287.28
|
| Rate for Payer: AHCCCS Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicare |
$164.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$383.21
|
| Rate for Payer: AZCH Complete Medicaid |
$130.17
|
| Rate for Payer: AZCH Complete Medicare |
$164.16
|
| Rate for Payer: Banner UC Health Medicaid |
$130.17
|
| Rate for Payer: Banner UC Health Medicare |
$164.16
|
| Rate for Payer: Bisbee Police All Plans |
$266.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$697.68
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cigna of AZ Commercial |
$718.20
|
| Rate for Payer: Copperpoint Commercial |
$253.94
|
| Rate for Payer: Health Net of AZ Commercial |
$615.60
|
| Rate for Payer: Health Net of AZ Medicare |
$287.28
|
| Rate for Payer: Humana of AZ Medicare |
$164.16
|
| Rate for Payer: Mercy Care Medicaid |
$130.17
|
| Rate for Payer: Self Pay Self Pay |
$820.80
|
| Rate for Payer: TriWest Medicare |
$164.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$184.68
|
|
|
12015 SPL FACE MUC MEM7.6-12.5
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
22282776
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.94 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,187.10
|
| Rate for Payer: Bisbee Police All Plans |
$342.94
|
| Rate for Payer: Cash Price |
$1,055.20
|
| Rate for Payer: Self Pay Self Pay |
$1,055.20
|
|
|
12015 SPL FACE MUC MEM7.6-12.5
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
22282776
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,187.10
|
| Rate for Payer: Aetna of AZ Medicare |
$369.32
|
| Rate for Payer: AHCCCS Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicaid |
$130.17
|
| Rate for Payer: Allwell Medicare |
$211.04
|
| Rate for Payer: Amerigroup Medicare |
$211.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$492.65
|
| Rate for Payer: AZCH Complete Medicaid |
$130.17
|
| Rate for Payer: AZCH Complete Medicare |
$211.04
|
| Rate for Payer: Banner UC Health Medicaid |
$130.17
|
| Rate for Payer: Banner UC Health Medicare |
$211.04
|
| Rate for Payer: Bisbee Police All Plans |
$342.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$896.92
|
| Rate for Payer: Cash Price |
$1,055.20
|
| Rate for Payer: Cash Price |
$1,055.20
|
| Rate for Payer: Cigna of AZ Commercial |
$923.30
|
| Rate for Payer: Copperpoint Commercial |
$326.45
|
| Rate for Payer: Health Net of AZ Commercial |
$791.40
|
| Rate for Payer: Health Net of AZ Medicare |
$369.32
|
| Rate for Payer: Humana of AZ Medicare |
$211.04
|
| Rate for Payer: Mercy Care Medicaid |
$130.17
|
| Rate for Payer: Self Pay Self Pay |
$1,055.20
|
| Rate for Payer: TriWest Medicare |
$211.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$237.42
|
|
|
12016 SPL FACE MUC MEM 12.6-20
|
Facility
|
IP
|
$1,236.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
22282777
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.36 |
| Max. Negotiated Rate |
$1,112.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,112.40
|
| Rate for Payer: Bisbee Police All Plans |
$321.36
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Self Pay Self Pay |
$988.80
|
|
|
12016 SPL FACE MUC MEM 12.6-20
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
22282777
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.76 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,112.40
|
| Rate for Payer: Aetna of AZ Medicare |
$346.08
|
| Rate for Payer: AHCCCS Medicaid |
$250.73
|
| Rate for Payer: Allwell Medicaid |
$250.73
|
| Rate for Payer: Allwell Medicare |
$197.76
|
| Rate for Payer: Amerigroup Medicare |
$197.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$461.65
|
| Rate for Payer: AZCH Complete Medicaid |
$250.73
|
| Rate for Payer: AZCH Complete Medicare |
$197.76
|
| Rate for Payer: Banner UC Health Medicaid |
$250.73
|
| Rate for Payer: Banner UC Health Medicare |
$197.76
|
| Rate for Payer: Bisbee Police All Plans |
$321.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$840.48
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cigna of AZ Commercial |
$865.20
|
| Rate for Payer: Copperpoint Commercial |
$305.91
|
| Rate for Payer: Health Net of AZ Commercial |
$741.60
|
| Rate for Payer: Health Net of AZ Medicare |
$346.08
|
| Rate for Payer: Humana of AZ Medicare |
$197.76
|
| Rate for Payer: Mercy Care Medicaid |
$250.73
|
| Rate for Payer: Self Pay Self Pay |
$988.80
|
| Rate for Payer: TriWest Medicare |
$197.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$222.48
|
|
|
12017 SPL FAC MUC MEM 20.1-30
|
Facility
|
OP
|
$1,589.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
22282778
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.73 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,430.10
|
| Rate for Payer: Aetna of AZ Medicare |
$444.92
|
| Rate for Payer: AHCCCS Medicaid |
$250.73
|
| Rate for Payer: Allwell Medicaid |
$250.73
|
| Rate for Payer: Allwell Medicare |
$254.24
|
| Rate for Payer: Amerigroup Medicare |
$254.24
|
| Rate for Payer: APIPA Medicare/Medicaid |
$593.49
|
| Rate for Payer: AZCH Complete Medicaid |
$250.73
|
| Rate for Payer: AZCH Complete Medicare |
$254.24
|
| Rate for Payer: Banner UC Health Medicaid |
$250.73
|
| Rate for Payer: Banner UC Health Medicare |
$254.24
|
| Rate for Payer: Bisbee Police All Plans |
$413.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,080.52
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,112.30
|
| Rate for Payer: Copperpoint Commercial |
$393.28
|
| Rate for Payer: Health Net of AZ Commercial |
$953.40
|
| Rate for Payer: Health Net of AZ Medicare |
$444.92
|
| Rate for Payer: Humana of AZ Medicare |
$254.24
|
| Rate for Payer: Mercy Care Medicaid |
$250.73
|
| Rate for Payer: Self Pay Self Pay |
$1,271.20
|
| Rate for Payer: TriWest Medicare |
$254.24
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$286.02
|
|
|
12017 SPL FAC MUC MEM 20.1-30
|
Facility
|
IP
|
$1,589.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
22282778
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$413.14 |
| Max. Negotiated Rate |
$1,430.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,430.10
|
| Rate for Payer: Bisbee Police All Plans |
$413.14
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Self Pay Self Pay |
$1,271.20
|
|
