|
10140 ID HMTMA SRMA TLD COLEC
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
22282761
|
|
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
|
|
|
10MM BLUNT TIP TROCAR
|
Facility
IP
|
$796.00
|
|
| Hospital Charge Code |
22561229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.96 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Aetna of AZ Commercial |
$716.40
|
| Rate for Payer: Bisbee Police All Plans |
$206.96
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Self Pay Self Pay |
$636.80
|
|
|
10MM BLUNT TIP TROCAR
|
Facility
OP
|
$796.00
|
|
| Hospital Charge Code |
22561229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Aetna of AZ Commercial |
$716.40
|
| Rate for Payer: Aetna of AZ Medicare |
$222.88
|
| Rate for Payer: Allwell Medicare |
$119.40
|
| Rate for Payer: Amerigroup Medicare |
$119.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$297.31
|
| Rate for Payer: AZCH Complete Medicare |
$119.40
|
| Rate for Payer: Banner UC Health Medicare |
$119.40
|
| Rate for Payer: Bisbee Police All Plans |
$206.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$541.28
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cigna of AZ Commercial |
$557.20
|
| Rate for Payer: Copperpoint Commercial |
$197.01
|
| Rate for Payer: Health Net of AZ Commercial |
$477.60
|
| Rate for Payer: Health Net of AZ Medicare |
$222.88
|
| Rate for Payer: Humana of AZ Medicare |
$119.40
|
| Rate for Payer: Self Pay Self Pay |
$636.80
|
| Rate for Payer: TriWest Medicare |
$119.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$464.07
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$143.28
|
|
|
11000 DBR INFC SKIN 10% BDY SU
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
22282762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of AZ Commercial |
$157.50
|
| Rate for Payer: Bisbee Police All Plans |
$45.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Self Pay Self Pay |
$140.00
|
|
|
11000 DBR INFC SKIN 10% BDY SU
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
22282762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$157.50
|
| Rate for Payer: Aetna of AZ Medicare |
$49.00
|
| Rate for Payer: AHCCCS Medicaid |
$760.04
|
| Rate for Payer: Allwell Medicaid |
$760.04
|
| Rate for Payer: Allwell Medicare |
$26.25
|
| Rate for Payer: Amerigroup Medicare |
$26.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$65.36
|
| Rate for Payer: AZCH Complete Medicaid |
$760.04
|
| Rate for Payer: AZCH Complete Medicare |
$26.25
|
| Rate for Payer: Banner UC Health Medicaid |
$760.04
|
| Rate for Payer: Banner UC Health Medicare |
$26.25
|
| Rate for Payer: Bisbee Police All Plans |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$119.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna of AZ Commercial |
$122.50
|
| Rate for Payer: Copperpoint Commercial |
$43.31
|
| Rate for Payer: Health Net of AZ Commercial |
$105.00
|
| Rate for Payer: Health Net of AZ Medicare |
$49.00
|
| Rate for Payer: Humana of AZ Medicare |
$26.25
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: Self Pay Self Pay |
$140.00
|
| Rate for Payer: TriWest Medicare |
$26.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.50
|
|
|
11730 AVULS NAIL SIMPLE SGL
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
22282763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$225.00
|
| Rate for Payer: Aetna of AZ Medicare |
$70.00
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$37.50
|
| Rate for Payer: Amerigroup Medicare |
$37.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$93.38
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$37.50
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$37.50
|
| Rate for Payer: Bisbee Police All Plans |
$65.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$170.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of AZ Commercial |
$175.00
|
| Rate for Payer: Copperpoint Commercial |
$61.88
|
| Rate for Payer: Health Net of AZ Commercial |
$150.00
|
| Rate for Payer: Health Net of AZ Medicare |
$70.00
|
| Rate for Payer: Humana of AZ Medicare |
$37.50
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$200.00
|
| Rate for Payer: TriWest Medicare |
$37.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$45.00
|
|
|
11730 AVULS NAIL SIMPLE SGL
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
22282763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of AZ Commercial |
$225.00
|
| Rate for Payer: Bisbee Police All Plans |
$65.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Self Pay Self Pay |
$200.00
|
|
|
11732 EA ADDTL NAIL PLATE AVUI
|
Facility
IP
|
$164.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
22282764
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna of AZ Commercial |
$147.60
|
| Rate for Payer: Bisbee Police All Plans |
$42.64
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Self Pay Self Pay |
$131.20
|
|
|
11732 EA ADDTL NAIL PLATE AVUI
|
Facility
OP
|
$164.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
22282764
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$147.60
|
| Rate for Payer: Aetna of AZ Medicare |
$45.92
|
| Rate for Payer: AHCCCS Medicaid |
$137.98
|
| Rate for Payer: Allwell Medicaid |
$137.98
|
| Rate for Payer: Allwell Medicare |
$24.60
|
| Rate for Payer: Amerigroup Medicare |
$24.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$61.25
|
| Rate for Payer: AZCH Complete Medicaid |
$137.98
|
| Rate for Payer: AZCH Complete Medicare |
$24.60
|
| Rate for Payer: Banner UC Health Medicaid |
$137.98
|
| Rate for Payer: Banner UC Health Medicare |
$24.60
|
| Rate for Payer: Bisbee Police All Plans |
$42.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$111.52
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cigna of AZ Commercial |
$114.80
|
| Rate for Payer: Copperpoint Commercial |
$40.59
|
| Rate for Payer: Health Net of AZ Commercial |
$98.40
|
| Rate for Payer: Health Net of AZ Medicare |
$45.92
|
| Rate for Payer: Humana of AZ Medicare |
$24.60
|
| Rate for Payer: Mercy Care Medicaid |
$137.98
|
| Rate for Payer: Self Pay Self Pay |
$131.20
|
| Rate for Payer: TriWest Medicare |
$24.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$29.52
|
|
|
11740 EVAC SUB HEMATOMA
|
Facility
IP
|
$126.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
22282765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna of AZ Commercial |
$113.40
|
| Rate for Payer: Bisbee Police All Plans |
$32.76
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Self Pay Self Pay |
$100.80
|
|
|
11740 EVAC SUB HEMATOMA
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
22282765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$113.40
|
| Rate for Payer: Aetna of AZ Medicare |
$35.28
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$18.90
|
| Rate for Payer: Amerigroup Medicare |
$18.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$47.06
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$18.90
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$18.90
|
| Rate for Payer: Bisbee Police All Plans |
$32.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$85.68
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna of AZ Commercial |
$88.20
|
| Rate for Payer: Copperpoint Commercial |
$31.18
|
| Rate for Payer: Health Net of AZ Commercial |
$75.60
|
| Rate for Payer: Health Net of AZ Medicare |
$35.28
|
| Rate for Payer: Humana of AZ Medicare |
$18.90
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$100.80
|
| Rate for Payer: TriWest Medicare |
$18.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$22.68
|
|
|
11760 RPR NAIL BED
|
Facility
IP
|
$497.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
22282766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$129.22 |
| Max. Negotiated Rate |
$447.30 |
| Rate for Payer: Aetna of AZ Commercial |
$447.30
|
| Rate for Payer: Bisbee Police All Plans |
$129.22
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Self Pay Self Pay |
$397.60
|
|
|
11760 RPR NAIL BED
|
Facility
OP
|
$497.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
22282766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$447.30
|
| Rate for Payer: Aetna of AZ Medicare |
$139.16
|
| Rate for Payer: AHCCCS Medicaid |
$760.04
|
| Rate for Payer: Allwell Medicaid |
$760.04
|
| Rate for Payer: Allwell Medicare |
$74.55
|
| Rate for Payer: Amerigroup Medicare |
$74.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$185.63
|
| Rate for Payer: AZCH Complete Medicaid |
$760.04
|
| Rate for Payer: AZCH Complete Medicare |
$74.55
|
| Rate for Payer: Banner UC Health Medicaid |
$760.04
|
| Rate for Payer: Banner UC Health Medicare |
$74.55
|
| Rate for Payer: Bisbee Police All Plans |
$129.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$337.96
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cigna of AZ Commercial |
$347.90
|
| Rate for Payer: Copperpoint Commercial |
$123.01
|
| Rate for Payer: Health Net of AZ Commercial |
$298.20
|
| Rate for Payer: Health Net of AZ Medicare |
$139.16
|
| Rate for Payer: Humana of AZ Medicare |
$74.55
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: Self Pay Self Pay |
$397.60
|
| Rate for Payer: TriWest Medicare |
$74.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$89.46
|
|
|
12001 REPAIR SMPLE WND 2.5CM OR LESS
|
Facility
IP
|
$441.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
22282767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna of AZ Commercial |
$396.90
|
| Rate for Payer: Bisbee Police All Plans |
$114.66
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Self Pay Self Pay |
$352.80
|
|
|
12001 REPAIR SMPLE WND 2.5CM OR LESS
|
Facility
OP
|
$441.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
22282767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$396.90
|
| Rate for Payer: Aetna of AZ Medicare |
$123.48
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$66.15
|
| Rate for Payer: Amerigroup Medicare |
$66.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$164.71
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$66.15
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$66.15
|
| Rate for Payer: Bisbee Police All Plans |
$114.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$299.88
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna of AZ Commercial |
$308.70
|
| Rate for Payer: Copperpoint Commercial |
$109.15
|
| Rate for Payer: Health Net of AZ Commercial |
$264.60
|
| Rate for Payer: Health Net of AZ Medicare |
$123.48
|
| Rate for Payer: Humana of AZ Medicare |
$66.15
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$352.80
|
| Rate for Payer: TriWest Medicare |
$66.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$79.38
|
|
|
12002 REPAIR SMPLE WND 2.6CM -7.5CM
|
Facility
IP
|
$573.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
22282768
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
12002 REPAIR SMPLE WND 2.6CM -7.5CM
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
22282768
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$515.70
|
| Rate for Payer: Aetna of AZ Medicare |
$160.44
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| 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 |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$85.95
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| 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 |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$458.40
|
| Rate for Payer: TriWest Medicare |
$85.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$103.14
|
|
|
12004 REPAIR SMPLE WND 7.5CM - 12.5CM
|
Facility
IP
|
$706.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
22282769
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$635.40 |
| Rate for Payer: Aetna of AZ Commercial |
$635.40
|
| Rate for Payer: Bisbee Police All Plans |
$183.56
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Self Pay Self Pay |
$564.80
|
|
|
12004 REPAIR SMPLE WND 7.5CM - 12.5CM
|
Facility
OP
|
$706.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
22282769
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.90 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$635.40
|
| Rate for Payer: Aetna of AZ Medicare |
$197.68
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$105.90
|
| Rate for Payer: Amerigroup Medicare |
$105.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$263.69
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$105.90
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$105.90
|
| Rate for Payer: Bisbee Police All Plans |
$183.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$480.08
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cigna of AZ Commercial |
$494.20
|
| Rate for Payer: Copperpoint Commercial |
$174.74
|
| Rate for Payer: Health Net of AZ Commercial |
$423.60
|
| Rate for Payer: Health Net of AZ Medicare |
$197.68
|
| Rate for Payer: Humana of AZ Medicare |
$105.90
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$564.80
|
| Rate for Payer: TriWest Medicare |
$105.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$127.08
|
|
|
12005 SUPSCLP NK XNXTR 12.6-20
|
Facility
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
22282770
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$901.80
|
| Rate for Payer: Aetna of AZ Medicare |
$280.56
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicare |
$150.30
|
| Rate for Payer: Amerigroup Medicare |
$150.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$374.25
|
| Rate for Payer: AZCH Complete Medicaid |
$501.46
|
| Rate for Payer: AZCH Complete Medicare |
$150.30
|
| Rate for Payer: Banner UC Health Medicaid |
$501.46
|
| Rate for Payer: Banner UC Health Medicare |
$150.30
|
| Rate for Payer: Bisbee Police All Plans |
$260.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$681.36
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna of AZ Commercial |
$701.40
|
| Rate for Payer: Copperpoint Commercial |
$248.00
|
| Rate for Payer: Health Net of AZ Commercial |
$601.20
|
| Rate for Payer: Health Net of AZ Medicare |
$280.56
|
| Rate for Payer: Humana of AZ Medicare |
$150.30
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: Self Pay Self Pay |
$801.60
|
| Rate for Payer: TriWest Medicare |
$150.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$180.36
|
|
|
12005 SUPSCLP NK XNXTR 12.6-20
|
Facility
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
22282770
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.52 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Aetna of AZ Commercial |
$901.80
|
| Rate for Payer: Bisbee Police All Plans |
$260.52
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Self Pay Self Pay |
$801.60
|
|
|
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 |
$174.00 |
| 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 |
$501.46
|
| Rate for Payer: Allwell Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicare |
$174.00
|
| Rate for Payer: Amerigroup Medicare |
$174.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$433.26
|
| Rate for Payer: AZCH Complete Medicaid |
$501.46
|
| Rate for Payer: AZCH Complete Medicare |
$174.00
|
| Rate for Payer: Banner UC Health Medicaid |
$501.46
|
| Rate for Payer: Banner UC Health Medicare |
$174.00
|
| 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 |
$174.00
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: Self Pay Self Pay |
$928.00
|
| Rate for Payer: TriWest Medicare |
$174.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$208.80
|
|
|
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
|
|
|
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 |
$192.30 |
| 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 |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$192.30
|
| Rate for Payer: Amerigroup Medicare |
$192.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$478.83
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$192.30
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$192.30
|
| 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 |
$192.30
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$1,025.60
|
| Rate for Payer: TriWest Medicare |
$192.30
|
| 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
|
|
