|
10060 I D ABSCESS
|
Facility
OP
|
$412.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
22273442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$370.80
|
| Rate for Payer: Aetna Medicare |
$115.36
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$70.04
|
| Rate for Payer: Amerigroup Medicare |
$70.04
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$153.88
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$70.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$70.04
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$107.12
|
| Rate for Payer: Cigna All Products |
$288.40
|
| Rate for Payer: Copperpoint |
$115.57
|
| Rate for Payer: HealthNet Commercial |
$247.20
|
| Rate for Payer: HealthNet Medicare |
$115.36
|
| Rate for Payer: Humana Medicare |
$70.04
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$329.60
|
| Rate for Payer: Veterans (Triwest) |
$70.04
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$240.20
|
| Rate for Payer: United Healthcare Medicare |
$74.16
|
|
|
10120 INCS REM FOB SUB CUT S
|
Facility
OP
|
$410.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
22282760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$501.46 |
| Rate for Payer: Aetna POS, PPO, HMO |
$369.00
|
| Rate for Payer: Aetna Medicare |
$114.80
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$69.70
|
| Rate for Payer: Amerigroup Medicare |
$69.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$153.13
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$69.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$69.70
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$106.60
|
| Rate for Payer: Cigna All Products |
$287.00
|
| Rate for Payer: Copperpoint |
$115.01
|
| Rate for Payer: HealthNet Commercial |
$246.00
|
| Rate for Payer: HealthNet Medicare |
$114.80
|
| Rate for Payer: Humana Medicare |
$69.70
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$328.00
|
| Rate for Payer: Veterans (Triwest) |
$69.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$239.03
|
| Rate for Payer: United Healthcare Medicare |
$73.80
|
|
|
10120 INCS REM FOB SUB CUT S
|
Facility
IP
|
$410.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
22282760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$369.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$69.70
|
| Rate for Payer: Amerigroup Medicare |
$69.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$69.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$69.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$106.60
|
| Rate for Payer: Copperpoint |
$115.01
|
| Rate for Payer: Humana Medicare |
$69.70
|
| Rate for Payer: SELF PAY |
$328.00
|
| Rate for Payer: Veterans (Triwest) |
$69.70
|
|
|
10140 ID HMTMA SRMA TLD COLEC
|
Facility
OP
|
$410.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
22282761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$2,040.16 |
| Rate for Payer: Aetna POS, PPO, HMO |
$369.00
|
| Rate for Payer: Aetna Medicare |
$114.80
|
| Rate for Payer: AHCCCS Medicaid |
$2,040.16
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$2,040.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$69.70
|
| Rate for Payer: Amerigroup Medicare |
$69.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$153.13
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$2,040.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$69.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$69.70
|
| Rate for Payer: Banner University Family Care Medicaid |
$2,040.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$106.60
|
| Rate for Payer: Cigna All Products |
$287.00
|
| Rate for Payer: Copperpoint |
$115.01
|
| Rate for Payer: HealthNet Commercial |
$246.00
|
| Rate for Payer: HealthNet Medicare |
$114.80
|
| Rate for Payer: Humana Medicare |
$69.70
|
| Rate for Payer: Mercy Care Medicaid |
$2,040.16
|
| Rate for Payer: SELF PAY |
$328.00
|
| Rate for Payer: Veterans (Triwest) |
$69.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$239.03
|
| Rate for Payer: United Healthcare Medicare |
$73.80
|
|
|
10140 ID HMTMA SRMA TLD COLEC
|
Facility
IP
|
$410.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
22282761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$369.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$69.70
|
| Rate for Payer: Amerigroup Medicare |
$69.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$69.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$69.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$106.60
|
| Rate for Payer: Copperpoint |
$115.01
|
| Rate for Payer: Humana Medicare |
$69.70
|
| Rate for Payer: SELF PAY |
$328.00
|
| Rate for Payer: Veterans (Triwest) |
$69.70
|
|
|
10MM BLUNT TIP TROCAR
|
Facility
IP
|
$758.00
|
|
| Hospital Charge Code |
22561229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.86 |
| Max. Negotiated Rate |
$682.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$682.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$128.86
|
| Rate for Payer: Amerigroup Medicare |
$128.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$128.86
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$128.86
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.08
|
| Rate for Payer: Copperpoint |
$212.62
|
| Rate for Payer: Humana Medicare |
$128.86
|
| Rate for Payer: SELF PAY |
$606.40
|
| Rate for Payer: Veterans (Triwest) |
$128.86
|
|
|
10MM BLUNT TIP TROCAR
|
Facility
OP
|
$758.00
|
|
| Hospital Charge Code |
22561229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.86 |
| Max. Negotiated Rate |
$682.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$682.20
|
| Rate for Payer: Aetna Medicare |
$212.24
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$128.86
|
| Rate for Payer: Amerigroup Medicare |
$128.86
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$283.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$128.86
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$128.86
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$197.08
|
| Rate for Payer: Cigna All Products |
$530.60
|
| Rate for Payer: Copperpoint |
$212.62
|
| Rate for Payer: HealthNet Commercial |
$454.80
|
| Rate for Payer: HealthNet Medicare |
$212.24
|
| Rate for Payer: Humana Medicare |
$128.86
|
| Rate for Payer: SELF PAY |
$606.40
|
| Rate for Payer: Veterans (Triwest) |
$128.86
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$441.91
|
| Rate for Payer: United Healthcare Medicare |
$136.44
|
|
|
11000 DBR INFC SKIN 10% BDY SU
|
Facility
IP
|
$167.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
22282762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.39 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$150.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$28.39
|
| Rate for Payer: Amerigroup Medicare |
$28.39
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$28.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$28.39
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$43.42
|
| Rate for Payer: Copperpoint |
$46.84
|
| Rate for Payer: Humana Medicare |
$28.39
|
| Rate for Payer: SELF PAY |
$133.60
|
| Rate for Payer: Veterans (Triwest) |
$28.39
|
|
|
11000 DBR INFC SKIN 10% BDY SU
|
Facility
OP
|
$167.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
22282762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.39 |
| Max. Negotiated Rate |
$760.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$150.30
|
| Rate for Payer: Aetna Medicare |
$46.76
|
| Rate for Payer: AHCCCS Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$28.39
|
| Rate for Payer: Amerigroup Medicare |
$28.39
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$62.37
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$28.39
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$28.39
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$43.42
|
| Rate for Payer: Cigna All Products |
$116.90
|
| Rate for Payer: Copperpoint |
$46.84
|
| Rate for Payer: HealthNet Commercial |
$100.20
|
| Rate for Payer: HealthNet Medicare |
$46.76
|
| Rate for Payer: Humana Medicare |
$28.39
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$133.60
|
| Rate for Payer: Veterans (Triwest) |
$28.39
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$97.36
|
| Rate for Payer: United Healthcare Medicare |
$30.06
|
|
|
11730 AVULS NAIL SIMPLE SGL
|
Facility
IP
|
$238.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
22282763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$214.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.46
|
| Rate for Payer: Amerigroup Medicare |
$40.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.46
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.88
|
| Rate for Payer: Copperpoint |
$66.76
|
| Rate for Payer: Humana Medicare |
$40.46
|
| Rate for Payer: SELF PAY |
$190.40
|
| Rate for Payer: Veterans (Triwest) |
$40.46
|
|
|
11730 AVULS NAIL SIMPLE SGL
|
Facility
OP
|
$238.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
22282763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$260.34 |
| Rate for Payer: Aetna POS, PPO, HMO |
$214.20
|
| Rate for Payer: Aetna Medicare |
$66.64
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.46
|
| Rate for Payer: Amerigroup Medicare |
$40.46
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$88.89
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.46
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.46
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$61.88
|
| Rate for Payer: Cigna All Products |
$166.60
|
| Rate for Payer: Copperpoint |
$66.76
|
| Rate for Payer: HealthNet Commercial |
$142.80
|
| Rate for Payer: HealthNet Medicare |
$66.64
|
| Rate for Payer: Humana Medicare |
$40.46
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$190.40
|
| Rate for Payer: Veterans (Triwest) |
$40.46
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$138.75
|
| Rate for Payer: United Healthcare Medicare |
$42.84
|
|
|
11732 EA ADDTL NAIL PLATE AVUI
|
Facility
OP
|
$156.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
22282764
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$140.40
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: AHCCCS Medicaid |
$137.98
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$137.98
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$26.52
|
| Rate for Payer: Amerigroup Medicare |
$26.52
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$58.27
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$137.98
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$26.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$26.52
|
| Rate for Payer: Banner University Family Care Medicaid |
$137.98
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$40.56
|
| Rate for Payer: Cigna All Products |
$109.20
|
| Rate for Payer: Copperpoint |
$43.76
|
| Rate for Payer: HealthNet Commercial |
$93.60
|
| Rate for Payer: HealthNet Medicare |
$43.68
|
| Rate for Payer: Humana Medicare |
$26.52
|
| Rate for Payer: Mercy Care Medicaid |
$137.98
|
| Rate for Payer: SELF PAY |
$124.80
|
| Rate for Payer: Veterans (Triwest) |
$26.52
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$90.95
|
| Rate for Payer: United Healthcare Medicare |
$28.08
|
|
|
11732 EA ADDTL NAIL PLATE AVUI
|
Facility
IP
|
$156.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
22282764
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$140.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$26.52
|
| Rate for Payer: Amerigroup Medicare |
$26.52
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$26.52
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$26.52
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$40.56
|
| Rate for Payer: Copperpoint |
$43.76
|
| Rate for Payer: Humana Medicare |
$26.52
|
| Rate for Payer: SELF PAY |
$124.80
|
| Rate for Payer: Veterans (Triwest) |
$26.52
|
|
|
11740 EVAC SUB HEMATOMA
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
22282765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$108.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$20.40
|
| Rate for Payer: Amerigroup Medicare |
$20.40
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$20.40
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$20.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$31.20
|
| Rate for Payer: Copperpoint |
$33.66
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: SELF PAY |
$96.00
|
| Rate for Payer: Veterans (Triwest) |
$20.40
|
|
|
11740 EVAC SUB HEMATOMA
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
22282765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$162.32 |
| Rate for Payer: Aetna POS, PPO, HMO |
$108.00
|
| Rate for Payer: Aetna Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$162.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$20.40
|
| Rate for Payer: Amerigroup Medicare |
$20.40
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$44.82
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$162.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$20.40
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$20.40
|
| Rate for Payer: Banner University Family Care Medicaid |
$162.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$31.20
|
| Rate for Payer: Cigna All Products |
$84.00
|
| Rate for Payer: Copperpoint |
$33.66
|
| Rate for Payer: HealthNet Commercial |
$72.00
|
| Rate for Payer: HealthNet Medicare |
$33.60
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: SELF PAY |
$96.00
|
| Rate for Payer: Veterans (Triwest) |
$20.40
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$69.96
|
| Rate for Payer: United Healthcare Medicare |
$21.60
|
|
|
11760 RPR NAIL BED
|
Facility
IP
|
$473.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
22282766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.41 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: Humana Medicare |
$80.41
|
| Rate for Payer: SELF PAY |
$378.40
|
| Rate for Payer: Aetna POS, PPO, HMO |
$425.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$80.41
|
| Rate for Payer: Amerigroup Medicare |
$80.41
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$80.41
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$80.41
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$122.98
|
| Rate for Payer: Copperpoint |
$132.68
|
| Rate for Payer: Veterans (Triwest) |
$80.41
|
|
|
11760 RPR NAIL BED
|
Facility
OP
|
$473.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
22282766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.41 |
| Max. Negotiated Rate |
$760.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$425.70
|
| Rate for Payer: Aetna Medicare |
$132.44
|
| Rate for Payer: AHCCCS Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$760.04
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$80.41
|
| Rate for Payer: Amerigroup Medicare |
$80.41
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$176.67
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$80.41
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$80.41
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$122.98
|
| Rate for Payer: Cigna All Products |
$331.10
|
| Rate for Payer: Copperpoint |
$132.68
|
| Rate for Payer: HealthNet Commercial |
$283.80
|
| Rate for Payer: HealthNet Medicare |
$132.44
|
| Rate for Payer: Humana Medicare |
$80.41
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$378.40
|
| Rate for Payer: Veterans (Triwest) |
$80.41
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$275.76
|
| Rate for Payer: United Healthcare Medicare |
$85.14
|
|
|
12001 REPAIR SMPLE WND 2.5CM OR LESS
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
22282767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$378.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$71.40
|
| Rate for Payer: Amerigroup Medicare |
$71.40
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$71.40
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$274.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$109.20
|
| Rate for Payer: Copperpoint |
$117.81
|
| Rate for Payer: Humana Medicare |
$71.40
|
| Rate for Payer: SELF PAY |
$336.00
|
| Rate for Payer: Veterans (Triwest) |
$71.40
|
|
|
12001 REPAIR SMPLE WND 2.5CM OR LESS
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
22282767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$378.00
|
| Rate for Payer: Aetna Medicare |
$117.60
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$71.40
|
| Rate for Payer: Amerigroup Medicare |
$71.40
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$156.87
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$71.40
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$71.40
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$274.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$109.20
|
| Rate for Payer: Cigna All Products |
$294.00
|
| Rate for Payer: Copperpoint |
$117.81
|
| Rate for Payer: HealthNet Commercial |
$252.00
|
| Rate for Payer: HealthNet Medicare |
$117.60
|
| Rate for Payer: Humana Medicare |
$71.40
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$336.00
|
| Rate for Payer: Veterans (Triwest) |
$71.40
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$244.86
|
| Rate for Payer: United Healthcare Medicare |
$75.60
|
|
|
12002 REPAIR SMPLE WND 2.6CM -7.5CM
|
Facility
IP
|
$546.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
22282768
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$491.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$92.82
|
| Rate for Payer: Amerigroup Medicare |
$92.82
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$92.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$92.82
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$327.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$141.96
|
| Rate for Payer: Copperpoint |
$153.15
|
| Rate for Payer: Humana Medicare |
$92.82
|
| Rate for Payer: SELF PAY |
$436.80
|
| Rate for Payer: Veterans (Triwest) |
$92.82
|
|
|
12002 REPAIR SMPLE WND 2.6CM -7.5CM
|
Facility
OP
|
$546.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
22282768
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$491.40
|
| Rate for Payer: Aetna Medicare |
$152.88
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$92.82
|
| Rate for Payer: Amerigroup Medicare |
$92.82
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$203.93
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$92.82
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$92.82
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$327.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$141.96
|
| Rate for Payer: Cigna All Products |
$382.20
|
| Rate for Payer: Copperpoint |
$153.15
|
| Rate for Payer: HealthNet Commercial |
$327.60
|
| Rate for Payer: HealthNet Medicare |
$152.88
|
| Rate for Payer: Humana Medicare |
$92.82
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$436.80
|
| Rate for Payer: Veterans (Triwest) |
$92.82
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$318.32
|
| Rate for Payer: United Healthcare Medicare |
$98.28
|
|
|
12004 REPAIR SMPLE WND 7.5CM - 12.5CM
|
Facility
IP
|
$672.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
22282769
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$604.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$114.24
|
| Rate for Payer: Amerigroup Medicare |
$114.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$114.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$387.60
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$174.72
|
| Rate for Payer: Copperpoint |
$188.50
|
| Rate for Payer: Humana Medicare |
$114.24
|
| Rate for Payer: SELF PAY |
$537.60
|
| Rate for Payer: Veterans (Triwest) |
$114.24
|
|
|
12004 REPAIR SMPLE WND 7.5CM - 12.5CM
|
Facility
OP
|
$672.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
22282769
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$604.80
|
| Rate for Payer: Aetna Medicare |
$188.16
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$260.34
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$114.24
|
| Rate for Payer: Amerigroup Medicare |
$114.24
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$250.99
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$114.24
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$114.24
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$387.60
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$174.72
|
| Rate for Payer: Cigna All Products |
$470.40
|
| Rate for Payer: Copperpoint |
$188.50
|
| Rate for Payer: HealthNet Commercial |
$403.20
|
| Rate for Payer: HealthNet Medicare |
$188.16
|
| Rate for Payer: Humana Medicare |
$114.24
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$537.60
|
| Rate for Payer: Veterans (Triwest) |
$114.24
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$391.78
|
| Rate for Payer: United Healthcare Medicare |
$120.96
|
|
|
12005 SUPSCLP NK XNXTR 12.6-20
|
Facility
IP
|
$954.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
22282770
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.18 |
| Max. Negotiated Rate |
$858.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$858.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$162.18
|
| Rate for Payer: Amerigroup Medicare |
$162.18
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$162.18
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$162.18
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$248.04
|
| Rate for Payer: Copperpoint |
$267.60
|
| Rate for Payer: Humana Medicare |
$162.18
|
| Rate for Payer: SELF PAY |
$763.20
|
| Rate for Payer: Veterans (Triwest) |
$162.18
|
|
|
12005 SUPSCLP NK XNXTR 12.6-20
|
Facility
OP
|
$954.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
22282770
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.18 |
| Max. Negotiated Rate |
$858.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$858.60
|
| Rate for Payer: Aetna Medicare |
$267.12
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$501.46
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$162.18
|
| Rate for Payer: Amerigroup Medicare |
$162.18
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$356.32
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$162.18
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$162.18
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$248.04
|
| Rate for Payer: Cigna All Products |
$667.80
|
| Rate for Payer: Copperpoint |
$267.60
|
| Rate for Payer: HealthNet Commercial |
$572.40
|
| Rate for Payer: HealthNet Medicare |
$267.12
|
| Rate for Payer: Humana Medicare |
$162.18
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$763.20
|
| Rate for Payer: Veterans (Triwest) |
$162.18
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$556.18
|
| Rate for Payer: United Healthcare Medicare |
$171.72
|
|