|
12006 SUP SCPNKXGNXTR 20.1-30
|
Facility
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
22282771
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$994.50
|
| Rate for Payer: Aetna Medicare |
$309.40
|
| 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 |
$187.85
|
| Rate for Payer: Amerigroup Medicare |
$187.85
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$412.72
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$187.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$187.85
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$287.30
|
| Rate for Payer: Cigna All Products |
$773.50
|
| Rate for Payer: Copperpoint |
$309.95
|
| Rate for Payer: HealthNet Commercial |
$663.00
|
| Rate for Payer: HealthNet Medicare |
$309.40
|
| Rate for Payer: Humana Medicare |
$187.85
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$884.00
|
| Rate for Payer: Veterans (Triwest) |
$187.85
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$644.21
|
| Rate for Payer: United Healthcare Medicare |
$198.90
|
|
|
12006 SUP SCPNKXGNXTR 20.1-30
|
Facility
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
22282771
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$994.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$187.85
|
| Rate for Payer: Amerigroup Medicare |
$187.85
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$187.85
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$187.85
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$287.30
|
| Rate for Payer: Copperpoint |
$309.95
|
| Rate for Payer: Humana Medicare |
$187.85
|
| Rate for Payer: SELF PAY |
$884.00
|
| Rate for Payer: Veterans (Triwest) |
$187.85
|
|
|
12007 SUP SCLP NK XGN XTR >30
|
Facility
OP
|
$1,221.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
22282772
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.57 |
| Max. Negotiated Rate |
$1,098.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,098.90
|
| Rate for Payer: Aetna Medicare |
$341.88
|
| 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 |
$207.57
|
| Rate for Payer: Amerigroup Medicare |
$207.57
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$456.04
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$207.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$207.57
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$317.46
|
| Rate for Payer: Cigna All Products |
$854.70
|
| Rate for Payer: Copperpoint |
$342.49
|
| Rate for Payer: HealthNet Commercial |
$732.60
|
| Rate for Payer: HealthNet Medicare |
$341.88
|
| Rate for Payer: Humana Medicare |
$207.57
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$976.80
|
| Rate for Payer: Veterans (Triwest) |
$207.57
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$711.84
|
| Rate for Payer: United Healthcare Medicare |
$219.78
|
|
|
12007 SUP SCLP NK XGN XTR >30
|
Facility
IP
|
$1,221.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
22282772
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.57 |
| Max. Negotiated Rate |
$1,098.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,098.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$207.57
|
| Rate for Payer: Amerigroup Medicare |
$207.57
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$207.57
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$207.57
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$317.46
|
| Rate for Payer: Copperpoint |
$342.49
|
| Rate for Payer: Humana Medicare |
$207.57
|
| Rate for Payer: SELF PAY |
$976.80
|
| Rate for Payer: Veterans (Triwest) |
$207.57
|
|
|
12011 SPL FACE MUC MEMB 2.5
|
Facility
IP
|
$514.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
22282773
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$462.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$87.38
|
| Rate for Payer: Amerigroup Medicare |
$87.38
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$87.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$87.38
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$335.92
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$133.64
|
| Rate for Payer: Copperpoint |
$144.18
|
| Rate for Payer: Humana Medicare |
$87.38
|
| Rate for Payer: SELF PAY |
$411.20
|
| Rate for Payer: Veterans (Triwest) |
$87.38
|
|
|
12011 SPL FACE MUC MEMB 2.5
|
Facility
OP
|
$514.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
22282773
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$462.60
|
| Rate for Payer: Aetna Medicare |
$143.92
|
| 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 |
$87.38
|
| Rate for Payer: Amerigroup Medicare |
$87.38
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$191.98
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$87.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$87.38
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$335.92
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$133.64
|
| Rate for Payer: Cigna All Products |
$359.80
|
| Rate for Payer: Copperpoint |
$144.18
|
| Rate for Payer: HealthNet Commercial |
$308.40
|
| Rate for Payer: HealthNet Medicare |
$143.92
|
| Rate for Payer: Humana Medicare |
$87.38
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$411.20
|
| Rate for Payer: Veterans (Triwest) |
$87.38
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$299.66
|
| Rate for Payer: United Healthcare Medicare |
$92.52
|
|
|
12013 SPL FACE MUCMEMB 2.6-5.0
|
Facility
IP
|
$595.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
22282774
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$535.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$101.15
|
| Rate for Payer: Amerigroup Medicare |
$101.15
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$101.15
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$101.15
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$154.70
|
| Rate for Payer: Copperpoint |
$166.90
|
| Rate for Payer: Humana Medicare |
$101.15
|
| Rate for Payer: SELF PAY |
$476.00
|
| Rate for Payer: Veterans (Triwest) |
$101.15
|
|
|
12013 SPL FACE MUCMEMB 2.6-5.0
|
Facility
OP
|
$595.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
22282774
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$535.50
|
| Rate for Payer: Aetna Medicare |
$166.60
|
| 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 |
$101.15
|
| Rate for Payer: Amerigroup Medicare |
$101.15
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$222.23
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$101.15
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$101.15
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$154.70
|
| Rate for Payer: Cigna All Products |
$416.50
|
| Rate for Payer: Copperpoint |
$166.90
|
| Rate for Payer: HealthNet Commercial |
$357.00
|
| Rate for Payer: HealthNet Medicare |
$166.60
|
| Rate for Payer: Humana Medicare |
$101.15
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$476.00
|
| Rate for Payer: Veterans (Triwest) |
$101.15
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$346.88
|
| Rate for Payer: United Healthcare Medicare |
$107.10
|
|
|
12014 SPL FACE MUC MEM 5.1-7.5
|
Facility
IP
|
$724.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
22282775
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.08 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$651.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$123.08
|
| Rate for Payer: Amerigroup Medicare |
$123.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$123.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$123.08
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$188.24
|
| Rate for Payer: Copperpoint |
$203.08
|
| Rate for Payer: Humana Medicare |
$123.08
|
| Rate for Payer: SELF PAY |
$579.20
|
| Rate for Payer: Veterans (Triwest) |
$123.08
|
|
|
12014 SPL FACE MUC MEM 5.1-7.5
|
Facility
OP
|
$724.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
22282775
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.08 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$651.60
|
| Rate for Payer: Aetna Medicare |
$202.72
|
| 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 |
$123.08
|
| Rate for Payer: Amerigroup Medicare |
$123.08
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$270.41
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$123.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$123.08
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$188.24
|
| Rate for Payer: Cigna All Products |
$506.80
|
| Rate for Payer: Copperpoint |
$203.08
|
| Rate for Payer: HealthNet Commercial |
$434.40
|
| Rate for Payer: HealthNet Medicare |
$202.72
|
| Rate for Payer: Humana Medicare |
$123.08
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$579.20
|
| Rate for Payer: Veterans (Triwest) |
$123.08
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$422.09
|
| Rate for Payer: United Healthcare Medicare |
$130.32
|
|
|
12015 SPL FACE MUC MEM7.6-12.5
|
Facility
IP
|
$930.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
22282776
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.10 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$837.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$158.10
|
| Rate for Payer: Amerigroup Medicare |
$158.10
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$158.10
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$158.10
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$241.80
|
| Rate for Payer: Copperpoint |
$260.87
|
| Rate for Payer: Humana Medicare |
$158.10
|
| Rate for Payer: SELF PAY |
$744.00
|
| Rate for Payer: Veterans (Triwest) |
$158.10
|
|
|
12015 SPL FACE MUC MEM7.6-12.5
|
Facility
OP
|
$930.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
22282776
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.10 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$837.00
|
| Rate for Payer: Aetna Medicare |
$260.40
|
| 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 |
$158.10
|
| Rate for Payer: Amerigroup Medicare |
$158.10
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$347.36
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$158.10
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$158.10
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$241.80
|
| Rate for Payer: Cigna All Products |
$651.00
|
| Rate for Payer: Copperpoint |
$260.87
|
| Rate for Payer: HealthNet Commercial |
$558.00
|
| Rate for Payer: HealthNet Medicare |
$260.40
|
| Rate for Payer: Humana Medicare |
$158.10
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$744.00
|
| Rate for Payer: Veterans (Triwest) |
$158.10
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$542.19
|
| Rate for Payer: United Healthcare Medicare |
$167.40
|
|
|
12016 SPL FACE MUC MEM 12.6-20
|
Facility
IP
|
$1,177.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
22282777
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.09 |
| Max. Negotiated Rate |
$1,059.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,059.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$200.09
|
| Rate for Payer: Amerigroup Medicare |
$200.09
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$200.09
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$200.09
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$306.02
|
| Rate for Payer: Copperpoint |
$330.15
|
| Rate for Payer: Humana Medicare |
$200.09
|
| Rate for Payer: SELF PAY |
$941.60
|
| Rate for Payer: Veterans (Triwest) |
$200.09
|
|
|
12016 SPL FACE MUC MEM 12.6-20
|
Facility
OP
|
$1,177.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
22282777
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.09 |
| Max. Negotiated Rate |
$1,059.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,059.30
|
| Rate for Payer: Aetna Medicare |
$329.56
|
| 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 |
$200.09
|
| Rate for Payer: Amerigroup Medicare |
$200.09
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$439.61
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$200.09
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$200.09
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$306.02
|
| Rate for Payer: Cigna All Products |
$823.90
|
| Rate for Payer: Copperpoint |
$330.15
|
| Rate for Payer: HealthNet Commercial |
$706.20
|
| Rate for Payer: HealthNet Medicare |
$329.56
|
| Rate for Payer: Humana Medicare |
$200.09
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$941.60
|
| Rate for Payer: Veterans (Triwest) |
$200.09
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$686.19
|
| Rate for Payer: United Healthcare Medicare |
$211.86
|
|
|
12017 SPL FAC MUC MEM 20.1-30
|
Facility
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
22282778
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.21 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,361.70
|
| Rate for Payer: Aetna Medicare |
$423.64
|
| 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 |
$257.21
|
| Rate for Payer: Amerigroup Medicare |
$257.21
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$565.11
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$257.21
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$257.21
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$393.38
|
| Rate for Payer: Cigna All Products |
$1,059.10
|
| Rate for Payer: Copperpoint |
$424.40
|
| Rate for Payer: HealthNet Commercial |
$907.80
|
| Rate for Payer: HealthNet Medicare |
$423.64
|
| Rate for Payer: Humana Medicare |
$257.21
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$1,210.40
|
| Rate for Payer: Veterans (Triwest) |
$257.21
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$882.08
|
| Rate for Payer: United Healthcare Medicare |
$272.34
|
|
|
12017 SPL FAC MUC MEM 20.1-30
|
Facility
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
22282778
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.21 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,361.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$257.21
|
| Rate for Payer: Amerigroup Medicare |
$257.21
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$257.21
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$257.21
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$393.38
|
| Rate for Payer: Copperpoint |
$424.40
|
| Rate for Payer: Humana Medicare |
$257.21
|
| Rate for Payer: SELF PAY |
$1,210.40
|
| Rate for Payer: Veterans (Triwest) |
$257.21
|
|
|
12018 SPL FACE MUC MEMB >30
|
Facility
IP
|
$1,875.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
22282779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$1,687.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,687.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$318.75
|
| Rate for Payer: Amerigroup Medicare |
$318.75
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$318.75
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$318.75
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$487.50
|
| Rate for Payer: Copperpoint |
$525.94
|
| Rate for Payer: Humana Medicare |
$318.75
|
| Rate for Payer: SELF PAY |
$1,500.00
|
| Rate for Payer: Veterans (Triwest) |
$318.75
|
|
|
12018 SPL FACE MUC MEMB >30
|
Facility
OP
|
$1,875.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
22282779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.34 |
| Max. Negotiated Rate |
$1,687.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,687.50
|
| Rate for Payer: Aetna Medicare |
$525.00
|
| 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 |
$318.75
|
| Rate for Payer: Amerigroup Medicare |
$318.75
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$700.31
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$260.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$318.75
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$318.75
|
| Rate for Payer: Banner University Family Care Medicaid |
$260.34
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$487.50
|
| Rate for Payer: Cigna All Products |
$1,312.50
|
| Rate for Payer: Copperpoint |
$525.94
|
| Rate for Payer: HealthNet Commercial |
$1,125.00
|
| Rate for Payer: HealthNet Medicare |
$525.00
|
| Rate for Payer: Humana Medicare |
$318.75
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: SELF PAY |
$1,500.00
|
| Rate for Payer: Veterans (Triwest) |
$318.75
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,093.12
|
| Rate for Payer: United Healthcare Medicare |
$337.50
|
|
|
12020 SUP WND DEHIS SMPL
|
Facility
OP
|
$799.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
22282780
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.83 |
| Max. Negotiated Rate |
$760.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$719.10
|
| Rate for Payer: Aetna Medicare |
$223.72
|
| 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 |
$135.83
|
| Rate for Payer: Amerigroup Medicare |
$135.83
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$298.43
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$760.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$135.83
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$135.83
|
| Rate for Payer: Banner University Family Care Medicaid |
$760.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$207.74
|
| Rate for Payer: Cigna All Products |
$559.30
|
| Rate for Payer: Copperpoint |
$224.12
|
| Rate for Payer: HealthNet Commercial |
$479.40
|
| Rate for Payer: HealthNet Medicare |
$223.72
|
| Rate for Payer: Humana Medicare |
$135.83
|
| Rate for Payer: Mercy Care Medicaid |
$760.04
|
| Rate for Payer: SELF PAY |
$639.20
|
| Rate for Payer: Veterans (Triwest) |
$135.83
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$465.82
|
| Rate for Payer: United Healthcare Medicare |
$143.82
|
|
|
12020 SUP WND DEHIS SMPL
|
Facility
IP
|
$799.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
22282780
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.83 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$719.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$135.83
|
| Rate for Payer: Amerigroup Medicare |
$135.83
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$135.83
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$135.83
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$207.74
|
| Rate for Payer: Copperpoint |
$224.12
|
| Rate for Payer: Humana Medicare |
$135.83
|
| Rate for Payer: SELF PAY |
$639.20
|
| Rate for Payer: Veterans (Triwest) |
$135.83
|
|
|
12021 SUP WND DEHIS W/PACK
|
Facility
OP
|
$511.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
22282781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.87 |
| Max. Negotiated Rate |
$501.46 |
| Rate for Payer: Aetna POS, PPO, HMO |
$459.90
|
| Rate for Payer: Aetna Medicare |
$143.08
|
| 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 |
$86.87
|
| Rate for Payer: Amerigroup Medicare |
$86.87
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$190.86
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$86.87
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$86.87
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$132.86
|
| Rate for Payer: Cigna All Products |
$357.70
|
| Rate for Payer: Copperpoint |
$143.34
|
| Rate for Payer: HealthNet Commercial |
$306.60
|
| Rate for Payer: HealthNet Medicare |
$143.08
|
| Rate for Payer: Humana Medicare |
$86.87
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$408.80
|
| Rate for Payer: Veterans (Triwest) |
$86.87
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$297.91
|
| Rate for Payer: United Healthcare Medicare |
$91.98
|
|
|
12021 SUP WND DEHIS W/PACK
|
Facility
IP
|
$511.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
22282781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.87 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$459.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$86.87
|
| Rate for Payer: Amerigroup Medicare |
$86.87
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$86.87
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$86.87
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$132.86
|
| Rate for Payer: Copperpoint |
$143.34
|
| Rate for Payer: Humana Medicare |
$86.87
|
| Rate for Payer: SELF PAY |
$408.80
|
| Rate for Payer: Veterans (Triwest) |
$86.87
|
|
|
12031 REPAIR INTMD WND 2.5CM OR LESS
|
Facility
OP
|
$1,053.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
22282782
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$947.70
|
| Rate for Payer: Aetna Medicare |
$294.84
|
| 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 |
$179.01
|
| Rate for Payer: Amerigroup Medicare |
$179.01
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$393.30
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$501.46
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$179.01
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$179.01
|
| Rate for Payer: Banner University Family Care Medicaid |
$501.46
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$273.78
|
| Rate for Payer: Cigna All Products |
$737.10
|
| Rate for Payer: Copperpoint |
$295.37
|
| Rate for Payer: HealthNet Commercial |
$631.80
|
| Rate for Payer: HealthNet Medicare |
$294.84
|
| Rate for Payer: Humana Medicare |
$179.01
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: SELF PAY |
$842.40
|
| Rate for Payer: Veterans (Triwest) |
$179.01
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$613.90
|
| Rate for Payer: United Healthcare Medicare |
$189.54
|
|
|
12031 REPAIR INTMD WND 2.5CM OR LESS
|
Facility
IP
|
$1,053.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
22282782
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$947.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$179.01
|
| Rate for Payer: Amerigroup Medicare |
$179.01
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$179.01
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$179.01
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$273.78
|
| Rate for Payer: Copperpoint |
$295.37
|
| Rate for Payer: Humana Medicare |
$179.01
|
| Rate for Payer: SELF PAY |
$842.40
|
| Rate for Payer: Veterans (Triwest) |
$179.01
|
|
|
12032 REPAIR INTMD WND 2.6CM TO 7.5CM
|
Facility
IP
|
$1,361.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
22282783
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$231.37 |
| Max. Negotiated Rate |
$1,224.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,224.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$231.37
|
| Rate for Payer: Amerigroup Medicare |
$231.37
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$231.37
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$231.37
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$353.86
|
| Rate for Payer: Copperpoint |
$381.76
|
| Rate for Payer: Humana Medicare |
$231.37
|
| Rate for Payer: SELF PAY |
$1,088.80
|
| Rate for Payer: Veterans (Triwest) |
$231.37
|
|