|
28490 CLSD TX FX GR TOE W/O MA
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
22282872
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.82 |
| Max. Negotiated Rate |
$411.30 |
| Rate for Payer: Aetna of AZ Commercial |
$411.30
|
| Rate for Payer: Bisbee Police All Plans |
$118.82
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Self Pay Self Pay |
$365.60
|
|
|
28495 CLSD TX FX GR TOE W/MANI
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
22282873
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$522.00
|
| Rate for Payer: Aetna of AZ Medicare |
$162.40
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$92.80
|
| Rate for Payer: Amerigroup Medicare |
$92.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$216.63
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$92.80
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$92.80
|
| Rate for Payer: Bisbee Police All Plans |
$150.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$394.40
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cigna of AZ Commercial |
$406.00
|
| Rate for Payer: Copperpoint Commercial |
$143.55
|
| Rate for Payer: Health Net of AZ Commercial |
$348.00
|
| Rate for Payer: Health Net of AZ Medicare |
$162.40
|
| Rate for Payer: Humana of AZ Medicare |
$92.80
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$464.00
|
| Rate for Payer: TriWest Medicare |
$92.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$104.40
|
|
|
28495 CLSD TX FX GR TOE W/MANI
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
22282873
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of AZ Commercial |
$522.00
|
| Rate for Payer: Bisbee Police All Plans |
$150.80
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Self Pay Self Pay |
$464.00
|
|
|
28660 REDUCTION DISLOCATED TOE
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
22282874
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.52 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$357.30
|
| Rate for Payer: Aetna of AZ Medicare |
$111.16
|
| Rate for Payer: AHCCCS Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicaid |
$149.49
|
| Rate for Payer: Allwell Medicare |
$63.52
|
| Rate for Payer: Amerigroup Medicare |
$63.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$148.28
|
| Rate for Payer: AZCH Complete Medicaid |
$149.49
|
| Rate for Payer: AZCH Complete Medicare |
$63.52
|
| Rate for Payer: Banner UC Health Medicaid |
$149.49
|
| Rate for Payer: Banner UC Health Medicare |
$63.52
|
| Rate for Payer: Bisbee Police All Plans |
$103.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$269.96
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Cigna of AZ Commercial |
$277.90
|
| Rate for Payer: Copperpoint Commercial |
$98.26
|
| Rate for Payer: Health Net of AZ Commercial |
$238.20
|
| Rate for Payer: Health Net of AZ Medicare |
$111.16
|
| Rate for Payer: Humana of AZ Medicare |
$63.52
|
| Rate for Payer: Mercy Care Medicaid |
$149.49
|
| Rate for Payer: Self Pay Self Pay |
$317.60
|
| Rate for Payer: TriWest Medicare |
$63.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$71.46
|
|
|
28660 REDUCTION DISLOCATED TOE
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
22282874
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$357.30 |
| Rate for Payer: Aetna of AZ Commercial |
$357.30
|
| Rate for Payer: Bisbee Police All Plans |
$103.22
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Self Pay Self Pay |
$317.60
|
|
|
29105 APL LNG ARM SPLNT
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
22282875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.46 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna of AZ Commercial |
$243.90
|
| Rate for Payer: Bisbee Police All Plans |
$70.46
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Self Pay Self Pay |
$216.80
|
|
|
29105 APL LNG ARM SPLNT
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
22282875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.36 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$243.90
|
| Rate for Payer: Aetna of AZ Medicare |
$75.88
|
| Rate for Payer: AHCCCS Medicaid |
$102.36
|
| Rate for Payer: Allwell Medicaid |
$102.36
|
| Rate for Payer: Allwell Medicare |
$43.36
|
| Rate for Payer: Amerigroup Medicare |
$43.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$101.22
|
| Rate for Payer: AZCH Complete Medicaid |
$102.36
|
| Rate for Payer: AZCH Complete Medicare |
$43.36
|
| Rate for Payer: Banner UC Health Medicaid |
$102.36
|
| Rate for Payer: Banner UC Health Medicare |
$43.36
|
| Rate for Payer: Bisbee Police All Plans |
$70.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$184.28
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cigna of AZ Commercial |
$189.70
|
| Rate for Payer: Copperpoint Commercial |
$67.07
|
| Rate for Payer: Health Net of AZ Commercial |
$162.60
|
| Rate for Payer: Health Net of AZ Medicare |
$75.88
|
| Rate for Payer: Humana of AZ Medicare |
$43.36
|
| Rate for Payer: Mercy Care Medicaid |
$102.36
|
| Rate for Payer: Self Pay Self Pay |
$216.80
|
| Rate for Payer: TriWest Medicare |
$43.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.78
|
|
|
29125 APL SPLINT SHORT ARM
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
22282876
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$273.60
|
| Rate for Payer: Aetna of AZ Medicare |
$85.12
|
| Rate for Payer: AHCCCS Medicaid |
$81.16
|
| Rate for Payer: Allwell Medicaid |
$81.16
|
| Rate for Payer: Allwell Medicare |
$48.64
|
| Rate for Payer: Amerigroup Medicare |
$48.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$113.54
|
| Rate for Payer: AZCH Complete Medicaid |
$81.16
|
| Rate for Payer: AZCH Complete Medicare |
$48.64
|
| Rate for Payer: Banner UC Health Medicaid |
$81.16
|
| Rate for Payer: Banner UC Health Medicare |
$48.64
|
| Rate for Payer: Bisbee Police All Plans |
$79.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$206.72
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cigna of AZ Commercial |
$212.80
|
| Rate for Payer: Copperpoint Commercial |
$75.24
|
| Rate for Payer: Health Net of AZ Commercial |
$182.40
|
| Rate for Payer: Health Net of AZ Medicare |
$85.12
|
| Rate for Payer: Humana of AZ Medicare |
$48.64
|
| Rate for Payer: Mercy Care Medicaid |
$81.16
|
| Rate for Payer: Self Pay Self Pay |
$243.20
|
| Rate for Payer: TriWest Medicare |
$48.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$54.72
|
|
|
29125 APL SPLINT SHORT ARM
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
22282876
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.04 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of AZ Commercial |
$273.60
|
| Rate for Payer: Bisbee Police All Plans |
$79.04
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Self Pay Self Pay |
$243.20
|
|
|
29130 APL FNG SPLNT STATIC
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
22282877
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of AZ Commercial |
$207.90
|
| Rate for Payer: Bisbee Police All Plans |
$60.06
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Self Pay Self Pay |
$184.80
|
|
|
29130 APL FNG SPLNT STATIC
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
22282877
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$207.90
|
| Rate for Payer: Aetna of AZ Medicare |
$64.68
|
| Rate for Payer: AHCCCS Medicaid |
$81.16
|
| Rate for Payer: Allwell Medicaid |
$81.16
|
| Rate for Payer: Allwell Medicare |
$36.96
|
| Rate for Payer: Amerigroup Medicare |
$36.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$86.28
|
| Rate for Payer: AZCH Complete Medicaid |
$81.16
|
| Rate for Payer: AZCH Complete Medicare |
$36.96
|
| Rate for Payer: Banner UC Health Medicaid |
$81.16
|
| Rate for Payer: Banner UC Health Medicare |
$36.96
|
| Rate for Payer: Bisbee Police All Plans |
$60.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$157.08
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna of AZ Commercial |
$161.70
|
| Rate for Payer: Copperpoint Commercial |
$57.17
|
| Rate for Payer: Health Net of AZ Commercial |
$138.60
|
| Rate for Payer: Health Net of AZ Medicare |
$64.68
|
| Rate for Payer: Humana of AZ Medicare |
$36.96
|
| Rate for Payer: Mercy Care Medicaid |
$81.16
|
| Rate for Payer: Self Pay Self Pay |
$184.80
|
| Rate for Payer: TriWest Medicare |
$36.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.58
|
|
|
29131 APL FNG SPLNT DYNAMIC
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
22282878
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna of AZ Commercial |
$114.30
|
| Rate for Payer: Bisbee Police All Plans |
$33.02
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Self Pay Self Pay |
$101.60
|
|
|
29131 APL FNG SPLNT DYNAMIC
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
22282878
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$114.30
|
| Rate for Payer: Aetna of AZ Medicare |
$35.56
|
| Rate for Payer: AHCCCS Medicaid |
$40.35
|
| Rate for Payer: Allwell Medicaid |
$40.35
|
| Rate for Payer: Allwell Medicare |
$20.32
|
| Rate for Payer: Amerigroup Medicare |
$20.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$47.43
|
| Rate for Payer: AZCH Complete Medicaid |
$40.35
|
| Rate for Payer: AZCH Complete Medicare |
$20.32
|
| Rate for Payer: Banner UC Health Medicaid |
$40.35
|
| Rate for Payer: Banner UC Health Medicare |
$20.32
|
| Rate for Payer: Bisbee Police All Plans |
$33.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$86.36
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cigna of AZ Commercial |
$88.90
|
| Rate for Payer: Copperpoint Commercial |
$31.43
|
| Rate for Payer: Health Net of AZ Commercial |
$76.20
|
| Rate for Payer: Health Net of AZ Medicare |
$35.56
|
| Rate for Payer: Humana of AZ Medicare |
$20.32
|
| Rate for Payer: Mercy Care Medicaid |
$40.35
|
| Rate for Payer: Self Pay Self Pay |
$101.60
|
| Rate for Payer: TriWest Medicare |
$20.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$22.86
|
|
|
29200 STRAPPING THORAX
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 29200
|
| Hospital Charge Code |
22282879
|
|
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
|
|
|
29200 STRAPPING THORAX
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 29200
|
| Hospital Charge Code |
22282879
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.00 |
| 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 |
$102.36
|
| Rate for Payer: Allwell Medicaid |
$102.36
|
| Rate for Payer: Allwell Medicare |
$28.00
|
| Rate for Payer: Amerigroup Medicare |
$28.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$65.36
|
| Rate for Payer: AZCH Complete Medicaid |
$102.36
|
| Rate for Payer: AZCH Complete Medicare |
$28.00
|
| Rate for Payer: Banner UC Health Medicaid |
$102.36
|
| Rate for Payer: Banner UC Health Medicare |
$28.00
|
| 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 |
$28.00
|
| Rate for Payer: Mercy Care Medicaid |
$102.36
|
| Rate for Payer: Self Pay Self Pay |
$140.00
|
| Rate for Payer: TriWest Medicare |
$28.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.50
|
|
|
29220 STRAPPING LOW BACK
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 29220
|
| Hospital Charge Code |
22282880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna of AZ Commercial |
$142.20
|
| Rate for Payer: Bisbee Police All Plans |
$41.08
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Self Pay Self Pay |
$126.40
|
|
|
29220 STRAPPING LOW BACK
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 29220
|
| Hospital Charge Code |
22282880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna of AZ Commercial |
$142.20
|
| Rate for Payer: Aetna of AZ Medicare |
$44.24
|
| Rate for Payer: Allwell Medicare |
$25.28
|
| Rate for Payer: Amerigroup Medicare |
$25.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$59.01
|
| Rate for Payer: AZCH Complete Medicare |
$25.28
|
| Rate for Payer: Banner UC Health Medicare |
$25.28
|
| Rate for Payer: Bisbee Police All Plans |
$41.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$107.44
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cigna of AZ Commercial |
$110.60
|
| Rate for Payer: Copperpoint Commercial |
$39.10
|
| Rate for Payer: Health Net of AZ Commercial |
$94.80
|
| Rate for Payer: Health Net of AZ Medicare |
$44.24
|
| Rate for Payer: Humana of AZ Medicare |
$25.28
|
| Rate for Payer: Self Pay Self Pay |
$126.40
|
| Rate for Payer: TriWest Medicare |
$25.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$92.11
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.44
|
|
|
29240 STRAPPING SHOULDER.
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
22282881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$189.00
|
| Rate for Payer: Aetna of AZ Medicare |
$58.80
|
| Rate for Payer: AHCCCS Medicaid |
$81.16
|
| Rate for Payer: Allwell Medicaid |
$81.16
|
| Rate for Payer: Allwell Medicare |
$33.60
|
| Rate for Payer: Amerigroup Medicare |
$33.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$78.44
|
| Rate for Payer: AZCH Complete Medicaid |
$81.16
|
| Rate for Payer: AZCH Complete Medicare |
$33.60
|
| Rate for Payer: Banner UC Health Medicaid |
$81.16
|
| Rate for Payer: Banner UC Health Medicare |
$33.60
|
| Rate for Payer: Bisbee Police All Plans |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$142.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna of AZ Commercial |
$147.00
|
| Rate for Payer: Copperpoint Commercial |
$51.98
|
| Rate for Payer: Health Net of AZ Commercial |
$126.00
|
| Rate for Payer: Health Net of AZ Medicare |
$58.80
|
| Rate for Payer: Humana of AZ Medicare |
$33.60
|
| Rate for Payer: Mercy Care Medicaid |
$81.16
|
| Rate for Payer: Self Pay Self Pay |
$168.00
|
| Rate for Payer: TriWest Medicare |
$33.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$37.80
|
|
|
29240 STRAPPING SHOULDER.
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
22282881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of AZ Commercial |
$189.00
|
| Rate for Payer: Bisbee Police All Plans |
$54.60
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Self Pay Self Pay |
$168.00
|
|
|
29260 STRAPPING ELB/WRIST
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
22282882
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna of AZ Commercial |
$127.80
|
| Rate for Payer: Bisbee Police All Plans |
$36.92
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Self Pay Self Pay |
$113.60
|
|
|
29260 STRAPPING ELB/WRIST
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
22282882
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$127.80
|
| Rate for Payer: Aetna of AZ Medicare |
$39.76
|
| Rate for Payer: AHCCCS Medicaid |
$40.35
|
| Rate for Payer: Allwell Medicaid |
$40.35
|
| Rate for Payer: Allwell Medicare |
$22.72
|
| Rate for Payer: Amerigroup Medicare |
$22.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$53.04
|
| Rate for Payer: AZCH Complete Medicaid |
$40.35
|
| Rate for Payer: AZCH Complete Medicare |
$22.72
|
| Rate for Payer: Banner UC Health Medicaid |
$40.35
|
| Rate for Payer: Banner UC Health Medicare |
$22.72
|
| Rate for Payer: Bisbee Police All Plans |
$36.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$96.56
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cigna of AZ Commercial |
$99.40
|
| Rate for Payer: Copperpoint Commercial |
$35.15
|
| Rate for Payer: Health Net of AZ Commercial |
$85.20
|
| Rate for Payer: Health Net of AZ Medicare |
$39.76
|
| Rate for Payer: Humana of AZ Medicare |
$22.72
|
| Rate for Payer: Mercy Care Medicaid |
$40.35
|
| Rate for Payer: Self Pay Self Pay |
$113.60
|
| Rate for Payer: TriWest Medicare |
$22.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.56
|
|
|
29280 STRAPPING HAND/FINGER
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
22282883
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna of AZ Commercial |
$127.80
|
| Rate for Payer: Bisbee Police All Plans |
$36.92
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Self Pay Self Pay |
$113.60
|
|
|
29280 STRAPPING HAND/FINGER
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
22282883
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$127.80
|
| Rate for Payer: Aetna of AZ Medicare |
$39.76
|
| Rate for Payer: AHCCCS Medicaid |
$40.35
|
| Rate for Payer: Allwell Medicaid |
$40.35
|
| Rate for Payer: Allwell Medicare |
$22.72
|
| Rate for Payer: Amerigroup Medicare |
$22.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$53.04
|
| Rate for Payer: AZCH Complete Medicaid |
$40.35
|
| Rate for Payer: AZCH Complete Medicare |
$22.72
|
| Rate for Payer: Banner UC Health Medicaid |
$40.35
|
| Rate for Payer: Banner UC Health Medicare |
$22.72
|
| Rate for Payer: Bisbee Police All Plans |
$36.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$96.56
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cigna of AZ Commercial |
$99.40
|
| Rate for Payer: Copperpoint Commercial |
$35.15
|
| Rate for Payer: Health Net of AZ Commercial |
$85.20
|
| Rate for Payer: Health Net of AZ Medicare |
$39.76
|
| Rate for Payer: Humana of AZ Medicare |
$22.72
|
| Rate for Payer: Mercy Care Medicaid |
$40.35
|
| Rate for Payer: Self Pay Self Pay |
$113.60
|
| Rate for Payer: TriWest Medicare |
$22.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.56
|
|
|
29365 APPL CAST BRACE LNG LEG
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
22282884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.78 |
| Max. Negotiated Rate |
$452.70 |
| Rate for Payer: Aetna of AZ Commercial |
$452.70
|
| Rate for Payer: Bisbee Police All Plans |
$130.78
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Self Pay Self Pay |
$402.40
|
|
|
29365 APPL CAST BRACE LNG LEG
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
22282884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.48 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$452.70
|
| Rate for Payer: Aetna of AZ Medicare |
$140.84
|
| Rate for Payer: AHCCCS Medicaid |
$174.85
|
| Rate for Payer: Allwell Medicaid |
$174.85
|
| Rate for Payer: Allwell Medicare |
$80.48
|
| Rate for Payer: Amerigroup Medicare |
$80.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$187.87
|
| Rate for Payer: AZCH Complete Medicaid |
$174.85
|
| Rate for Payer: AZCH Complete Medicare |
$80.48
|
| Rate for Payer: Banner UC Health Medicaid |
$174.85
|
| Rate for Payer: Banner UC Health Medicare |
$80.48
|
| Rate for Payer: Bisbee Police All Plans |
$130.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$342.04
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cigna of AZ Commercial |
$352.10
|
| Rate for Payer: Copperpoint Commercial |
$124.49
|
| Rate for Payer: Health Net of AZ Commercial |
$301.80
|
| Rate for Payer: Health Net of AZ Medicare |
$140.84
|
| Rate for Payer: Humana of AZ Medicare |
$80.48
|
| Rate for Payer: Mercy Care Medicaid |
$174.85
|
| Rate for Payer: Self Pay Self Pay |
$402.40
|
| Rate for Payer: TriWest Medicare |
$80.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$90.54
|
|
