|
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 |
$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 |
$204.72
|
| Rate for Payer: Allwell Medicaid |
$204.72
|
| 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 |
$204.72
|
| Rate for Payer: AZCH Complete Medicare |
$26.25
|
| Rate for Payer: Banner UC Health Medicaid |
$204.72
|
| 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 |
$204.72
|
| 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
|
|
|
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 |
$23.70 |
| 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 |
$23.70
|
| Rate for Payer: Amerigroup Medicare |
$23.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$59.01
|
| Rate for Payer: AZCH Complete Medicare |
$23.70
|
| Rate for Payer: Banner UC Health Medicare |
$23.70
|
| 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 |
$23.70
|
| Rate for Payer: Self Pay Self Pay |
$126.40
|
| Rate for Payer: TriWest Medicare |
$23.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$92.11
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.44
|
|
|
29240 STRAPPING SHOULDER.
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
22282881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of AZ Commercial |
$198.90
|
| Rate for Payer: Bisbee Police All Plans |
$57.46
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Self Pay Self Pay |
$176.80
|
|
|
29240 STRAPPING SHOULDER.
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
22282881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$198.90
|
| Rate for Payer: Aetna of AZ Medicare |
$61.88
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$33.15
|
| Rate for Payer: Amerigroup Medicare |
$33.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$82.54
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$33.15
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$33.15
|
| Rate for Payer: Bisbee Police All Plans |
$57.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$150.28
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cigna of AZ Commercial |
$154.70
|
| Rate for Payer: Copperpoint Commercial |
$54.70
|
| Rate for Payer: Health Net of AZ Commercial |
$132.60
|
| Rate for Payer: Health Net of AZ Medicare |
$61.88
|
| Rate for Payer: Humana of AZ Medicare |
$33.15
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$176.80
|
| Rate for Payer: TriWest Medicare |
$33.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$39.78
|
|
|
29260 STRAPPING ELB/WRIST
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
22282882
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of AZ Commercial |
$134.10
|
| Rate for Payer: Bisbee Police All Plans |
$38.74
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Self Pay Self Pay |
$119.20
|
|
|
29260 STRAPPING ELB/WRIST
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
22282882
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$134.10
|
| Rate for Payer: Aetna of AZ Medicare |
$41.72
|
| Rate for Payer: AHCCCS Medicaid |
$80.70
|
| Rate for Payer: Allwell Medicaid |
$80.70
|
| Rate for Payer: Allwell Medicare |
$22.35
|
| Rate for Payer: Amerigroup Medicare |
$22.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.65
|
| Rate for Payer: AZCH Complete Medicaid |
$80.70
|
| Rate for Payer: AZCH Complete Medicare |
$22.35
|
| Rate for Payer: Banner UC Health Medicaid |
$80.70
|
| Rate for Payer: Banner UC Health Medicare |
$22.35
|
| Rate for Payer: Bisbee Police All Plans |
$38.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$101.32
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cigna of AZ Commercial |
$104.30
|
| Rate for Payer: Copperpoint Commercial |
$36.88
|
| Rate for Payer: Health Net of AZ Commercial |
$89.40
|
| Rate for Payer: Health Net of AZ Medicare |
$41.72
|
| Rate for Payer: Humana of AZ Medicare |
$22.35
|
| Rate for Payer: Mercy Care Medicaid |
$80.70
|
| Rate for Payer: Self Pay Self Pay |
$119.20
|
| Rate for Payer: TriWest Medicare |
$22.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.82
|
|
|
29280 STRAPPING HAND/FINGER
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
22282883
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$134.10
|
| Rate for Payer: Aetna of AZ Medicare |
$41.72
|
| Rate for Payer: AHCCCS Medicaid |
$80.70
|
| Rate for Payer: Allwell Medicaid |
$80.70
|
| Rate for Payer: Allwell Medicare |
$22.35
|
| Rate for Payer: Amerigroup Medicare |
$22.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.65
|
| Rate for Payer: AZCH Complete Medicaid |
$80.70
|
| Rate for Payer: AZCH Complete Medicare |
$22.35
|
| Rate for Payer: Banner UC Health Medicaid |
$80.70
|
| Rate for Payer: Banner UC Health Medicare |
$22.35
|
| Rate for Payer: Bisbee Police All Plans |
$38.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$101.32
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cigna of AZ Commercial |
$104.30
|
| Rate for Payer: Copperpoint Commercial |
$36.88
|
| Rate for Payer: Health Net of AZ Commercial |
$89.40
|
| Rate for Payer: Health Net of AZ Medicare |
$41.72
|
| Rate for Payer: Humana of AZ Medicare |
$22.35
|
| Rate for Payer: Mercy Care Medicaid |
$80.70
|
| Rate for Payer: Self Pay Self Pay |
$119.20
|
| Rate for Payer: TriWest Medicare |
$22.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.82
|
|
|
29280 STRAPPING HAND/FINGER
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
22282883
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of AZ Commercial |
$134.10
|
| Rate for Payer: Bisbee Police All Plans |
$38.74
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Self Pay Self Pay |
$119.20
|
|
|
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 |
$75.45 |
| 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 |
$349.70
|
| Rate for Payer: Allwell Medicaid |
$349.70
|
| Rate for Payer: Allwell Medicare |
$75.45
|
| Rate for Payer: Amerigroup Medicare |
$75.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$187.87
|
| Rate for Payer: AZCH Complete Medicaid |
$349.70
|
| Rate for Payer: AZCH Complete Medicare |
$75.45
|
| Rate for Payer: Banner UC Health Medicaid |
$349.70
|
| Rate for Payer: Banner UC Health Medicare |
$75.45
|
| 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 |
$75.45
|
| Rate for Payer: Mercy Care Medicaid |
$349.70
|
| Rate for Payer: Self Pay Self Pay |
$402.40
|
| Rate for Payer: TriWest Medicare |
$75.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$90.54
|
|
|
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
|
|
|
29505 APPL SPLINT LONG LEG
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
22282885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.78 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of AZ Commercial |
$227.70
|
| Rate for Payer: Bisbee Police All Plans |
$65.78
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Self Pay Self Pay |
$202.40
|
|
|
29505 APPL SPLINT LONG LEG
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
22282885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$227.70
|
| Rate for Payer: Aetna of AZ Medicare |
$70.84
|
| Rate for Payer: AHCCCS Medicaid |
$204.72
|
| Rate for Payer: Allwell Medicaid |
$204.72
|
| Rate for Payer: Allwell Medicare |
$37.95
|
| Rate for Payer: Amerigroup Medicare |
$37.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$94.50
|
| Rate for Payer: AZCH Complete Medicaid |
$204.72
|
| Rate for Payer: AZCH Complete Medicare |
$37.95
|
| Rate for Payer: Banner UC Health Medicaid |
$204.72
|
| Rate for Payer: Banner UC Health Medicare |
$37.95
|
| Rate for Payer: Bisbee Police All Plans |
$65.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$172.04
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cigna of AZ Commercial |
$177.10
|
| Rate for Payer: Copperpoint Commercial |
$62.62
|
| Rate for Payer: Health Net of AZ Commercial |
$151.80
|
| Rate for Payer: Health Net of AZ Medicare |
$70.84
|
| Rate for Payer: Humana of AZ Medicare |
$37.95
|
| Rate for Payer: Mercy Care Medicaid |
$204.72
|
| Rate for Payer: Self Pay Self Pay |
$202.40
|
| Rate for Payer: TriWest Medicare |
$37.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$45.54
|
|
|
29515 APPL SPLINT SHRT LEG
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
22282886
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Aetna of AZ Commercial |
$245.70
|
| Rate for Payer: Bisbee Police All Plans |
$70.98
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Self Pay Self Pay |
$218.40
|
|
|
29515 APPL SPLINT SHRT LEG
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
22282886
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$245.70
|
| Rate for Payer: Aetna of AZ Medicare |
$76.44
|
| Rate for Payer: AHCCCS Medicaid |
$204.72
|
| Rate for Payer: Allwell Medicaid |
$204.72
|
| Rate for Payer: Allwell Medicare |
$40.95
|
| Rate for Payer: Amerigroup Medicare |
$40.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$101.97
|
| Rate for Payer: AZCH Complete Medicaid |
$204.72
|
| Rate for Payer: AZCH Complete Medicare |
$40.95
|
| Rate for Payer: Banner UC Health Medicaid |
$204.72
|
| Rate for Payer: Banner UC Health Medicare |
$40.95
|
| Rate for Payer: Bisbee Police All Plans |
$70.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$185.64
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna of AZ Commercial |
$191.10
|
| Rate for Payer: Copperpoint Commercial |
$67.57
|
| Rate for Payer: Health Net of AZ Commercial |
$163.80
|
| Rate for Payer: Health Net of AZ Medicare |
$76.44
|
| Rate for Payer: Humana of AZ Medicare |
$40.95
|
| Rate for Payer: Mercy Care Medicaid |
$204.72
|
| Rate for Payer: Self Pay Self Pay |
$218.40
|
| Rate for Payer: TriWest Medicare |
$40.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$49.14
|
|
|
29520 STRAPPING HIP
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
22282887
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Bisbee Police All Plans |
$36.14
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Self Pay Self Pay |
$111.20
|
|
|
29520 STRAPPING HIP
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
22282887
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Aetna of AZ Medicare |
$38.92
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$20.85
|
| Rate for Payer: Amerigroup Medicare |
$20.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$51.92
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$20.85
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$20.85
|
| Rate for Payer: Bisbee Police All Plans |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$94.52
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cigna of AZ Commercial |
$97.30
|
| Rate for Payer: Copperpoint Commercial |
$34.40
|
| Rate for Payer: Health Net of AZ Commercial |
$83.40
|
| Rate for Payer: Health Net of AZ Medicare |
$38.92
|
| Rate for Payer: Humana of AZ Medicare |
$20.85
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$111.20
|
| Rate for Payer: TriWest Medicare |
$20.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.02
|
|
|
29530 STRAPPING KNEE
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
22282888
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
29530 STRAPPING KNEE
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
22282888
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Aetna of AZ Medicare |
$49.56
|
| Rate for Payer: AHCCCS Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicaid |
$162.32
|
| Rate for Payer: Allwell Medicare |
$26.55
|
| Rate for Payer: Amerigroup Medicare |
$26.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$66.11
|
| Rate for Payer: AZCH Complete Medicaid |
$162.32
|
| Rate for Payer: AZCH Complete Medicare |
$26.55
|
| Rate for Payer: Banner UC Health Medicaid |
$162.32
|
| Rate for Payer: Banner UC Health Medicare |
$26.55
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$120.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$123.90
|
| Rate for Payer: Copperpoint Commercial |
$43.81
|
| Rate for Payer: Health Net of AZ Commercial |
$106.20
|
| Rate for Payer: Health Net of AZ Medicare |
$49.56
|
| Rate for Payer: Humana of AZ Medicare |
$26.55
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
| Rate for Payer: TriWest Medicare |
$26.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.86
|
|
|
29540 STRAPPING ANKLE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
22282889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of AZ Commercial |
$130.50
|
| Rate for Payer: Bisbee Police All Plans |
$37.70
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Self Pay Self Pay |
$116.00
|
|
|
29540 STRAPPING ANKLE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
22282889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$130.50
|
| Rate for Payer: Aetna of AZ Medicare |
$40.60
|
| Rate for Payer: AHCCCS Medicaid |
$204.72
|
| Rate for Payer: Allwell Medicaid |
$204.72
|
| Rate for Payer: Allwell Medicare |
$21.75
|
| Rate for Payer: Amerigroup Medicare |
$21.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$54.16
|
| Rate for Payer: AZCH Complete Medicaid |
$204.72
|
| Rate for Payer: AZCH Complete Medicare |
$21.75
|
| Rate for Payer: Banner UC Health Medicaid |
$204.72
|
| Rate for Payer: Banner UC Health Medicare |
$21.75
|
| Rate for Payer: Bisbee Police All Plans |
$37.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna of AZ Commercial |
$101.50
|
| Rate for Payer: Copperpoint Commercial |
$35.89
|
| Rate for Payer: Health Net of AZ Commercial |
$87.00
|
| Rate for Payer: Health Net of AZ Medicare |
$40.60
|
| Rate for Payer: Humana of AZ Medicare |
$21.75
|
| Rate for Payer: Mercy Care Medicaid |
$204.72
|
| Rate for Payer: Self Pay Self Pay |
$116.00
|
| Rate for Payer: TriWest Medicare |
$21.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.10
|
|
|
29550 STRAPPING TOES
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
22282890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$120.60
|
| Rate for Payer: Aetna of AZ Medicare |
$37.52
|
| Rate for Payer: AHCCCS Medicaid |
$80.70
|
| Rate for Payer: Allwell Medicaid |
$80.70
|
| Rate for Payer: Allwell Medicare |
$20.10
|
| Rate for Payer: Amerigroup Medicare |
$20.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$50.05
|
| Rate for Payer: AZCH Complete Medicaid |
$80.70
|
| Rate for Payer: AZCH Complete Medicare |
$20.10
|
| Rate for Payer: Banner UC Health Medicaid |
$80.70
|
| Rate for Payer: Banner UC Health Medicare |
$20.10
|
| Rate for Payer: Bisbee Police All Plans |
$34.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$91.12
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cigna of AZ Commercial |
$93.80
|
| Rate for Payer: Copperpoint Commercial |
$33.16
|
| Rate for Payer: Health Net of AZ Commercial |
$80.40
|
| Rate for Payer: Health Net of AZ Medicare |
$37.52
|
| Rate for Payer: Humana of AZ Medicare |
$20.10
|
| Rate for Payer: Mercy Care Medicaid |
$80.70
|
| Rate for Payer: Self Pay Self Pay |
$107.20
|
| Rate for Payer: TriWest Medicare |
$20.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$24.12
|
|
|
29550 STRAPPING TOES
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
22282890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of AZ Commercial |
$120.60
|
| Rate for Payer: Bisbee Police All Plans |
$34.84
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Self Pay Self Pay |
$107.20
|
|
|
29580 STRAPPING UNNA BOOT
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
22282891
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of AZ Commercial |
$153.00
|
| Rate for Payer: Bisbee Police All Plans |
$44.20
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Self Pay Self Pay |
$136.00
|
|
