|
29125 APL SPLINT SHORT ARM
|
Facility
IP
|
$214.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
22282876
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$192.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$36.38
|
| Rate for Payer: Amerigroup Medicare |
$36.38
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$36.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$36.38
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$55.64
|
| Rate for Payer: Copperpoint |
$60.03
|
| Rate for Payer: Humana Medicare |
$36.38
|
| Rate for Payer: SELF PAY |
$171.20
|
| Rate for Payer: Veterans (Triwest) |
$36.38
|
|
|
29125 APL SPLINT SHORT ARM
|
Facility
OP
|
$214.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
22282876
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$192.60
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| 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 |
$36.38
|
| Rate for Payer: Amerigroup Medicare |
$36.38
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$79.93
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$162.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$36.38
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$36.38
|
| Rate for Payer: Banner University Family Care Medicaid |
$162.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$55.64
|
| Rate for Payer: Cigna All Products |
$149.80
|
| Rate for Payer: Copperpoint |
$60.03
|
| Rate for Payer: HealthNet Commercial |
$128.40
|
| Rate for Payer: HealthNet Medicare |
$59.92
|
| Rate for Payer: Humana Medicare |
$36.38
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: SELF PAY |
$171.20
|
| Rate for Payer: Veterans (Triwest) |
$36.38
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$124.76
|
| Rate for Payer: United Healthcare Medicare |
$38.52
|
|
|
29130 APL FNG SPLNT STATIC
|
Facility
IP
|
$145.00
|
|
| Hospital Charge Code |
24083758
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$130.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$24.65
|
| Rate for Payer: Amerigroup Medicare |
$24.65
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$24.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$24.65
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$37.70
|
| Rate for Payer: Copperpoint |
$40.67
|
| Rate for Payer: Humana Medicare |
$24.65
|
| Rate for Payer: SELF PAY |
$116.00
|
| Rate for Payer: Veterans (Triwest) |
$24.65
|
|
|
29130 APL FNG SPLNT STATIC
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
22282877
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$126.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$23.80
|
| Rate for Payer: Amerigroup Medicare |
$23.80
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.40
|
| Rate for Payer: Copperpoint |
$39.27
|
| Rate for Payer: Humana Medicare |
$23.80
|
| Rate for Payer: SELF PAY |
$112.00
|
| Rate for Payer: Veterans (Triwest) |
$23.80
|
|
|
29130 APL FNG SPLNT STATIC
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
22282877
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$162.32 |
| Rate for Payer: Aetna POS, PPO, HMO |
$126.00
|
| Rate for Payer: Aetna Medicare |
$39.20
|
| 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 |
$23.80
|
| Rate for Payer: Amerigroup Medicare |
$23.80
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$52.29
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$162.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$23.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$23.80
|
| Rate for Payer: Banner University Family Care Medicaid |
$162.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.40
|
| Rate for Payer: Cigna All Products |
$98.00
|
| Rate for Payer: Copperpoint |
$39.27
|
| Rate for Payer: HealthNet Commercial |
$84.00
|
| Rate for Payer: HealthNet Medicare |
$39.20
|
| Rate for Payer: Humana Medicare |
$23.80
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: SELF PAY |
$112.00
|
| Rate for Payer: Veterans (Triwest) |
$23.80
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$81.62
|
| Rate for Payer: United Healthcare Medicare |
$25.20
|
|
|
29130 APL FNG SPLNT STATIC
|
Facility
OP
|
$145.00
|
|
| Hospital Charge Code |
24083758
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$130.50
|
| Rate for Payer: Aetna Medicare |
$40.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$24.65
|
| Rate for Payer: Amerigroup Medicare |
$24.65
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$54.16
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$24.65
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$24.65
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$37.70
|
| Rate for Payer: Cigna All Products |
$101.50
|
| Rate for Payer: Copperpoint |
$40.67
|
| Rate for Payer: HealthNet Commercial |
$87.00
|
| Rate for Payer: HealthNet Medicare |
$40.60
|
| Rate for Payer: Humana Medicare |
$24.65
|
| Rate for Payer: SELF PAY |
$116.00
|
| Rate for Payer: Veterans (Triwest) |
$24.65
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$84.53
|
| Rate for Payer: United Healthcare Medicare |
$26.10
|
|
|
29131 APL FNG SPLNT DYNAMIC
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
22282878
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$115.20
|
| Rate for Payer: Aetna Medicare |
$35.84
|
| Rate for Payer: AHCCCS Medicaid |
$80.70
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$80.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$21.76
|
| Rate for Payer: Amerigroup Medicare |
$21.76
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$47.81
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$80.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$21.76
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$21.76
|
| Rate for Payer: Banner University Family Care Medicaid |
$80.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$33.28
|
| Rate for Payer: Cigna All Products |
$89.60
|
| Rate for Payer: Copperpoint |
$35.90
|
| Rate for Payer: HealthNet Commercial |
$76.80
|
| Rate for Payer: HealthNet Medicare |
$35.84
|
| Rate for Payer: Humana Medicare |
$21.76
|
| Rate for Payer: Mercy Care Medicaid |
$80.70
|
| Rate for Payer: SELF PAY |
$102.40
|
| Rate for Payer: Veterans (Triwest) |
$21.76
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$74.62
|
| Rate for Payer: United Healthcare Medicare |
$23.04
|
|
|
29131 APL FNG SPLNT DYNAMIC
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
22282878
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$115.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$21.76
|
| Rate for Payer: Amerigroup Medicare |
$21.76
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$21.76
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$21.76
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$33.28
|
| Rate for Payer: Copperpoint |
$35.90
|
| Rate for Payer: Humana Medicare |
$21.76
|
| Rate for Payer: SELF PAY |
$102.40
|
| Rate for Payer: Veterans (Triwest) |
$21.76
|
|
|
29200 STRAPPING THORAX
|
Facility
OP
|
$167.00
|
|
|
Service Code
|
CPT 29200
|
| Hospital Charge Code |
22282879
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.39 |
| Max. Negotiated Rate |
$204.72 |
| Rate for Payer: Aetna POS, PPO, HMO |
$150.30
|
| Rate for Payer: Aetna Medicare |
$46.76
|
| Rate for Payer: AHCCCS Medicaid |
$204.72
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$204.72
|
| 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 |
$204.72
|
| 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 |
$204.72
|
| 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 |
$204.72
|
| 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
|
|
|
29200 STRAPPING THORAX
|
Facility
IP
|
$167.00
|
|
|
Service Code
|
CPT 29200
|
| Hospital Charge Code |
22282879
|
|
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
|
|
|
29220 STRAPPING LOW BACK
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 29220
|
| Hospital Charge Code |
22282880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$135.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$25.50
|
| Rate for Payer: Amerigroup Medicare |
$25.50
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$25.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$25.50
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$39.00
|
| Rate for Payer: Copperpoint |
$42.08
|
| Rate for Payer: Humana Medicare |
$25.50
|
| Rate for Payer: SELF PAY |
$120.00
|
| Rate for Payer: Veterans (Triwest) |
$25.50
|
|
|
29220 STRAPPING LOW BACK
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 29220
|
| Hospital Charge Code |
22282880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$135.00
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$25.50
|
| Rate for Payer: Amerigroup Medicare |
$25.50
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$56.02
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$25.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$25.50
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$39.00
|
| Rate for Payer: Cigna All Products |
$105.00
|
| Rate for Payer: Copperpoint |
$42.08
|
| Rate for Payer: HealthNet Commercial |
$90.00
|
| Rate for Payer: HealthNet Medicare |
$42.00
|
| Rate for Payer: Humana Medicare |
$25.50
|
| Rate for Payer: SELF PAY |
$120.00
|
| Rate for Payer: Veterans (Triwest) |
$25.50
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$87.45
|
| Rate for Payer: United Healthcare Medicare |
$27.00
|
|
|
29240 STRAPPING SHOULDER.
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
22282881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$189.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$35.70
|
| Rate for Payer: Amerigroup Medicare |
$35.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$35.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$35.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$54.60
|
| Rate for Payer: Copperpoint |
$58.91
|
| Rate for Payer: Humana Medicare |
$35.70
|
| Rate for Payer: SELF PAY |
$168.00
|
| Rate for Payer: Veterans (Triwest) |
$35.70
|
|
|
29240 STRAPPING SHOULDER.
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
22282881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$189.00
|
| Rate for Payer: Aetna Medicare |
$58.80
|
| 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 |
$35.70
|
| Rate for Payer: Amerigroup Medicare |
$35.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$78.44
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$162.32
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$35.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$35.70
|
| Rate for Payer: Banner University Family Care Medicaid |
$162.32
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$54.60
|
| Rate for Payer: Cigna All Products |
$147.00
|
| Rate for Payer: Copperpoint |
$58.91
|
| Rate for Payer: HealthNet Commercial |
$126.00
|
| Rate for Payer: HealthNet Medicare |
$58.80
|
| Rate for Payer: Humana Medicare |
$35.70
|
| Rate for Payer: Mercy Care Medicaid |
$162.32
|
| Rate for Payer: SELF PAY |
$168.00
|
| Rate for Payer: Veterans (Triwest) |
$35.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$122.43
|
| Rate for Payer: United Healthcare Medicare |
$37.80
|
|
|
29260 STRAPPING ELB/WRIST
|
Facility
IP
|
$142.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
22282882
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$127.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$24.14
|
| Rate for Payer: Amerigroup Medicare |
$24.14
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$24.14
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$24.14
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.92
|
| Rate for Payer: Copperpoint |
$39.83
|
| Rate for Payer: Humana Medicare |
$24.14
|
| Rate for Payer: SELF PAY |
$113.60
|
| Rate for Payer: Veterans (Triwest) |
$24.14
|
|
|
29260 STRAPPING ELB/WRIST
|
Facility
OP
|
$142.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
22282882
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$127.80
|
| Rate for Payer: Aetna Medicare |
$39.76
|
| Rate for Payer: AHCCCS Medicaid |
$80.70
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$80.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$24.14
|
| Rate for Payer: Amerigroup Medicare |
$24.14
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$53.04
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$80.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$24.14
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$24.14
|
| Rate for Payer: Banner University Family Care Medicaid |
$80.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.92
|
| Rate for Payer: Cigna All Products |
$99.40
|
| Rate for Payer: Copperpoint |
$39.83
|
| Rate for Payer: HealthNet Commercial |
$85.20
|
| Rate for Payer: HealthNet Medicare |
$39.76
|
| Rate for Payer: Humana Medicare |
$24.14
|
| Rate for Payer: Mercy Care Medicaid |
$80.70
|
| Rate for Payer: SELF PAY |
$113.60
|
| Rate for Payer: Veterans (Triwest) |
$24.14
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$82.79
|
| Rate for Payer: United Healthcare Medicare |
$25.56
|
|
|
29280 STRAPPING HAND/FINGER
|
Facility
OP
|
$142.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
22282883
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$127.80
|
| Rate for Payer: Aetna Medicare |
$39.76
|
| Rate for Payer: AHCCCS Medicaid |
$80.70
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$80.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$24.14
|
| Rate for Payer: Amerigroup Medicare |
$24.14
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$53.04
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$80.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$24.14
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$24.14
|
| Rate for Payer: Banner University Family Care Medicaid |
$80.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.92
|
| Rate for Payer: Cigna All Products |
$99.40
|
| Rate for Payer: Copperpoint |
$39.83
|
| Rate for Payer: HealthNet Commercial |
$85.20
|
| Rate for Payer: HealthNet Medicare |
$39.76
|
| Rate for Payer: Humana Medicare |
$24.14
|
| Rate for Payer: Mercy Care Medicaid |
$80.70
|
| Rate for Payer: SELF PAY |
$113.60
|
| Rate for Payer: Veterans (Triwest) |
$24.14
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$82.79
|
| Rate for Payer: United Healthcare 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 |
$24.14 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$127.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$24.14
|
| Rate for Payer: Amerigroup Medicare |
$24.14
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$24.14
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$24.14
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$36.92
|
| Rate for Payer: Copperpoint |
$39.83
|
| Rate for Payer: Humana Medicare |
$24.14
|
| Rate for Payer: SELF PAY |
$113.60
|
| Rate for Payer: Veterans (Triwest) |
$24.14
|
|
|
29365 APPL CAST BRACE LNG LEG
|
Facility
IP
|
$479.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
22282884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.43 |
| Max. Negotiated Rate |
$431.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$431.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$81.43
|
| Rate for Payer: Amerigroup Medicare |
$81.43
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$81.43
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$81.43
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$124.54
|
| Rate for Payer: Copperpoint |
$134.36
|
| Rate for Payer: Humana Medicare |
$81.43
|
| Rate for Payer: SELF PAY |
$383.20
|
| Rate for Payer: Veterans (Triwest) |
$81.43
|
|
|
29365 APPL CAST BRACE LNG LEG
|
Facility
OP
|
$479.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
22282884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.43 |
| Max. Negotiated Rate |
$431.10 |
| Rate for Payer: Mercy Care Medicaid |
$349.70
|
| Rate for Payer: SELF PAY |
$383.20
|
| Rate for Payer: Aetna POS, PPO, HMO |
$431.10
|
| Rate for Payer: Aetna Medicare |
$134.12
|
| Rate for Payer: AHCCCS Medicaid |
$349.70
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$349.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$81.43
|
| Rate for Payer: Amerigroup Medicare |
$81.43
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$178.91
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$349.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$81.43
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$81.43
|
| Rate for Payer: Banner University Family Care Medicaid |
$349.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$124.54
|
| Rate for Payer: Cigna All Products |
$335.30
|
| Rate for Payer: Copperpoint |
$134.36
|
| Rate for Payer: HealthNet Commercial |
$287.40
|
| Rate for Payer: HealthNet Medicare |
$134.12
|
| Rate for Payer: Humana Medicare |
$81.43
|
| Rate for Payer: Veterans (Triwest) |
$81.43
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$279.26
|
| Rate for Payer: United Healthcare Medicare |
$86.22
|
|
|
29505 APPL SPLINT LONG LEG
|
Facility
OP
|
$241.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
22282885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.97 |
| Max. Negotiated Rate |
$216.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$216.90
|
| Rate for Payer: Aetna Medicare |
$67.48
|
| Rate for Payer: AHCCCS Medicaid |
$204.72
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$204.72
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.97
|
| Rate for Payer: Amerigroup Medicare |
$40.97
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$90.01
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$204.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.97
|
| Rate for Payer: Banner University Family Care Medicaid |
$204.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$62.66
|
| Rate for Payer: Cigna All Products |
$168.70
|
| Rate for Payer: Copperpoint |
$67.60
|
| Rate for Payer: HealthNet Commercial |
$144.60
|
| Rate for Payer: HealthNet Medicare |
$67.48
|
| Rate for Payer: Humana Medicare |
$40.97
|
| Rate for Payer: Mercy Care Medicaid |
$204.72
|
| Rate for Payer: SELF PAY |
$192.80
|
| Rate for Payer: Veterans (Triwest) |
$40.97
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$140.50
|
| Rate for Payer: United Healthcare Medicare |
$43.38
|
|
|
29505 APPL SPLINT LONG LEG
|
Facility
IP
|
$241.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
22282885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.97 |
| Max. Negotiated Rate |
$216.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$216.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$40.97
|
| Rate for Payer: Amerigroup Medicare |
$40.97
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$40.97
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$40.97
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$62.66
|
| Rate for Payer: Copperpoint |
$67.60
|
| Rate for Payer: Humana Medicare |
$40.97
|
| Rate for Payer: SELF PAY |
$192.80
|
| Rate for Payer: Veterans (Triwest) |
$40.97
|
|
|
29515 APPL SPLINT SHRT LEG
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
22282886
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$234.00
|
| Rate for Payer: Aetna Medicare |
$72.80
|
| Rate for Payer: AHCCCS Medicaid |
$204.72
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$204.72
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$44.20
|
| Rate for Payer: Amerigroup Medicare |
$44.20
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$97.11
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$204.72
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$44.20
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$44.20
|
| Rate for Payer: Banner University Family Care Medicaid |
$204.72
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$67.60
|
| Rate for Payer: Cigna All Products |
$182.00
|
| Rate for Payer: Copperpoint |
$72.93
|
| Rate for Payer: HealthNet Commercial |
$156.00
|
| Rate for Payer: HealthNet Medicare |
$72.80
|
| Rate for Payer: Humana Medicare |
$44.20
|
| Rate for Payer: Mercy Care Medicaid |
$204.72
|
| Rate for Payer: SELF PAY |
$208.00
|
| Rate for Payer: Veterans (Triwest) |
$44.20
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$151.58
|
| Rate for Payer: United Healthcare Medicare |
$46.80
|
|
|
29515 APPL SPLINT SHRT LEG
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
22282886
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$234.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$44.20
|
| Rate for Payer: Amerigroup Medicare |
$44.20
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$44.20
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$44.20
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$67.60
|
| Rate for Payer: Copperpoint |
$72.93
|
| Rate for Payer: Humana Medicare |
$44.20
|
| Rate for Payer: SELF PAY |
$208.00
|
| Rate for Payer: Veterans (Triwest) |
$44.20
|
|
|
29520 STRAPPING HIP
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
22282887
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$118.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$22.44
|
| Rate for Payer: Amerigroup Medicare |
$22.44
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$22.44
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$22.44
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$34.32
|
| Rate for Payer: Copperpoint |
$37.03
|
| Rate for Payer: Humana Medicare |
$22.44
|
| Rate for Payer: SELF PAY |
$105.60
|
| Rate for Payer: Veterans (Triwest) |
$22.44
|
|