|
29505 APPL SPLINT LONG LEG
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
22282885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.49 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna of AZ Commercial |
$275.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$48.96
|
| Rate for Payer: Banner UC Health Medicare |
$48.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$208.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$41.49
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$48.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$48.96
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna of AZ Commercial |
$214.20
|
| Rate for Payer: Devoted Health Medicare |
$55.08
|
| Rate for Payer: Humana of AZ Medicare |
$48.96
|
| Rate for Payer: Mercy Care Medicaid |
$41.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$41.49
|
| Rate for Payer: Seven Corners Travel Insurance |
$251.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$208.08
|
| Rate for Payer: TriWest Medicare |
$48.96
|
| Rate for Payer: United Healthcare Commercial |
$175.03
|
| Rate for Payer: United Healthcare Medicare |
$48.96
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$58.14
|
| Rate for Payer: Veterans Affairs TRICARE |
$48.47
|
|
|
29505 APPL SPLINT LONG LEG
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
22282885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna of AZ Commercial |
$275.40
|
| Rate for Payer: Cash Price |
$244.80
|
|
|
29515 APPL SPLINT SHRT LEG
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
22282886
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.70 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Aetna of AZ Commercial |
$272.70
|
| Rate for Payer: Cash Price |
$242.40
|
|
|
29515 APPL SPLINT SHRT LEG
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
22282886
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Aetna of AZ Commercial |
$272.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$48.48
|
| Rate for Payer: Banner UC Health Medicare |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$206.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$48.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$48.48
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna of AZ Commercial |
$212.10
|
| Rate for Payer: Devoted Health Medicare |
$54.54
|
| Rate for Payer: Humana of AZ Medicare |
$48.48
|
| Rate for Payer: Mercy Care Medicaid |
$25.11
|
| Rate for Payer: NaphCare Correctional Healthcare |
$25.11
|
| Rate for Payer: Seven Corners Travel Insurance |
$251.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$206.04
|
| Rate for Payer: TriWest Medicare |
$48.48
|
| Rate for Payer: United Healthcare Commercial |
$173.32
|
| Rate for Payer: United Healthcare Medicare |
$48.48
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$57.57
|
| Rate for Payer: Veterans Affairs TRICARE |
$48.00
|
|
|
29520 STRAPPING HIP
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
22282887
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
|
|
29520 STRAPPING HIP
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
22282887
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.53 |
| Max. Negotiated Rate |
$205.86 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$22.24
|
| Rate for Payer: Banner UC Health Medicare |
$22.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$94.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17.53
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$22.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$22.24
|
| 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: Devoted Health Medicare |
$25.02
|
| Rate for Payer: Humana of AZ Medicare |
$22.24
|
| Rate for Payer: Mercy Care Medicaid |
$17.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17.53
|
| Rate for Payer: Seven Corners Travel Insurance |
$205.86
|
| Rate for Payer: Southwest Service Administrators UFCW |
$94.52
|
| Rate for Payer: TriWest Medicare |
$22.24
|
| Rate for Payer: United Healthcare Commercial |
$79.51
|
| Rate for Payer: United Healthcare Medicare |
$22.24
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$26.41
|
| Rate for Payer: Veterans Affairs TRICARE |
$22.02
|
|
|
29530 KNEE IMMOBLIZER Clinic Charge
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
10197413
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$205.86 |
| Rate for Payer: Aetna of AZ Commercial |
$90.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$16.16
|
| Rate for Payer: Banner UC Health Medicare |
$16.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$68.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12.51
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$16.16
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cigna of AZ Commercial |
$70.70
|
| Rate for Payer: Devoted Health Medicare |
$18.18
|
| Rate for Payer: Humana of AZ Medicare |
$16.16
|
| Rate for Payer: Mercy Care Medicaid |
$12.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12.51
|
| Rate for Payer: Seven Corners Travel Insurance |
$205.86
|
| Rate for Payer: Southwest Service Administrators UFCW |
$68.68
|
| Rate for Payer: TriWest Medicare |
$16.16
|
| Rate for Payer: United Healthcare Commercial |
$57.77
|
| Rate for Payer: United Healthcare Medicare |
$16.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$16.00
|
|
|
29530 KNEE IMMOBLIZER Clinic Charge
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
10197413
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna of AZ Commercial |
$90.90
|
| Rate for Payer: Cash Price |
$80.80
|
|
|
29530 STRAPPING KNEE
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
22282888
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$205.86 |
| Rate for Payer: Aetna of AZ Commercial |
$151.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$26.88
|
| Rate for Payer: Banner UC Health Medicare |
$26.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12.51
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$26.88
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$26.88
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna of AZ Commercial |
$117.60
|
| Rate for Payer: Devoted Health Medicare |
$30.24
|
| Rate for Payer: Humana of AZ Medicare |
$26.88
|
| Rate for Payer: Mercy Care Medicaid |
$12.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12.51
|
| Rate for Payer: Seven Corners Travel Insurance |
$205.86
|
| Rate for Payer: Southwest Service Administrators UFCW |
$114.24
|
| Rate for Payer: TriWest Medicare |
$26.88
|
| Rate for Payer: United Healthcare Commercial |
$96.10
|
| Rate for Payer: United Healthcare Medicare |
$26.88
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$31.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$26.61
|
|
|
29530 STRAPPING KNEE
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
22282888
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna of AZ Commercial |
$151.20
|
| Rate for Payer: Cash Price |
$134.40
|
|
|
29540 ANKLE STRAPPING Clinic Charge
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
10197414
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of AZ Commercial |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
|
|
29540 ANKLE STRAPPING Clinic Charge
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
10197414
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$251.43 |
| Rate for Payer: Aetna of AZ Commercial |
$102.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$18.24
|
| Rate for Payer: Banner UC Health Medicare |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$77.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$18.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$18.24
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna of AZ Commercial |
$79.80
|
| Rate for Payer: Devoted Health Medicare |
$20.52
|
| Rate for Payer: Humana of AZ Medicare |
$18.24
|
| Rate for Payer: Mercy Care Medicaid |
$11.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11.80
|
| Rate for Payer: Seven Corners Travel Insurance |
$251.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$77.52
|
| Rate for Payer: TriWest Medicare |
$18.24
|
| Rate for Payer: United Healthcare Commercial |
$65.21
|
| Rate for Payer: United Healthcare Medicare |
$18.24
|
| Rate for Payer: Veterans Affairs TRICARE |
$18.06
|
|
|
29540 STRAPPING ANKLE
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
22282889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$251.43 |
| Rate for Payer: Aetna of AZ Commercial |
$124.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$22.08
|
| Rate for Payer: Banner UC Health Medicare |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$93.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$22.08
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$22.08
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna of AZ Commercial |
$96.60
|
| Rate for Payer: Devoted Health Medicare |
$24.84
|
| Rate for Payer: Humana of AZ Medicare |
$22.08
|
| Rate for Payer: Mercy Care Medicaid |
$11.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11.80
|
| Rate for Payer: Seven Corners Travel Insurance |
$251.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$93.84
|
| Rate for Payer: TriWest Medicare |
$22.08
|
| Rate for Payer: United Healthcare Commercial |
$78.94
|
| Rate for Payer: United Healthcare Medicare |
$22.08
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$26.22
|
| Rate for Payer: Veterans Affairs TRICARE |
$21.86
|
|
|
29540 STRAPPING ANKLE
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
22282889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of AZ Commercial |
$124.20
|
| Rate for Payer: Cash Price |
$110.40
|
|
|
29550 STRAPPING TOES
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
22282890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of AZ Commercial |
$120.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$21.44
|
| Rate for Payer: Banner UC Health Medicare |
$21.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$91.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$21.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$21.44
|
| 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: Devoted Health Medicare |
$24.12
|
| Rate for Payer: Humana of AZ Medicare |
$21.44
|
| Rate for Payer: Mercy Care Medicaid |
$8.58
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8.58
|
| Rate for Payer: Seven Corners Travel Insurance |
$91.28
|
| Rate for Payer: Southwest Service Administrators UFCW |
$91.12
|
| Rate for Payer: TriWest Medicare |
$21.44
|
| Rate for Payer: United Healthcare Commercial |
$76.65
|
| Rate for Payer: United Healthcare Medicare |
$21.44
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$25.46
|
| Rate for Payer: Veterans Affairs TRICARE |
$21.23
|
|
|
29550 STRAPPING TOES
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
22282890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of AZ Commercial |
$120.60
|
| Rate for Payer: Cash Price |
$107.20
|
|
|
29580 STRAPPING UNNA BOOT
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
22282891
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.30 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna of AZ Commercial |
$186.30
|
| Rate for Payer: Cash Price |
$165.60
|
|
|
29580 STRAPPING UNNA BOOT
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
22282891
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.79 |
| Max. Negotiated Rate |
$251.43 |
| Rate for Payer: Aetna of AZ Commercial |
$186.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$33.12
|
| Rate for Payer: Banner UC Health Medicare |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$140.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$39.69
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$33.12
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$33.12
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of AZ Commercial |
$144.90
|
| Rate for Payer: Devoted Health Medicare |
$37.26
|
| Rate for Payer: Humana of AZ Medicare |
$33.12
|
| Rate for Payer: Mercy Care Medicaid |
$39.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$39.69
|
| Rate for Payer: Seven Corners Travel Insurance |
$251.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$140.76
|
| Rate for Payer: TriWest Medicare |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$118.40
|
| Rate for Payer: United Healthcare Medicare |
$33.12
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$39.33
|
| Rate for Payer: Veterans Affairs TRICARE |
$32.79
|
|
|
29581 Application of Mulitplayer Compression System: Leg(Bel
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
24089559
|
| Min. Negotiated Rate |
$17.11 |
| Max. Negotiated Rate |
$251.43 |
| Rate for Payer: Aetna of AZ Commercial |
$97.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$17.28
|
| Rate for Payer: Banner UC Health Medicare |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$62.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$17.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$17.28
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of AZ Commercial |
$75.60
|
| Rate for Payer: Devoted Health Medicare |
$19.44
|
| Rate for Payer: Humana of AZ Medicare |
$17.28
|
| Rate for Payer: Mercy Care Medicaid |
$62.06
|
| Rate for Payer: NaphCare Correctional Healthcare |
$62.06
|
| Rate for Payer: Seven Corners Travel Insurance |
$251.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$73.44
|
| Rate for Payer: TriWest Medicare |
$17.28
|
| Rate for Payer: United Healthcare Commercial |
$61.78
|
| Rate for Payer: United Healthcare Medicare |
$17.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$17.11
|
|
|
29581 Application of Mulitplayer Compression System: Leg(Bel
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
24089559
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of AZ Commercial |
$97.20
|
| Rate for Payer: Cash Price |
$86.40
|
|
|
29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL
|
Facility
|
IP
|
$2,951.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
23206694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,655.90 |
| Max. Negotiated Rate |
$2,655.90 |
| Rate for Payer: Aetna of AZ Commercial |
$2,655.90
|
| Rate for Payer: Cash Price |
$2,360.80
|
|
|
29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL
|
Facility
|
OP
|
$2,951.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
23206694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$467.44 |
| Max. Negotiated Rate |
$5,062.66 |
| Rate for Payer: Aetna of AZ Commercial |
$2,655.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$472.16
|
| Rate for Payer: Banner UC Health Medicare |
$1,062.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$2,006.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$472.16
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$472.16
|
| Rate for Payer: Cash Price |
$2,360.80
|
| Rate for Payer: Cash Price |
$2,360.80
|
| Rate for Payer: Cash Price |
$2,360.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,475.50
|
| Rate for Payer: Devoted Health Medicare |
$531.18
|
| Rate for Payer: Humana of AZ Medicare |
$472.16
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,062.88
|
| Rate for Payer: Seven Corners Travel Insurance |
$5,062.66
|
| Rate for Payer: Southwest Service Administrators UFCW |
$2,006.68
|
| Rate for Payer: TriWest Medicare |
$472.16
|
| Rate for Payer: United Healthcare Commercial |
$4,838.00
|
| Rate for Payer: United Healthcare Medicare |
$472.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$467.44
|
|
|
30300 RMV FB NOSE
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
22282892
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of AZ Commercial |
$350.10
|
| Rate for Payer: Cash Price |
$311.20
|
|
|
30300 RMV FB NOSE
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
22282892
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of AZ Commercial |
$350.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$62.24
|
| Rate for Payer: Banner UC Health Medicare |
$62.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$264.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$62.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$62.24
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Cigna of AZ Commercial |
$272.30
|
| Rate for Payer: Devoted Health Medicare |
$70.02
|
| Rate for Payer: Humana of AZ Medicare |
$62.24
|
| Rate for Payer: Mercy Care Medicaid |
$91.55
|
| Rate for Payer: NaphCare Correctional Healthcare |
$91.55
|
| Rate for Payer: Seven Corners Travel Insurance |
$205.86
|
| Rate for Payer: Southwest Service Administrators UFCW |
$264.52
|
| Rate for Payer: TriWest Medicare |
$62.24
|
| Rate for Payer: United Healthcare Commercial |
$222.51
|
| Rate for Payer: United Healthcare Medicare |
$62.24
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$73.91
|
| Rate for Payer: Veterans Affairs TRICARE |
$61.62
|
|
|
30901 TX EPISTAXIS ANT SIMPLE
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
22282893
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.14 |
| Max. Negotiated Rate |
$613.80 |
| Rate for Payer: Aetna of AZ Commercial |
$613.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$109.12
|
| Rate for Payer: Banner UC Health Medicare |
$109.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$463.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$105.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$109.12
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$109.12
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cigna of AZ Commercial |
$477.40
|
| Rate for Payer: Devoted Health Medicare |
$122.76
|
| Rate for Payer: Humana of AZ Medicare |
$109.12
|
| Rate for Payer: Mercy Care Medicaid |
$105.14
|
| Rate for Payer: NaphCare Correctional Healthcare |
$105.14
|
| Rate for Payer: Seven Corners Travel Insurance |
$205.86
|
| Rate for Payer: Southwest Service Administrators UFCW |
$463.76
|
| Rate for Payer: TriWest Medicare |
$109.12
|
| Rate for Payer: United Healthcare Commercial |
$390.10
|
| Rate for Payer: United Healthcare Medicare |
$109.12
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$129.58
|
| Rate for Payer: Veterans Affairs TRICARE |
$108.03
|
|
