|
SPLINT COLLES X-SMALL LEFT HAND
|
Facility
OP
|
$55.00
|
|
| Hospital Charge Code |
22354292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$49.50
|
| Rate for Payer: Aetna Medicare |
$15.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$9.35
|
| Rate for Payer: Amerigroup Medicare |
$9.35
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$20.54
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$9.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$9.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$14.30
|
| Rate for Payer: Cigna All Products |
$38.50
|
| Rate for Payer: Copperpoint |
$15.43
|
| Rate for Payer: HealthNet Commercial |
$33.00
|
| Rate for Payer: HealthNet Medicare |
$15.40
|
| Rate for Payer: Humana Medicare |
$9.35
|
| Rate for Payer: SELF PAY |
$44.00
|
| Rate for Payer: Veterans (Triwest) |
$9.35
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$32.06
|
| Rate for Payer: United Healthcare Medicare |
$9.90
|
|
|
SPLINT COLLES X-SMALL RIGHT HAND
|
Facility
OP
|
$55.00
|
|
| Hospital Charge Code |
22354296
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: SELF PAY |
$44.00
|
| Rate for Payer: Aetna POS, PPO, HMO |
$49.50
|
| Rate for Payer: Aetna Medicare |
$15.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$9.35
|
| Rate for Payer: Amerigroup Medicare |
$9.35
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$20.54
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$9.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$9.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$14.30
|
| Rate for Payer: Cigna All Products |
$38.50
|
| Rate for Payer: Copperpoint |
$15.43
|
| Rate for Payer: HealthNet Commercial |
$33.00
|
| Rate for Payer: HealthNet Medicare |
$15.40
|
| Rate for Payer: Humana Medicare |
$9.35
|
| Rate for Payer: Veterans (Triwest) |
$9.35
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$32.06
|
| Rate for Payer: United Healthcare Medicare |
$9.90
|
|
|
SPLINT COLLES X-SMALL RIGHT HAND
|
Facility
IP
|
$55.00
|
|
| Hospital Charge Code |
22354296
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$49.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$9.35
|
| Rate for Payer: Amerigroup Medicare |
$9.35
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$9.35
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$9.35
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$14.30
|
| Rate for Payer: Copperpoint |
$15.43
|
| Rate for Payer: Humana Medicare |
$9.35
|
| Rate for Payer: SELF PAY |
$44.00
|
| Rate for Payer: Veterans (Triwest) |
$9.35
|
|
|
SPLINT LEG LARGE
|
Facility
IP
|
$97.00
|
|
| Hospital Charge Code |
22354301
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$87.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.49
|
| Rate for Payer: Amerigroup Medicare |
$16.49
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.49
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.49
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$25.22
|
| Rate for Payer: Copperpoint |
$27.21
|
| Rate for Payer: Humana Medicare |
$16.49
|
| Rate for Payer: SELF PAY |
$77.60
|
| Rate for Payer: Veterans (Triwest) |
$16.49
|
|
|
SPLINT LEG LARGE
|
Facility
OP
|
$97.00
|
|
| Hospital Charge Code |
22354301
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: SELF PAY |
$77.60
|
| Rate for Payer: Aetna POS, PPO, HMO |
$87.30
|
| Rate for Payer: Aetna Medicare |
$27.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.49
|
| Rate for Payer: Amerigroup Medicare |
$16.49
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$36.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.49
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.49
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$25.22
|
| Rate for Payer: Cigna All Products |
$67.90
|
| Rate for Payer: Copperpoint |
$27.21
|
| Rate for Payer: HealthNet Commercial |
$58.20
|
| Rate for Payer: HealthNet Medicare |
$27.16
|
| Rate for Payer: Humana Medicare |
$16.49
|
| Rate for Payer: Veterans (Triwest) |
$16.49
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$17.46
|
|
|
SPLINT LEG MEDIUM
|
Facility
OP
|
$97.00
|
|
| Hospital Charge Code |
22354300
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$87.30
|
| Rate for Payer: Aetna Medicare |
$27.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.49
|
| Rate for Payer: Amerigroup Medicare |
$16.49
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$36.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.49
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.49
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$25.22
|
| Rate for Payer: Cigna All Products |
$67.90
|
| Rate for Payer: Copperpoint |
$27.21
|
| Rate for Payer: HealthNet Commercial |
$58.20
|
| Rate for Payer: HealthNet Medicare |
$27.16
|
| Rate for Payer: Humana Medicare |
$16.49
|
| Rate for Payer: SELF PAY |
$77.60
|
| Rate for Payer: Veterans (Triwest) |
$16.49
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$17.46
|
|
|
SPLINT LEG MEDIUM
|
Facility
IP
|
$97.00
|
|
| Hospital Charge Code |
22354300
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$87.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.49
|
| Rate for Payer: Amerigroup Medicare |
$16.49
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.49
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.49
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$25.22
|
| Rate for Payer: Copperpoint |
$27.21
|
| Rate for Payer: Humana Medicare |
$16.49
|
| Rate for Payer: SELF PAY |
$77.60
|
| Rate for Payer: Veterans (Triwest) |
$16.49
|
|
|
SPLINT LEG SMALL
|
Facility
OP
|
$97.00
|
|
| Hospital Charge Code |
22354299
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$87.30
|
| Rate for Payer: Aetna Medicare |
$27.16
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.49
|
| Rate for Payer: Amerigroup Medicare |
$16.49
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$36.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.49
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.49
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$25.22
|
| Rate for Payer: Cigna All Products |
$67.90
|
| Rate for Payer: Copperpoint |
$27.21
|
| Rate for Payer: HealthNet Commercial |
$58.20
|
| Rate for Payer: HealthNet Medicare |
$27.16
|
| Rate for Payer: Humana Medicare |
$16.49
|
| Rate for Payer: SELF PAY |
$77.60
|
| Rate for Payer: Veterans (Triwest) |
$16.49
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$17.46
|
|
|
SPLINT LEG SMALL
|
Facility
IP
|
$97.00
|
|
| Hospital Charge Code |
22354299
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna POS, PPO, HMO |
$87.30
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$16.49
|
| Rate for Payer: Amerigroup Medicare |
$16.49
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$16.49
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$16.49
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$25.22
|
| Rate for Payer: Copperpoint |
$27.21
|
| Rate for Payer: Humana Medicare |
$16.49
|
| Rate for Payer: SELF PAY |
$77.60
|
| Rate for Payer: Veterans (Triwest) |
$16.49
|
|
|
SPLINT WRIST/FA LG LEFT HAND
|
Facility
IP
|
$89.00
|
|
| Hospital Charge Code |
22354270
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$80.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.13
|
| Rate for Payer: Amerigroup Medicare |
$15.13
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.13
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.13
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.14
|
| Rate for Payer: Copperpoint |
$24.96
|
| Rate for Payer: Humana Medicare |
$15.13
|
| Rate for Payer: SELF PAY |
$71.20
|
| Rate for Payer: Veterans (Triwest) |
$15.13
|
|
|
SPLINT WRIST/FA LG LEFT HAND
|
Facility
OP
|
$89.00
|
|
| Hospital Charge Code |
22354270
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$80.10
|
| Rate for Payer: Aetna Medicare |
$24.92
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.13
|
| Rate for Payer: Amerigroup Medicare |
$15.13
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$33.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.13
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.13
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.14
|
| Rate for Payer: Cigna All Products |
$62.30
|
| Rate for Payer: Copperpoint |
$24.96
|
| Rate for Payer: HealthNet Commercial |
$53.40
|
| Rate for Payer: HealthNet Medicare |
$24.92
|
| Rate for Payer: Humana Medicare |
$15.13
|
| Rate for Payer: SELF PAY |
$71.20
|
| Rate for Payer: Veterans (Triwest) |
$15.13
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$51.89
|
| Rate for Payer: United Healthcare Medicare |
$16.02
|
|
|
SPLINT WRIST/FA LG RIGHT HAND
|
Facility
IP
|
$89.00
|
|
| Hospital Charge Code |
22354269
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$80.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.13
|
| Rate for Payer: Amerigroup Medicare |
$15.13
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.13
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.13
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.14
|
| Rate for Payer: Copperpoint |
$24.96
|
| Rate for Payer: Humana Medicare |
$15.13
|
| Rate for Payer: SELF PAY |
$71.20
|
| Rate for Payer: Veterans (Triwest) |
$15.13
|
|
|
SPLINT WRIST/FA LG RIGHT HAND
|
Facility
OP
|
$89.00
|
|
| Hospital Charge Code |
22354269
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$80.10
|
| Rate for Payer: Aetna Medicare |
$24.92
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.13
|
| Rate for Payer: Amerigroup Medicare |
$15.13
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$33.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.13
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.13
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.14
|
| Rate for Payer: Cigna All Products |
$62.30
|
| Rate for Payer: Copperpoint |
$24.96
|
| Rate for Payer: HealthNet Commercial |
$53.40
|
| Rate for Payer: HealthNet Medicare |
$24.92
|
| Rate for Payer: Humana Medicare |
$15.13
|
| Rate for Payer: SELF PAY |
$71.20
|
| Rate for Payer: Veterans (Triwest) |
$15.13
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$51.89
|
| Rate for Payer: United Healthcare Medicare |
$16.02
|
|
|
SPLINT WRIST/FA MED LEFT HAND
|
Facility
OP
|
$110.00
|
|
| Hospital Charge Code |
22354248
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$99.00
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.70
|
| Rate for Payer: Amerigroup Medicare |
$18.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$41.09
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$28.60
|
| Rate for Payer: Cigna All Products |
$77.00
|
| Rate for Payer: Copperpoint |
$30.86
|
| Rate for Payer: HealthNet Commercial |
$66.00
|
| Rate for Payer: HealthNet Medicare |
$30.80
|
| Rate for Payer: Humana Medicare |
$18.70
|
| Rate for Payer: SELF PAY |
$88.00
|
| Rate for Payer: Veterans (Triwest) |
$18.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$64.13
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
|
|
SPLINT WRIST/FA MED LEFT HAND
|
Facility
IP
|
$110.00
|
|
| Hospital Charge Code |
22354248
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$99.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.70
|
| Rate for Payer: Amerigroup Medicare |
$18.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$28.60
|
| Rate for Payer: Copperpoint |
$30.86
|
| Rate for Payer: Humana Medicare |
$18.70
|
| Rate for Payer: SELF PAY |
$88.00
|
| Rate for Payer: Veterans (Triwest) |
$18.70
|
|
|
SPLINT WRIST/FA MED RIGHT HAND
|
Facility
IP
|
$110.00
|
|
| Hospital Charge Code |
22354249
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$99.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.70
|
| Rate for Payer: Amerigroup Medicare |
$18.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$28.60
|
| Rate for Payer: Copperpoint |
$30.86
|
| Rate for Payer: Humana Medicare |
$18.70
|
| Rate for Payer: SELF PAY |
$88.00
|
| Rate for Payer: Veterans (Triwest) |
$18.70
|
|
|
SPLINT WRIST/FA MED RIGHT HAND
|
Facility
OP
|
$110.00
|
|
| Hospital Charge Code |
22354249
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: SELF PAY |
$88.00
|
| Rate for Payer: Veterans (Triwest) |
$18.70
|
| Rate for Payer: Aetna POS, PPO, HMO |
$99.00
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.70
|
| Rate for Payer: Amerigroup Medicare |
$18.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$41.09
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$28.60
|
| Rate for Payer: Cigna All Products |
$77.00
|
| Rate for Payer: Copperpoint |
$30.86
|
| Rate for Payer: HealthNet Commercial |
$66.00
|
| Rate for Payer: HealthNet Medicare |
$30.80
|
| Rate for Payer: Humana Medicare |
$18.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$64.13
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
|
|
SPLINT WRIST/FA SM LEFT HAND
|
Facility
IP
|
$110.00
|
|
| Hospital Charge Code |
22354266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$99.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.70
|
| Rate for Payer: Amerigroup Medicare |
$18.70
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$28.60
|
| Rate for Payer: Copperpoint |
$30.86
|
| Rate for Payer: Humana Medicare |
$18.70
|
| Rate for Payer: SELF PAY |
$88.00
|
| Rate for Payer: Veterans (Triwest) |
$18.70
|
|
|
SPLINT WRIST/FA SM LEFT HAND
|
Facility
OP
|
$110.00
|
|
| Hospital Charge Code |
22354266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$99.00
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.70
|
| Rate for Payer: Amerigroup Medicare |
$18.70
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$41.09
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.70
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.70
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$28.60
|
| Rate for Payer: Cigna All Products |
$77.00
|
| Rate for Payer: Copperpoint |
$30.86
|
| Rate for Payer: HealthNet Commercial |
$66.00
|
| Rate for Payer: HealthNet Medicare |
$30.80
|
| Rate for Payer: Humana Medicare |
$18.70
|
| Rate for Payer: SELF PAY |
$88.00
|
| Rate for Payer: Veterans (Triwest) |
$18.70
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$64.13
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
|
|
SPLINT WRIST/FA SM RIGHT HAND
|
Facility
OP
|
$89.00
|
|
| Hospital Charge Code |
22354268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$80.10
|
| Rate for Payer: Aetna Medicare |
$24.92
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.13
|
| Rate for Payer: Amerigroup Medicare |
$15.13
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$33.24
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.13
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.13
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.14
|
| Rate for Payer: Cigna All Products |
$62.30
|
| Rate for Payer: Copperpoint |
$24.96
|
| Rate for Payer: HealthNet Commercial |
$53.40
|
| Rate for Payer: HealthNet Medicare |
$24.92
|
| Rate for Payer: Humana Medicare |
$15.13
|
| Rate for Payer: SELF PAY |
$71.20
|
| Rate for Payer: Veterans (Triwest) |
$15.13
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$51.89
|
| Rate for Payer: United Healthcare Medicare |
$16.02
|
|
|
SPLINT WRIST/FA SM RIGHT HAND
|
Facility
IP
|
$89.00
|
|
| Hospital Charge Code |
22354268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna POS, PPO, HMO |
$80.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$15.13
|
| Rate for Payer: Amerigroup Medicare |
$15.13
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$15.13
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$15.13
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$23.14
|
| Rate for Payer: Copperpoint |
$24.96
|
| Rate for Payer: Humana Medicare |
$15.13
|
| Rate for Payer: SELF PAY |
$71.20
|
| Rate for Payer: Veterans (Triwest) |
$15.13
|
|
|
SPLINT WRIST LARGE LEFT
|
Facility
IP
|
$44.00
|
|
| Hospital Charge Code |
22354254
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$39.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$7.48
|
| Rate for Payer: Amerigroup Medicare |
$7.48
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$7.48
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$7.48
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$11.44
|
| Rate for Payer: Copperpoint |
$12.34
|
| Rate for Payer: Humana Medicare |
$7.48
|
| Rate for Payer: SELF PAY |
$35.20
|
| Rate for Payer: Veterans (Triwest) |
$7.48
|
|
|
SPLINT WRIST LARGE LEFT
|
Facility
OP
|
$44.00
|
|
| Hospital Charge Code |
22354254
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$39.60
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$7.48
|
| Rate for Payer: Amerigroup Medicare |
$7.48
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$16.43
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$7.48
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$7.48
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$11.44
|
| Rate for Payer: Cigna All Products |
$30.80
|
| Rate for Payer: Copperpoint |
$12.34
|
| Rate for Payer: HealthNet Commercial |
$26.40
|
| Rate for Payer: HealthNet Medicare |
$12.32
|
| Rate for Payer: Humana Medicare |
$7.48
|
| Rate for Payer: SELF PAY |
$35.20
|
| Rate for Payer: Veterans (Triwest) |
$7.48
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$25.65
|
| Rate for Payer: United Healthcare Medicare |
$7.92
|
|
|
SPLINT WRIST LARGE RIGHT
|
Facility
IP
|
$36.00
|
|
| Hospital Charge Code |
22354255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$32.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.12
|
| Rate for Payer: Amerigroup Medicare |
$6.12
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.12
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$9.36
|
| Rate for Payer: Copperpoint |
$10.10
|
| Rate for Payer: Humana Medicare |
$6.12
|
| Rate for Payer: SELF PAY |
$28.80
|
| Rate for Payer: Veterans (Triwest) |
$6.12
|
|
|
SPLINT WRIST LARGE RIGHT
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
22354255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$32.40
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$6.12
|
| Rate for Payer: Amerigroup Medicare |
$6.12
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$13.45
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$6.12
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$6.12
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$9.36
|
| Rate for Payer: Cigna All Products |
$25.20
|
| Rate for Payer: Copperpoint |
$10.10
|
| Rate for Payer: HealthNet Commercial |
$21.60
|
| Rate for Payer: HealthNet Medicare |
$10.08
|
| Rate for Payer: Humana Medicare |
$6.12
|
| Rate for Payer: SELF PAY |
$28.80
|
| Rate for Payer: Veterans (Triwest) |
$6.12
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$20.99
|
| Rate for Payer: United Healthcare Medicare |
$6.48
|
|