|
SHOE POST-OP FEMALE LARGE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$13.92
|
| Rate for Payer: Banner UC Health Medicare |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$59.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$13.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$13.92
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna of AZ Commercial |
$60.90
|
| Rate for Payer: Devoted Health Medicare |
$15.66
|
| Rate for Payer: Humana of AZ Medicare |
$13.92
|
| Rate for Payer: Southwest Service Administrators UFCW |
$59.16
|
| Rate for Payer: TriWest Medicare |
$13.92
|
| Rate for Payer: United Healthcare Commercial |
$49.76
|
| Rate for Payer: United Healthcare Medicare |
$13.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.78
|
|
|
SHOE POST-OP FEMALE MEDIUM
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of AZ Commercial |
$56.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$10.08
|
| Rate for Payer: Banner UC Health Medicare |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$10.08
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$10.08
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of AZ Commercial |
$44.10
|
| Rate for Payer: Devoted Health Medicare |
$11.34
|
| Rate for Payer: Humana of AZ Medicare |
$10.08
|
| Rate for Payer: Southwest Service Administrators UFCW |
$42.84
|
| Rate for Payer: TriWest Medicare |
$10.08
|
| Rate for Payer: United Healthcare Commercial |
$36.04
|
| Rate for Payer: United Healthcare Medicare |
$10.08
|
| Rate for Payer: Veterans Affairs TRICARE |
$9.98
|
|
|
SHOE POST-OP FEMALE MEDIUM
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of AZ Commercial |
$56.70
|
| Rate for Payer: Cash Price |
$50.40
|
|
|
SHOE POST-OP FEMALE SMALL
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354282
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$13.92
|
| Rate for Payer: Banner UC Health Medicare |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$59.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$13.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$13.92
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna of AZ Commercial |
$60.90
|
| Rate for Payer: Devoted Health Medicare |
$15.66
|
| Rate for Payer: Humana of AZ Medicare |
$13.92
|
| Rate for Payer: Southwest Service Administrators UFCW |
$59.16
|
| Rate for Payer: TriWest Medicare |
$13.92
|
| Rate for Payer: United Healthcare Commercial |
$49.76
|
| Rate for Payer: United Healthcare Medicare |
$13.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.78
|
|
|
SHOE POST-OP FEMALE SMALL
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354282
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Cash Price |
$69.60
|
|
|
SHOE POST-OP MALE LARGE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Cash Price |
$69.60
|
|
|
SHOE POST-OP MALE LARGE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$13.92
|
| Rate for Payer: Banner UC Health Medicare |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$59.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$13.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$13.92
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna of AZ Commercial |
$60.90
|
| Rate for Payer: Devoted Health Medicare |
$15.66
|
| Rate for Payer: Humana of AZ Medicare |
$13.92
|
| Rate for Payer: Southwest Service Administrators UFCW |
$59.16
|
| Rate for Payer: TriWest Medicare |
$13.92
|
| Rate for Payer: United Healthcare Commercial |
$49.76
|
| Rate for Payer: United Healthcare Medicare |
$13.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.78
|
|
|
SHOE POST-OP MALE MEDIUM
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354286
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$13.92
|
| Rate for Payer: Banner UC Health Medicare |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$59.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$13.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$13.92
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna of AZ Commercial |
$60.90
|
| Rate for Payer: Devoted Health Medicare |
$15.66
|
| Rate for Payer: Humana of AZ Medicare |
$13.92
|
| Rate for Payer: Southwest Service Administrators UFCW |
$59.16
|
| Rate for Payer: TriWest Medicare |
$13.92
|
| Rate for Payer: United Healthcare Commercial |
$49.76
|
| Rate for Payer: United Healthcare Medicare |
$13.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.78
|
|
|
SHOE POST-OP MALE MEDIUM
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354286
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Cash Price |
$69.60
|
|
|
SHOE POST-OP MALE SMALL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354285
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Cash Price |
$26.40
|
|
|
SHOE POST-OP MALE SMALL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354285
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$5.28
|
| Rate for Payer: Banner UC Health Medicare |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$22.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$5.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$5.28
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of AZ Commercial |
$23.10
|
| Rate for Payer: Devoted Health Medicare |
$5.94
|
| Rate for Payer: Humana of AZ Medicare |
$5.28
|
| Rate for Payer: Southwest Service Administrators UFCW |
$22.44
|
| Rate for Payer: TriWest Medicare |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$18.88
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$5.23
|
|
|
SHOE POST-OP MALE X-SMALL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354306
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$5.28
|
| Rate for Payer: Banner UC Health Medicare |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$22.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$5.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$5.28
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of AZ Commercial |
$23.10
|
| Rate for Payer: Devoted Health Medicare |
$5.94
|
| Rate for Payer: Humana of AZ Medicare |
$5.28
|
| Rate for Payer: Southwest Service Administrators UFCW |
$22.44
|
| Rate for Payer: TriWest Medicare |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$18.88
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$5.23
|
|
|
SHOE POST-OP MALE X-SMALL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
22354306
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Cash Price |
$26.40
|
|
|
SHOE POST OP XL
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
24045512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$5.28
|
| Rate for Payer: Banner UC Health Medicare |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$22.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$5.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$5.28
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of AZ Commercial |
$23.10
|
| Rate for Payer: Devoted Health Medicare |
$5.94
|
| Rate for Payer: Humana of AZ Medicare |
$5.28
|
| Rate for Payer: Southwest Service Administrators UFCW |
$22.44
|
| Rate for Payer: TriWest Medicare |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$18.88
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$5.23
|
|
|
SHOE POST OP XL
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
24045512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Cash Price |
$26.40
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$15,847.43
|
|
|
Service Code
|
APR-DRG 3223
|
| Hospital Charge Code |
APRDRG3221
|
| Min. Negotiated Rate |
$15,847.43 |
| Max. Negotiated Rate |
$15,847.43 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,847.43
|
| Rate for Payer: Mercy Care Medicaid |
$15,847.43
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,847.43
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$26,533.26
|
|
|
Service Code
|
APR-DRG 3224
|
| Hospital Charge Code |
APRDRG3221
|
| Min. Negotiated Rate |
$26,533.26 |
| Max. Negotiated Rate |
$26,533.26 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$26,533.26
|
| Rate for Payer: Mercy Care Medicaid |
$26,533.26
|
| Rate for Payer: NaphCare Correctional Healthcare |
$26,533.26
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$10,051.76
|
|
|
Service Code
|
APR-DRG 3221
|
| Hospital Charge Code |
APRDRG3221
|
| Min. Negotiated Rate |
$10,051.76 |
| Max. Negotiated Rate |
$10,051.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,051.76
|
| Rate for Payer: Mercy Care Medicaid |
$10,051.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,051.76
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$15,847.43
|
|
|
Service Code
|
APR-DRG 3223
|
| Hospital Charge Code |
APRDRG3222
|
| Min. Negotiated Rate |
$15,847.43 |
| Max. Negotiated Rate |
$15,847.43 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,847.43
|
| Rate for Payer: Mercy Care Medicaid |
$15,847.43
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,847.43
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$26,533.26
|
|
|
Service Code
|
APR-DRG 3224
|
| Hospital Charge Code |
APRDRG3222
|
| Min. Negotiated Rate |
$26,533.26 |
| Max. Negotiated Rate |
$26,533.26 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$26,533.26
|
| Rate for Payer: Mercy Care Medicaid |
$26,533.26
|
| Rate for Payer: NaphCare Correctional Healthcare |
$26,533.26
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$11,399.15
|
|
|
Service Code
|
APR-DRG 3222
|
| Hospital Charge Code |
APRDRG3224
|
| Min. Negotiated Rate |
$11,399.15 |
| Max. Negotiated Rate |
$11,399.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,399.15
|
| Rate for Payer: Mercy Care Medicaid |
$11,399.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,399.15
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$10,051.76
|
|
|
Service Code
|
APR-DRG 3221
|
| Hospital Charge Code |
APRDRG3223
|
| Min. Negotiated Rate |
$10,051.76 |
| Max. Negotiated Rate |
$10,051.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,051.76
|
| Rate for Payer: Mercy Care Medicaid |
$10,051.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,051.76
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$10,051.76
|
|
|
Service Code
|
APR-DRG 3221
|
| Hospital Charge Code |
APRDRG3222
|
| Min. Negotiated Rate |
$10,051.76 |
| Max. Negotiated Rate |
$10,051.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,051.76
|
| Rate for Payer: Mercy Care Medicaid |
$10,051.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,051.76
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$10,051.76
|
|
|
Service Code
|
APR-DRG 3221
|
| Hospital Charge Code |
APRDRG3224
|
| Min. Negotiated Rate |
$10,051.76 |
| Max. Negotiated Rate |
$10,051.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,051.76
|
| Rate for Payer: Mercy Care Medicaid |
$10,051.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,051.76
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$15,847.43
|
|
|
Service Code
|
APR-DRG 3223
|
| Hospital Charge Code |
APRDRG3223
|
| Min. Negotiated Rate |
$15,847.43 |
| Max. Negotiated Rate |
$15,847.43 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,847.43
|
| Rate for Payer: Mercy Care Medicaid |
$15,847.43
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,847.43
|
|
