|
celecoxib 100 mg Cap [CQCH]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 904650261
|
| Hospital Charge Code |
105915790
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of AZ Commercial |
$0.76
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$0.13
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.13
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.13
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cigna of AZ Commercial |
$0.55
|
| Rate for Payer: Devoted Health Medicare |
$0.15
|
| Rate for Payer: Humana of AZ Medicare |
$0.13
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.57
|
| Rate for Payer: TriWest Medicare |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.13
|
|
|
celecoxib 100 mg Cap [CQCH]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 904650261
|
| Hospital Charge Code |
105915790
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of AZ Commercial |
$0.76
|
| Rate for Payer: Cash Price |
$0.67
|
|
|
Celiac Disease Comprehensive LC
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
10864418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Cash Price |
$118.40
|
|
|
Celiac Disease Comprehensive LC
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
10864418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$23.68
|
| Rate for Payer: Banner UC Health Medicare |
$23.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$100.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$23.68
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$23.68
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cigna of AZ Commercial |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$26.64
|
| Rate for Payer: Humana of AZ Medicare |
$23.68
|
| Rate for Payer: Seven Corners Travel Insurance |
$13.48
|
| Rate for Payer: Southwest Service Administrators UFCW |
$100.64
|
| Rate for Payer: TriWest Medicare |
$23.68
|
| Rate for Payer: United Healthcare Commercial |
$84.66
|
| Rate for Payer: United Healthcare Medicare |
$23.68
|
| Rate for Payer: Veterans Affairs TRICARE |
$23.44
|
|
|
Celiac Disease II LC
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
22311182
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
Celiac Disease II LC
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
22311182
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$102.60 |
| 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 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 |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$20.52
|
| Rate for Payer: Humana of AZ Medicare |
$18.24
|
| Rate for Payer: Seven Corners Travel Insurance |
$13.48
|
| 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
|
|
|
Cell count, Synovial w crystals, LC
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
28103161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$605.70 |
| Max. Negotiated Rate |
$605.70 |
| Rate for Payer: Aetna of AZ Commercial |
$605.70
|
| Rate for Payer: Cash Price |
$538.40
|
|
|
Cell count, Synovial w crystals, LC
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
7734612
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
|
|
Cell count, Synovial w crystals, LC
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
28103161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$605.70 |
| Rate for Payer: Aetna of AZ Commercial |
$605.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$107.68
|
| Rate for Payer: Banner UC Health Medicare |
$107.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$457.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$107.68
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$107.68
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cigna of AZ Commercial |
$437.45
|
| Rate for Payer: Devoted Health Medicare |
$121.14
|
| Rate for Payer: Humana of AZ Medicare |
$107.68
|
| Rate for Payer: Seven Corners Travel Insurance |
$10.63
|
| Rate for Payer: Southwest Service Administrators UFCW |
$457.64
|
| Rate for Payer: TriWest Medicare |
$107.68
|
| Rate for Payer: United Healthcare Commercial |
$384.96
|
| Rate for Payer: United Healthcare Medicare |
$107.68
|
| Rate for Payer: Veterans Affairs TRICARE |
$106.60
|
|
|
Cell count, Synovial w crystals, LC
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
7734612
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$16.00
|
| Rate for Payer: Banner UC Health Medicare |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$16.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna of AZ Commercial |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$18.00
|
| Rate for Payer: Humana of AZ Medicare |
$16.00
|
| Rate for Payer: Seven Corners Travel Insurance |
$8.12
|
| Rate for Payer: Southwest Service Administrators UFCW |
$68.00
|
| Rate for Payer: TriWest Medicare |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$57.20
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: Veterans Affairs TRICARE |
$15.84
|
|
|
Cell Ct, Synovial w/o Crystals LC
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
22587724
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
|
|
Cell Ct, Synovial w/o Crystals LC
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
22587724
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$16.00
|
| Rate for Payer: Banner UC Health Medicare |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$16.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna of AZ Commercial |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$18.00
|
| Rate for Payer: Humana of AZ Medicare |
$16.00
|
| Rate for Payer: Seven Corners Travel Insurance |
$8.12
|
| Rate for Payer: Southwest Service Administrators UFCW |
$68.00
|
| Rate for Payer: TriWest Medicare |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$57.20
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: Veterans Affairs TRICARE |
$15.84
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$6,029.94
|
|
|
Service Code
|
APR-DRG 3833
|
| Hospital Charge Code |
APRDRG3834
|
| Min. Negotiated Rate |
$6,029.94 |
| Max. Negotiated Rate |
$6,029.94 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,029.94
|
| Rate for Payer: Mercy Care Medicaid |
$6,029.94
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,029.94
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$3,991.67
|
|
|
Service Code
|
APR-DRG 3832
|
| Hospital Charge Code |
APRDRG3834
|
| Min. Negotiated Rate |
$3,991.67 |
| Max. Negotiated Rate |
$3,991.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,991.67
|
| Rate for Payer: Mercy Care Medicaid |
$3,991.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,991.67
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$12,128.61
|
|
|
Service Code
|
APR-DRG 3834
|
| Hospital Charge Code |
APRDRG3831
|
| Min. Negotiated Rate |
$12,128.61 |
| Max. Negotiated Rate |
$12,128.61 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,128.61
|
| Rate for Payer: Mercy Care Medicaid |
$12,128.61
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,128.61
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$6,029.94
|
|
|
Service Code
|
APR-DRG 3833
|
| Hospital Charge Code |
APRDRG3833
|
| Min. Negotiated Rate |
$6,029.94 |
| Max. Negotiated Rate |
$6,029.94 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,029.94
|
| Rate for Payer: Mercy Care Medicaid |
$6,029.94
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,029.94
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$6,029.94
|
|
|
Service Code
|
APR-DRG 3833
|
| Hospital Charge Code |
APRDRG3832
|
| Min. Negotiated Rate |
$6,029.94 |
| Max. Negotiated Rate |
$6,029.94 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,029.94
|
| Rate for Payer: Mercy Care Medicaid |
$6,029.94
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,029.94
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$3,991.67
|
|
|
Service Code
|
APR-DRG 3832
|
| Hospital Charge Code |
APRDRG3833
|
| Min. Negotiated Rate |
$3,991.67 |
| Max. Negotiated Rate |
$3,991.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,991.67
|
| Rate for Payer: Mercy Care Medicaid |
$3,991.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,991.67
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$12,128.61
|
|
|
Service Code
|
APR-DRG 3834
|
| Hospital Charge Code |
APRDRG3834
|
| Min. Negotiated Rate |
$12,128.61 |
| Max. Negotiated Rate |
$12,128.61 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,128.61
|
| Rate for Payer: Mercy Care Medicaid |
$12,128.61
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,128.61
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$3,010.41
|
|
|
Service Code
|
APR-DRG 3831
|
| Hospital Charge Code |
APRDRG3832
|
| Min. Negotiated Rate |
$3,010.41 |
| Max. Negotiated Rate |
$3,010.41 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,010.41
|
| Rate for Payer: Mercy Care Medicaid |
$3,010.41
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,010.41
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$6,029.94
|
|
|
Service Code
|
APR-DRG 3833
|
| Hospital Charge Code |
APRDRG3831
|
| Min. Negotiated Rate |
$6,029.94 |
| Max. Negotiated Rate |
$6,029.94 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,029.94
|
| Rate for Payer: Mercy Care Medicaid |
$6,029.94
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,029.94
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$12,128.61
|
|
|
Service Code
|
APR-DRG 3834
|
| Hospital Charge Code |
APRDRG3833
|
| Min. Negotiated Rate |
$12,128.61 |
| Max. Negotiated Rate |
$12,128.61 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,128.61
|
| Rate for Payer: Mercy Care Medicaid |
$12,128.61
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,128.61
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$3,010.41
|
|
|
Service Code
|
APR-DRG 3831
|
| Hospital Charge Code |
APRDRG3831
|
| Min. Negotiated Rate |
$3,010.41 |
| Max. Negotiated Rate |
$3,010.41 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,010.41
|
| Rate for Payer: Mercy Care Medicaid |
$3,010.41
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,010.41
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$3,991.67
|
|
|
Service Code
|
APR-DRG 3832
|
| Hospital Charge Code |
APRDRG3831
|
| Min. Negotiated Rate |
$3,991.67 |
| Max. Negotiated Rate |
$3,991.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,991.67
|
| Rate for Payer: Mercy Care Medicaid |
$3,991.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,991.67
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$3,991.67
|
|
|
Service Code
|
APR-DRG 3832
|
| Hospital Charge Code |
APRDRG3832
|
| Min. Negotiated Rate |
$3,991.67 |
| Max. Negotiated Rate |
$3,991.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,991.67
|
| Rate for Payer: Mercy Care Medicaid |
$3,991.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,991.67
|
|
