|
Closed Trtmt of Radial Head Subluxation In Child, Nursemaid Elbow, w/Manipulatio
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
1735551
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$25.10 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Aetna of AZ Commercial |
$232.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$41.28
|
| Rate for Payer: Banner UC Health Medicare |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$175.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$25.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$41.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$41.28
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna of AZ Commercial |
$180.60
|
| Rate for Payer: Devoted Health Medicare |
$46.44
|
| Rate for Payer: Humana of AZ Medicare |
$41.28
|
| Rate for Payer: Mercy Care Medicaid |
$25.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$25.10
|
| Rate for Payer: Seven Corners Travel Insurance |
$381.65
|
| Rate for Payer: Southwest Service Administrators UFCW |
$175.44
|
| Rate for Payer: TriWest Medicare |
$41.28
|
| Rate for Payer: United Healthcare Commercial |
$147.58
|
| Rate for Payer: United Healthcare Medicare |
$41.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$40.87
|
|
|
CLOSTRIDIUM DIFF AG TOXINS STOOL C DIFF AG TOX
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
22531673
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$12.32
|
| Rate for Payer: Banner UC Health Medicare |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$12.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$12.32
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cigna of AZ Commercial |
$50.05
|
| Rate for Payer: Devoted Health Medicare |
$13.86
|
| Rate for Payer: Humana of AZ Medicare |
$12.32
|
| Rate for Payer: Seven Corners Travel Insurance |
$17.37
|
| Rate for Payer: Southwest Service Administrators UFCW |
$52.36
|
| Rate for Payer: TriWest Medicare |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$44.04
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$12.20
|
|
|
CLOSTRIDIUM DIFF AG TOXINS STOOL C DIFF AG TOX
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
22531673
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
|
|
Clostridium difficile by DNA Amplification
|
Facility
|
OP
|
$148.00
|
|
| Hospital Charge Code |
2210298
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.44 |
| 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: 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: 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
|
|
|
Clostridium difficile by DNA Amplification
|
Facility
|
IP
|
$148.00
|
|
| Hospital Charge Code |
2210298
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
clotrimazole Top 1% Crm [CQCH]
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
NDC 68462018117
|
| Hospital Charge Code |
105917130
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna of AZ Commercial |
$3.13
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.56
|
| Rate for Payer: Banner UC Health Medicare |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.56
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.56
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of AZ Commercial |
$2.26
|
| Rate for Payer: Devoted Health Medicare |
$0.63
|
| Rate for Payer: Humana of AZ Medicare |
$0.56
|
| Rate for Payer: Southwest Service Administrators UFCW |
$2.37
|
| Rate for Payer: TriWest Medicare |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$1.99
|
| Rate for Payer: United Healthcare Medicare |
$0.56
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.55
|
|
|
clotrimazole Top 1% Crm [CQCH]
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
NDC 68462018117
|
| Hospital Charge Code |
105917130
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna of AZ Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$2.78
|
|
|
CLOTTING; FACTOR VIII (AHG), ONE STAGE
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
23090940
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
CLOTTING; FACTOR VIII (AHG), ONE STAGE
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
23090940
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$125.10 |
| 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 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 |
$90.35
|
| Rate for Payer: Devoted Health Medicare |
$25.02
|
| Rate for Payer: Humana of AZ Medicare |
$22.24
|
| Rate for Payer: Seven Corners Travel Insurance |
$25.95
|
| 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: Veterans Affairs TRICARE |
$22.02
|
|
|
Clozapine LC
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
2669527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna of AZ Commercial |
$233.10
|
| Rate for Payer: Cash Price |
$207.20
|
|
|
Clozapine LC
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
2669527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.22 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna of AZ Commercial |
$233.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$41.44
|
| Rate for Payer: Banner UC Health Medicare |
$41.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$176.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$41.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$41.44
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cigna of AZ Commercial |
$168.35
|
| Rate for Payer: Devoted Health Medicare |
$46.62
|
| Rate for Payer: Humana of AZ Medicare |
$41.44
|
| Rate for Payer: Seven Corners Travel Insurance |
$29.22
|
| Rate for Payer: Southwest Service Administrators UFCW |
$176.12
|
| Rate for Payer: TriWest Medicare |
$41.44
|
| Rate for Payer: United Healthcare Commercial |
$148.15
|
| Rate for Payer: United Healthcare Medicare |
$41.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$41.03
|
|
|
CMV PCR LC
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
2087573
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$629.10 |
| Max. Negotiated Rate |
$629.10 |
| Rate for Payer: Aetna of AZ Commercial |
$629.10
|
| Rate for Payer: Cash Price |
$559.20
|
|
|
CMV PCR LC
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
2087573
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$629.10 |
| Rate for Payer: Aetna of AZ Commercial |
$629.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$111.84
|
| Rate for Payer: Banner UC Health Medicare |
$111.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$475.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$111.84
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$111.84
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna of AZ Commercial |
$454.35
|
| Rate for Payer: Devoted Health Medicare |
$125.82
|
| Rate for Payer: Humana of AZ Medicare |
$111.84
|
| Rate for Payer: Seven Corners Travel Insurance |
$50.88
|
| Rate for Payer: Southwest Service Administrators UFCW |
$475.32
|
| Rate for Payer: TriWest Medicare |
$111.84
|
| Rate for Payer: United Healthcare Commercial |
$399.83
|
| Rate for Payer: United Healthcare Medicare |
$111.84
|
| Rate for Payer: Veterans Affairs TRICARE |
$110.72
|
|
|
CMV Quant DNA PCR (Plasma) LC
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
2029097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$287.10 |
| Max. Negotiated Rate |
$287.10 |
| Rate for Payer: Aetna of AZ Commercial |
$287.10
|
| Rate for Payer: Cash Price |
$255.20
|
|
|
CMV Quant DNA PCR (Plasma) LC
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
2029097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.53 |
| Max. Negotiated Rate |
$287.10 |
| Rate for Payer: Aetna of AZ Commercial |
$287.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$51.04
|
| Rate for Payer: Banner UC Health Medicare |
$51.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$216.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$51.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$51.04
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cigna of AZ Commercial |
$207.35
|
| Rate for Payer: Devoted Health Medicare |
$57.42
|
| Rate for Payer: Humana of AZ Medicare |
$51.04
|
| Rate for Payer: Seven Corners Travel Insurance |
$62.12
|
| Rate for Payer: Southwest Service Administrators UFCW |
$216.92
|
| Rate for Payer: TriWest Medicare |
$51.04
|
| Rate for Payer: United Healthcare Commercial |
$182.47
|
| Rate for Payer: United Healthcare Medicare |
$51.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$50.53
|
|
|
CO2 DETECTOR ADULT
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
22593124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of AZ Commercial |
$51.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$9.12
|
| Rate for Payer: Banner UC Health Medicare |
$9.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$9.12
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$9.12
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna of AZ Commercial |
$39.90
|
| Rate for Payer: Devoted Health Medicare |
$10.26
|
| Rate for Payer: Humana of AZ Medicare |
$9.12
|
| Rate for Payer: Southwest Service Administrators UFCW |
$38.76
|
| Rate for Payer: TriWest Medicare |
$9.12
|
| Rate for Payer: United Healthcare Commercial |
$32.60
|
| Rate for Payer: United Healthcare Medicare |
$9.12
|
| Rate for Payer: Veterans Affairs TRICARE |
$9.03
|
|
|
CO2 DETECTOR ADULT
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
22593124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of AZ Commercial |
$51.30
|
| Rate for Payer: Cash Price |
$45.60
|
|
|
CO2 EASY CARBON DIOXIDE DETECTORS
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
24180139
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$12.32
|
| Rate for Payer: Banner UC Health Medicare |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$12.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$12.32
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cigna of AZ Commercial |
$53.90
|
| Rate for Payer: Devoted Health Medicare |
$13.86
|
| Rate for Payer: Humana of AZ Medicare |
$12.32
|
| Rate for Payer: Southwest Service Administrators UFCW |
$52.36
|
| Rate for Payer: TriWest Medicare |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$44.04
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$12.20
|
|
|
CO2 EASY CARBON DIOXIDE DETECTORS
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
24180139
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
|
|
Coagulation And Platelet Disorders
|
Facility
|
IP
|
$21,425.67
|
|
|
Service Code
|
APR-DRG 6614
|
| Hospital Charge Code |
APRDRG6612
|
| Min. Negotiated Rate |
$21,425.67 |
| Max. Negotiated Rate |
$21,425.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$21,425.67
|
| Rate for Payer: Mercy Care Medicaid |
$21,425.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$21,425.67
|
|
|
Coagulation And Platelet Disorders
|
Facility
|
IP
|
$10,455.07
|
|
|
Service Code
|
APR-DRG 6613
|
| Hospital Charge Code |
APRDRG6612
|
| Min. Negotiated Rate |
$10,455.07 |
| Max. Negotiated Rate |
$10,455.07 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,455.07
|
| Rate for Payer: Mercy Care Medicaid |
$10,455.07
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,455.07
|
|
|
Coagulation And Platelet Disorders
|
Facility
|
IP
|
$21,425.67
|
|
|
Service Code
|
APR-DRG 6614
|
| Hospital Charge Code |
APRDRG6611
|
| Min. Negotiated Rate |
$21,425.67 |
| Max. Negotiated Rate |
$21,425.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$21,425.67
|
| Rate for Payer: Mercy Care Medicaid |
$21,425.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$21,425.67
|
|
|
Coagulation And Platelet Disorders
|
Facility
|
IP
|
$21,425.67
|
|
|
Service Code
|
APR-DRG 6614
|
| Hospital Charge Code |
APRDRG6614
|
| Min. Negotiated Rate |
$21,425.67 |
| Max. Negotiated Rate |
$21,425.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$21,425.67
|
| Rate for Payer: Mercy Care Medicaid |
$21,425.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$21,425.67
|
|
|
Coagulation And Platelet Disorders
|
Facility
|
IP
|
$5,502.48
|
|
|
Service Code
|
APR-DRG 6611
|
| Hospital Charge Code |
APRDRG6614
|
| Min. Negotiated Rate |
$5,502.48 |
| Max. Negotiated Rate |
$5,502.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,502.48
|
| Rate for Payer: Mercy Care Medicaid |
$5,502.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,502.48
|
|
|
Coagulation And Platelet Disorders
|
Facility
|
IP
|
$21,425.67
|
|
|
Service Code
|
APR-DRG 6614
|
| Hospital Charge Code |
APRDRG6613
|
| Min. Negotiated Rate |
$21,425.67 |
| Max. Negotiated Rate |
$21,425.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$21,425.67
|
| Rate for Payer: Mercy Care Medicaid |
$21,425.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$21,425.67
|
|
