|
INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO LOWER ABDO
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
28133130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$3,098.00 |
| Rate for Payer: Aetna of AZ Commercial |
$251.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$44.64
|
| Rate for Payer: Banner UC Health Medicare |
$46.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$56.13
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$44.64
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$44.64
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cigna of AZ Commercial |
$139.50
|
| Rate for Payer: Devoted Health Medicare |
$50.22
|
| Rate for Payer: Humana of AZ Medicare |
$44.64
|
| Rate for Payer: Mercy Care Medicaid |
$56.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$46.84
|
| Rate for Payer: Seven Corners Travel Insurance |
$1,092.18
|
| Rate for Payer: Southwest Service Administrators UFCW |
$189.72
|
| Rate for Payer: TriWest Medicare |
$44.64
|
| Rate for Payer: United Healthcare Commercial |
$3,098.00
|
| Rate for Payer: United Healthcare Medicare |
$44.64
|
| Rate for Payer: Veterans Affairs TRICARE |
$44.19
|
|
|
INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO LOWER ABDO
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
28133130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of AZ Commercial |
$251.10
|
| Rate for Payer: Cash Price |
$223.20
|
|
|
INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO RIB NERVE
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
27927130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of AZ Commercial |
$273.60
|
| Rate for Payer: Cash Price |
$243.20
|
|
|
INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO RIB NERVE
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
27927130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$3,098.00 |
| Rate for Payer: Aetna of AZ Commercial |
$273.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$48.64
|
| Rate for Payer: Banner UC Health Medicare |
$313.95
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$206.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$40.45
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$48.64
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$48.64
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cigna of AZ Commercial |
$152.00
|
| Rate for Payer: Devoted Health Medicare |
$54.72
|
| Rate for Payer: Humana of AZ Medicare |
$48.64
|
| Rate for Payer: Mercy Care Medicaid |
$40.45
|
| Rate for Payer: NaphCare Correctional Healthcare |
$313.95
|
| Rate for Payer: Seven Corners Travel Insurance |
$1,092.18
|
| Rate for Payer: Southwest Service Administrators UFCW |
$206.72
|
| Rate for Payer: TriWest Medicare |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$3,098.00
|
| Rate for Payer: United Healthcare Medicare |
$48.64
|
| Rate for Payer: Veterans Affairs TRICARE |
$48.15
|
|
|
INJECTION OF LOCAL ANESTHETIC FOR ABDOMINAL WALL PAIN CONTRO
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 64488 59
|
| Hospital Charge Code |
22282748
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$53.38 |
| Max. Negotiated Rate |
$303.30 |
| Rate for Payer: Aetna of AZ Commercial |
$303.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$53.92
|
| Rate for Payer: Banner UC Health Medicare |
$53.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$229.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$67.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$53.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$53.92
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cigna of AZ Commercial |
$219.05
|
| Rate for Payer: Devoted Health Medicare |
$60.66
|
| Rate for Payer: Humana of AZ Medicare |
$53.92
|
| Rate for Payer: Mercy Care Medicaid |
$67.30
|
| Rate for Payer: NaphCare Correctional Healthcare |
$67.30
|
| Rate for Payer: Southwest Service Administrators UFCW |
$229.16
|
| Rate for Payer: TriWest Medicare |
$53.92
|
| Rate for Payer: United Healthcare Commercial |
$192.76
|
| Rate for Payer: United Healthcare Medicare |
$53.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$53.38
|
|
|
INJECTION OF LOCAL ANESTHETIC FOR ABDOMINAL WALL PAIN CONTRO
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 64486 59
|
| Hospital Charge Code |
22282744
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$58.22 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of AZ Commercial |
$340.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$60.48
|
| Rate for Payer: Banner UC Health Medicare |
$60.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$257.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$58.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$60.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$60.48
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna of AZ Commercial |
$245.70
|
| Rate for Payer: Devoted Health Medicare |
$68.04
|
| Rate for Payer: Humana of AZ Medicare |
$60.48
|
| Rate for Payer: Mercy Care Medicaid |
$58.22
|
| Rate for Payer: NaphCare Correctional Healthcare |
$58.22
|
| Rate for Payer: Southwest Service Administrators UFCW |
$257.04
|
| Rate for Payer: TriWest Medicare |
$60.48
|
| Rate for Payer: United Healthcare Commercial |
$216.22
|
| Rate for Payer: United Healthcare Medicare |
$60.48
|
| Rate for Payer: Veterans Affairs TRICARE |
$59.88
|
|
|
INJECTION OF LOCAL ANESTHETIC FOR ABDOMINAL WALL PAIN CONTRO
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 64486 59
|
| Hospital Charge Code |
22282744
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of AZ Commercial |
$340.20
|
| Rate for Payer: Cash Price |
$302.40
|
|
|
INJECTION OF LOCAL ANESTHETIC FOR ABDOMINAL WALL PAIN CONTRO
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 64488 59
|
| Hospital Charge Code |
22282748
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$303.30 |
| Max. Negotiated Rate |
$303.30 |
| Rate for Payer: Aetna of AZ Commercial |
$303.30
|
| Rate for Payer: Cash Price |
$269.60
|
|
|
Injection of sclerosing solution; multiple veins, same leg
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
1164858
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of AZ Commercial |
$372.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$66.24
|
| Rate for Payer: Banner UC Health Medicare |
$66.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$281.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$74.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$66.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$66.24
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna of AZ Commercial |
$289.80
|
| Rate for Payer: Devoted Health Medicare |
$74.52
|
| Rate for Payer: Humana of AZ Medicare |
$66.24
|
| Rate for Payer: Mercy Care Medicaid |
$74.26
|
| Rate for Payer: NaphCare Correctional Healthcare |
$74.26
|
| Rate for Payer: Seven Corners Travel Insurance |
$205.86
|
| Rate for Payer: Southwest Service Administrators UFCW |
$281.52
|
| Rate for Payer: TriWest Medicare |
$66.24
|
| Rate for Payer: United Healthcare Commercial |
$236.81
|
| Rate for Payer: United Healthcare Medicare |
$66.24
|
| Rate for Payer: Veterans Affairs TRICARE |
$65.58
|
|
|
Injection of sclerosing solution; multiple veins, same leg
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
1164858
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of AZ Commercial |
$372.60
|
| Rate for Payer: Cash Price |
$331.20
|
|
|
INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO NERVE OF F
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
24049522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of AZ Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$136.00
|
|
|
INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO NERVE OF F
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
24049522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$2,671.00 |
| Rate for Payer: Aetna of AZ Commercial |
$153.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$27.20
|
| Rate for Payer: Banner UC Health Medicare |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$27.20
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$27.20
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna of AZ Commercial |
$85.00
|
| Rate for Payer: Devoted Health Medicare |
$30.60
|
| Rate for Payer: Humana of AZ Medicare |
$27.20
|
| Rate for Payer: Mercy Care Medicaid |
$17.08
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12.86
|
| Rate for Payer: Seven Corners Travel Insurance |
$474.93
|
| Rate for Payer: Southwest Service Administrators UFCW |
$115.60
|
| Rate for Payer: TriWest Medicare |
$27.20
|
| Rate for Payer: United Healthcare Commercial |
$2,671.00
|
| Rate for Payer: United Healthcare Medicare |
$27.20
|
| Rate for Payer: Veterans Affairs TRICARE |
$26.93
|
|
|
INJECTIONS OF TENDON SHEATH, LIGAMENT, OR MUSCLE MEMBRANE
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
24049521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of AZ Commercial |
$141.30
|
| Rate for Payer: Aetna of AZ Commercial |
$171.90
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$125.60
|
|
|
INJECTIONS OF TENDON SHEATH, LIGAMENT, OR MUSCLE MEMBRANE
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
24049521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$2,671.00 |
| Rate for Payer: Aetna of AZ Commercial |
$141.30
|
| Rate for Payer: Aetna of AZ Commercial |
$171.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$30.56
|
| Rate for Payer: Arizona Complete Health Allwell |
$25.12
|
| Rate for Payer: Banner UC Health Medicare |
$18.18
|
| Rate for Payer: Banner UC Health Medicare |
$18.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$129.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$106.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$30.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$25.12
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$30.56
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$25.12
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cigna of AZ Commercial |
$78.50
|
| Rate for Payer: Cigna of AZ Commercial |
$95.50
|
| Rate for Payer: Devoted Health Medicare |
$28.26
|
| Rate for Payer: Devoted Health Medicare |
$34.38
|
| Rate for Payer: Humana of AZ Medicare |
$30.56
|
| Rate for Payer: Humana of AZ Medicare |
$25.12
|
| Rate for Payer: Mercy Care Medicaid |
$19.52
|
| Rate for Payer: Mercy Care Medicaid |
$19.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$18.18
|
| Rate for Payer: NaphCare Correctional Healthcare |
$18.18
|
| Rate for Payer: Seven Corners Travel Insurance |
$474.93
|
| Rate for Payer: Seven Corners Travel Insurance |
$474.93
|
| Rate for Payer: Southwest Service Administrators UFCW |
$106.76
|
| Rate for Payer: Southwest Service Administrators UFCW |
$129.88
|
| Rate for Payer: TriWest Medicare |
$25.12
|
| Rate for Payer: TriWest Medicare |
$30.56
|
| Rate for Payer: United Healthcare Commercial |
$2,671.00
|
| Rate for Payer: United Healthcare Commercial |
$2,671.00
|
| Rate for Payer: United Healthcare Medicare |
$30.56
|
| Rate for Payer: United Healthcare Medicare |
$25.12
|
| Rate for Payer: Veterans Affairs TRICARE |
$30.25
|
| Rate for Payer: Veterans Affairs TRICARE |
$24.87
|
|
|
Injection, Vitamin B-12 Cyanocobalamin, up to 1000 mcg Charge
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
788040
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of AZ Commercial |
$30.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$5.44
|
| Rate for Payer: Banner UC Health Medicare |
$5.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$5.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$5.44
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cigna of AZ Commercial |
$23.80
|
| Rate for Payer: Devoted Health Medicare |
$6.12
|
| Rate for Payer: Humana of AZ Medicare |
$5.44
|
| Rate for Payer: Southwest Service Administrators UFCW |
$23.12
|
| Rate for Payer: TriWest Medicare |
$5.44
|
| Rate for Payer: United Healthcare Commercial |
$19.45
|
| Rate for Payer: United Healthcare Medicare |
$5.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$5.39
|
|
|
Injection, Vitamin B-12 Cyanocobalamin, up to 1000 mcg Charge
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
788040
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of AZ Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
|
|
Inj, Kenalog, Per 10mg Charge
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
788039
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of AZ Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$13.60
|
|
|
Inj, Kenalog, Per 10mg Charge
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
788039
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of AZ Commercial |
$15.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$2.72
|
| Rate for Payer: Banner UC Health Medicare |
$2.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$11.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$2.72
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$2.72
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cigna of AZ Commercial |
$11.90
|
| Rate for Payer: Devoted Health Medicare |
$3.06
|
| Rate for Payer: Humana of AZ Medicare |
$2.72
|
| Rate for Payer: Southwest Service Administrators UFCW |
$11.56
|
| Rate for Payer: TriWest Medicare |
$2.72
|
| Rate for Payer: United Healthcare Commercial |
$9.72
|
| Rate for Payer: United Healthcare Medicare |
$2.72
|
| Rate for Payer: Veterans Affairs TRICARE |
$2.69
|
|
|
INLAY OPTIMA 22CM
|
Facility
|
IP
|
$1,499.25
|
|
| Hospital Charge Code |
28046993
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,349.33 |
| Max. Negotiated Rate |
$1,349.33 |
| Rate for Payer: Aetna of AZ Commercial |
$1,349.33
|
| Rate for Payer: Cash Price |
$1,199.40
|
|
|
INLAY OPTIMA 22CM
|
Facility
|
OP
|
$1,499.25
|
|
| Hospital Charge Code |
28046993
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$237.48 |
| Max. Negotiated Rate |
$1,349.33 |
| Rate for Payer: Aetna of AZ Commercial |
$1,349.33
|
| Rate for Payer: Arizona Complete Health Allwell |
$239.88
|
| Rate for Payer: Banner UC Health Medicare |
$239.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,019.49
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$239.88
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$239.88
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,049.47
|
| Rate for Payer: Devoted Health Medicare |
$269.87
|
| Rate for Payer: Humana of AZ Medicare |
$239.88
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,019.49
|
| Rate for Payer: TriWest Medicare |
$239.88
|
| Rate for Payer: United Healthcare Commercial |
$857.57
|
| Rate for Payer: United Healthcare Medicare |
$239.88
|
| Rate for Payer: Veterans Affairs TRICARE |
$237.48
|
|
|
INSERT Insert Straight Catheter ER Charge
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
855315
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Aetna of AZ Commercial |
$481.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$85.60
|
| Rate for Payer: Banner UC Health Medicare |
$85.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$363.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$85.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$85.60
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cigna of AZ Commercial |
$374.50
|
| Rate for Payer: Devoted Health Medicare |
$96.30
|
| Rate for Payer: Humana of AZ Medicare |
$85.60
|
| Rate for Payer: Mercy Care Medicaid |
$19.18
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19.18
|
| Rate for Payer: Seven Corners Travel Insurance |
$205.86
|
| Rate for Payer: Southwest Service Administrators UFCW |
$363.80
|
| Rate for Payer: TriWest Medicare |
$85.60
|
| Rate for Payer: United Healthcare Commercial |
$306.02
|
| Rate for Payer: United Healthcare Medicare |
$85.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$84.74
|
|
|
INSERT Insert Straight Catheter ER Charge
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
855315
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$481.50 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Aetna of AZ Commercial |
$481.50
|
| Rate for Payer: Cash Price |
$428.00
|
|
|
Insertion Non-biodegradable drug delivery implant
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
24235391
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$467.10 |
| Max. Negotiated Rate |
$467.10 |
| Rate for Payer: Aetna of AZ Commercial |
$467.10
|
| Rate for Payer: Cash Price |
$415.20
|
|
|
Insertion Non-biodegradable drug delivery implant
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
24235391
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$467.10 |
| Rate for Payer: Aetna of AZ Commercial |
$467.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$83.04
|
| Rate for Payer: Banner UC Health Medicare |
$83.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$352.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$83.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$83.04
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cigna of AZ Commercial |
$363.30
|
| Rate for Payer: Devoted Health Medicare |
$93.42
|
| Rate for Payer: Humana of AZ Medicare |
$83.04
|
| Rate for Payer: Mercy Care Medicaid |
$38.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$38.71
|
| Rate for Payer: Seven Corners Travel Insurance |
$205.86
|
| Rate for Payer: Southwest Service Administrators UFCW |
$352.92
|
| Rate for Payer: TriWest Medicare |
$83.04
|
| Rate for Payer: United Healthcare Commercial |
$296.87
|
| Rate for Payer: United Healthcare Medicare |
$83.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$82.21
|
|
|
INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$346.75
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
22760242
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$312.07 |
| Rate for Payer: Aetna of AZ Commercial |
$312.07
|
| Rate for Payer: Arizona Complete Health Allwell |
$55.48
|
| Rate for Payer: Banner UC Health Medicare |
$55.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$235.79
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$55.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$55.48
|
| Rate for Payer: Cash Price |
$277.40
|
| Rate for Payer: Cash Price |
$277.40
|
| Rate for Payer: Cigna of AZ Commercial |
$242.72
|
| Rate for Payer: Devoted Health Medicare |
$62.41
|
| Rate for Payer: Humana of AZ Medicare |
$55.48
|
| Rate for Payer: Mercy Care Medicaid |
$38.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$38.71
|
| Rate for Payer: Seven Corners Travel Insurance |
$205.86
|
| Rate for Payer: Southwest Service Administrators UFCW |
$235.79
|
| Rate for Payer: TriWest Medicare |
$55.48
|
| Rate for Payer: United Healthcare Commercial |
$198.34
|
| Rate for Payer: United Healthcare Medicare |
$55.48
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$65.88
|
| Rate for Payer: Veterans Affairs TRICARE |
$54.93
|
|
