|
Insulin 70 units-30 units/mL 10 ml Sus[CQCH]
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
233245743
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of AZ Commercial |
$1.57
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.28
|
| Rate for Payer: Banner UC Health Medicare |
$0.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.28
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1.13
|
| Rate for Payer: Devoted Health Medicare |
$0.31
|
| Rate for Payer: Humana of AZ Medicare |
$0.28
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1.18
|
| Rate for Payer: TriWest Medicare |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.28
|
|
|
Insulin 70 units-30 units/mL 10 ml Sus[CQCH]
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
233245743
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of AZ Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$1.40
|
|
|
INSULIN AB
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
23603250
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.04 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of AZ Commercial |
$350.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$62.24
|
| Rate for Payer: Banner UC Health Medicare |
$62.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$264.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$62.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$62.24
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Cigna of AZ Commercial |
$252.85
|
| Rate for Payer: Devoted Health Medicare |
$70.02
|
| Rate for Payer: Humana of AZ Medicare |
$62.24
|
| Rate for Payer: Seven Corners Travel Insurance |
$31.04
|
| Rate for Payer: Southwest Service Administrators UFCW |
$264.52
|
| Rate for Payer: TriWest Medicare |
$62.24
|
| Rate for Payer: United Healthcare Commercial |
$222.51
|
| Rate for Payer: United Healthcare Medicare |
$62.24
|
| Rate for Payer: Veterans Affairs TRICARE |
$61.62
|
|
|
INSULIN AB
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
23603250
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of AZ Commercial |
$350.10
|
| Rate for Payer: Cash Price |
$311.20
|
|
|
insulin glargine 100 units/mL 10 mL MDV [CQCH]
|
Facility
|
IP
|
$8.33
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
105926643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna of AZ Commercial |
$7.50
|
| Rate for Payer: Cash Price |
$6.67
|
|
|
insulin glargine 100 units/mL 10 mL MDV [CQCH]
|
Facility
|
OP
|
$8.33
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
105926643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna of AZ Commercial |
$7.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$1.33
|
| Rate for Payer: Banner UC Health Medicare |
$1.33
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$5.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$1.33
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$1.33
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of AZ Commercial |
$5.41
|
| Rate for Payer: Devoted Health Medicare |
$1.50
|
| Rate for Payer: Humana of AZ Medicare |
$1.33
|
| Rate for Payer: Southwest Service Administrators UFCW |
$5.66
|
| Rate for Payer: TriWest Medicare |
$1.33
|
| Rate for Payer: United Healthcare Commercial |
$4.76
|
| Rate for Payer: United Healthcare Medicare |
$1.33
|
| Rate for Payer: Veterans Affairs TRICARE |
$1.32
|
|
|
Insulin LC
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
1285572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Aetna of AZ Commercial |
$164.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$29.28
|
| Rate for Payer: Banner UC Health Medicare |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$124.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$29.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$29.28
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna of AZ Commercial |
$118.95
|
| Rate for Payer: Devoted Health Medicare |
$32.94
|
| Rate for Payer: Humana of AZ Medicare |
$29.28
|
| Rate for Payer: Seven Corners Travel Insurance |
$16.57
|
| Rate for Payer: Southwest Service Administrators UFCW |
$124.44
|
| Rate for Payer: TriWest Medicare |
$29.28
|
| Rate for Payer: United Healthcare Commercial |
$104.68
|
| Rate for Payer: United Healthcare Medicare |
$29.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$28.99
|
|
|
Insulin LC
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
1285572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$164.70 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Aetna of AZ Commercial |
$164.70
|
| Rate for Payer: Cash Price |
$146.40
|
|
|
insulin lispro 100 units/mL 3 mL Inj [CQCH]
|
Facility
|
OP
|
$5.93
|
|
|
Service Code
|
HCPCS J1817
|
| Hospital Charge Code |
105926862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna of AZ Commercial |
$5.34
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.95
|
| Rate for Payer: Banner UC Health Medicare |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$4.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.95
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.95
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna of AZ Commercial |
$3.85
|
| Rate for Payer: Devoted Health Medicare |
$1.07
|
| Rate for Payer: Humana of AZ Medicare |
$0.95
|
| Rate for Payer: Southwest Service Administrators UFCW |
$4.03
|
| Rate for Payer: TriWest Medicare |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$3.39
|
| Rate for Payer: United Healthcare Medicare |
$0.95
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.94
|
|
|
insulin lispro 100 units/mL 3 mL Inj [CQCH]
|
Facility
|
IP
|
$5.93
|
|
|
Service Code
|
HCPCS J1817
|
| Hospital Charge Code |
105926862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna of AZ Commercial |
$5.34
|
| Rate for Payer: Cash Price |
$4.74
|
|
|
insulin NPH 100 units/mL 3 mL Inj [CQCH]
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
105926716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of AZ Commercial |
$4.04
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.72
|
| Rate for Payer: Banner UC Health Medicare |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$3.05
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.72
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: Cigna of AZ Commercial |
$2.92
|
| Rate for Payer: Devoted Health Medicare |
$0.81
|
| Rate for Payer: Humana of AZ Medicare |
$0.72
|
| Rate for Payer: Southwest Service Administrators UFCW |
$3.05
|
| Rate for Payer: TriWest Medicare |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
| Rate for Payer: United Healthcare Medicare |
$0.72
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.71
|
|
|
insulin NPH 100 units/mL 3 mL Inj [CQCH]
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
105926716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of AZ Commercial |
$4.04
|
| Rate for Payer: Cash Price |
$3.59
|
|
|
insulin regular 100 units/mL 3 mL Inj [CQCH]
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
105926935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of AZ Commercial |
$4.04
|
| Rate for Payer: Cash Price |
$3.59
|
|
|
insulin regular 100 units/mL 3 mL Inj [CQCH]
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
105926935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of AZ Commercial |
$4.04
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.72
|
| Rate for Payer: Banner UC Health Medicare |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$3.05
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.72
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: Cigna of AZ Commercial |
$2.92
|
| Rate for Payer: Devoted Health Medicare |
$0.81
|
| Rate for Payer: Humana of AZ Medicare |
$0.72
|
| Rate for Payer: Southwest Service Administrators UFCW |
$3.05
|
| Rate for Payer: TriWest Medicare |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
| Rate for Payer: United Healthcare Medicare |
$0.72
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.71
|
|
|
INSULIN TOTL
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
22481486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.70 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Aetna of AZ Commercial |
$173.70
|
| Rate for Payer: Cash Price |
$154.40
|
|
|
INSULIN TOTL
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
22481486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Aetna of AZ Commercial |
$173.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$30.88
|
| Rate for Payer: Banner UC Health Medicare |
$30.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$131.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$30.88
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$30.88
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Cigna of AZ Commercial |
$125.45
|
| Rate for Payer: Devoted Health Medicare |
$34.74
|
| Rate for Payer: Humana of AZ Medicare |
$30.88
|
| Rate for Payer: Seven Corners Travel Insurance |
$16.57
|
| Rate for Payer: Southwest Service Administrators UFCW |
$131.24
|
| Rate for Payer: TriWest Medicare |
$30.88
|
| Rate for Payer: United Healthcare Commercial |
$110.40
|
| Rate for Payer: United Healthcare Medicare |
$30.88
|
| Rate for Payer: Veterans Affairs TRICARE |
$30.57
|
|
|
INTEGRATED TUBING FOR FLUID MANAGEMENT
|
Facility
|
OP
|
$733.00
|
|
| Hospital Charge Code |
22354980
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.11 |
| Max. Negotiated Rate |
$659.70 |
| Rate for Payer: Aetna of AZ Commercial |
$659.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$117.28
|
| Rate for Payer: Banner UC Health Medicare |
$117.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$498.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$117.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$117.28
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cigna of AZ Commercial |
$513.10
|
| Rate for Payer: Devoted Health Medicare |
$131.94
|
| Rate for Payer: Humana of AZ Medicare |
$117.28
|
| Rate for Payer: Southwest Service Administrators UFCW |
$498.44
|
| Rate for Payer: TriWest Medicare |
$117.28
|
| Rate for Payer: United Healthcare Commercial |
$419.28
|
| Rate for Payer: United Healthcare Medicare |
$117.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$116.11
|
|
|
INTEGRATED TUBING FOR FLUID MANAGEMENT
|
Facility
|
IP
|
$733.00
|
|
| Hospital Charge Code |
22354980
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$659.70 |
| Max. Negotiated Rate |
$659.70 |
| Rate for Payer: Aetna of AZ Commercial |
$659.70
|
| Rate for Payer: Cash Price |
$586.40
|
|
|
Intentional Self-Harm And Attempted Suicide
|
Facility
|
IP
|
$3,187.16
|
|
|
Service Code
|
APR-DRG 8172
|
| Hospital Charge Code |
APRDRG8174
|
| Min. Negotiated Rate |
$3,187.16 |
| Max. Negotiated Rate |
$3,187.16 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,187.16
|
| Rate for Payer: Mercy Care Medicaid |
$3,187.16
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,187.16
|
|
|
Intentional Self-Harm And Attempted Suicide
|
Facility
|
IP
|
$3,187.16
|
|
|
Service Code
|
APR-DRG 8172
|
| Hospital Charge Code |
APRDRG8173
|
| Min. Negotiated Rate |
$3,187.16 |
| Max. Negotiated Rate |
$3,187.16 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,187.16
|
| Rate for Payer: Mercy Care Medicaid |
$3,187.16
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,187.16
|
|
|
Intentional Self-Harm And Attempted Suicide
|
Facility
|
IP
|
$2,520.13
|
|
|
Service Code
|
APR-DRG 8171
|
| Hospital Charge Code |
APRDRG8173
|
| Min. Negotiated Rate |
$2,520.13 |
| Max. Negotiated Rate |
$2,520.13 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,520.13
|
| Rate for Payer: Mercy Care Medicaid |
$2,520.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,520.13
|
|
|
Intentional Self-Harm And Attempted Suicide
|
Facility
|
IP
|
$10,416.49
|
|
|
Service Code
|
APR-DRG 8174
|
| Hospital Charge Code |
APRDRG8171
|
| Min. Negotiated Rate |
$10,416.49 |
| Max. Negotiated Rate |
$10,416.49 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,416.49
|
| Rate for Payer: Mercy Care Medicaid |
$10,416.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,416.49
|
|
|
Intentional Self-Harm And Attempted Suicide
|
Facility
|
IP
|
$5,210.00
|
|
|
Service Code
|
APR-DRG 8173
|
| Hospital Charge Code |
APRDRG8172
|
| Min. Negotiated Rate |
$5,210.00 |
| Max. Negotiated Rate |
$5,210.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,210.00
|
| Rate for Payer: Mercy Care Medicaid |
$5,210.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,210.00
|
|
|
Intentional Self-Harm And Attempted Suicide
|
Facility
|
IP
|
$2,520.13
|
|
|
Service Code
|
APR-DRG 8171
|
| Hospital Charge Code |
APRDRG8174
|
| Min. Negotiated Rate |
$2,520.13 |
| Max. Negotiated Rate |
$2,520.13 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,520.13
|
| Rate for Payer: Mercy Care Medicaid |
$2,520.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,520.13
|
|
|
Intentional Self-Harm And Attempted Suicide
|
Facility
|
IP
|
$10,416.49
|
|
|
Service Code
|
APR-DRG 8174
|
| Hospital Charge Code |
APRDRG8174
|
| Min. Negotiated Rate |
$10,416.49 |
| Max. Negotiated Rate |
$10,416.49 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,416.49
|
| Rate for Payer: Mercy Care Medicaid |
$10,416.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,416.49
|
|
