|
NEW PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH HIGH MEDICAL DECISION MAKING˜
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 98011
|
| Hospital Charge Code |
27943052
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH LOW MEDICAL DECISION MAKING
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 98009
|
| Hospital Charge Code |
27945071
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of AZ Commercial |
$132.30
|
| Rate for Payer: Cash Price |
$117.60
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH LOW MEDICAL DECISION MAKING
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 98009
|
| Hospital Charge Code |
27945071
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of AZ Commercial |
$132.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$23.52
|
| Rate for Payer: Banner UC Health Medicare |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4.31
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$23.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$23.52
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna of AZ Commercial |
$102.90
|
| Rate for Payer: Devoted Health Medicare |
$26.46
|
| Rate for Payer: Humana of AZ Medicare |
$23.52
|
| Rate for Payer: Mercy Care Medicaid |
$4.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4.31
|
| Rate for Payer: Southwest Service Administrators UFCW |
$99.96
|
| Rate for Payer: TriWest Medicare |
$23.52
|
| Rate for Payer: United Healthcare Commercial |
$84.08
|
| Rate for Payer: United Healthcare Medicare |
$23.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$23.28
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH MODERATE MEDICAL DECISION MAKING˜
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 98010
|
| Hospital Charge Code |
27943051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of AZ Commercial |
$207.90
|
| Rate for Payer: Cash Price |
$184.80
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH MODERATE MEDICAL DECISION MAKING˜
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 98010
|
| Hospital Charge Code |
27943051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of AZ Commercial |
$207.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$36.96
|
| Rate for Payer: Banner UC Health Medicare |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$157.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5.75
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$36.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$36.96
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna of AZ Commercial |
$161.70
|
| Rate for Payer: Devoted Health Medicare |
$41.58
|
| Rate for Payer: Humana of AZ Medicare |
$36.96
|
| Rate for Payer: Mercy Care Medicaid |
$5.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5.75
|
| Rate for Payer: Southwest Service Administrators UFCW |
$157.08
|
| Rate for Payer: TriWest Medicare |
$36.96
|
| Rate for Payer: United Healthcare Commercial |
$132.13
|
| Rate for Payer: United Healthcare Medicare |
$36.96
|
| Rate for Payer: Veterans Affairs TRICARE |
$36.59
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH STRAIGHTFORWARD MEDICAL DECISION MAKING
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 98008
|
| Hospital Charge Code |
27941098
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of AZ Commercial |
$76.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$13.60
|
| Rate for Payer: Banner UC Health Medicare |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$57.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$13.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna of AZ Commercial |
$59.50
|
| Rate for Payer: Devoted Health Medicare |
$15.30
|
| Rate for Payer: Humana of AZ Medicare |
$13.60
|
| Rate for Payer: Mercy Care Medicaid |
$3.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3.83
|
| Rate for Payer: Southwest Service Administrators UFCW |
$57.80
|
| Rate for Payer: TriWest Medicare |
$13.60
|
| Rate for Payer: United Healthcare Commercial |
$48.62
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.46
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH STRAIGHTFORWARD MEDICAL DECISION MAKING
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 98008
|
| Hospital Charge Code |
27941098
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of AZ Commercial |
$76.50
|
| Rate for Payer: Cash Price |
$68.00
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH HIGH MEDICAL
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 98003
|
| Hospital Charge Code |
27943050
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of AZ Commercial |
$299.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$53.28
|
| Rate for Payer: Banner UC Health Medicare |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$226.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$53.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$53.28
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna of AZ Commercial |
$233.10
|
| Rate for Payer: Devoted Health Medicare |
$59.94
|
| Rate for Payer: Humana of AZ Medicare |
$53.28
|
| Rate for Payer: Mercy Care Medicaid |
$28.50
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28.50
|
| Rate for Payer: Southwest Service Administrators UFCW |
$226.44
|
| Rate for Payer: TriWest Medicare |
$53.28
|
| Rate for Payer: United Healthcare Commercial |
$190.48
|
| Rate for Payer: United Healthcare Medicare |
$53.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$52.75
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH HIGH MEDICAL
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 98003
|
| Hospital Charge Code |
27943050
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$299.70 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of AZ Commercial |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH LOW MEDICAL DECISION MAKING
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 98001
|
| Hospital Charge Code |
27941093
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$137.70 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of AZ Commercial |
$137.70
|
| Rate for Payer: Cash Price |
$122.40
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH LOW MEDICAL DECISION MAKING
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 98001
|
| Hospital Charge Code |
27941093
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of AZ Commercial |
$137.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$24.48
|
| Rate for Payer: Banner UC Health Medicare |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$104.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$24.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$24.48
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna of AZ Commercial |
$107.10
|
| Rate for Payer: Devoted Health Medicare |
$27.54
|
| Rate for Payer: Humana of AZ Medicare |
$24.48
|
| Rate for Payer: Mercy Care Medicaid |
$21.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$21.32
|
| Rate for Payer: Southwest Service Administrators UFCW |
$104.04
|
| Rate for Payer: TriWest Medicare |
$24.48
|
| Rate for Payer: United Healthcare Commercial |
$87.52
|
| Rate for Payer: United Healthcare Medicare |
$24.48
|
| Rate for Payer: Veterans Affairs TRICARE |
$24.24
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH MODERATE MEDICAL DECISION MAKING
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 98002
|
| Hospital Charge Code |
27943049
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of AZ Commercial |
$222.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$39.52
|
| Rate for Payer: Banner UC Health Medicare |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$167.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$24.43
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$39.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$39.52
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cigna of AZ Commercial |
$172.90
|
| Rate for Payer: Devoted Health Medicare |
$44.46
|
| Rate for Payer: Humana of AZ Medicare |
$39.52
|
| Rate for Payer: Mercy Care Medicaid |
$24.43
|
| Rate for Payer: NaphCare Correctional Healthcare |
$24.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$167.96
|
| Rate for Payer: TriWest Medicare |
$39.52
|
| Rate for Payer: United Healthcare Commercial |
$141.28
|
| Rate for Payer: United Healthcare Medicare |
$39.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$39.12
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH MODERATE MEDICAL DECISION MAKING
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 98002
|
| Hospital Charge Code |
27943049
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of AZ Commercial |
$222.30
|
| Rate for Payer: Cash Price |
$197.60
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH STRAIGHTFORWARD MEDICAL DECISION
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 98000
|
| Hospital Charge Code |
27945070
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of AZ Commercial |
$79.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$14.08
|
| Rate for Payer: Banner UC Health Medicare |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$59.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$14.08
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$14.08
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cigna of AZ Commercial |
$61.60
|
| Rate for Payer: Devoted Health Medicare |
$15.84
|
| Rate for Payer: Humana of AZ Medicare |
$14.08
|
| Rate for Payer: Mercy Care Medicaid |
$17.72
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17.72
|
| Rate for Payer: Southwest Service Administrators UFCW |
$59.84
|
| Rate for Payer: TriWest Medicare |
$14.08
|
| Rate for Payer: United Healthcare Commercial |
$50.34
|
| Rate for Payer: United Healthcare Medicare |
$14.08
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.94
|
|
|
NEW PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH STRAIGHTFORWARD MEDICAL DECISION
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 98000
|
| Hospital Charge Code |
27945070
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of AZ Commercial |
$79.20
|
| Rate for Payer: Cash Price |
$70.40
|
|
|
NGAGE STONE EXTRACTOR 2.2 NITINOL
|
Facility
|
IP
|
$1,322.30
|
|
| Hospital Charge Code |
22834568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,190.07 |
| Max. Negotiated Rate |
$1,190.07 |
| Rate for Payer: Aetna of AZ Commercial |
$1,190.07
|
| Rate for Payer: Cash Price |
$1,057.84
|
|
|
NGAGE STONE EXTRACTOR 2.2 NITINOL
|
Facility
|
OP
|
$1,322.30
|
|
| Hospital Charge Code |
22834568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.45 |
| Max. Negotiated Rate |
$1,190.07 |
| Rate for Payer: Aetna of AZ Commercial |
$1,190.07
|
| Rate for Payer: Arizona Complete Health Allwell |
$211.57
|
| Rate for Payer: Banner UC Health Medicare |
$211.57
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$899.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$211.57
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$211.57
|
| Rate for Payer: Cash Price |
$1,057.84
|
| Rate for Payer: Cigna of AZ Commercial |
$925.61
|
| Rate for Payer: Devoted Health Medicare |
$238.01
|
| Rate for Payer: Humana of AZ Medicare |
$211.57
|
| Rate for Payer: Southwest Service Administrators UFCW |
$899.16
|
| Rate for Payer: TriWest Medicare |
$211.57
|
| Rate for Payer: United Healthcare Commercial |
$756.36
|
| Rate for Payer: United Healthcare Medicare |
$211.57
|
| Rate for Payer: Veterans Affairs TRICARE |
$209.45
|
|
|
niCARdipine 20 mg/200 mL-NaCl Premix IV Sol[CQCH]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
NDC 10122031310
|
| Hospital Charge Code |
124700531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of AZ Commercial |
$0.39
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.07
|
| Rate for Payer: Banner UC Health Medicare |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.07
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.07
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of AZ Commercial |
$0.28
|
| Rate for Payer: Devoted Health Medicare |
$0.08
|
| Rate for Payer: Humana of AZ Medicare |
$0.07
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.29
|
| Rate for Payer: TriWest Medicare |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.25
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.07
|
|
|
niCARdipine 20 mg/200 mL-NaCl Premix IV Sol[CQCH]
|
Facility
|
IP
|
$0.43
|
|
|
Service Code
|
NDC 10122031310
|
| Hospital Charge Code |
124700531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of AZ Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.35
|
|
|
NICORE NITINOL GUIDEWIRE STRAIGHT TIP
|
Facility
|
OP
|
$420.55
|
|
| Hospital Charge Code |
29573353
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$378.50 |
| Rate for Payer: Aetna of AZ Commercial |
$378.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$67.29
|
| Rate for Payer: Banner UC Health Medicare |
$67.29
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$285.97
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$67.29
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$67.29
|
| Rate for Payer: Cash Price |
$336.44
|
| Rate for Payer: Cigna of AZ Commercial |
$294.38
|
| Rate for Payer: Devoted Health Medicare |
$75.70
|
| Rate for Payer: Humana of AZ Medicare |
$67.29
|
| Rate for Payer: Southwest Service Administrators UFCW |
$285.97
|
| Rate for Payer: TriWest Medicare |
$67.29
|
| Rate for Payer: United Healthcare Commercial |
$240.55
|
| Rate for Payer: United Healthcare Medicare |
$67.29
|
| Rate for Payer: Veterans Affairs TRICARE |
$66.62
|
|
|
NICORE NITINOL GUIDEWIRE STRAIGHT TIP
|
Facility
|
IP
|
$420.55
|
|
| Hospital Charge Code |
29573353
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$378.50 |
| Max. Negotiated Rate |
$378.50 |
| Rate for Payer: Aetna of AZ Commercial |
$378.50
|
| Rate for Payer: Cash Price |
$336.44
|
|
|
nicotine 21 mg patch [CQCH]
|
Facility
|
IP
|
$1.78
|
|
|
Service Code
|
NDC 67512614
|
| Hospital Charge Code |
105933829
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.42
|
|
|
nicotine 21 mg patch [CQCH]
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
NDC 67512614
|
| Hospital Charge Code |
105933829
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1.60
|
| 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 |
$1.21
|
| 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 |
$1.42
|
| Rate for Payer: Cigna of AZ Commercial |
$1.16
|
| Rate for Payer: Devoted Health Medicare |
$0.32
|
| Rate for Payer: Humana of AZ Medicare |
$0.28
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1.21
|
| Rate for Payer: TriWest Medicare |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.28
|
|
|
nicotine 2mg Lozenge[CQCH]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 135050802
|
| Hospital Charge Code |
122695398
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of AZ Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.26
|
|
|
nicotine 2mg Lozenge[CQCH]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 135050802
|
| Hospital Charge Code |
122695398
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of AZ Commercial |
$0.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.05
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.05
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.05
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of AZ Commercial |
$0.21
|
| Rate for Payer: Devoted Health Medicare |
$0.06
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.22
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.05
|
|
