|
pantoprazole 40 mg Tab [CQCH]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 51079005120
|
| Hospital Charge Code |
105935743
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of AZ Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
|
|
PARAGARD NON HORMONAL IUD CQCH_AZ
|
Facility
|
OP
|
$2,278.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
28223763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.84 |
| Max. Negotiated Rate |
$2,050.20 |
| Rate for Payer: Aetna of AZ Commercial |
$2,050.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$364.48
|
| Rate for Payer: Banner UC Health Medicare |
$364.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,549.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$364.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$364.48
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,594.60
|
| Rate for Payer: Devoted Health Medicare |
$410.04
|
| Rate for Payer: Humana of AZ Medicare |
$364.48
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,549.04
|
| Rate for Payer: TriWest Medicare |
$364.48
|
| Rate for Payer: United Healthcare Commercial |
$1,303.02
|
| Rate for Payer: United Healthcare Medicare |
$364.48
|
| Rate for Payer: Veterans Affairs TRICARE |
$360.84
|
|
|
PARAGARD NON HORMONAL IUD CQCH_AZ
|
Facility
|
IP
|
$2,278.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
28223763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,050.20 |
| Max. Negotiated Rate |
$2,050.20 |
| Rate for Payer: Aetna of AZ Commercial |
$2,050.20
|
| Rate for Payer: Cash Price |
$1,822.40
|
|
|
Parasite ID, Worm LC
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
22311201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$67.20
|
|
|
Parasite ID, Worm LC
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
22311201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$13.44
|
| Rate for Payer: Banner UC Health Medicare |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$13.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$13.44
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna of AZ Commercial |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$15.12
|
| Rate for Payer: Humana of AZ Medicare |
$13.44
|
| Rate for Payer: Seven Corners Travel Insurance |
$6.25
|
| Rate for Payer: Southwest Service Administrators UFCW |
$57.12
|
| Rate for Payer: TriWest Medicare |
$13.44
|
| Rate for Payer: United Healthcare Commercial |
$48.05
|
| Rate for Payer: United Healthcare Medicare |
$13.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.31
|
|
|
.Parasite ID, Worm Result LC
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
22311160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of AZ Commercial |
$72.00
|
| Rate for Payer: Cash Price |
$64.00
|
|
|
.Parasite ID, Worm Result LC
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
22311160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of AZ Commercial |
$72.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$12.80
|
| Rate for Payer: Banner UC Health Medicare |
$12.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$54.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$12.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$12.80
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna of AZ Commercial |
$52.00
|
| Rate for Payer: Devoted Health Medicare |
$14.40
|
| Rate for Payer: Humana of AZ Medicare |
$12.80
|
| Rate for Payer: Seven Corners Travel Insurance |
$6.25
|
| Rate for Payer: Southwest Service Administrators UFCW |
$54.40
|
| Rate for Payer: TriWest Medicare |
$12.80
|
| Rate for Payer: United Healthcare Commercial |
$45.76
|
| Rate for Payer: United Healthcare Medicare |
$12.80
|
| Rate for Payer: Veterans Affairs TRICARE |
$12.67
|
|
|
Paravaginal repair abdominal or vaginal
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
CPT 57284
|
| Hospital Charge Code |
27267806
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,888.00 |
| Max. Negotiated Rate |
$3,888.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,888.00
|
| Rate for Payer: Cash Price |
$3,456.00
|
|
|
Paravaginal repair abdominal or vaginal
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
CPT 57284
|
| Hospital Charge Code |
27267806
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$684.29 |
| Max. Negotiated Rate |
$7,740.14 |
| Rate for Payer: Aetna of AZ Commercial |
$3,888.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$691.20
|
| Rate for Payer: Banner UC Health Medicare |
$2,101.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$2,937.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$691.20
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$691.20
|
| Rate for Payer: Cash Price |
$3,456.00
|
| Rate for Payer: Cash Price |
$3,456.00
|
| Rate for Payer: Cash Price |
$3,456.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,160.00
|
| Rate for Payer: Devoted Health Medicare |
$777.60
|
| Rate for Payer: Humana of AZ Medicare |
$691.20
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,101.86
|
| Rate for Payer: Seven Corners Travel Insurance |
$7,740.14
|
| Rate for Payer: Southwest Service Administrators UFCW |
$2,937.60
|
| Rate for Payer: TriWest Medicare |
$691.20
|
| Rate for Payer: United Healthcare Commercial |
$5,611.00
|
| Rate for Payer: United Healthcare Medicare |
$691.20
|
| Rate for Payer: Veterans Affairs TRICARE |
$684.29
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
24049516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$2,671.00 |
| 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 Health Choice |
$58.65
|
| 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: Cash Price |
$61.60
|
| Rate for Payer: Cigna of AZ Commercial |
$38.50
|
| Rate for Payer: Devoted Health Medicare |
$13.86
|
| Rate for Payer: Humana of AZ Medicare |
$12.32
|
| Rate for Payer: Mercy Care Medicaid |
$58.65
|
| Rate for Payer: NaphCare Correctional Healthcare |
$58.65
|
| Rate for Payer: Seven Corners Travel Insurance |
$310.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$52.36
|
| Rate for Payer: TriWest Medicare |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$2,671.00
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$12.20
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
24049517
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$2,671.00 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Aetna of AZ Commercial |
$81.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$14.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$17.44
|
| Rate for Payer: Banner UC Health Medicare |
$14.40
|
| Rate for Payer: Banner UC Health Medicare |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$74.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$64.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$64.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$14.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$14.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$17.44
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of AZ Commercial |
$45.00
|
| Rate for Payer: Cigna of AZ Commercial |
$54.50
|
| Rate for Payer: Devoted Health Medicare |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$19.62
|
| Rate for Payer: Humana of AZ Medicare |
$17.44
|
| Rate for Payer: Humana of AZ Medicare |
$14.40
|
| Rate for Payer: Mercy Care Medicaid |
$64.01
|
| Rate for Payer: Mercy Care Medicaid |
$64.01
|
| Rate for Payer: NaphCare Correctional Healthcare |
$64.01
|
| Rate for Payer: NaphCare Correctional Healthcare |
$64.01
|
| Rate for Payer: Seven Corners Travel Insurance |
$310.43
|
| Rate for Payer: Seven Corners Travel Insurance |
$310.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$61.20
|
| Rate for Payer: Southwest Service Administrators UFCW |
$74.12
|
| Rate for Payer: TriWest Medicare |
$17.44
|
| Rate for Payer: TriWest Medicare |
$14.40
|
| Rate for Payer: United Healthcare Commercial |
$2,671.00
|
| Rate for Payer: United Healthcare Commercial |
$2,671.00
|
| Rate for Payer: United Healthcare Medicare |
$17.44
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$17.27
|
| Rate for Payer: Veterans Affairs TRICARE |
$14.26
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
24049518
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$2,671.00 |
| Rate for Payer: Aetna of AZ Commercial |
$126.90
|
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$22.56
|
| Rate for Payer: Arizona Complete Health Allwell |
$23.68
|
| Rate for Payer: Banner UC Health Medicare |
$36.36
|
| Rate for Payer: Banner UC Health Medicare |
$36.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$100.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$95.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$64.73
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$64.73
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$22.56
|
| 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: Care1st Health Plan Arizona Medicare |
$22.56
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna of AZ Commercial |
$74.00
|
| Rate for Payer: Cigna of AZ Commercial |
$70.50
|
| Rate for Payer: Devoted Health Medicare |
$26.64
|
| Rate for Payer: Devoted Health Medicare |
$25.38
|
| Rate for Payer: Humana of AZ Medicare |
$23.68
|
| Rate for Payer: Humana of AZ Medicare |
$22.56
|
| Rate for Payer: Mercy Care Medicaid |
$64.73
|
| Rate for Payer: Mercy Care Medicaid |
$64.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$36.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$36.36
|
| Rate for Payer: Seven Corners Travel Insurance |
$310.43
|
| Rate for Payer: Seven Corners Travel Insurance |
$310.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$95.88
|
| Rate for Payer: Southwest Service Administrators UFCW |
$100.64
|
| Rate for Payer: TriWest Medicare |
$22.56
|
| Rate for Payer: TriWest Medicare |
$23.68
|
| Rate for Payer: United Healthcare Commercial |
$2,671.00
|
| Rate for Payer: United Healthcare Commercial |
$2,671.00
|
| Rate for Payer: United Healthcare Medicare |
$22.56
|
| Rate for Payer: United Healthcare Medicare |
$23.68
|
| Rate for Payer: Veterans Affairs TRICARE |
$22.33
|
| Rate for Payer: Veterans Affairs TRICARE |
$23.44
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
24049517
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of AZ Commercial |
$81.00
|
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$72.00
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
24049516
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
24049518
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Aetna of AZ Commercial |
$126.90
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$118.40
|
|
|
Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more tha
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
1165835
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$310.43 |
| Rate for Payer: Aetna of AZ Commercial |
$160.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$28.48
|
| Rate for Payer: Banner UC Health Medicare |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$121.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$64.73
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$28.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$28.48
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cigna of AZ Commercial |
$124.60
|
| Rate for Payer: Devoted Health Medicare |
$32.04
|
| Rate for Payer: Humana of AZ Medicare |
$28.48
|
| Rate for Payer: Mercy Care Medicaid |
$64.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$64.73
|
| Rate for Payer: Seven Corners Travel Insurance |
$310.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$121.04
|
| Rate for Payer: TriWest Medicare |
$28.48
|
| Rate for Payer: United Healthcare Commercial |
$101.82
|
| Rate for Payer: United Healthcare Medicare |
$28.48
|
| Rate for Payer: Veterans Affairs TRICARE |
$28.20
|
|
|
Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more tha
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
1165835
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.20 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna of AZ Commercial |
$160.20
|
| Rate for Payer: Cash Price |
$142.40
|
|
|
Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single l
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
7876609
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$96.30 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Aetna of AZ Commercial |
$96.30
|
| Rate for Payer: Cash Price |
$85.60
|
|
|
Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single l
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
7876609
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$310.43 |
| Rate for Payer: Aetna of AZ Commercial |
$96.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$17.12
|
| Rate for Payer: Banner UC Health Medicare |
$17.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$72.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$17.12
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$17.12
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cigna of AZ Commercial |
$74.90
|
| Rate for Payer: Devoted Health Medicare |
$19.26
|
| Rate for Payer: Humana of AZ Medicare |
$17.12
|
| Rate for Payer: Mercy Care Medicaid |
$58.65
|
| Rate for Payer: NaphCare Correctional Healthcare |
$58.65
|
| Rate for Payer: Seven Corners Travel Insurance |
$310.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$72.76
|
| Rate for Payer: TriWest Medicare |
$17.12
|
| Rate for Payer: United Healthcare Commercial |
$61.20
|
| Rate for Payer: United Healthcare Medicare |
$17.12
|
| Rate for Payer: Veterans Affairs TRICARE |
$16.95
|
|
|
PARoxetine 20 mg Tab [CQCH]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 904567761
|
| Hospital Charge Code |
105935810
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of AZ Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
|
|
PARoxetine 20 mg Tab [CQCH]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 904567761
|
| Hospital Charge Code |
105935810
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of AZ Commercial |
$0.13
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.02
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of AZ Commercial |
$0.09
|
| Rate for Payer: Devoted Health Medicare |
$0.03
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.10
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.02
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION OR DIAPHYSECTOMY) BONEÿ
|
Facility
|
IP
|
$4,040.00
|
|
|
Service Code
|
CPT 27640
|
| Hospital Charge Code |
24043287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,636.00 |
| Max. Negotiated Rate |
$3,636.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,232.00
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION OR DIAPHYSECTOMY) BONEÿ
|
Facility
|
OP
|
$4,040.00
|
|
|
Service Code
|
CPT 27640
|
| Hospital Charge Code |
24043287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.94 |
| Max. Negotiated Rate |
$5,062.66 |
| Rate for Payer: Aetna of AZ Commercial |
$3,636.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$646.40
|
| Rate for Payer: Banner UC Health Medicare |
$1,062.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$2,747.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$646.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$646.40
|
| Rate for Payer: Cash Price |
$3,232.00
|
| Rate for Payer: Cash Price |
$3,232.00
|
| Rate for Payer: Cash Price |
$3,232.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,020.00
|
| Rate for Payer: Devoted Health Medicare |
$727.20
|
| Rate for Payer: Humana of AZ Medicare |
$646.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,062.88
|
| Rate for Payer: Seven Corners Travel Insurance |
$5,062.66
|
| Rate for Payer: Southwest Service Administrators UFCW |
$2,747.20
|
| Rate for Payer: TriWest Medicare |
$646.40
|
| Rate for Payer: United Healthcare Commercial |
$4,838.00
|
| Rate for Payer: United Healthcare Medicare |
$646.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$639.94
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY
|
Facility
|
IP
|
$2,146.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
24043291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,931.40 |
| Max. Negotiated Rate |
$1,931.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,931.40
|
| Rate for Payer: Cash Price |
$1,716.80
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY
|
Facility
|
OP
|
$2,146.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
24043291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.53 |
| Max. Negotiated Rate |
$5,062.66 |
| Rate for Payer: Aetna of AZ Commercial |
$1,931.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$343.36
|
| Rate for Payer: Banner UC Health Medicare |
$1,062.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,459.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$148.53
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$343.36
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$343.36
|
| Rate for Payer: Cash Price |
$1,716.80
|
| Rate for Payer: Cash Price |
$1,716.80
|
| Rate for Payer: Cash Price |
$1,716.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,073.00
|
| Rate for Payer: Devoted Health Medicare |
$386.28
|
| Rate for Payer: Humana of AZ Medicare |
$343.36
|
| Rate for Payer: Mercy Care Medicaid |
$148.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,062.88
|
| Rate for Payer: Seven Corners Travel Insurance |
$5,062.66
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,459.28
|
| Rate for Payer: TriWest Medicare |
$343.36
|
| Rate for Payer: United Healthcare Commercial |
$4,169.00
|
| Rate for Payer: United Healthcare Medicare |
$343.36
|
| Rate for Payer: Veterans Affairs TRICARE |
$339.93
|
|
