|
Parvovirus B19, Human, IgG/IgM LC
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
2269428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna of AZ Commercial |
$165.60
|
| Rate for Payer: Cash Price |
$147.20
|
|
|
PATH CONSULT INTRAOP 1 BLOCK
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
22545722
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Aetna of AZ Commercial |
$166.50
|
| Rate for Payer: Cash Price |
$148.00
|
|
|
PATH CONSULT INTRAOP 1 BLOCK
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
22545722
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$263.61 |
| Rate for Payer: Aetna of AZ Commercial |
$166.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$29.60
|
| Rate for Payer: Banner UC Health Medicare |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$29.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$70.64
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna of AZ Commercial |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$33.30
|
| Rate for Payer: Humana of AZ Medicare |
$29.60
|
| Rate for Payer: Seven Corners Travel Insurance |
$263.61
|
| Rate for Payer: Southwest Service Administrators UFCW |
$125.80
|
| Rate for Payer: TriWest Medicare |
$29.60
|
| Rate for Payer: United Healthcare Commercial |
$105.82
|
| Rate for Payer: United Healthcare Medicare |
$29.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$29.30
|
|
|
PATH CONSULT INTRAOP EA ADDL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
22545724
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$38.91 |
| Rate for Payer: Aetna of AZ Commercial |
$26.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$4.64
|
| Rate for Payer: Banner UC Health Medicare |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$19.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$4.64
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$38.91
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cigna of AZ Commercial |
$18.85
|
| Rate for Payer: Devoted Health Medicare |
$5.22
|
| Rate for Payer: Humana of AZ Medicare |
$4.64
|
| Rate for Payer: Southwest Service Administrators UFCW |
$19.72
|
| Rate for Payer: TriWest Medicare |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$16.59
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: Veterans Affairs TRICARE |
$4.59
|
|
|
PATH CONSULT INTRAOP EA ADDL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
22545724
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna of AZ Commercial |
$26.10
|
| Rate for Payer: Cash Price |
$23.20
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC
|
Facility
|
IP
|
$13,381.40
|
|
|
Service Code
|
MSDRG 543
|
| Min. Negotiated Rate |
$13,381.40 |
| Max. Negotiated Rate |
$13,381.40 |
| Rate for Payer: Seven Corners Travel Insurance |
$13,381.40
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$22,830.48
|
|
|
Service Code
|
MSDRG 542
|
| Min. Negotiated Rate |
$22,830.48 |
| Max. Negotiated Rate |
$22,830.48 |
| Rate for Payer: Seven Corners Travel Insurance |
$22,830.48
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$9,917.12
|
|
|
Service Code
|
MSDRG 544
|
| Min. Negotiated Rate |
$9,917.12 |
| Max. Negotiated Rate |
$9,917.12 |
| Rate for Payer: Seven Corners Travel Insurance |
$9,917.12
|
|
|
PATIENT MUG
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
22355587
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna of AZ Commercial |
$13.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$2.40
|
| Rate for Payer: Banner UC Health Medicare |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$2.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of AZ Commercial |
$10.50
|
| Rate for Payer: Devoted Health Medicare |
$2.70
|
| Rate for Payer: Humana of AZ Medicare |
$2.40
|
| Rate for Payer: Southwest Service Administrators UFCW |
$10.20
|
| Rate for Payer: TriWest Medicare |
$2.40
|
| Rate for Payer: United Healthcare Commercial |
$8.58
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$2.38
|
|
|
PATIENT MUG
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
22355587
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna of AZ Commercial |
$13.50
|
| Rate for Payer: Cash Price |
$12.00
|
|
|
PATIENT PROGRAMER
|
Facility
|
OP
|
$6,823.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
22354563
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,080.76 |
| Max. Negotiated Rate |
$6,140.70 |
| Rate for Payer: Aetna of AZ Commercial |
$6,140.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$1,091.68
|
| Rate for Payer: Banner UC Health Medicare |
$1,091.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$4,639.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$1,091.68
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$1,091.68
|
| Rate for Payer: Cash Price |
$5,458.40
|
| Rate for Payer: Cigna of AZ Commercial |
$4,776.10
|
| Rate for Payer: Devoted Health Medicare |
$1,228.14
|
| Rate for Payer: Humana of AZ Medicare |
$1,091.68
|
| Rate for Payer: Southwest Service Administrators UFCW |
$4,639.64
|
| Rate for Payer: TriWest Medicare |
$1,091.68
|
| Rate for Payer: United Healthcare Commercial |
$3,902.76
|
| Rate for Payer: United Healthcare Medicare |
$1,091.68
|
| Rate for Payer: Veterans Affairs TRICARE |
$1,080.76
|
|
|
PATIENT PROGRAMER
|
Facility
|
IP
|
$6,823.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
22354563
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6,140.70 |
| Max. Negotiated Rate |
$6,140.70 |
| Rate for Payer: Aetna of AZ Commercial |
$6,140.70
|
| Rate for Payer: Cash Price |
$5,458.40
|
|
|
PAYMENT FOR COMMUNICATION TECHNOLOGY-BASED SERVICES
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS G0071
|
| Hospital Charge Code |
23926446
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of AZ Commercial |
$81.90
|
| Rate for Payer: Cash Price |
$72.80
|
|
|
PAYMENT FOR COMMUNICATION TECHNOLOGY-BASED SERVICES
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS G0071
|
| Hospital Charge Code |
23926446
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of AZ Commercial |
$81.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$14.56
|
| Rate for Payer: Banner UC Health Medicare |
$14.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$61.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$14.56
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$14.56
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cigna of AZ Commercial |
$63.70
|
| Rate for Payer: Devoted Health Medicare |
$16.38
|
| Rate for Payer: Humana of AZ Medicare |
$14.56
|
| Rate for Payer: Southwest Service Administrators UFCW |
$61.88
|
| Rate for Payer: TriWest Medicare |
$14.56
|
| Rate for Payer: United Healthcare Commercial |
$52.05
|
| Rate for Payer: United Healthcare Medicare |
$14.56
|
| Rate for Payer: Veterans Affairs TRICARE |
$14.41
|
|
|
PEDIALYTE 1 LITER BOTTLE
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
22354906
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of AZ Commercial |
$54.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$9.60
|
| Rate for Payer: Banner UC Health Medicare |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$9.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna of AZ Commercial |
$42.00
|
| Rate for Payer: Devoted Health Medicare |
$10.80
|
| Rate for Payer: Humana of AZ Medicare |
$9.60
|
| Rate for Payer: Southwest Service Administrators UFCW |
$40.80
|
| Rate for Payer: TriWest Medicare |
$9.60
|
| Rate for Payer: United Healthcare Commercial |
$34.32
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$9.50
|
|
|
PEDIALYTE 1 LITER BOTTLE
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
22354906
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of AZ Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$48.00
|
|
|
pedialyte oral electrolyte pwder pkt [CQCH]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 70074056091
|
| Hospital Charge Code |
105955114
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of AZ Commercial |
$0.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.16
|
| Rate for Payer: Banner UC Health Medicare |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.16
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.16
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of AZ Commercial |
$0.65
|
| Rate for Payer: Devoted Health Medicare |
$0.18
|
| Rate for Payer: Humana of AZ Medicare |
$0.16
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.68
|
| Rate for Payer: TriWest Medicare |
$0.16
|
| Rate for Payer: United Healthcare Commercial |
$0.57
|
| Rate for Payer: United Healthcare Medicare |
$0.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.16
|
|
|
pedialyte oral electrolyte pwder pkt [CQCH]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 70074056091
|
| Hospital Charge Code |
105955114
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of AZ Commercial |
$0.90
|
| Rate for Payer: Cash Price |
$0.80
|
|
|
PEDINEB PACIFIER NEBULIZERS
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
27728002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna of AZ Commercial |
$49.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$8.80
|
| Rate for Payer: Banner UC Health Medicare |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$37.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$8.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$8.80
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna of AZ Commercial |
$38.50
|
| Rate for Payer: Devoted Health Medicare |
$9.90
|
| Rate for Payer: Humana of AZ Medicare |
$8.80
|
| Rate for Payer: Southwest Service Administrators UFCW |
$37.40
|
| Rate for Payer: TriWest Medicare |
$8.80
|
| Rate for Payer: United Healthcare Commercial |
$31.46
|
| Rate for Payer: United Healthcare Medicare |
$8.80
|
| Rate for Payer: Veterans Affairs TRICARE |
$8.71
|
|
|
PEDINEB PACIFIER NEBULIZERS
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
27728002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna of AZ Commercial |
$49.50
|
| Rate for Payer: Cash Price |
$44.00
|
|
|
Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures
|
Facility
|
IP
|
$34,134.33
|
|
|
Service Code
|
APR-DRG 5104
|
| Hospital Charge Code |
APRDRG5104
|
| Min. Negotiated Rate |
$34,134.33 |
| Max. Negotiated Rate |
$34,134.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$34,134.33
|
| Rate for Payer: Mercy Care Medicaid |
$34,134.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$34,134.33
|
|
|
Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures
|
Facility
|
IP
|
$8,637.04
|
|
|
Service Code
|
APR-DRG 5101
|
| Hospital Charge Code |
APRDRG5103
|
| Min. Negotiated Rate |
$8,637.04 |
| Max. Negotiated Rate |
$8,637.04 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,637.04
|
| Rate for Payer: Mercy Care Medicaid |
$8,637.04
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,637.04
|
|
|
Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures
|
Facility
|
IP
|
$16,580.39
|
|
|
Service Code
|
APR-DRG 5103
|
| Hospital Charge Code |
APRDRG5101
|
| Min. Negotiated Rate |
$16,580.39 |
| Max. Negotiated Rate |
$16,580.39 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,580.39
|
| Rate for Payer: Mercy Care Medicaid |
$16,580.39
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,580.39
|
|
|
Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures
|
Facility
|
IP
|
$10,957.27
|
|
|
Service Code
|
APR-DRG 5102
|
| Hospital Charge Code |
APRDRG5102
|
| Min. Negotiated Rate |
$10,957.27 |
| Max. Negotiated Rate |
$10,957.27 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,957.27
|
| Rate for Payer: Mercy Care Medicaid |
$10,957.27
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,957.27
|
|
|
Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures
|
Facility
|
IP
|
$8,637.04
|
|
|
Service Code
|
APR-DRG 5101
|
| Hospital Charge Code |
APRDRG5102
|
| Min. Negotiated Rate |
$8,637.04 |
| Max. Negotiated Rate |
$8,637.04 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,637.04
|
| Rate for Payer: Mercy Care Medicaid |
$8,637.04
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,637.04
|
|
