|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$14,282.61
|
|
|
Service Code
|
APR-DRG 3173
|
| Hospital Charge Code |
APRDRG3173
|
| Min. Negotiated Rate |
$14,282.61 |
| Max. Negotiated Rate |
$14,282.61 |
| Rate for Payer: AHCCCS Medicaid |
$14,282.61
|
| Rate for Payer: Allwell Medicaid |
$14,282.61
|
| Rate for Payer: AZCH Complete Medicaid |
$14,282.61
|
| Rate for Payer: Banner UC Health Medicaid |
$14,282.61
|
| Rate for Payer: Mercy Care Medicaid |
$14,282.61
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$6,375.02
|
|
|
Service Code
|
APR-DRG 3171
|
| Hospital Charge Code |
APRDRG3171
|
| Min. Negotiated Rate |
$6,375.02 |
| Max. Negotiated Rate |
$6,375.02 |
| Rate for Payer: AHCCCS Medicaid |
$6,375.02
|
| Rate for Payer: Allwell Medicaid |
$6,375.02
|
| Rate for Payer: AZCH Complete Medicaid |
$6,375.02
|
| Rate for Payer: Banner UC Health Medicaid |
$6,375.02
|
| Rate for Payer: Mercy Care Medicaid |
$6,375.02
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$27,861.71
|
|
|
Service Code
|
APR-DRG 3174
|
| Hospital Charge Code |
APRDRG3171
|
| Min. Negotiated Rate |
$27,861.71 |
| Max. Negotiated Rate |
$27,861.71 |
| Rate for Payer: AHCCCS Medicaid |
$27,861.71
|
| Rate for Payer: Allwell Medicaid |
$27,861.71
|
| Rate for Payer: AZCH Complete Medicaid |
$27,861.71
|
| Rate for Payer: Banner UC Health Medicaid |
$27,861.71
|
| Rate for Payer: Mercy Care Medicaid |
$27,861.71
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$8,805.38
|
|
|
Service Code
|
APR-DRG 3172
|
| Hospital Charge Code |
APRDRG3171
|
| Min. Negotiated Rate |
$8,805.38 |
| Max. Negotiated Rate |
$8,805.38 |
| Rate for Payer: AHCCCS Medicaid |
$8,805.38
|
| Rate for Payer: Allwell Medicaid |
$8,805.38
|
| Rate for Payer: AZCH Complete Medicaid |
$8,805.38
|
| Rate for Payer: Banner UC Health Medicaid |
$8,805.38
|
| Rate for Payer: Mercy Care Medicaid |
$8,805.38
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$27,861.71
|
|
|
Service Code
|
APR-DRG 3174
|
| Hospital Charge Code |
APRDRG3172
|
| Min. Negotiated Rate |
$27,861.71 |
| Max. Negotiated Rate |
$27,861.71 |
| Rate for Payer: AHCCCS Medicaid |
$27,861.71
|
| Rate for Payer: Allwell Medicaid |
$27,861.71
|
| Rate for Payer: AZCH Complete Medicaid |
$27,861.71
|
| Rate for Payer: Banner UC Health Medicaid |
$27,861.71
|
| Rate for Payer: Mercy Care Medicaid |
$27,861.71
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$8,805.38
|
|
|
Service Code
|
APR-DRG 3172
|
| Hospital Charge Code |
APRDRG3173
|
| Min. Negotiated Rate |
$8,805.38 |
| Max. Negotiated Rate |
$8,805.38 |
| Rate for Payer: AHCCCS Medicaid |
$8,805.38
|
| Rate for Payer: Allwell Medicaid |
$8,805.38
|
| Rate for Payer: AZCH Complete Medicaid |
$8,805.38
|
| Rate for Payer: Banner UC Health Medicaid |
$8,805.38
|
| Rate for Payer: Mercy Care Medicaid |
$8,805.38
|
|
|
tenecteplase 50 mg REC inj[CQCH]
|
Facility
|
IP
|
$7,158.34
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
242057163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,861.17 |
| Max. Negotiated Rate |
$6,442.51 |
| Rate for Payer: Aetna of AZ Commercial |
$6,442.51
|
| Rate for Payer: Bisbee Police All Plans |
$1,861.17
|
| Rate for Payer: Cash Price |
$5,726.67
|
| Rate for Payer: Self Pay Self Pay |
$5,726.67
|
|
|
tenecteplase 50 mg REC inj[CQCH]
|
Facility
|
OP
|
$7,158.34
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
242057163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$229.84 |
| Max. Negotiated Rate |
$6,442.51 |
| Rate for Payer: Aetna of AZ Commercial |
$6,442.51
|
| Rate for Payer: Aetna of AZ Medicare |
$2,004.34
|
| Rate for Payer: AHCCCS Medicaid |
$229.84
|
| Rate for Payer: Allwell Medicaid |
$229.84
|
| Rate for Payer: Allwell Medicare |
$1,073.75
|
| Rate for Payer: Amerigroup Medicare |
$1,073.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,673.64
|
| Rate for Payer: AZCH Complete Medicaid |
$229.84
|
| Rate for Payer: AZCH Complete Medicare |
$1,073.75
|
| Rate for Payer: Banner UC Health Medicaid |
$229.84
|
| Rate for Payer: Banner UC Health Medicare |
$1,073.75
|
| Rate for Payer: Bisbee Police All Plans |
$1,861.17
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4,867.67
|
| Rate for Payer: Cash Price |
$5,726.67
|
| Rate for Payer: Cash Price |
$5,726.67
|
| Rate for Payer: Cigna of AZ Commercial |
$5,010.84
|
| Rate for Payer: Copperpoint Commercial |
$1,771.69
|
| Rate for Payer: Health Net of AZ Commercial |
$4,295.00
|
| Rate for Payer: Health Net of AZ Medicare |
$2,004.34
|
| Rate for Payer: Humana of AZ Medicare |
$1,073.75
|
| Rate for Payer: Mercy Care Medicaid |
$229.84
|
| Rate for Payer: Self Pay Self Pay |
$5,726.67
|
| Rate for Payer: TriWest Medicare |
$1,073.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4,173.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,288.50
|
|
|
TENOTOMY PERCUTANEOUS ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA
|
Facility
|
IP
|
$1,355.00
|
|
|
Service Code
|
CPT 27606
|
| Hospital Charge Code |
24043322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$352.30 |
| Max. Negotiated Rate |
$1,219.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,219.50
|
| Rate for Payer: Bisbee Police All Plans |
$352.30
|
| Rate for Payer: Cash Price |
$1,084.00
|
| Rate for Payer: Self Pay Self Pay |
$1,084.00
|
|
|
TENOTOMY PERCUTANEOUS ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA
|
Facility
|
OP
|
$1,355.00
|
|
|
Service Code
|
CPT 27606
|
| Hospital Charge Code |
24043322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$203.25 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,219.50
|
| Rate for Payer: Aetna of AZ Medicare |
$379.40
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$203.25
|
| Rate for Payer: Amerigroup Medicare |
$203.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$506.09
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$203.25
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$203.25
|
| Rate for Payer: Bisbee Police All Plans |
$352.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$921.40
|
| Rate for Payer: Cash Price |
$1,084.00
|
| Rate for Payer: Cash Price |
$1,084.00
|
| Rate for Payer: Cigna of AZ Commercial |
$677.50
|
| Rate for Payer: Copperpoint Commercial |
$335.36
|
| Rate for Payer: Health Net of AZ Commercial |
$813.00
|
| Rate for Payer: Health Net of AZ Medicare |
$379.40
|
| Rate for Payer: Humana of AZ Medicare |
$203.25
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,084.00
|
| Rate for Payer: TriWest Medicare |
$203.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$243.90
|
|
|
TENOTOMY PERCUTANEOUS ACHILLES TENDON (SEPARATE PROCEDURE); LOCAL ANESTHESIA
|
Facility
|
IP
|
$912.00
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
24043323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$237.12 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Aetna of AZ Commercial |
$820.80
|
| Rate for Payer: Bisbee Police All Plans |
$237.12
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Self Pay Self Pay |
$729.60
|
|
|
TENOTOMY PERCUTANEOUS ACHILLES TENDON (SEPARATE PROCEDURE); LOCAL ANESTHESIA
|
Facility
|
OP
|
$912.00
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
24043323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$820.80
|
| Rate for Payer: Aetna of AZ Medicare |
$255.36
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$136.80
|
| Rate for Payer: Amerigroup Medicare |
$136.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$340.63
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$136.80
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$136.80
|
| Rate for Payer: Bisbee Police All Plans |
$237.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$620.16
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna of AZ Commercial |
$456.00
|
| Rate for Payer: Copperpoint Commercial |
$225.72
|
| Rate for Payer: Health Net of AZ Commercial |
$547.20
|
| Rate for Payer: Health Net of AZ Medicare |
$255.36
|
| Rate for Payer: Humana of AZ Medicare |
$136.80
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$729.60
|
| Rate for Payer: TriWest Medicare |
$136.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$164.16
|
|
|
TENOTOMY PERCUTANEOUS TOE; SINGLE TENDON -Tech
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
24043285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$264.16 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Aetna of AZ Commercial |
$914.40
|
| Rate for Payer: Bisbee Police All Plans |
$264.16
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Self Pay Self Pay |
$812.80
|
|
|
TENOTOMY PERCUTANEOUS TOE; SINGLE TENDON -Tech
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
24043285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$914.40
|
| Rate for Payer: Aetna of AZ Medicare |
$284.48
|
| Rate for Payer: AHCCCS Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicaid |
$2,018.90
|
| Rate for Payer: Allwell Medicare |
$152.40
|
| Rate for Payer: Amerigroup Medicare |
$152.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$379.48
|
| Rate for Payer: AZCH Complete Medicaid |
$2,018.90
|
| Rate for Payer: AZCH Complete Medicare |
$152.40
|
| Rate for Payer: Banner UC Health Medicaid |
$2,018.90
|
| Rate for Payer: Banner UC Health Medicare |
$152.40
|
| Rate for Payer: Bisbee Police All Plans |
$264.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$690.88
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cigna of AZ Commercial |
$508.00
|
| Rate for Payer: Copperpoint Commercial |
$251.46
|
| Rate for Payer: Health Net of AZ Commercial |
$609.60
|
| Rate for Payer: Health Net of AZ Medicare |
$284.48
|
| Rate for Payer: Humana of AZ Medicare |
$152.40
|
| Rate for Payer: Mercy Care Medicaid |
$2,018.90
|
| Rate for Payer: Self Pay Self Pay |
$812.80
|
| Rate for Payer: TriWest Medicare |
$152.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$182.88
|
|
|
Tensoplast 6in
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
22926425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of AZ Commercial |
$40.50
|
| Rate for Payer: Bisbee Police All Plans |
$11.70
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Self Pay Self Pay |
$36.00
|
|
|
Tensoplast 6in
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
22926425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of AZ Commercial |
$40.50
|
| Rate for Payer: Aetna of AZ Medicare |
$12.60
|
| Rate for Payer: Allwell Medicare |
$6.75
|
| Rate for Payer: Amerigroup Medicare |
$6.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$16.81
|
| Rate for Payer: AZCH Complete Medicare |
$6.75
|
| Rate for Payer: Banner UC Health Medicare |
$6.75
|
| Rate for Payer: Bisbee Police All Plans |
$11.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of AZ Commercial |
$31.50
|
| Rate for Payer: Copperpoint Commercial |
$11.14
|
| Rate for Payer: Health Net of AZ Commercial |
$27.00
|
| Rate for Payer: Health Net of AZ Medicare |
$12.60
|
| Rate for Payer: Humana of AZ Medicare |
$6.75
|
| Rate for Payer: Self Pay Self Pay |
$36.00
|
| Rate for Payer: TriWest Medicare |
$6.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$26.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.10
|
|
|
terazosin 1 mg Cap [CQCH]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 904612661
|
| Hospital Charge Code |
105943313
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of AZ Commercial |
$0.11
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Self Pay Self Pay |
$0.10
|
|
|
terazosin 1 mg Cap [CQCH]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 904612661
|
| Hospital Charge Code |
105943313
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of AZ Commercial |
$0.11
|
| Rate for Payer: Aetna of AZ Medicare |
$0.03
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.04
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of AZ Commercial |
$0.08
|
| Rate for Payer: Copperpoint Commercial |
$0.03
|
| Rate for Payer: Health Net of AZ Commercial |
$0.07
|
| Rate for Payer: Health Net of AZ Medicare |
$0.03
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.10
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.07
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
|
terazosin 5 mg Cap [CQCH]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 51079093820
|
| Hospital Charge Code |
105943248
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of AZ Commercial |
$0.12
|
| Rate for Payer: Aetna of AZ Medicare |
$0.04
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.05
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of AZ Commercial |
$0.08
|
| Rate for Payer: Copperpoint Commercial |
$0.03
|
| Rate for Payer: Health Net of AZ Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Medicare |
$0.04
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.10
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
|
terazosin 5 mg Cap [CQCH]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 51079093820
|
| Hospital Charge Code |
105943248
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of AZ Commercial |
$0.12
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Self Pay Self Pay |
$0.10
|
|
|
terbutaline 1 mg/1 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$1.07
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
105943380
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna of AZ Commercial |
$0.96
|
| Rate for Payer: Aetna of AZ Medicare |
$0.30
|
| Rate for Payer: AHCCCS Medicaid |
$2.50
|
| Rate for Payer: Allwell Medicaid |
$2.50
|
| Rate for Payer: Allwell Medicare |
$0.16
|
| Rate for Payer: Amerigroup Medicare |
$0.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.40
|
| Rate for Payer: AZCH Complete Medicaid |
$2.50
|
| Rate for Payer: AZCH Complete Medicare |
$0.16
|
| Rate for Payer: Banner UC Health Medicaid |
$2.50
|
| Rate for Payer: Banner UC Health Medicare |
$0.16
|
| Rate for Payer: Bisbee Police All Plans |
$0.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.73
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of AZ Commercial |
$0.70
|
| Rate for Payer: Copperpoint Commercial |
$0.26
|
| Rate for Payer: Health Net of AZ Commercial |
$0.64
|
| Rate for Payer: Health Net of AZ Medicare |
$0.30
|
| Rate for Payer: Humana of AZ Medicare |
$0.16
|
| Rate for Payer: Mercy Care Medicaid |
$2.50
|
| Rate for Payer: Self Pay Self Pay |
$0.86
|
| Rate for Payer: TriWest Medicare |
$0.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.62
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.19
|
|
|
terbutaline 1 mg/1 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$1.07
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
105943380
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of AZ Commercial |
$0.96
|
| Rate for Payer: Bisbee Police All Plans |
$0.28
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Self Pay Self Pay |
$0.86
|
|
|
Testosterone, Free, Direct LC
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
1905846
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$286.20 |
| Rate for Payer: Aetna of AZ Commercial |
$286.20
|
| Rate for Payer: Aetna of AZ Medicare |
$89.04
|
| Rate for Payer: AHCCCS Medicaid |
$25.47
|
| Rate for Payer: Allwell Medicaid |
$25.47
|
| Rate for Payer: Allwell Medicare |
$47.70
|
| Rate for Payer: Amerigroup Medicare |
$47.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$118.77
|
| Rate for Payer: AZCH Complete Medicaid |
$25.47
|
| Rate for Payer: AZCH Complete Medicare |
$47.70
|
| Rate for Payer: Banner UC Health Medicaid |
$25.47
|
| Rate for Payer: Banner UC Health Medicare |
$47.70
|
| Rate for Payer: Bisbee Police All Plans |
$82.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$216.24
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna of AZ Commercial |
$206.70
|
| Rate for Payer: Copperpoint Commercial |
$78.70
|
| Rate for Payer: Health Net of AZ Commercial |
$190.80
|
| Rate for Payer: Health Net of AZ Medicare |
$89.04
|
| Rate for Payer: Humana of AZ Medicare |
$47.70
|
| Rate for Payer: Mercy Care Medicaid |
$25.47
|
| Rate for Payer: Self Pay Self Pay |
$254.40
|
| Rate for Payer: TriWest Medicare |
$47.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$185.39
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$57.24
|
|
|
Testosterone, Free, Direct LC
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
1905846
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$286.20 |
| Rate for Payer: Aetna of AZ Commercial |
$286.20
|
| Rate for Payer: Bisbee Police All Plans |
$82.68
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Self Pay Self Pay |
$254.40
|
|
|
Testosterone, Serum LC
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
1285542
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of AZ Commercial |
$304.20
|
| Rate for Payer: Aetna of AZ Medicare |
$94.64
|
| Rate for Payer: AHCCCS Medicaid |
$25.81
|
| Rate for Payer: Allwell Medicaid |
$25.81
|
| Rate for Payer: Allwell Medicare |
$50.70
|
| Rate for Payer: Amerigroup Medicare |
$50.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$126.24
|
| Rate for Payer: AZCH Complete Medicaid |
$25.81
|
| Rate for Payer: AZCH Complete Medicare |
$50.70
|
| Rate for Payer: Banner UC Health Medicaid |
$25.81
|
| Rate for Payer: Banner UC Health Medicare |
$50.70
|
| Rate for Payer: Bisbee Police All Plans |
$87.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$229.84
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cigna of AZ Commercial |
$219.70
|
| Rate for Payer: Copperpoint Commercial |
$83.66
|
| Rate for Payer: Health Net of AZ Commercial |
$202.80
|
| Rate for Payer: Health Net of AZ Medicare |
$94.64
|
| Rate for Payer: Humana of AZ Medicare |
$50.70
|
| Rate for Payer: Mercy Care Medicaid |
$25.81
|
| Rate for Payer: Self Pay Self Pay |
$270.40
|
| Rate for Payer: TriWest Medicare |
$50.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$197.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$60.84
|
|
