|
TI6 TH SERIES KWIRE 0.80 x 70MM
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
24358108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of AZ Commercial |
$88.20
|
| Rate for Payer: Bisbee Police All Plans |
$25.48
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Self Pay Self Pay |
$78.40
|
|
|
TI6 TH SERIES KWIRE 0.80 x 70MM
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
24358108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of AZ Commercial |
$88.20
|
| Rate for Payer: Aetna of AZ Medicare |
$27.44
|
| Rate for Payer: Allwell Medicare |
$14.70
|
| Rate for Payer: Amerigroup Medicare |
$14.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$36.60
|
| Rate for Payer: AZCH Complete Medicare |
$14.70
|
| Rate for Payer: Banner UC Health Medicare |
$14.70
|
| Rate for Payer: Bisbee Police All Plans |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$66.64
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cigna of AZ Commercial |
$68.60
|
| Rate for Payer: Copperpoint Commercial |
$24.26
|
| Rate for Payer: Health Net of AZ Commercial |
$58.80
|
| Rate for Payer: Health Net of AZ Medicare |
$27.44
|
| Rate for Payer: Humana of AZ Medicare |
$14.70
|
| Rate for Payer: Self Pay Self Pay |
$78.40
|
| Rate for Payer: TriWest Medicare |
$14.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$57.13
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$17.64
|
|
|
timolol Ophth 0.5% Sol [CQCH]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 64980051405
|
| Hospital Charge Code |
105943863
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of AZ Commercial |
$0.79
|
| Rate for Payer: Aetna of AZ Medicare |
$0.25
|
| Rate for Payer: Allwell Medicare |
$0.13
|
| Rate for Payer: Amerigroup Medicare |
$0.13
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.33
|
| Rate for Payer: AZCH Complete Medicare |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$0.13
|
| Rate for Payer: Bisbee Police All Plans |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of AZ Commercial |
$0.57
|
| Rate for Payer: Copperpoint Commercial |
$0.22
|
| Rate for Payer: Health Net of AZ Commercial |
$0.53
|
| Rate for Payer: Health Net of AZ Medicare |
$0.25
|
| Rate for Payer: Humana of AZ Medicare |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$0.70
|
| Rate for Payer: TriWest Medicare |
$0.13
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.51
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.16
|
|
|
timolol Ophth 0.5% Sol [CQCH]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 64980051405
|
| Hospital Charge Code |
105943863
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of AZ Commercial |
$0.79
|
| Rate for Payer: Bisbee Police All Plans |
$0.23
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Self Pay Self Pay |
$0.70
|
|
|
TINTRA OK MESH
|
Facility
|
IP
|
$8,171.00
|
|
| Hospital Charge Code |
22354194
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,124.46 |
| Max. Negotiated Rate |
$7,353.90 |
| Rate for Payer: Aetna of AZ Commercial |
$7,353.90
|
| Rate for Payer: Bisbee Police All Plans |
$2,124.46
|
| Rate for Payer: Cash Price |
$6,536.80
|
| Rate for Payer: Self Pay Self Pay |
$6,536.80
|
|
|
TINTRA OK MESH
|
Facility
|
OP
|
$8,171.00
|
|
| Hospital Charge Code |
22354194
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,225.65 |
| Max. Negotiated Rate |
$7,353.90 |
| Rate for Payer: Aetna of AZ Commercial |
$7,353.90
|
| Rate for Payer: Aetna of AZ Medicare |
$2,287.88
|
| Rate for Payer: Allwell Medicare |
$1,225.65
|
| Rate for Payer: Amerigroup Medicare |
$1,225.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3,051.87
|
| Rate for Payer: AZCH Complete Medicare |
$1,225.65
|
| Rate for Payer: Banner UC Health Medicare |
$1,225.65
|
| Rate for Payer: Bisbee Police All Plans |
$2,124.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5,556.28
|
| Rate for Payer: Cash Price |
$6,536.80
|
| Rate for Payer: Cigna of AZ Commercial |
$5,719.70
|
| Rate for Payer: Copperpoint Commercial |
$2,022.32
|
| Rate for Payer: Health Net of AZ Commercial |
$4,902.60
|
| Rate for Payer: Health Net of AZ Medicare |
$2,287.88
|
| Rate for Payer: Humana of AZ Medicare |
$1,225.65
|
| Rate for Payer: Self Pay Self Pay |
$6,536.80
|
| Rate for Payer: TriWest Medicare |
$1,225.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4,763.69
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,470.78
|
|
|
tiotropium 18 mcg Cap UD [CQCH]
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
NDC 68180096412
|
| Hospital Charge Code |
229029583
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna of AZ Commercial |
$405.00
|
| Rate for Payer: Bisbee Police All Plans |
$117.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Self Pay Self Pay |
$360.00
|
|
|
tiotropium 18 mcg Cap UD [CQCH]
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
NDC 68180096412
|
| Hospital Charge Code |
229029583
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna of AZ Commercial |
$405.00
|
| Rate for Payer: Aetna of AZ Medicare |
$126.00
|
| Rate for Payer: Allwell Medicare |
$67.50
|
| Rate for Payer: Amerigroup Medicare |
$67.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$168.08
|
| Rate for Payer: AZCH Complete Medicare |
$67.50
|
| Rate for Payer: Banner UC Health Medicare |
$67.50
|
| Rate for Payer: Bisbee Police All Plans |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$306.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna of AZ Commercial |
$315.00
|
| Rate for Payer: Copperpoint Commercial |
$111.38
|
| Rate for Payer: Health Net of AZ Commercial |
$270.00
|
| Rate for Payer: Health Net of AZ Medicare |
$126.00
|
| Rate for Payer: Humana of AZ Medicare |
$67.50
|
| Rate for Payer: Self Pay Self Pay |
$360.00
|
| Rate for Payer: TriWest Medicare |
$67.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$262.35
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$81.00
|
|
|
tiotropium HandiHaler -with # 5 each 18 mcg Inh Cap [CQCH]
|
Facility
|
OP
|
$37.22
|
|
|
Service Code
|
NDC 597007575
|
| Hospital Charge Code |
105943928
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$33.50 |
| Rate for Payer: Aetna of AZ Commercial |
$33.50
|
| Rate for Payer: Aetna of AZ Medicare |
$10.42
|
| Rate for Payer: Allwell Medicare |
$5.58
|
| Rate for Payer: Amerigroup Medicare |
$5.58
|
| Rate for Payer: APIPA Medicare/Medicaid |
$13.90
|
| Rate for Payer: AZCH Complete Medicare |
$5.58
|
| Rate for Payer: Banner UC Health Medicare |
$5.58
|
| Rate for Payer: Bisbee Police All Plans |
$9.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$25.31
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cigna of AZ Commercial |
$24.19
|
| Rate for Payer: Copperpoint Commercial |
$9.21
|
| Rate for Payer: Health Net of AZ Commercial |
$22.33
|
| Rate for Payer: Health Net of AZ Medicare |
$10.42
|
| Rate for Payer: Humana of AZ Medicare |
$5.58
|
| Rate for Payer: Self Pay Self Pay |
$29.78
|
| Rate for Payer: TriWest Medicare |
$5.58
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$21.70
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.70
|
|
|
tiotropium HandiHaler -with # 5 each 18 mcg Inh Cap [CQCH]
|
Facility
|
IP
|
$37.22
|
|
|
Service Code
|
NDC 597007575
|
| Hospital Charge Code |
105943928
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$33.50 |
| Rate for Payer: Aetna of AZ Commercial |
$33.50
|
| Rate for Payer: Bisbee Police All Plans |
$9.68
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Self Pay Self Pay |
$29.78
|
|
|
Tissue Culture
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633906
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Aetna of AZ Commercial |
$224.10
|
| Rate for Payer: Aetna of AZ Medicare |
$69.72
|
| Rate for Payer: AHCCCS Medicaid |
$8.62
|
| Rate for Payer: Allwell Medicaid |
$8.62
|
| Rate for Payer: Allwell Medicare |
$37.35
|
| Rate for Payer: Amerigroup Medicare |
$37.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$93.00
|
| Rate for Payer: AZCH Complete Medicaid |
$8.62
|
| Rate for Payer: AZCH Complete Medicare |
$37.35
|
| Rate for Payer: Banner UC Health Medicaid |
$8.62
|
| Rate for Payer: Banner UC Health Medicare |
$37.35
|
| Rate for Payer: Bisbee Police All Plans |
$64.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$169.32
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna of AZ Commercial |
$161.85
|
| Rate for Payer: Copperpoint Commercial |
$61.63
|
| Rate for Payer: Health Net of AZ Commercial |
$149.40
|
| Rate for Payer: Health Net of AZ Medicare |
$69.72
|
| Rate for Payer: Humana of AZ Medicare |
$37.35
|
| Rate for Payer: Mercy Care Medicaid |
$8.62
|
| Rate for Payer: Self Pay Self Pay |
$199.20
|
| Rate for Payer: TriWest Medicare |
$37.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$145.17
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$44.82
|
|
|
Tissue Culture
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633906
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Aetna of AZ Commercial |
$224.10
|
| Rate for Payer: Bisbee Police All Plans |
$64.74
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Self Pay Self Pay |
$199.20
|
|
|
TITAN ASSEMBLY KIT
|
Facility
|
OP
|
$3,136.00
|
|
| Hospital Charge Code |
23110714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.40 |
| Max. Negotiated Rate |
$2,822.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,822.40
|
| Rate for Payer: Aetna of AZ Medicare |
$878.08
|
| Rate for Payer: Allwell Medicare |
$470.40
|
| Rate for Payer: Amerigroup Medicare |
$470.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,171.30
|
| Rate for Payer: AZCH Complete Medicare |
$470.40
|
| Rate for Payer: Banner UC Health Medicare |
$470.40
|
| Rate for Payer: Bisbee Police All Plans |
$815.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,132.48
|
| Rate for Payer: Cash Price |
$2,508.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,195.20
|
| Rate for Payer: Copperpoint Commercial |
$776.16
|
| Rate for Payer: Health Net of AZ Commercial |
$1,881.60
|
| Rate for Payer: Health Net of AZ Medicare |
$878.08
|
| Rate for Payer: Humana of AZ Medicare |
$470.40
|
| Rate for Payer: Self Pay Self Pay |
$2,508.80
|
| Rate for Payer: TriWest Medicare |
$470.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,828.29
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$564.48
|
|
|
TITAN ASSEMBLY KIT
|
Facility
|
IP
|
$3,136.00
|
|
| Hospital Charge Code |
23110714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.36 |
| Max. Negotiated Rate |
$2,822.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,822.40
|
| Rate for Payer: Bisbee Police All Plans |
$815.36
|
| Rate for Payer: Cash Price |
$2,508.80
|
| Rate for Payer: Self Pay Self Pay |
$2,508.80
|
|
|
TITAN CL RESERVOIR
|
Facility
|
IP
|
$11,432.00
|
|
| Hospital Charge Code |
23110713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,972.32 |
| Max. Negotiated Rate |
$10,288.80 |
| Rate for Payer: Aetna of AZ Commercial |
$10,288.80
|
| Rate for Payer: Bisbee Police All Plans |
$2,972.32
|
| Rate for Payer: Cash Price |
$9,145.60
|
| Rate for Payer: Self Pay Self Pay |
$9,145.60
|
|
|
TITAN CL RESERVOIR
|
Facility
|
OP
|
$11,432.00
|
|
| Hospital Charge Code |
23110713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,714.80 |
| Max. Negotiated Rate |
$10,288.80 |
| Rate for Payer: Aetna of AZ Commercial |
$10,288.80
|
| Rate for Payer: Aetna of AZ Medicare |
$3,200.96
|
| Rate for Payer: Allwell Medicare |
$1,714.80
|
| Rate for Payer: Amerigroup Medicare |
$1,714.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4,269.85
|
| Rate for Payer: AZCH Complete Medicare |
$1,714.80
|
| Rate for Payer: Banner UC Health Medicare |
$1,714.80
|
| Rate for Payer: Bisbee Police All Plans |
$2,972.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$7,773.76
|
| Rate for Payer: Cash Price |
$9,145.60
|
| Rate for Payer: Cigna of AZ Commercial |
$8,002.40
|
| Rate for Payer: Copperpoint Commercial |
$2,829.42
|
| Rate for Payer: Health Net of AZ Commercial |
$6,859.20
|
| Rate for Payer: Health Net of AZ Medicare |
$3,200.96
|
| Rate for Payer: Humana of AZ Medicare |
$1,714.80
|
| Rate for Payer: Self Pay Self Pay |
$9,145.60
|
| Rate for Payer: TriWest Medicare |
$1,714.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$6,664.86
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2,057.76
|
|
|
TITAN CYLINDER SET W/ PUMP
|
Facility
|
IP
|
$52,056.00
|
|
| Hospital Charge Code |
23110715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13,534.56 |
| Max. Negotiated Rate |
$46,850.40 |
| Rate for Payer: Aetna of AZ Commercial |
$46,850.40
|
| Rate for Payer: Bisbee Police All Plans |
$13,534.56
|
| Rate for Payer: Cash Price |
$41,644.80
|
| Rate for Payer: Self Pay Self Pay |
$41,644.80
|
|
|
TITAN CYLINDER SET W/ PUMP
|
Facility
|
OP
|
$52,056.00
|
|
| Hospital Charge Code |
23110715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,808.40 |
| Max. Negotiated Rate |
$46,850.40 |
| Rate for Payer: Aetna of AZ Commercial |
$46,850.40
|
| Rate for Payer: Aetna of AZ Medicare |
$14,575.68
|
| Rate for Payer: Allwell Medicare |
$7,808.40
|
| Rate for Payer: Amerigroup Medicare |
$7,808.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$19,442.92
|
| Rate for Payer: AZCH Complete Medicare |
$7,808.40
|
| Rate for Payer: Banner UC Health Medicare |
$7,808.40
|
| Rate for Payer: Bisbee Police All Plans |
$13,534.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$35,398.08
|
| Rate for Payer: Cash Price |
$41,644.80
|
| Rate for Payer: Cigna of AZ Commercial |
$36,439.20
|
| Rate for Payer: Copperpoint Commercial |
$12,883.86
|
| Rate for Payer: Health Net of AZ Commercial |
$31,233.60
|
| Rate for Payer: Health Net of AZ Medicare |
$14,575.68
|
| Rate for Payer: Humana of AZ Medicare |
$7,808.40
|
| Rate for Payer: Self Pay Self Pay |
$41,644.80
|
| Rate for Payer: TriWest Medicare |
$7,808.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$30,348.65
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$9,370.08
|
|
|
tobramycin 80 mg/2 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
105943993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna of AZ Commercial |
$0.63
|
| Rate for Payer: Aetna of AZ Medicare |
$0.20
|
| Rate for Payer: AHCCCS Medicaid |
$5.16
|
| Rate for Payer: Allwell Medicaid |
$5.16
|
| Rate for Payer: Allwell Medicare |
$0.11
|
| Rate for Payer: Amerigroup Medicare |
$0.11
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.26
|
| Rate for Payer: AZCH Complete Medicaid |
$5.16
|
| Rate for Payer: AZCH Complete Medicare |
$0.11
|
| Rate for Payer: Banner UC Health Medicaid |
$5.16
|
| Rate for Payer: Banner UC Health Medicare |
$0.11
|
| Rate for Payer: Bisbee Police All Plans |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of AZ Commercial |
$0.46
|
| Rate for Payer: Copperpoint Commercial |
$0.17
|
| Rate for Payer: Health Net of AZ Commercial |
$0.42
|
| Rate for Payer: Health Net of AZ Medicare |
$0.20
|
| Rate for Payer: Humana of AZ Medicare |
$0.11
|
| Rate for Payer: Mercy Care Medicaid |
$5.16
|
| Rate for Payer: Self Pay Self Pay |
$0.56
|
| Rate for Payer: TriWest Medicare |
$0.11
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.13
|
|
|
tobramycin 80 mg/2 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$0.70
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
105943993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna of AZ Commercial |
$0.63
|
| Rate for Payer: Bisbee Police All Plans |
$0.18
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Self Pay Self Pay |
$0.56
|
|
|
tocilizumab 200 mg/10 ml Sol[CQCH]
|
Facility
|
OP
|
$128.80
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
233011115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna of AZ Commercial |
$115.92
|
| Rate for Payer: Aetna of AZ Medicare |
$36.06
|
| Rate for Payer: AHCCCS Medicaid |
$9.58
|
| Rate for Payer: Allwell Medicaid |
$9.58
|
| Rate for Payer: Allwell Medicare |
$19.32
|
| Rate for Payer: Amerigroup Medicare |
$19.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$48.11
|
| Rate for Payer: AZCH Complete Medicaid |
$9.58
|
| Rate for Payer: AZCH Complete Medicare |
$19.32
|
| Rate for Payer: Banner UC Health Medicaid |
$9.58
|
| Rate for Payer: Banner UC Health Medicare |
$19.32
|
| Rate for Payer: Bisbee Police All Plans |
$33.49
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$87.58
|
| Rate for Payer: Cash Price |
$103.04
|
| Rate for Payer: Cash Price |
$103.04
|
| Rate for Payer: Cigna of AZ Commercial |
$83.72
|
| Rate for Payer: Copperpoint Commercial |
$31.88
|
| Rate for Payer: Health Net of AZ Commercial |
$77.28
|
| Rate for Payer: Health Net of AZ Medicare |
$36.06
|
| Rate for Payer: Humana of AZ Medicare |
$19.32
|
| Rate for Payer: Mercy Care Medicaid |
$9.58
|
| Rate for Payer: Self Pay Self Pay |
$103.04
|
| Rate for Payer: TriWest Medicare |
$19.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$75.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$23.18
|
|
|
tocilizumab 200 mg/10 ml Sol[CQCH]
|
Facility
|
IP
|
$128.80
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
233011115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna of AZ Commercial |
$115.92
|
| Rate for Payer: Bisbee Police All Plans |
$33.49
|
| Rate for Payer: Cash Price |
$103.04
|
| Rate for Payer: Self Pay Self Pay |
$103.04
|
|
|
tocilizumab 80 mg/4 mL Sol[CQCH]
|
Facility
|
OP
|
$128.80
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
233007748
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna of AZ Commercial |
$115.92
|
| Rate for Payer: Aetna of AZ Medicare |
$36.06
|
| Rate for Payer: AHCCCS Medicaid |
$9.58
|
| Rate for Payer: Allwell Medicaid |
$9.58
|
| Rate for Payer: Allwell Medicare |
$19.32
|
| Rate for Payer: Amerigroup Medicare |
$19.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$48.11
|
| Rate for Payer: AZCH Complete Medicaid |
$9.58
|
| Rate for Payer: AZCH Complete Medicare |
$19.32
|
| Rate for Payer: Banner UC Health Medicaid |
$9.58
|
| Rate for Payer: Banner UC Health Medicare |
$19.32
|
| Rate for Payer: Bisbee Police All Plans |
$33.49
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$87.58
|
| Rate for Payer: Cash Price |
$103.04
|
| Rate for Payer: Cash Price |
$103.04
|
| Rate for Payer: Cigna of AZ Commercial |
$83.72
|
| Rate for Payer: Copperpoint Commercial |
$31.88
|
| Rate for Payer: Health Net of AZ Commercial |
$77.28
|
| Rate for Payer: Health Net of AZ Medicare |
$36.06
|
| Rate for Payer: Humana of AZ Medicare |
$19.32
|
| Rate for Payer: Mercy Care Medicaid |
$9.58
|
| Rate for Payer: Self Pay Self Pay |
$103.04
|
| Rate for Payer: TriWest Medicare |
$19.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$75.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$23.18
|
|
|
tocilizumab 80 mg/4 mL Sol[CQCH]
|
Facility
|
IP
|
$128.80
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
233007748
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna of AZ Commercial |
$115.92
|
| Rate for Payer: Bisbee Police All Plans |
$33.49
|
| Rate for Payer: Cash Price |
$103.04
|
| Rate for Payer: Self Pay Self Pay |
$103.04
|
|
|
Tonsil And Adenoid Procedures
|
Facility
|
IP
|
$5,522.12
|
|
|
Service Code
|
APR-DRG 0972
|
| Hospital Charge Code |
APRDRG0972
|
| Min. Negotiated Rate |
$5,522.12 |
| Max. Negotiated Rate |
$5,522.12 |
| Rate for Payer: AHCCCS Medicaid |
$5,522.12
|
| Rate for Payer: Allwell Medicaid |
$5,522.12
|
| Rate for Payer: AZCH Complete Medicaid |
$5,522.12
|
| Rate for Payer: Banner UC Health Medicaid |
$5,522.12
|
| Rate for Payer: Mercy Care Medicaid |
$5,522.12
|
|
