|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$8,805.38
|
|
|
Service Code
|
APR-DRG 3172
|
| Hospital Charge Code |
APRDRG3172
|
| Min. Negotiated Rate |
$8,805.38 |
| Max. Negotiated Rate |
$8,805.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,805.38
|
| Rate for Payer: Mercy Care Medicaid |
$8,805.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$27,861.71
|
| Rate for Payer: Mercy Care Medicaid |
$27,861.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,861.71
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$6,375.02
|
|
|
Service Code
|
APR-DRG 3171
|
| Hospital Charge Code |
APRDRG3172
|
| Min. Negotiated Rate |
$6,375.02 |
| Max. Negotiated Rate |
$6,375.02 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,375.02
|
| Rate for Payer: Mercy Care Medicaid |
$6,375.02
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,375.02
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$14,282.61
|
|
|
Service Code
|
APR-DRG 3173
|
| Hospital Charge Code |
APRDRG3172
|
| Min. Negotiated Rate |
$14,282.61 |
| Max. Negotiated Rate |
$14,282.61 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,282.61
|
| Rate for Payer: Mercy Care Medicaid |
$14,282.61
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,282.61
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$6,375.02
|
|
|
Service Code
|
APR-DRG 3171
|
| Hospital Charge Code |
APRDRG3173
|
| Min. Negotiated Rate |
$6,375.02 |
| Max. Negotiated Rate |
$6,375.02 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,375.02
|
| Rate for Payer: Mercy Care Medicaid |
$6,375.02
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,375.02
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$14,282.61
|
|
|
Service Code
|
APR-DRG 3173
|
| Hospital Charge Code |
APRDRG3171
|
| Min. Negotiated Rate |
$14,282.61 |
| Max. Negotiated Rate |
$14,282.61 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,282.61
|
| Rate for Payer: Mercy Care Medicaid |
$14,282.61
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,282.61
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$27,861.71
|
| Rate for Payer: Mercy Care Medicaid |
$27,861.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,861.71
|
|
|
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 |
$6,442.51 |
| Max. Negotiated Rate |
$6,442.51 |
| Rate for Payer: Aetna of AZ Commercial |
$6,442.51
|
| Rate for Payer: Cash Price |
$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 |
$315.26 |
| Max. Negotiated Rate |
$6,442.51 |
| Rate for Payer: Aetna of AZ Commercial |
$6,442.51
|
| Rate for Payer: Arizona Complete Health Allwell |
$1,145.33
|
| Rate for Payer: Banner UC Health Medicare |
$1,145.33
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$4,867.67
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$1,145.33
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$1,145.33
|
| 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: Devoted Health Medicare |
$1,288.50
|
| Rate for Payer: Humana of AZ Medicare |
$1,145.33
|
| Rate for Payer: Seven Corners Travel Insurance |
$315.26
|
| Rate for Payer: Southwest Service Administrators UFCW |
$4,867.67
|
| Rate for Payer: TriWest Medicare |
$1,145.33
|
| Rate for Payer: United Healthcare Commercial |
$4,094.57
|
| Rate for Payer: United Healthcare Medicare |
$1,145.33
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$1,360.08
|
| Rate for Payer: Veterans Affairs TRICARE |
$1,133.88
|
|
|
Tensoplast 6in
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
22926425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of AZ Commercial |
$40.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$7.20
|
| Rate for Payer: Banner UC Health Medicare |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$7.20
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$7.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of AZ Commercial |
$31.50
|
| Rate for Payer: Devoted Health Medicare |
$8.10
|
| Rate for Payer: Humana of AZ Medicare |
$7.20
|
| Rate for Payer: Southwest Service Administrators UFCW |
$30.60
|
| Rate for Payer: TriWest Medicare |
$7.20
|
| Rate for Payer: United Healthcare Commercial |
$25.74
|
| Rate for Payer: United Healthcare Medicare |
$7.20
|
| Rate for Payer: Veterans Affairs TRICARE |
$7.13
|
|
|
Tensoplast 6in
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
22926425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of AZ Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$36.00
|
|
|
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: 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 |
$0.08
|
| 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 |
$0.10
|
| Rate for Payer: Cigna of AZ Commercial |
$0.08
|
| Rate for Payer: Devoted Health Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.08
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.07
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.02
|
|
|
terazosin 1 mg Cap [CQCH]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 904612661
|
| Hospital Charge Code |
105943313
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of AZ Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
|
|
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: 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 |
$0.09
|
| 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 |
$0.10
|
| Rate for Payer: Cigna of AZ Commercial |
$0.08
|
| Rate for Payer: Devoted Health Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.09
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.07
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: Veterans Affairs TRICARE |
$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 |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of AZ Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$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 |
$0.17 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of AZ Commercial |
$0.96
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.17
|
| Rate for Payer: Banner UC Health Medicare |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.17
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.17
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of AZ Commercial |
$0.70
|
| Rate for Payer: Devoted Health Medicare |
$0.19
|
| Rate for Payer: Humana of AZ Medicare |
$0.17
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.73
|
| Rate for Payer: TriWest Medicare |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.61
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.17
|
|
|
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 |
$0.96 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of AZ Commercial |
$0.96
|
| Rate for Payer: Cash Price |
$0.86
|
|
|
TESTES PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$26,931.33
|
|
|
Service Code
|
MSDRG 711
|
| Min. Negotiated Rate |
$26,931.33 |
| Max. Negotiated Rate |
$26,931.33 |
| Rate for Payer: Seven Corners Travel Insurance |
$26,931.33
|
|
|
TESTES PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,289.92
|
|
|
Service Code
|
MSDRG 712
|
| Min. Negotiated Rate |
$14,289.92 |
| Max. Negotiated Rate |
$14,289.92 |
| Rate for Payer: Seven Corners Travel Insurance |
$14,289.92
|
|
|
TEST FOR DETECTING 3 BIOMARKERS ASSOCIATED WITH RISK FOR LIV
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
CPT 81517
|
| Hospital Charge Code |
28011458
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$792.00 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna of AZ Commercial |
$792.00
|
| Rate for Payer: Cash Price |
$704.00
|
|
|
TEST FOR DETECTING 3 BIOMARKERS ASSOCIATED WITH RISK FOR LIV
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT 81517
|
| Hospital Charge Code |
28011458
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$139.39 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna of AZ Commercial |
$792.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$140.80
|
| Rate for Payer: Banner UC Health Medicare |
$140.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$598.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$140.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$140.80
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cigna of AZ Commercial |
$572.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Humana of AZ Medicare |
$140.80
|
| Rate for Payer: Seven Corners Travel Insurance |
$255.48
|
| Rate for Payer: Southwest Service Administrators UFCW |
$598.40
|
| Rate for Payer: TriWest Medicare |
$140.80
|
| Rate for Payer: United Healthcare Commercial |
$503.36
|
| Rate for Payer: United Healthcare Medicare |
$140.80
|
| Rate for Payer: Veterans Affairs TRICARE |
$139.39
|
|
|
Testosterone, Free, Direct LC
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
1905846
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$271.80 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Aetna of AZ Commercial |
$271.80
|
| Rate for Payer: Cash Price |
$241.60
|
|
|
Testosterone, Free, Direct LC
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
1905846
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Aetna of AZ Commercial |
$271.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$48.32
|
| Rate for Payer: Banner UC Health Medicare |
$48.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$205.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$48.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$48.32
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cigna of AZ Commercial |
$196.30
|
| Rate for Payer: Devoted Health Medicare |
$54.36
|
| Rate for Payer: Humana of AZ Medicare |
$48.32
|
| Rate for Payer: Seven Corners Travel Insurance |
$36.93
|
| Rate for Payer: Southwest Service Administrators UFCW |
$205.36
|
| Rate for Payer: TriWest Medicare |
$48.32
|
| Rate for Payer: United Healthcare Commercial |
$172.74
|
| Rate for Payer: United Healthcare Medicare |
$48.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$47.84
|
|
|
Testosterone, Serum LC
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
1285542
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$399.60 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna of AZ Commercial |
$399.60
|
| Rate for Payer: Aetna of AZ Commercial |
$288.90
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$256.80
|
|
|
Testosterone, Serum LC
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
1285542
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.42 |
| Max. Negotiated Rate |
$288.90 |
| Rate for Payer: Aetna of AZ Commercial |
$288.90
|
| Rate for Payer: Aetna of AZ Commercial |
$399.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$71.04
|
| Rate for Payer: Arizona Complete Health Allwell |
$51.36
|
| Rate for Payer: Banner UC Health Medicare |
$71.04
|
| Rate for Payer: Banner UC Health Medicare |
$51.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$218.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$51.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$71.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$51.36
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$71.04
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna of AZ Commercial |
$288.60
|
| Rate for Payer: Cigna of AZ Commercial |
$208.65
|
| Rate for Payer: Devoted Health Medicare |
$79.92
|
| Rate for Payer: Devoted Health Medicare |
$57.78
|
| Rate for Payer: Humana of AZ Medicare |
$51.36
|
| Rate for Payer: Humana of AZ Medicare |
$71.04
|
| Rate for Payer: Seven Corners Travel Insurance |
$37.42
|
| Rate for Payer: Seven Corners Travel Insurance |
$37.42
|
| Rate for Payer: Southwest Service Administrators UFCW |
$301.92
|
| Rate for Payer: Southwest Service Administrators UFCW |
$218.28
|
| Rate for Payer: TriWest Medicare |
$51.36
|
| Rate for Payer: TriWest Medicare |
$71.04
|
| Rate for Payer: United Healthcare Commercial |
$183.61
|
| Rate for Payer: United Healthcare Commercial |
$253.97
|
| Rate for Payer: United Healthcare Medicare |
$51.36
|
| Rate for Payer: United Healthcare Medicare |
$71.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$70.33
|
| Rate for Payer: Veterans Affairs TRICARE |
$50.85
|
|
