|
ADAPTER AIRWAY CO2 TIDALWAVE
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
22354926
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of AZ Commercial |
$64.80
|
| Rate for Payer: Cash Price |
$57.60
|
|
|
ADAPTER AIRWAY CO2 TIDALWAVE
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
22354926
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of AZ Commercial |
$64.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$11.52
|
| Rate for Payer: Banner UC Health Medicare |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$48.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$11.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$11.52
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of AZ Commercial |
$50.40
|
| Rate for Payer: Devoted Health Medicare |
$12.96
|
| Rate for Payer: Humana of AZ Medicare |
$11.52
|
| Rate for Payer: Southwest Service Administrators UFCW |
$48.96
|
| Rate for Payer: TriWest Medicare |
$11.52
|
| Rate for Payer: United Healthcare Commercial |
$41.18
|
| Rate for Payer: United Healthcare Medicare |
$11.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$11.40
|
|
|
ADAPTER ETT CO2 PED/ADULT (TIDAL WAVE)
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
22355405
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of AZ Commercial |
$30.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$5.44
|
| Rate for Payer: Banner UC Health Medicare |
$5.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$5.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$5.44
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cigna of AZ Commercial |
$23.80
|
| Rate for Payer: Devoted Health Medicare |
$6.12
|
| Rate for Payer: Humana of AZ Medicare |
$5.44
|
| Rate for Payer: Southwest Service Administrators UFCW |
$23.12
|
| Rate for Payer: TriWest Medicare |
$5.44
|
| Rate for Payer: United Healthcare Commercial |
$19.45
|
| Rate for Payer: United Healthcare Medicare |
$5.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$5.39
|
|
|
ADAPTER ETT CO2 PED/ADULT (TIDAL WAVE)
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
22355405
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of AZ Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
|
|
ADAPTER SAMPLING NC CO2
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
22354925
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of AZ Commercial |
$76.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$13.60
|
| Rate for Payer: Banner UC Health Medicare |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$57.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$13.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna of AZ Commercial |
$59.50
|
| Rate for Payer: Devoted Health Medicare |
$15.30
|
| Rate for Payer: Humana of AZ Medicare |
$13.60
|
| Rate for Payer: Southwest Service Administrators UFCW |
$57.80
|
| Rate for Payer: TriWest Medicare |
$13.60
|
| Rate for Payer: United Healthcare Commercial |
$48.62
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.46
|
|
|
ADAPTER SAMPLING NC CO2
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
22354925
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of AZ Commercial |
$76.50
|
| Rate for Payer: Cash Price |
$68.00
|
|
|
ADAPTER SAMPLING SIDESTREAM CO2
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
22354924
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of AZ Commercial |
$62.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$11.04
|
| Rate for Payer: Banner UC Health Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$11.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$11.04
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna of AZ Commercial |
$48.30
|
| Rate for Payer: Devoted Health Medicare |
$12.42
|
| Rate for Payer: Humana of AZ Medicare |
$11.04
|
| Rate for Payer: Southwest Service Administrators UFCW |
$46.92
|
| Rate for Payer: TriWest Medicare |
$11.04
|
| Rate for Payer: United Healthcare Commercial |
$39.47
|
| Rate for Payer: United Healthcare Medicare |
$11.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$10.93
|
|
|
ADAPTER SAMPLING SIDESTREAM CO2
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
22354924
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of AZ Commercial |
$62.10
|
| Rate for Payer: Cash Price |
$55.20
|
|
|
ADD IV PUSH NEW MED
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
22283170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$40.80
|
| Rate for Payer: Banner UC Health Medicare |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$40.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$40.80
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna of AZ Commercial |
$178.50
|
| Rate for Payer: Devoted Health Medicare |
$45.90
|
| Rate for Payer: Humana of AZ Medicare |
$40.80
|
| Rate for Payer: Seven Corners Travel Insurance |
$72.46
|
| Rate for Payer: Southwest Service Administrators UFCW |
$173.40
|
| Rate for Payer: TriWest Medicare |
$40.80
|
| Rate for Payer: United Healthcare Commercial |
$145.86
|
| Rate for Payer: United Healthcare Medicare |
$40.80
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$48.45
|
| Rate for Payer: Veterans Affairs TRICARE |
$40.39
|
|
|
ADD IV PUSH NEW MED
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
22283170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Cash Price |
$204.00
|
|
|
ADD IV PUSH SAME MED
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
22283171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$40.80
|
| Rate for Payer: Banner UC Health Medicare |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$40.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$40.80
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna of AZ Commercial |
$178.50
|
| Rate for Payer: Devoted Health Medicare |
$45.90
|
| Rate for Payer: Humana of AZ Medicare |
$40.80
|
| Rate for Payer: Southwest Service Administrators UFCW |
$173.40
|
| Rate for Payer: TriWest Medicare |
$40.80
|
| Rate for Payer: United Healthcare Commercial |
$145.86
|
| Rate for Payer: United Healthcare Medicare |
$40.80
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$48.45
|
| Rate for Payer: Veterans Affairs TRICARE |
$40.39
|
|
|
ADD IV PUSH SAME MED
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
22283171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Cash Price |
$204.00
|
|
|
adenosine 12 mg Inj PFS [CQCH]
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
105909256
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna of AZ Commercial |
$3.82
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.68
|
| Rate for Payer: Banner UC Health Medicare |
$0.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.68
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.68
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cigna of AZ Commercial |
$2.76
|
| Rate for Payer: Devoted Health Medicare |
$0.76
|
| Rate for Payer: Humana of AZ Medicare |
$0.68
|
| Rate for Payer: Southwest Service Administrators UFCW |
$2.88
|
| Rate for Payer: TriWest Medicare |
$0.68
|
| Rate for Payer: United Healthcare Commercial |
$2.43
|
| Rate for Payer: United Healthcare Medicare |
$0.68
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.67
|
|
|
adenosine 12 mg Inj PFS [CQCH]
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
105909256
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna of AZ Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$3.39
|
|
|
adenosine 6 mg Inj [CQCH]
|
Facility
|
OP
|
$4.77
|
|
|
Service Code
|
HCPCS J0150
|
| Hospital Charge Code |
105909329
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna of AZ Commercial |
$4.29
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.76
|
| Rate for Payer: Banner UC Health Medicare |
$0.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$3.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.76
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cigna of AZ Commercial |
$3.10
|
| Rate for Payer: Devoted Health Medicare |
$0.86
|
| Rate for Payer: Humana of AZ Medicare |
$0.76
|
| Rate for Payer: Southwest Service Administrators UFCW |
$3.24
|
| Rate for Payer: TriWest Medicare |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$2.73
|
| Rate for Payer: United Healthcare Medicare |
$0.76
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.76
|
|
|
adenosine 6 mg Inj [CQCH]
|
Facility
|
IP
|
$4.77
|
|
|
Service Code
|
HCPCS J0150
|
| Hospital Charge Code |
105909329
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna of AZ Commercial |
$4.29
|
| Rate for Payer: Cash Price |
$3.81
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA: DEFECT
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
24049289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$217.57 |
| Max. Negotiated Rate |
$5,483.10 |
| Rate for Payer: Aetna of AZ Commercial |
$3,833.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$681.44
|
| Rate for Payer: Banner UC Health Medicare |
$1,177.45
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$2,896.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$217.57
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$681.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$681.44
|
| Rate for Payer: Cash Price |
$3,407.20
|
| Rate for Payer: Cash Price |
$3,407.20
|
| Rate for Payer: Cash Price |
$3,407.20
|
| Rate for Payer: Cigna of AZ Commercial |
$2,129.50
|
| Rate for Payer: Devoted Health Medicare |
$766.62
|
| Rate for Payer: Humana of AZ Medicare |
$681.44
|
| Rate for Payer: Mercy Care Medicaid |
$217.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,177.45
|
| Rate for Payer: Seven Corners Travel Insurance |
$5,483.10
|
| Rate for Payer: Southwest Service Administrators UFCW |
$2,896.12
|
| Rate for Payer: TriWest Medicare |
$681.44
|
| Rate for Payer: United Healthcare Commercial |
$4,838.00
|
| Rate for Payer: United Healthcare Medicare |
$681.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$674.63
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA: DEFECT
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
24049289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,833.10 |
| Max. Negotiated Rate |
$3,833.10 |
| Rate for Payer: Aetna of AZ Commercial |
$3,833.10
|
| Rate for Payer: Cash Price |
$3,407.20
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$1,892.38
|
|
|
Service Code
|
APR-DRG 7551
|
| Hospital Charge Code |
APRDRG7554
|
| Min. Negotiated Rate |
$1,892.38 |
| Max. Negotiated Rate |
$1,892.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,892.38
|
| Rate for Payer: Mercy Care Medicaid |
$1,892.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,892.38
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$12,163.68
|
|
|
Service Code
|
APR-DRG 7554
|
| Hospital Charge Code |
APRDRG7553
|
| Min. Negotiated Rate |
$12,163.68 |
| Max. Negotiated Rate |
$12,163.68 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,163.68
|
| Rate for Payer: Mercy Care Medicaid |
$12,163.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,163.68
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$4,436.36
|
|
|
Service Code
|
APR-DRG 7553
|
| Hospital Charge Code |
APRDRG7554
|
| Min. Negotiated Rate |
$4,436.36 |
| Max. Negotiated Rate |
$4,436.36 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,436.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,436.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,436.36
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$12,163.68
|
|
|
Service Code
|
APR-DRG 7554
|
| Hospital Charge Code |
APRDRG7552
|
| Min. Negotiated Rate |
$12,163.68 |
| Max. Negotiated Rate |
$12,163.68 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,163.68
|
| Rate for Payer: Mercy Care Medicaid |
$12,163.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,163.68
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$12,163.68
|
|
|
Service Code
|
APR-DRG 7554
|
| Hospital Charge Code |
APRDRG7551
|
| Min. Negotiated Rate |
$12,163.68 |
| Max. Negotiated Rate |
$12,163.68 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,163.68
|
| Rate for Payer: Mercy Care Medicaid |
$12,163.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,163.68
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$1,892.38
|
|
|
Service Code
|
APR-DRG 7551
|
| Hospital Charge Code |
APRDRG7553
|
| Min. Negotiated Rate |
$1,892.38 |
| Max. Negotiated Rate |
$1,892.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,892.38
|
| Rate for Payer: Mercy Care Medicaid |
$1,892.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,892.38
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$4,436.36
|
|
|
Service Code
|
APR-DRG 7553
|
| Hospital Charge Code |
APRDRG7551
|
| Min. Negotiated Rate |
$4,436.36 |
| Max. Negotiated Rate |
$4,436.36 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,436.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,436.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,436.36
|
|
