|
CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT U0001
|
| Hospital Charge Code |
23934510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of AZ Commercial |
$177.30
|
| Rate for Payer: Bisbee Police All Plans |
$51.22
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Self Pay Self Pay |
$157.60
|
|
|
C Diff Ag and Toxin
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
22414087
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of AZ Commercial |
$143.10
|
| Rate for Payer: Aetna of AZ Medicare |
$44.52
|
| Rate for Payer: AHCCCS Medicaid |
$11.98
|
| Rate for Payer: Allwell Medicaid |
$11.98
|
| Rate for Payer: Allwell Medicare |
$23.85
|
| Rate for Payer: Amerigroup Medicare |
$23.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$59.39
|
| Rate for Payer: AZCH Complete Medicaid |
$11.98
|
| Rate for Payer: AZCH Complete Medicare |
$23.85
|
| Rate for Payer: Banner UC Health Medicaid |
$11.98
|
| Rate for Payer: Banner UC Health Medicare |
$23.85
|
| Rate for Payer: Bisbee Police All Plans |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$108.12
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna of AZ Commercial |
$103.35
|
| Rate for Payer: Copperpoint Commercial |
$39.35
|
| Rate for Payer: Health Net of AZ Commercial |
$95.40
|
| Rate for Payer: Health Net of AZ Medicare |
$44.52
|
| Rate for Payer: Humana of AZ Medicare |
$23.85
|
| Rate for Payer: Mercy Care Medicaid |
$11.98
|
| Rate for Payer: Self Pay Self Pay |
$127.20
|
| Rate for Payer: TriWest Medicare |
$23.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$92.70
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.62
|
|
|
C Diff Ag and Toxin
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
22414087
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of AZ Commercial |
$143.10
|
| Rate for Payer: Bisbee Police All Plans |
$41.34
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Self Pay Self Pay |
$127.20
|
|
|
C. Diff Antigen and Toxin
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
21986571
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Bisbee Police All Plans |
$20.02
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Self Pay Self Pay |
$61.60
|
|
|
C. Diff Antigen and Toxin
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
21986571
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Aetna of AZ Medicare |
$21.56
|
| Rate for Payer: AHCCCS Medicaid |
$11.98
|
| Rate for Payer: Allwell Medicaid |
$11.98
|
| Rate for Payer: Allwell Medicare |
$11.55
|
| Rate for Payer: Amerigroup Medicare |
$11.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$28.76
|
| Rate for Payer: AZCH Complete Medicaid |
$11.98
|
| Rate for Payer: AZCH Complete Medicare |
$11.55
|
| Rate for Payer: Banner UC Health Medicaid |
$11.98
|
| Rate for Payer: Banner UC Health Medicare |
$11.55
|
| Rate for Payer: Bisbee Police All Plans |
$20.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$52.36
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cigna of AZ Commercial |
$50.05
|
| Rate for Payer: Copperpoint Commercial |
$19.06
|
| Rate for Payer: Health Net of AZ Commercial |
$46.20
|
| Rate for Payer: Health Net of AZ Medicare |
$21.56
|
| Rate for Payer: Humana of AZ Medicare |
$11.55
|
| Rate for Payer: Mercy Care Medicaid |
$11.98
|
| Rate for Payer: Self Pay Self Pay |
$61.60
|
| Rate for Payer: TriWest Medicare |
$11.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$44.89
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.86
|
|
|
C. difficile Toxin Gene NAA LC
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
21661560
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.64 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of AZ Commercial |
$417.60
|
| Rate for Payer: Bisbee Police All Plans |
$120.64
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Self Pay Self Pay |
$371.20
|
|
|
C. difficile Toxin Gene NAA LC
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
21661560
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of AZ Commercial |
$417.60
|
| Rate for Payer: Aetna of AZ Medicare |
$129.92
|
| Rate for Payer: AHCCCS Medicaid |
$37.27
|
| Rate for Payer: Allwell Medicaid |
$37.27
|
| Rate for Payer: Allwell Medicare |
$69.60
|
| Rate for Payer: Amerigroup Medicare |
$69.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$173.30
|
| Rate for Payer: AZCH Complete Medicaid |
$37.27
|
| Rate for Payer: AZCH Complete Medicare |
$69.60
|
| Rate for Payer: Banner UC Health Medicaid |
$37.27
|
| Rate for Payer: Banner UC Health Medicare |
$69.60
|
| Rate for Payer: Bisbee Police All Plans |
$120.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$315.52
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cigna of AZ Commercial |
$301.60
|
| Rate for Payer: Copperpoint Commercial |
$114.84
|
| Rate for Payer: Health Net of AZ Commercial |
$278.40
|
| Rate for Payer: Health Net of AZ Medicare |
$129.92
|
| Rate for Payer: Humana of AZ Medicare |
$69.60
|
| Rate for Payer: Mercy Care Medicaid |
$37.27
|
| Rate for Payer: Self Pay Self Pay |
$371.20
|
| Rate for Payer: TriWest Medicare |
$69.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$270.51
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$83.52
|
|
|
C DIFF TOX GENE
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
23298043
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna of AZ Commercial |
$253.80
|
| Rate for Payer: Aetna of AZ Medicare |
$78.96
|
| Rate for Payer: AHCCCS Medicaid |
$37.27
|
| Rate for Payer: Allwell Medicaid |
$37.27
|
| Rate for Payer: Allwell Medicare |
$42.30
|
| Rate for Payer: Amerigroup Medicare |
$42.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$105.33
|
| Rate for Payer: AZCH Complete Medicaid |
$37.27
|
| Rate for Payer: AZCH Complete Medicare |
$42.30
|
| Rate for Payer: Banner UC Health Medicaid |
$37.27
|
| Rate for Payer: Banner UC Health Medicare |
$42.30
|
| Rate for Payer: Bisbee Police All Plans |
$73.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$191.76
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna of AZ Commercial |
$183.30
|
| Rate for Payer: Copperpoint Commercial |
$69.80
|
| Rate for Payer: Health Net of AZ Commercial |
$169.20
|
| Rate for Payer: Health Net of AZ Medicare |
$78.96
|
| Rate for Payer: Humana of AZ Medicare |
$42.30
|
| Rate for Payer: Mercy Care Medicaid |
$37.27
|
| Rate for Payer: Self Pay Self Pay |
$225.60
|
| Rate for Payer: TriWest Medicare |
$42.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$164.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$50.76
|
|
|
C DIFF TOX GENE
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
23298043
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna of AZ Commercial |
$253.80
|
| Rate for Payer: Bisbee Police All Plans |
$73.32
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Self Pay Self Pay |
$225.60
|
|
|
CEA LC
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
2269423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Aetna of AZ Commercial |
$223.20
|
| Rate for Payer: Bisbee Police All Plans |
$64.48
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Self Pay Self Pay |
$198.40
|
|
|
CEA LC
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
2269423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Aetna of AZ Commercial |
$223.20
|
| Rate for Payer: Aetna of AZ Medicare |
$69.44
|
| Rate for Payer: AHCCCS Medicaid |
$18.96
|
| Rate for Payer: Allwell Medicaid |
$18.96
|
| Rate for Payer: Allwell Medicare |
$37.20
|
| Rate for Payer: Amerigroup Medicare |
$37.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$92.63
|
| Rate for Payer: AZCH Complete Medicaid |
$18.96
|
| Rate for Payer: AZCH Complete Medicare |
$37.20
|
| Rate for Payer: Banner UC Health Medicaid |
$18.96
|
| Rate for Payer: Banner UC Health Medicare |
$37.20
|
| Rate for Payer: Bisbee Police All Plans |
$64.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$168.64
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cigna of AZ Commercial |
$161.20
|
| Rate for Payer: Copperpoint Commercial |
$61.38
|
| Rate for Payer: Health Net of AZ Commercial |
$148.80
|
| Rate for Payer: Health Net of AZ Medicare |
$69.44
|
| Rate for Payer: Humana of AZ Medicare |
$37.20
|
| Rate for Payer: Mercy Care Medicaid |
$18.96
|
| Rate for Payer: Self Pay Self Pay |
$198.40
|
| Rate for Payer: TriWest Medicare |
$37.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$144.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$44.64
|
|
|
ceFAZolin 1 gm Inj [CQCH]
|
Facility
|
IP
|
$0.63
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
105914847
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of AZ Commercial |
$0.57
|
| Rate for Payer: Bisbee Police All Plans |
$0.16
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Self Pay Self Pay |
$0.50
|
|
|
ceFAZolin 1 gm Inj [CQCH]
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
105914847
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of AZ Commercial |
$0.57
|
| Rate for Payer: Aetna of AZ Medicare |
$0.18
|
| Rate for Payer: AHCCCS Medicaid |
$1.38
|
| Rate for Payer: Allwell Medicaid |
$1.38
|
| Rate for Payer: Allwell Medicare |
$0.09
|
| Rate for Payer: Amerigroup Medicare |
$0.09
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.24
|
| Rate for Payer: AZCH Complete Medicaid |
$1.38
|
| Rate for Payer: AZCH Complete Medicare |
$0.09
|
| Rate for Payer: Banner UC Health Medicaid |
$1.38
|
| Rate for Payer: Banner UC Health Medicare |
$0.09
|
| Rate for Payer: Bisbee Police All Plans |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cigna of AZ Commercial |
$0.41
|
| Rate for Payer: Copperpoint Commercial |
$0.16
|
| Rate for Payer: Health Net of AZ Commercial |
$0.38
|
| Rate for Payer: Health Net of AZ Medicare |
$0.18
|
| Rate for Payer: Humana of AZ Medicare |
$0.09
|
| Rate for Payer: Mercy Care Medicaid |
$1.38
|
| Rate for Payer: Self Pay Self Pay |
$0.50
|
| Rate for Payer: TriWest Medicare |
$0.09
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.37
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.11
|
|
|
ceFAZolin 1 gm IVPB[CQCH]
|
Facility
|
IP
|
$3.34
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
135817684
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna of AZ Commercial |
$3.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.87
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Self Pay Self Pay |
$2.67
|
|
|
ceFAZolin 1 gm IVPB[CQCH]
|
Facility
|
OP
|
$3.34
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
135817684
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna of AZ Commercial |
$3.01
|
| Rate for Payer: Aetna of AZ Medicare |
$0.94
|
| Rate for Payer: AHCCCS Medicaid |
$1.38
|
| Rate for Payer: Allwell Medicaid |
$1.38
|
| Rate for Payer: Allwell Medicare |
$0.50
|
| Rate for Payer: Amerigroup Medicare |
$0.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.25
|
| Rate for Payer: AZCH Complete Medicaid |
$1.38
|
| Rate for Payer: AZCH Complete Medicare |
$0.50
|
| Rate for Payer: Banner UC Health Medicaid |
$1.38
|
| Rate for Payer: Banner UC Health Medicare |
$0.50
|
| Rate for Payer: Bisbee Police All Plans |
$0.87
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cigna of AZ Commercial |
$2.17
|
| Rate for Payer: Copperpoint Commercial |
$0.83
|
| Rate for Payer: Health Net of AZ Commercial |
$2.00
|
| Rate for Payer: Health Net of AZ Medicare |
$0.94
|
| Rate for Payer: Humana of AZ Medicare |
$0.50
|
| Rate for Payer: Mercy Care Medicaid |
$1.38
|
| Rate for Payer: Self Pay Self Pay |
$2.67
|
| Rate for Payer: TriWest Medicare |
$0.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.95
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.60
|
|
|
ceFAZolin 2 gm REC [CQCH]
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
213338088
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna of AZ Commercial |
$3.85
|
| Rate for Payer: Bisbee Police All Plans |
$1.11
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Self Pay Self Pay |
$3.42
|
|
|
ceFAZolin 2 gm REC [CQCH]
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
213338088
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna of AZ Commercial |
$3.85
|
| Rate for Payer: Aetna of AZ Medicare |
$1.20
|
| Rate for Payer: AHCCCS Medicaid |
$1.38
|
| Rate for Payer: Allwell Medicaid |
$1.38
|
| Rate for Payer: Allwell Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.60
|
| Rate for Payer: AZCH Complete Medicaid |
$1.38
|
| Rate for Payer: AZCH Complete Medicare |
$0.64
|
| Rate for Payer: Banner UC Health Medicaid |
$1.38
|
| Rate for Payer: Banner UC Health Medicare |
$0.64
|
| Rate for Payer: Bisbee Police All Plans |
$1.11
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cigna of AZ Commercial |
$2.78
|
| Rate for Payer: Copperpoint Commercial |
$1.06
|
| Rate for Payer: Health Net of AZ Commercial |
$2.57
|
| Rate for Payer: Health Net of AZ Medicare |
$1.20
|
| Rate for Payer: Humana of AZ Medicare |
$0.64
|
| Rate for Payer: Mercy Care Medicaid |
$1.38
|
| Rate for Payer: Self Pay Self Pay |
$3.42
|
| Rate for Payer: TriWest Medicare |
$0.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.77
|
|
|
cefdinir 125 mg/5 mL REC[CQCH]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 16714039202
|
| Hospital Charge Code |
160942771
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of AZ Commercial |
$0.08
|
| Rate for Payer: Aetna of AZ Medicare |
$0.03
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.03
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of AZ Commercial |
$0.06
|
| Rate for Payer: Copperpoint Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Commercial |
$0.05
|
| Rate for Payer: Health Net of AZ Medicare |
$0.03
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.07
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
|
cefdinir 125 mg/5 mL REC[CQCH]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 16714039202
|
| Hospital Charge Code |
160942771
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of AZ Commercial |
$0.08
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Self Pay Self Pay |
$0.07
|
|
|
cefdinir 300 mg Cap [CQCH]
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
NDC 16714039102
|
| Hospital Charge Code |
107734593
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of AZ Commercial |
$1.73
|
| Rate for Payer: Bisbee Police All Plans |
$0.50
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Self Pay Self Pay |
$1.54
|
|
|
cefdinir 300 mg Cap [CQCH]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
NDC 16714039102
|
| Hospital Charge Code |
107734593
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of AZ Commercial |
$1.73
|
| Rate for Payer: Aetna of AZ Medicare |
$0.54
|
| Rate for Payer: Allwell Medicare |
$0.29
|
| Rate for Payer: Amerigroup Medicare |
$0.29
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.72
|
| Rate for Payer: AZCH Complete Medicare |
$0.29
|
| Rate for Payer: Banner UC Health Medicare |
$0.29
|
| Rate for Payer: Bisbee Police All Plans |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cigna of AZ Commercial |
$1.25
|
| Rate for Payer: Copperpoint Commercial |
$0.48
|
| Rate for Payer: Health Net of AZ Commercial |
$1.15
|
| Rate for Payer: Health Net of AZ Medicare |
$0.54
|
| Rate for Payer: Humana of AZ Medicare |
$0.29
|
| Rate for Payer: Self Pay Self Pay |
$1.54
|
| Rate for Payer: TriWest Medicare |
$0.29
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.35
|
|
|
cefepime 1 gm Inj [CQCH]
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
105914993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna of AZ Commercial |
$3.56
|
| Rate for Payer: Aetna of AZ Medicare |
$1.11
|
| Rate for Payer: AHCCCS Medicaid |
$2.44
|
| Rate for Payer: Allwell Medicaid |
$2.44
|
| Rate for Payer: Allwell Medicare |
$0.59
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.48
|
| Rate for Payer: AZCH Complete Medicaid |
$2.44
|
| Rate for Payer: AZCH Complete Medicare |
$0.59
|
| Rate for Payer: Banner UC Health Medicaid |
$2.44
|
| Rate for Payer: Banner UC Health Medicare |
$0.59
|
| Rate for Payer: Bisbee Police All Plans |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cigna of AZ Commercial |
$2.57
|
| Rate for Payer: Copperpoint Commercial |
$0.98
|
| Rate for Payer: Health Net of AZ Commercial |
$2.38
|
| Rate for Payer: Health Net of AZ Medicare |
$1.11
|
| Rate for Payer: Humana of AZ Medicare |
$0.59
|
| Rate for Payer: Mercy Care Medicaid |
$2.44
|
| Rate for Payer: Self Pay Self Pay |
$3.17
|
| Rate for Payer: TriWest Medicare |
$0.59
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.71
|
|
|
cefepime 1 gm Inj [CQCH]
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
105914993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna of AZ Commercial |
$3.56
|
| Rate for Payer: Bisbee Police All Plans |
$1.03
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Self Pay Self Pay |
$3.17
|
|
|
cefepime 2 gm Inj [CQCH]
|
Facility
|
IP
|
$9.03
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
105914920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Aetna of AZ Commercial |
$8.13
|
| Rate for Payer: Bisbee Police All Plans |
$2.35
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Self Pay Self Pay |
$7.22
|
|
|
cefepime 2 gm Inj [CQCH]
|
Facility
|
OP
|
$9.03
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
105914920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Aetna of AZ Commercial |
$8.13
|
| Rate for Payer: Aetna of AZ Medicare |
$2.53
|
| Rate for Payer: AHCCCS Medicaid |
$2.44
|
| Rate for Payer: Allwell Medicaid |
$2.44
|
| Rate for Payer: Allwell Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicare |
$1.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.37
|
| Rate for Payer: AZCH Complete Medicaid |
$2.44
|
| Rate for Payer: AZCH Complete Medicare |
$1.35
|
| Rate for Payer: Banner UC Health Medicaid |
$2.44
|
| Rate for Payer: Banner UC Health Medicare |
$1.35
|
| Rate for Payer: Bisbee Police All Plans |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6.14
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cigna of AZ Commercial |
$5.87
|
| Rate for Payer: Copperpoint Commercial |
$2.23
|
| Rate for Payer: Health Net of AZ Commercial |
$5.42
|
| Rate for Payer: Health Net of AZ Medicare |
$2.53
|
| Rate for Payer: Humana of AZ Medicare |
$1.35
|
| Rate for Payer: Mercy Care Medicaid |
$2.44
|
| Rate for Payer: Self Pay Self Pay |
$7.22
|
| Rate for Payer: TriWest Medicare |
$1.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.26
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.63
|
|
