|
cefOXitin 1 gm Inj [CQCH]
|
Facility
|
IP
|
$3.63
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
105915139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna of AZ Commercial |
$3.27
|
| Rate for Payer: Bisbee Police All Plans |
$0.94
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Self Pay Self Pay |
$2.90
|
|
|
cefOXitin 1 gm Inj [CQCH]
|
Facility
|
OP
|
$3.63
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
105915139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna of AZ Commercial |
$3.27
|
| Rate for Payer: Aetna of AZ Medicare |
$1.02
|
| Rate for Payer: AHCCCS Medicaid |
$9.26
|
| Rate for Payer: Allwell Medicaid |
$9.26
|
| Rate for Payer: Allwell Medicare |
$0.54
|
| Rate for Payer: Amerigroup Medicare |
$0.54
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.36
|
| Rate for Payer: AZCH Complete Medicaid |
$9.26
|
| Rate for Payer: AZCH Complete Medicare |
$0.54
|
| Rate for Payer: Banner UC Health Medicaid |
$9.26
|
| Rate for Payer: Banner UC Health Medicare |
$0.54
|
| Rate for Payer: Bisbee Police All Plans |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.47
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna of AZ Commercial |
$2.36
|
| Rate for Payer: Copperpoint Commercial |
$0.90
|
| Rate for Payer: Health Net of AZ Commercial |
$2.18
|
| Rate for Payer: Health Net of AZ Medicare |
$1.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.54
|
| Rate for Payer: Mercy Care Medicaid |
$9.26
|
| Rate for Payer: Self Pay Self Pay |
$2.90
|
| Rate for Payer: TriWest Medicare |
$0.54
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.65
|
|
|
cefOXitin 2 gm Inj [CQCH]
|
Facility
|
OP
|
$5.41
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
105915066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna of AZ Commercial |
$4.87
|
| Rate for Payer: Aetna of AZ Medicare |
$1.51
|
| Rate for Payer: AHCCCS Medicaid |
$9.26
|
| Rate for Payer: Allwell Medicaid |
$9.26
|
| Rate for Payer: Allwell Medicare |
$0.81
|
| Rate for Payer: Amerigroup Medicare |
$0.81
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.02
|
| Rate for Payer: AZCH Complete Medicaid |
$9.26
|
| Rate for Payer: AZCH Complete Medicare |
$0.81
|
| Rate for Payer: Banner UC Health Medicaid |
$9.26
|
| Rate for Payer: Banner UC Health Medicare |
$0.81
|
| Rate for Payer: Bisbee Police All Plans |
$1.41
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cigna of AZ Commercial |
$3.52
|
| Rate for Payer: Copperpoint Commercial |
$1.34
|
| Rate for Payer: Health Net of AZ Commercial |
$3.25
|
| Rate for Payer: Health Net of AZ Medicare |
$1.51
|
| Rate for Payer: Humana of AZ Medicare |
$0.81
|
| Rate for Payer: Mercy Care Medicaid |
$9.26
|
| Rate for Payer: Self Pay Self Pay |
$4.33
|
| Rate for Payer: TriWest Medicare |
$0.81
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.97
|
|
|
cefOXitin 2 gm Inj [CQCH]
|
Facility
|
IP
|
$5.41
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
105915066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna of AZ Commercial |
$4.87
|
| Rate for Payer: Bisbee Police All Plans |
$1.41
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Self Pay Self Pay |
$4.33
|
|
|
cefTAZidime 1 gm REC[CQCH]
|
Facility
|
IP
|
$2.97
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
141532362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of AZ Commercial |
$2.67
|
| Rate for Payer: Bisbee Police All Plans |
$0.77
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Self Pay Self Pay |
$2.38
|
|
|
cefTAZidime 1 gm REC[CQCH]
|
Facility
|
OP
|
$2.97
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
141532362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna of AZ Commercial |
$2.67
|
| Rate for Payer: Aetna of AZ Medicare |
$0.83
|
| Rate for Payer: AHCCCS Medicaid |
$3.76
|
| Rate for Payer: Allwell Medicaid |
$3.76
|
| Rate for Payer: Allwell Medicare |
$0.45
|
| Rate for Payer: Amerigroup Medicare |
$0.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.11
|
| Rate for Payer: AZCH Complete Medicaid |
$3.76
|
| Rate for Payer: AZCH Complete Medicare |
$0.45
|
| Rate for Payer: Banner UC Health Medicaid |
$3.76
|
| Rate for Payer: Banner UC Health Medicare |
$0.45
|
| Rate for Payer: Bisbee Police All Plans |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of AZ Commercial |
$1.93
|
| Rate for Payer: Copperpoint Commercial |
$0.74
|
| Rate for Payer: Health Net of AZ Commercial |
$1.78
|
| Rate for Payer: Health Net of AZ Medicare |
$0.83
|
| Rate for Payer: Humana of AZ Medicare |
$0.45
|
| Rate for Payer: Mercy Care Medicaid |
$3.76
|
| Rate for Payer: Self Pay Self Pay |
$2.38
|
| Rate for Payer: TriWest Medicare |
$0.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.53
|
|
|
cefTRIAXone 1 gm Inj [CQCH]
|
Facility
|
OP
|
$2.77
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
105915652
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna of AZ Commercial |
$2.49
|
| Rate for Payer: Aetna of AZ Medicare |
$0.78
|
| Rate for Payer: AHCCCS Medicaid |
$1.00
|
| Rate for Payer: Allwell Medicaid |
$1.00
|
| Rate for Payer: Allwell Medicare |
$0.42
|
| Rate for Payer: Amerigroup Medicare |
$0.42
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.03
|
| Rate for Payer: AZCH Complete Medicaid |
$1.00
|
| Rate for Payer: AZCH Complete Medicare |
$0.42
|
| Rate for Payer: Banner UC Health Medicaid |
$1.00
|
| Rate for Payer: Banner UC Health Medicare |
$0.42
|
| Rate for Payer: Bisbee Police All Plans |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of AZ Commercial |
$1.80
|
| Rate for Payer: Copperpoint Commercial |
$0.69
|
| Rate for Payer: Health Net of AZ Commercial |
$1.66
|
| Rate for Payer: Health Net of AZ Medicare |
$0.78
|
| Rate for Payer: Humana of AZ Medicare |
$0.42
|
| Rate for Payer: Mercy Care Medicaid |
$1.00
|
| Rate for Payer: Self Pay Self Pay |
$2.22
|
| Rate for Payer: TriWest Medicare |
$0.42
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.61
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.50
|
|
|
cefTRIAXone 1 gm Inj [CQCH]
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
105915652
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna of AZ Commercial |
$2.49
|
| Rate for Payer: Bisbee Police All Plans |
$0.72
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Self Pay Self Pay |
$2.22
|
|
|
cefTRIAXone 2 gm Inj [CQCH]
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
105915506
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna of AZ Commercial |
$1.92
|
| Rate for Payer: Bisbee Police All Plans |
$0.55
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Self Pay Self Pay |
$1.70
|
|
|
cefTRIAXone 2 gm Inj [CQCH]
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
105915506
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna of AZ Commercial |
$1.92
|
| Rate for Payer: Aetna of AZ Medicare |
$0.60
|
| Rate for Payer: AHCCCS Medicaid |
$1.00
|
| Rate for Payer: Allwell Medicaid |
$1.00
|
| Rate for Payer: Allwell Medicare |
$0.32
|
| Rate for Payer: Amerigroup Medicare |
$0.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.80
|
| Rate for Payer: AZCH Complete Medicaid |
$1.00
|
| Rate for Payer: AZCH Complete Medicare |
$0.32
|
| Rate for Payer: Banner UC Health Medicaid |
$1.00
|
| Rate for Payer: Banner UC Health Medicare |
$0.32
|
| Rate for Payer: Bisbee Police All Plans |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of AZ Commercial |
$1.38
|
| Rate for Payer: Copperpoint Commercial |
$0.53
|
| Rate for Payer: Health Net of AZ Commercial |
$1.28
|
| Rate for Payer: Health Net of AZ Medicare |
$0.60
|
| Rate for Payer: Humana of AZ Medicare |
$0.32
|
| Rate for Payer: Mercy Care Medicaid |
$1.00
|
| Rate for Payer: Self Pay Self Pay |
$1.70
|
| Rate for Payer: TriWest Medicare |
$0.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.38
|
|
|
cefTRIAXone 500 mg Inj [CQCH]
|
Facility
|
IP
|
$0.92
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
105915433
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Aetna of AZ Commercial |
$0.83
|
| Rate for Payer: Bisbee Police All Plans |
$0.24
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Self Pay Self Pay |
$0.74
|
|
|
cefTRIAXone 500 mg Inj [CQCH]
|
Facility
|
OP
|
$0.92
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
105915433
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of AZ Commercial |
$0.83
|
| Rate for Payer: Aetna of AZ Medicare |
$0.26
|
| Rate for Payer: AHCCCS Medicaid |
$1.00
|
| Rate for Payer: Allwell Medicaid |
$1.00
|
| Rate for Payer: Allwell Medicare |
$0.14
|
| Rate for Payer: Amerigroup Medicare |
$0.14
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.34
|
| Rate for Payer: AZCH Complete Medicaid |
$1.00
|
| Rate for Payer: AZCH Complete Medicare |
$0.14
|
| Rate for Payer: Banner UC Health Medicaid |
$1.00
|
| Rate for Payer: Banner UC Health Medicare |
$0.14
|
| Rate for Payer: Bisbee Police All Plans |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of AZ Commercial |
$0.60
|
| Rate for Payer: Copperpoint Commercial |
$0.23
|
| Rate for Payer: Health Net of AZ Commercial |
$0.55
|
| Rate for Payer: Health Net of AZ Medicare |
$0.26
|
| Rate for Payer: Humana of AZ Medicare |
$0.14
|
| Rate for Payer: Mercy Care Medicaid |
$1.00
|
| Rate for Payer: Self Pay Self Pay |
$0.74
|
| Rate for Payer: TriWest Medicare |
$0.14
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.54
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.17
|
|
|
cefTRIAXone INJ : 1 GM VIAL
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
22331184
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of AZ Commercial |
$31.50
|
| Rate for Payer: Bisbee Police All Plans |
$9.10
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Self Pay Self Pay |
$28.00
|
|
|
cefTRIAXone INJ : 1 GM VIAL
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
22331184
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of AZ Commercial |
$31.50
|
| Rate for Payer: Aetna of AZ Medicare |
$9.80
|
| Rate for Payer: Allwell Medicare |
$5.25
|
| Rate for Payer: Amerigroup Medicare |
$5.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$13.07
|
| Rate for Payer: AZCH Complete Medicare |
$5.25
|
| Rate for Payer: Banner UC Health Medicare |
$5.25
|
| Rate for Payer: Bisbee Police All Plans |
$9.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna of AZ Commercial |
$22.75
|
| Rate for Payer: Copperpoint Commercial |
$8.66
|
| Rate for Payer: Health Net of AZ Commercial |
$21.00
|
| Rate for Payer: Health Net of AZ Medicare |
$9.80
|
| Rate for Payer: Humana of AZ Medicare |
$5.25
|
| Rate for Payer: Self Pay Self Pay |
$28.00
|
| Rate for Payer: TriWest Medicare |
$5.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$20.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.30
|
|
|
cefuroxime 250 mg Tab [CQCH]
|
Facility
|
OP
|
$1.65
|
|
|
Service Code
|
NDC 16714040002
|
| Hospital Charge Code |
105915725
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of AZ Commercial |
$1.48
|
| Rate for Payer: Aetna of AZ Medicare |
$0.46
|
| Rate for Payer: Allwell Medicare |
$0.25
|
| Rate for Payer: Amerigroup Medicare |
$0.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.62
|
| Rate for Payer: AZCH Complete Medicare |
$0.25
|
| Rate for Payer: Banner UC Health Medicare |
$0.25
|
| Rate for Payer: Bisbee Police All Plans |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.12
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cigna of AZ Commercial |
$1.07
|
| Rate for Payer: Copperpoint Commercial |
$0.41
|
| Rate for Payer: Health Net of AZ Commercial |
$0.99
|
| Rate for Payer: Health Net of AZ Medicare |
$0.46
|
| Rate for Payer: Humana of AZ Medicare |
$0.25
|
| Rate for Payer: Self Pay Self Pay |
$1.32
|
| Rate for Payer: TriWest Medicare |
$0.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.30
|
|
|
cefuroxime 250 mg Tab [CQCH]
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
NDC 16714040002
|
| Hospital Charge Code |
105915725
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of AZ Commercial |
$1.48
|
| Rate for Payer: Bisbee Police All Plans |
$0.43
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Self Pay Self Pay |
$1.32
|
|
|
celecoxib 100 mg Cap [CQCH]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 904650261
|
| Hospital Charge Code |
105915790
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of AZ Commercial |
$0.76
|
| Rate for Payer: Aetna of AZ Medicare |
$0.24
|
| Rate for Payer: Allwell Medicare |
$0.13
|
| Rate for Payer: Amerigroup Medicare |
$0.13
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.31
|
| Rate for Payer: AZCH Complete Medicare |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$0.13
|
| Rate for Payer: Bisbee Police All Plans |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.57
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cigna of AZ Commercial |
$0.55
|
| Rate for Payer: Copperpoint Commercial |
$0.21
|
| Rate for Payer: Health Net of AZ Commercial |
$0.50
|
| Rate for Payer: Health Net of AZ Medicare |
$0.24
|
| Rate for Payer: Humana of AZ Medicare |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$0.67
|
| Rate for Payer: TriWest Medicare |
$0.13
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.15
|
|
|
celecoxib 100 mg Cap [CQCH]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 904650261
|
| Hospital Charge Code |
105915790
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of AZ Commercial |
$0.76
|
| Rate for Payer: Bisbee Police All Plans |
$0.22
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Self Pay Self Pay |
$0.67
|
|
|
Celiac Disease Comprehensive LC
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
10864418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Bisbee Police All Plans |
$40.56
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Self Pay Self Pay |
$124.80
|
|
|
Celiac Disease Comprehensive LC
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
10864418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Aetna of AZ Medicare |
$43.68
|
| Rate for Payer: AHCCCS Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicare |
$23.40
|
| Rate for Payer: Amerigroup Medicare |
$23.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$58.27
|
| Rate for Payer: AZCH Complete Medicaid |
$9.30
|
| Rate for Payer: AZCH Complete Medicare |
$23.40
|
| Rate for Payer: Banner UC Health Medicaid |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$23.40
|
| Rate for Payer: Bisbee Police All Plans |
$40.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$106.08
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna of AZ Commercial |
$101.40
|
| Rate for Payer: Copperpoint Commercial |
$38.61
|
| Rate for Payer: Health Net of AZ Commercial |
$93.60
|
| Rate for Payer: Health Net of AZ Medicare |
$43.68
|
| Rate for Payer: Humana of AZ Medicare |
$23.40
|
| Rate for Payer: Mercy Care Medicaid |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$124.80
|
| Rate for Payer: TriWest Medicare |
$23.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$90.95
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.08
|
|
|
Celiac Disease II LC
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
22311182
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Aetna of AZ Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicare |
$18.00
|
| Rate for Payer: Amerigroup Medicare |
$18.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicaid |
$9.30
|
| Rate for Payer: AZCH Complete Medicare |
$18.00
|
| Rate for Payer: Banner UC Health Medicaid |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of AZ Commercial |
$78.00
|
| Rate for Payer: Copperpoint Commercial |
$29.70
|
| Rate for Payer: Health Net of AZ Commercial |
$72.00
|
| Rate for Payer: Health Net of AZ Medicare |
$33.60
|
| Rate for Payer: Humana of AZ Medicare |
$18.00
|
| Rate for Payer: Mercy Care Medicaid |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$18.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.60
|
|
|
Celiac Disease II LC
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
22311182
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
|
|
Cell Ct, Synovial w/o Crystals LC
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
22587724
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Aetna of AZ Medicare |
$28.00
|
| Rate for Payer: AHCCCS Medicaid |
$5.60
|
| Rate for Payer: Allwell Medicaid |
$5.60
|
| Rate for Payer: Allwell Medicare |
$15.00
|
| Rate for Payer: Amerigroup Medicare |
$15.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$37.35
|
| Rate for Payer: AZCH Complete Medicaid |
$5.60
|
| Rate for Payer: AZCH Complete Medicare |
$15.00
|
| Rate for Payer: Banner UC Health Medicaid |
$5.60
|
| Rate for Payer: Banner UC Health Medicare |
$15.00
|
| Rate for Payer: Bisbee Police All Plans |
$26.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$68.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna of AZ Commercial |
$65.00
|
| Rate for Payer: Copperpoint Commercial |
$24.75
|
| Rate for Payer: Health Net of AZ Commercial |
$60.00
|
| Rate for Payer: Health Net of AZ Medicare |
$28.00
|
| Rate for Payer: Humana of AZ Medicare |
$15.00
|
| Rate for Payer: Mercy Care Medicaid |
$5.60
|
| Rate for Payer: Self Pay Self Pay |
$80.00
|
| Rate for Payer: TriWest Medicare |
$15.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$58.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.00
|
|
|
Cell Ct, Synovial w/o Crystals LC
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
22587724
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Bisbee Police All Plans |
$26.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Self Pay Self Pay |
$80.00
|
|
|
Cellulitis And Other Skin Infections
|
Facility
|
IP
|
$3,991.67
|
|
|
Service Code
|
APR-DRG 3832
|
| Hospital Charge Code |
APRDRG3831
|
| Min. Negotiated Rate |
$3,991.67 |
| Max. Negotiated Rate |
$3,991.67 |
| Rate for Payer: AHCCCS Medicaid |
$3,991.67
|
| Rate for Payer: Allwell Medicaid |
$3,991.67
|
| Rate for Payer: AZCH Complete Medicaid |
$3,991.67
|
| Rate for Payer: Banner UC Health Medicaid |
$3,991.67
|
| Rate for Payer: Mercy Care Medicaid |
$3,991.67
|
|
