|
DIGITAL SCREW SZ 2MM X 44MM
|
Facility
|
IP
|
$2,180.00
|
|
| Hospital Charge Code |
27595623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$566.80 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,962.00
|
| Rate for Payer: Bisbee Police All Plans |
$566.80
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Self Pay Self Pay |
$1,744.00
|
|
|
digoxin 125 mcg (0.125 mg) Tab [CQCH]
|
Facility
|
OP
|
$1.23
|
|
|
Service Code
|
NDC 904592161
|
| Hospital Charge Code |
105918974
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of AZ Commercial |
$1.11
|
| Rate for Payer: Aetna of AZ Medicare |
$0.34
|
| Rate for Payer: Allwell Medicare |
$0.20
|
| Rate for Payer: Amerigroup Medicare |
$0.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.46
|
| Rate for Payer: AZCH Complete Medicare |
$0.20
|
| Rate for Payer: Banner UC Health Medicare |
$0.20
|
| Rate for Payer: Bisbee Police All Plans |
$0.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna of AZ Commercial |
$0.80
|
| Rate for Payer: Copperpoint Commercial |
$0.30
|
| Rate for Payer: Health Net of AZ Commercial |
$0.74
|
| Rate for Payer: Health Net of AZ Medicare |
$0.34
|
| Rate for Payer: Humana of AZ Medicare |
$0.20
|
| Rate for Payer: Self Pay Self Pay |
$0.98
|
| Rate for Payer: TriWest Medicare |
$0.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.22
|
|
|
digoxin 125 mcg (0.125 mg) Tab [CQCH]
|
Facility
|
IP
|
$1.23
|
|
|
Service Code
|
NDC 904592161
|
| Hospital Charge Code |
105918974
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of AZ Commercial |
$1.11
|
| Rate for Payer: Bisbee Police All Plans |
$0.32
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Self Pay Self Pay |
$0.98
|
|
|
digoxin 500 mcg (0.25 mg/mL) Inj Sol [CQCH]
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
105918899
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of AZ Commercial |
$1.39
|
| Rate for Payer: Aetna of AZ Medicare |
$0.43
|
| Rate for Payer: Allwell Medicare |
$0.25
|
| Rate for Payer: Amerigroup Medicare |
$0.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.58
|
| Rate for Payer: AZCH Complete Medicare |
$0.25
|
| Rate for Payer: Banner UC Health Medicare |
$0.25
|
| Rate for Payer: Bisbee Police All Plans |
$0.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cigna of AZ Commercial |
$1.00
|
| Rate for Payer: Copperpoint Commercial |
$0.38
|
| Rate for Payer: Health Net of AZ Commercial |
$0.92
|
| Rate for Payer: Health Net of AZ Medicare |
$0.43
|
| Rate for Payer: Humana of AZ Medicare |
$0.25
|
| Rate for Payer: Self Pay Self Pay |
$1.23
|
| Rate for Payer: TriWest Medicare |
$0.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.28
|
|
|
digoxin 500 mcg (0.25 mg/mL) Inj Sol [CQCH]
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
105918899
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of AZ Commercial |
$1.39
|
| Rate for Payer: Bisbee Police All Plans |
$0.40
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Self Pay Self Pay |
$1.23
|
|
|
Digoxin Level
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
633719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna of AZ Commercial |
$165.60
|
| Rate for Payer: Bisbee Police All Plans |
$47.84
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Self Pay Self Pay |
$147.20
|
|
|
Digoxin Level
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
633719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna of AZ Commercial |
$165.60
|
| Rate for Payer: Aetna of AZ Medicare |
$51.52
|
| Rate for Payer: Allwell Medicare |
$29.44
|
| Rate for Payer: Amerigroup Medicare |
$29.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$68.72
|
| Rate for Payer: AZCH Complete Medicare |
$29.44
|
| Rate for Payer: Banner UC Health Medicare |
$29.44
|
| Rate for Payer: Bisbee Police All Plans |
$47.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$125.12
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cigna of AZ Commercial |
$119.60
|
| Rate for Payer: Copperpoint Commercial |
$45.54
|
| Rate for Payer: Health Net of AZ Commercial |
$110.40
|
| Rate for Payer: Health Net of AZ Medicare |
$51.52
|
| Rate for Payer: Humana of AZ Medicare |
$29.44
|
| Rate for Payer: Self Pay Self Pay |
$147.20
|
| Rate for Payer: TriWest Medicare |
$29.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$107.27
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$33.12
|
|
|
Dihydrotestosterone LC
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
6781102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna of AZ Commercial |
$257.40
|
| Rate for Payer: Bisbee Police All Plans |
$74.36
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Self Pay Self Pay |
$228.80
|
|
|
Dihydrotestosterone LC
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
6781102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna of AZ Commercial |
$257.40
|
| Rate for Payer: Aetna of AZ Medicare |
$80.08
|
| Rate for Payer: Allwell Medicare |
$45.76
|
| Rate for Payer: Amerigroup Medicare |
$45.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$106.82
|
| Rate for Payer: AZCH Complete Medicare |
$45.76
|
| Rate for Payer: Banner UC Health Medicare |
$45.76
|
| Rate for Payer: Bisbee Police All Plans |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$194.48
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cigna of AZ Commercial |
$185.90
|
| Rate for Payer: Copperpoint Commercial |
$70.78
|
| Rate for Payer: Health Net of AZ Commercial |
$171.60
|
| Rate for Payer: Health Net of AZ Medicare |
$80.08
|
| Rate for Payer: Humana of AZ Medicare |
$45.76
|
| Rate for Payer: Self Pay Self Pay |
$228.80
|
| Rate for Payer: TriWest Medicare |
$45.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$166.74
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$51.48
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$5,973.12
|
|
|
Service Code
|
APR-DRG 5172
|
| Hospital Charge Code |
APRDRG5171
|
| Min. Negotiated Rate |
$5,973.12 |
| Max. Negotiated Rate |
$5,973.12 |
| Rate for Payer: AHCCCS Medicaid |
$5,973.12
|
| Rate for Payer: Allwell Medicaid |
$5,973.12
|
| Rate for Payer: AZCH Complete Medicaid |
$5,973.12
|
| Rate for Payer: Banner UC Health Medicaid |
$5,973.12
|
| Rate for Payer: Mercy Care Medicaid |
$5,973.12
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$10,337.23
|
|
|
Service Code
|
APR-DRG 5173
|
| Hospital Charge Code |
APRDRG5172
|
| Min. Negotiated Rate |
$10,337.23 |
| Max. Negotiated Rate |
$10,337.23 |
| Rate for Payer: AHCCCS Medicaid |
$10,337.23
|
| Rate for Payer: Allwell Medicaid |
$10,337.23
|
| Rate for Payer: AZCH Complete Medicaid |
$10,337.23
|
| Rate for Payer: Banner UC Health Medicaid |
$10,337.23
|
| Rate for Payer: Mercy Care Medicaid |
$10,337.23
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$10,337.23
|
|
|
Service Code
|
APR-DRG 5173
|
| Hospital Charge Code |
APRDRG5173
|
| Min. Negotiated Rate |
$10,337.23 |
| Max. Negotiated Rate |
$10,337.23 |
| Rate for Payer: AHCCCS Medicaid |
$10,337.23
|
| Rate for Payer: Allwell Medicaid |
$10,337.23
|
| Rate for Payer: AZCH Complete Medicaid |
$10,337.23
|
| Rate for Payer: Banner UC Health Medicaid |
$10,337.23
|
| Rate for Payer: Mercy Care Medicaid |
$10,337.23
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$10,337.23
|
|
|
Service Code
|
APR-DRG 5173
|
| Hospital Charge Code |
APRDRG5171
|
| Min. Negotiated Rate |
$10,337.23 |
| Max. Negotiated Rate |
$10,337.23 |
| Rate for Payer: AHCCCS Medicaid |
$10,337.23
|
| Rate for Payer: Allwell Medicaid |
$10,337.23
|
| Rate for Payer: AZCH Complete Medicaid |
$10,337.23
|
| Rate for Payer: Banner UC Health Medicaid |
$10,337.23
|
| Rate for Payer: Mercy Care Medicaid |
$10,337.23
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$5,973.12
|
|
|
Service Code
|
APR-DRG 5172
|
| Hospital Charge Code |
APRDRG5172
|
| Min. Negotiated Rate |
$5,973.12 |
| Max. Negotiated Rate |
$5,973.12 |
| Rate for Payer: AHCCCS Medicaid |
$5,973.12
|
| Rate for Payer: Allwell Medicaid |
$5,973.12
|
| Rate for Payer: AZCH Complete Medicaid |
$5,973.12
|
| Rate for Payer: Banner UC Health Medicaid |
$5,973.12
|
| Rate for Payer: Mercy Care Medicaid |
$5,973.12
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$4,712.71
|
|
|
Service Code
|
APR-DRG 5171
|
| Hospital Charge Code |
APRDRG5174
|
| Min. Negotiated Rate |
$4,712.71 |
| Max. Negotiated Rate |
$4,712.71 |
| Rate for Payer: AHCCCS Medicaid |
$4,712.71
|
| Rate for Payer: Allwell Medicaid |
$4,712.71
|
| Rate for Payer: AZCH Complete Medicaid |
$4,712.71
|
| Rate for Payer: Banner UC Health Medicaid |
$4,712.71
|
| Rate for Payer: Mercy Care Medicaid |
$4,712.71
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$25,133.27
|
|
|
Service Code
|
APR-DRG 5174
|
| Hospital Charge Code |
APRDRG5171
|
| Min. Negotiated Rate |
$25,133.27 |
| Max. Negotiated Rate |
$25,133.27 |
| Rate for Payer: AHCCCS Medicaid |
$25,133.27
|
| Rate for Payer: Allwell Medicaid |
$25,133.27
|
| Rate for Payer: AZCH Complete Medicaid |
$25,133.27
|
| Rate for Payer: Banner UC Health Medicaid |
$25,133.27
|
| Rate for Payer: Mercy Care Medicaid |
$25,133.27
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$25,133.27
|
|
|
Service Code
|
APR-DRG 5174
|
| Hospital Charge Code |
APRDRG5172
|
| Min. Negotiated Rate |
$25,133.27 |
| Max. Negotiated Rate |
$25,133.27 |
| Rate for Payer: AHCCCS Medicaid |
$25,133.27
|
| Rate for Payer: Allwell Medicaid |
$25,133.27
|
| Rate for Payer: AZCH Complete Medicaid |
$25,133.27
|
| Rate for Payer: Banner UC Health Medicaid |
$25,133.27
|
| Rate for Payer: Mercy Care Medicaid |
$25,133.27
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$5,973.12
|
|
|
Service Code
|
APR-DRG 5172
|
| Hospital Charge Code |
APRDRG5174
|
| Min. Negotiated Rate |
$5,973.12 |
| Max. Negotiated Rate |
$5,973.12 |
| Rate for Payer: AHCCCS Medicaid |
$5,973.12
|
| Rate for Payer: Allwell Medicaid |
$5,973.12
|
| Rate for Payer: AZCH Complete Medicaid |
$5,973.12
|
| Rate for Payer: Banner UC Health Medicaid |
$5,973.12
|
| Rate for Payer: Mercy Care Medicaid |
$5,973.12
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$4,712.71
|
|
|
Service Code
|
APR-DRG 5171
|
| Hospital Charge Code |
APRDRG5173
|
| Min. Negotiated Rate |
$4,712.71 |
| Max. Negotiated Rate |
$4,712.71 |
| Rate for Payer: AHCCCS Medicaid |
$4,712.71
|
| Rate for Payer: Allwell Medicaid |
$4,712.71
|
| Rate for Payer: AZCH Complete Medicaid |
$4,712.71
|
| Rate for Payer: Banner UC Health Medicaid |
$4,712.71
|
| Rate for Payer: Mercy Care Medicaid |
$4,712.71
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$4,712.71
|
|
|
Service Code
|
APR-DRG 5171
|
| Hospital Charge Code |
APRDRG5172
|
| Min. Negotiated Rate |
$4,712.71 |
| Max. Negotiated Rate |
$4,712.71 |
| Rate for Payer: AHCCCS Medicaid |
$4,712.71
|
| Rate for Payer: Allwell Medicaid |
$4,712.71
|
| Rate for Payer: AZCH Complete Medicaid |
$4,712.71
|
| Rate for Payer: Banner UC Health Medicaid |
$4,712.71
|
| Rate for Payer: Mercy Care Medicaid |
$4,712.71
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$5,973.12
|
|
|
Service Code
|
APR-DRG 5172
|
| Hospital Charge Code |
APRDRG5173
|
| Min. Negotiated Rate |
$5,973.12 |
| Max. Negotiated Rate |
$5,973.12 |
| Rate for Payer: AHCCCS Medicaid |
$5,973.12
|
| Rate for Payer: Allwell Medicaid |
$5,973.12
|
| Rate for Payer: AZCH Complete Medicaid |
$5,973.12
|
| Rate for Payer: Banner UC Health Medicaid |
$5,973.12
|
| Rate for Payer: Mercy Care Medicaid |
$5,973.12
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$4,712.71
|
|
|
Service Code
|
APR-DRG 5171
|
| Hospital Charge Code |
APRDRG5171
|
| Min. Negotiated Rate |
$4,712.71 |
| Max. Negotiated Rate |
$4,712.71 |
| Rate for Payer: AHCCCS Medicaid |
$4,712.71
|
| Rate for Payer: Allwell Medicaid |
$4,712.71
|
| Rate for Payer: AZCH Complete Medicaid |
$4,712.71
|
| Rate for Payer: Banner UC Health Medicaid |
$4,712.71
|
| Rate for Payer: Mercy Care Medicaid |
$4,712.71
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$25,133.27
|
|
|
Service Code
|
APR-DRG 5174
|
| Hospital Charge Code |
APRDRG5174
|
| Min. Negotiated Rate |
$25,133.27 |
| Max. Negotiated Rate |
$25,133.27 |
| Rate for Payer: AHCCCS Medicaid |
$25,133.27
|
| Rate for Payer: Allwell Medicaid |
$25,133.27
|
| Rate for Payer: AZCH Complete Medicaid |
$25,133.27
|
| Rate for Payer: Banner UC Health Medicaid |
$25,133.27
|
| Rate for Payer: Mercy Care Medicaid |
$25,133.27
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$25,133.27
|
|
|
Service Code
|
APR-DRG 5174
|
| Hospital Charge Code |
APRDRG5173
|
| Min. Negotiated Rate |
$25,133.27 |
| Max. Negotiated Rate |
$25,133.27 |
| Rate for Payer: AHCCCS Medicaid |
$25,133.27
|
| Rate for Payer: Allwell Medicaid |
$25,133.27
|
| Rate for Payer: AZCH Complete Medicaid |
$25,133.27
|
| Rate for Payer: Banner UC Health Medicaid |
$25,133.27
|
| Rate for Payer: Mercy Care Medicaid |
$25,133.27
|
|
|
Dilation And Curettage For Non-Obstetric Diagnoses
|
Facility
|
IP
|
$10,337.23
|
|
|
Service Code
|
APR-DRG 5173
|
| Hospital Charge Code |
APRDRG5174
|
| Min. Negotiated Rate |
$10,337.23 |
| Max. Negotiated Rate |
$10,337.23 |
| Rate for Payer: AHCCCS Medicaid |
$10,337.23
|
| Rate for Payer: Allwell Medicaid |
$10,337.23
|
| Rate for Payer: AZCH Complete Medicaid |
$10,337.23
|
| Rate for Payer: Banner UC Health Medicaid |
$10,337.23
|
| Rate for Payer: Mercy Care Medicaid |
$10,337.23
|
|
