|
FINE NEEDLE ASPIRATION; WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
22209352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.95 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,289.70
|
| Rate for Payer: Aetna of AZ Medicare |
$401.24
|
| Rate for Payer: AHCCCS Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicaid |
$501.46
|
| Rate for Payer: Allwell Medicare |
$214.95
|
| Rate for Payer: Amerigroup Medicare |
$214.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$535.23
|
| Rate for Payer: AZCH Complete Medicaid |
$501.46
|
| Rate for Payer: AZCH Complete Medicare |
$214.95
|
| Rate for Payer: Banner UC Health Medicaid |
$501.46
|
| Rate for Payer: Banner UC Health Medicare |
$214.95
|
| Rate for Payer: Bisbee Police All Plans |
$372.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$974.44
|
| Rate for Payer: Cash Price |
$1,146.40
|
| Rate for Payer: Cash Price |
$1,146.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,003.10
|
| Rate for Payer: Copperpoint Commercial |
$354.67
|
| Rate for Payer: Health Net of AZ Commercial |
$859.80
|
| Rate for Payer: Health Net of AZ Medicare |
$401.24
|
| Rate for Payer: Humana of AZ Medicare |
$214.95
|
| Rate for Payer: Mercy Care Medicaid |
$501.46
|
| Rate for Payer: Self Pay Self Pay |
$1,146.40
|
| Rate for Payer: TriWest Medicare |
$214.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$257.94
|
|
|
FISTULA PLUG COOK
|
Facility
|
IP
|
$2,854.00
|
|
| Hospital Charge Code |
22921514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$742.04 |
| Max. Negotiated Rate |
$2,568.60 |
| Rate for Payer: Aetna of AZ Commercial |
$2,568.60
|
| Rate for Payer: Bisbee Police All Plans |
$742.04
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Self Pay Self Pay |
$2,283.20
|
|
|
FISTULA PLUG COOK
|
Facility
|
OP
|
$2,854.00
|
|
| Hospital Charge Code |
22921514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.10 |
| Max. Negotiated Rate |
$2,568.60 |
| Rate for Payer: Aetna of AZ Commercial |
$2,568.60
|
| Rate for Payer: Aetna of AZ Medicare |
$799.12
|
| Rate for Payer: Allwell Medicare |
$428.10
|
| Rate for Payer: Amerigroup Medicare |
$428.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,065.97
|
| Rate for Payer: AZCH Complete Medicare |
$428.10
|
| Rate for Payer: Banner UC Health Medicare |
$428.10
|
| Rate for Payer: Bisbee Police All Plans |
$742.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,940.72
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,997.80
|
| Rate for Payer: Copperpoint Commercial |
$706.36
|
| Rate for Payer: Health Net of AZ Commercial |
$1,712.40
|
| Rate for Payer: Health Net of AZ Medicare |
$799.12
|
| Rate for Payer: Humana of AZ Medicare |
$428.10
|
| Rate for Payer: Self Pay Self Pay |
$2,283.20
|
| Rate for Payer: TriWest Medicare |
$428.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,663.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$513.72
|
|
|
FIT
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT G0328 QW
|
| Hospital Charge Code |
22068803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna of AZ Commercial |
$100.80
|
| Rate for Payer: Bisbee Police All Plans |
$29.12
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Self Pay Self Pay |
$89.60
|
|
|
FIT
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT G0328 QW
|
| Hospital Charge Code |
22068803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna of AZ Commercial |
$100.80
|
| Rate for Payer: Aetna of AZ Medicare |
$31.36
|
| Rate for Payer: Allwell Medicare |
$16.80
|
| Rate for Payer: Amerigroup Medicare |
$16.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$41.83
|
| Rate for Payer: AZCH Complete Medicare |
$16.80
|
| Rate for Payer: Banner UC Health Medicare |
$16.80
|
| Rate for Payer: Bisbee Police All Plans |
$29.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$76.16
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cigna of AZ Commercial |
$72.80
|
| Rate for Payer: Copperpoint Commercial |
$27.72
|
| Rate for Payer: Health Net of AZ Commercial |
$67.20
|
| Rate for Payer: Health Net of AZ Medicare |
$31.36
|
| Rate for Payer: Humana of AZ Medicare |
$16.80
|
| Rate for Payer: Self Pay Self Pay |
$89.60
|
| Rate for Payer: TriWest Medicare |
$16.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$65.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$20.16
|
|
|
flecainide 100 mg Tab [CQCH]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 50268032115
|
| Hospital Charge Code |
112812246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna of AZ Commercial |
$0.60
|
| Rate for Payer: Bisbee Police All Plans |
$0.17
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Self Pay Self Pay |
$0.54
|
|
|
flecainide 100 mg Tab [CQCH]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 50268032115
|
| Hospital Charge Code |
112812246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna of AZ Commercial |
$0.60
|
| Rate for Payer: Aetna of AZ Medicare |
$0.19
|
| Rate for Payer: Allwell Medicare |
$0.10
|
| Rate for Payer: Amerigroup Medicare |
$0.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.25
|
| Rate for Payer: AZCH Complete Medicare |
$0.10
|
| Rate for Payer: Banner UC Health Medicare |
$0.10
|
| Rate for Payer: Bisbee Police All Plans |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of AZ Commercial |
$0.44
|
| Rate for Payer: Copperpoint Commercial |
$0.17
|
| Rate for Payer: Health Net of AZ Commercial |
$0.40
|
| Rate for Payer: Health Net of AZ Medicare |
$0.19
|
| Rate for Payer: Humana of AZ Medicare |
$0.10
|
| Rate for Payer: Self Pay Self Pay |
$0.54
|
| Rate for Payer: TriWest Medicare |
$0.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.39
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.12
|
|
|
Fleets Saline Enema 133 mL [CQCH]
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
NDC 132020140
|
| Hospital Charge Code |
105941046
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna of AZ Commercial |
$0.89
|
| Rate for Payer: Bisbee Police All Plans |
$0.26
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Self Pay Self Pay |
$0.79
|
|
|
Fleets Saline Enema 133 mL [CQCH]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 132020140
|
| Hospital Charge Code |
105941046
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna of AZ Commercial |
$0.89
|
| Rate for Payer: Aetna of AZ Medicare |
$0.28
|
| Rate for Payer: Allwell Medicare |
$0.15
|
| Rate for Payer: Amerigroup Medicare |
$0.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.37
|
| Rate for Payer: AZCH Complete Medicare |
$0.15
|
| Rate for Payer: Banner UC Health Medicare |
$0.15
|
| Rate for Payer: Bisbee Police All Plans |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of AZ Commercial |
$0.64
|
| Rate for Payer: Copperpoint Commercial |
$0.25
|
| Rate for Payer: Health Net of AZ Commercial |
$0.59
|
| Rate for Payer: Health Net of AZ Medicare |
$0.28
|
| Rate for Payer: Humana of AZ Medicare |
$0.15
|
| Rate for Payer: Self Pay Self Pay |
$0.79
|
| Rate for Payer: TriWest Medicare |
$0.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.18
|
|
|
FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
IP
|
$482.00
|
|
| Hospital Charge Code |
1184683
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$125.32 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Aetna of AZ Commercial |
$433.80
|
| Rate for Payer: Bisbee Police All Plans |
$125.32
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Self Pay Self Pay |
$385.60
|
|
|
FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$482.00
|
|
| Hospital Charge Code |
1184683
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$72.30 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Aetna of AZ Commercial |
$433.80
|
| Rate for Payer: Aetna of AZ Medicare |
$134.96
|
| Rate for Payer: Allwell Medicare |
$72.30
|
| Rate for Payer: Amerigroup Medicare |
$72.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$180.03
|
| Rate for Payer: AZCH Complete Medicare |
$72.30
|
| Rate for Payer: Banner UC Health Medicare |
$72.30
|
| Rate for Payer: Bisbee Police All Plans |
$125.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$327.76
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cigna of AZ Commercial |
$337.40
|
| Rate for Payer: Copperpoint Commercial |
$119.30
|
| Rate for Payer: Health Net of AZ Commercial |
$289.20
|
| Rate for Payer: Health Net of AZ Medicare |
$134.96
|
| Rate for Payer: Humana of AZ Medicare |
$72.30
|
| Rate for Payer: Self Pay Self Pay |
$385.60
|
| Rate for Payer: TriWest Medicare |
$72.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$281.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$86.76
|
|
|
florastor 250mg cap [CQCH]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 66825000201
|
| Hospital Charge Code |
108083252
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of AZ Commercial |
$0.48
|
| Rate for Payer: Aetna of AZ Medicare |
$0.15
|
| Rate for Payer: Allwell Medicare |
$0.08
|
| Rate for Payer: Amerigroup Medicare |
$0.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.20
|
| Rate for Payer: AZCH Complete Medicare |
$0.08
|
| Rate for Payer: Banner UC Health Medicare |
$0.08
|
| Rate for Payer: Bisbee Police All Plans |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of AZ Commercial |
$0.34
|
| Rate for Payer: Copperpoint Commercial |
$0.13
|
| Rate for Payer: Health Net of AZ Commercial |
$0.32
|
| Rate for Payer: Health Net of AZ Medicare |
$0.15
|
| Rate for Payer: Humana of AZ Medicare |
$0.08
|
| Rate for Payer: Self Pay Self Pay |
$0.42
|
| Rate for Payer: TriWest Medicare |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.10
|
|
|
florastor 250mg cap [CQCH]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 66825000201
|
| Hospital Charge Code |
108083252
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of AZ Commercial |
$0.48
|
| Rate for Payer: Bisbee Police All Plans |
$0.14
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Self Pay Self Pay |
$0.42
|
|
|
fluconazole 100 mg Tab [CQCH]
|
Facility
|
IP
|
$1.57
|
|
|
Service Code
|
NDC 68084072801
|
| Hospital Charge Code |
105922853
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of AZ Commercial |
$1.41
|
| Rate for Payer: Bisbee Police All Plans |
$0.41
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Self Pay Self Pay |
$1.26
|
|
|
fluconazole 100 mg Tab [CQCH]
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
NDC 68084072801
|
| Hospital Charge Code |
105922853
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of AZ Commercial |
$1.41
|
| Rate for Payer: Aetna of AZ Medicare |
$0.44
|
| Rate for Payer: Allwell Medicare |
$0.24
|
| Rate for Payer: Amerigroup Medicare |
$0.24
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.59
|
| Rate for Payer: AZCH Complete Medicare |
$0.24
|
| Rate for Payer: Banner UC Health Medicare |
$0.24
|
| Rate for Payer: Bisbee Police All Plans |
$0.41
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of AZ Commercial |
$1.02
|
| Rate for Payer: Copperpoint Commercial |
$0.39
|
| Rate for Payer: Health Net of AZ Commercial |
$0.94
|
| Rate for Payer: Health Net of AZ Medicare |
$0.44
|
| Rate for Payer: Humana of AZ Medicare |
$0.24
|
| Rate for Payer: Self Pay Self Pay |
$1.26
|
| Rate for Payer: TriWest Medicare |
$0.24
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.28
|
|
|
fludrocortisone 0.1 mg Tab [CQCH]
|
Facility
|
OP
|
$0.77
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
105922918
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Aetna of AZ Commercial |
$0.69
|
| Rate for Payer: Aetna of AZ Medicare |
$0.22
|
| Rate for Payer: Allwell Medicare |
$0.12
|
| Rate for Payer: Amerigroup Medicare |
$0.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.29
|
| Rate for Payer: AZCH Complete Medicare |
$0.12
|
| Rate for Payer: Banner UC Health Medicare |
$0.12
|
| Rate for Payer: Bisbee Police All Plans |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna of AZ Commercial |
$0.50
|
| Rate for Payer: Copperpoint Commercial |
$0.19
|
| Rate for Payer: Health Net of AZ Commercial |
$0.46
|
| Rate for Payer: Health Net of AZ Medicare |
$0.22
|
| Rate for Payer: Humana of AZ Medicare |
$0.12
|
| Rate for Payer: Self Pay Self Pay |
$0.62
|
| Rate for Payer: TriWest Medicare |
$0.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.45
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.14
|
|
|
fludrocortisone 0.1 mg Tab [CQCH]
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
105922918
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Aetna of AZ Commercial |
$0.69
|
| Rate for Payer: Bisbee Police All Plans |
$0.20
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Self Pay Self Pay |
$0.62
|
|
|
FLUENT DISPOSABLE PACK
|
Facility
|
OP
|
$990.00
|
|
| Hospital Charge Code |
27448974
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Aetna of AZ Commercial |
$891.00
|
| Rate for Payer: Aetna of AZ Medicare |
$277.20
|
| Rate for Payer: Allwell Medicare |
$148.50
|
| Rate for Payer: Amerigroup Medicare |
$148.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$369.76
|
| Rate for Payer: AZCH Complete Medicare |
$148.50
|
| Rate for Payer: Banner UC Health Medicare |
$148.50
|
| Rate for Payer: Bisbee Police All Plans |
$257.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$673.20
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of AZ Commercial |
$693.00
|
| Rate for Payer: Copperpoint Commercial |
$245.02
|
| Rate for Payer: Health Net of AZ Commercial |
$594.00
|
| Rate for Payer: Health Net of AZ Medicare |
$277.20
|
| Rate for Payer: Humana of AZ Medicare |
$148.50
|
| Rate for Payer: Self Pay Self Pay |
$792.00
|
| Rate for Payer: TriWest Medicare |
$148.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$577.17
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$178.20
|
|
|
FLUENT DISPOSABLE PACK
|
Facility
|
IP
|
$990.00
|
|
| Hospital Charge Code |
27448974
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$257.40 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Aetna of AZ Commercial |
$891.00
|
| Rate for Payer: Bisbee Police All Plans |
$257.40
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Self Pay Self Pay |
$792.00
|
|
|
flumazenil 0.5 mg/5 mL IV Sol [CQCH]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
105922998
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of AZ Commercial |
$0.55
|
| Rate for Payer: Bisbee Police All Plans |
$0.16
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Self Pay Self Pay |
$0.49
|
|
|
flumazenil 0.5 mg/5 mL IV Sol [CQCH]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 63323042405
|
| Hospital Charge Code |
105922998
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of AZ Commercial |
$0.55
|
| Rate for Payer: Aetna of AZ Medicare |
$0.17
|
| Rate for Payer: Allwell Medicare |
$0.09
|
| Rate for Payer: Amerigroup Medicare |
$0.09
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.23
|
| Rate for Payer: AZCH Complete Medicare |
$0.09
|
| 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 |
$0.41
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of AZ Commercial |
$0.40
|
| Rate for Payer: Copperpoint Commercial |
$0.15
|
| Rate for Payer: Health Net of AZ Commercial |
$0.37
|
| Rate for Payer: Health Net of AZ Medicare |
$0.17
|
| Rate for Payer: Humana of AZ Medicare |
$0.09
|
| Rate for Payer: Self Pay Self Pay |
$0.49
|
| Rate for Payer: TriWest Medicare |
$0.09
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.36
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.11
|
|
|
fluorescein 1 mg ophthalmic Test strip [CQCH]
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
105923065
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of AZ Commercial |
$0.84
|
| Rate for Payer: Aetna of AZ Medicare |
$0.26
|
| Rate for Payer: Allwell Medicare |
$0.14
|
| Rate for Payer: Amerigroup Medicare |
$0.14
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.35
|
| Rate for Payer: AZCH Complete Medicare |
$0.14
|
| 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: Cigna of AZ Commercial |
$0.60
|
| Rate for Payer: Copperpoint Commercial |
$0.23
|
| Rate for Payer: Health Net of AZ Commercial |
$0.56
|
| Rate for Payer: Health Net of AZ Medicare |
$0.26
|
| Rate for Payer: Humana of AZ Medicare |
$0.14
|
| 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
|
|
|
fluorescein 1 mg ophthalmic Test strip [CQCH]
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
105923065
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of AZ Commercial |
$0.84
|
| 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
|
|
|
fluorescein-proparacaine ophthalmic 0.25%-0.5% Sol[CQCH]
|
Facility
|
IP
|
$7.37
|
|
|
Service Code
|
NDC 54799050721
|
| Hospital Charge Code |
134270412
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Aetna of AZ Commercial |
$6.63
|
| Rate for Payer: Bisbee Police All Plans |
$1.92
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Self Pay Self Pay |
$5.90
|
|
|
fluorescein-proparacaine ophthalmic 0.25%-0.5% Sol[CQCH]
|
Facility
|
OP
|
$7.37
|
|
|
Service Code
|
NDC 54799050721
|
| Hospital Charge Code |
134270412
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Aetna of AZ Commercial |
$6.63
|
| Rate for Payer: Aetna of AZ Medicare |
$2.06
|
| Rate for Payer: Allwell Medicare |
$1.11
|
| Rate for Payer: Amerigroup Medicare |
$1.11
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.75
|
| Rate for Payer: AZCH Complete Medicare |
$1.11
|
| Rate for Payer: Banner UC Health Medicare |
$1.11
|
| Rate for Payer: Bisbee Police All Plans |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5.01
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna of AZ Commercial |
$4.79
|
| Rate for Payer: Copperpoint Commercial |
$1.82
|
| Rate for Payer: Health Net of AZ Commercial |
$4.42
|
| Rate for Payer: Health Net of AZ Medicare |
$2.06
|
| Rate for Payer: Humana of AZ Medicare |
$1.11
|
| Rate for Payer: Self Pay Self Pay |
$5.90
|
| Rate for Payer: TriWest Medicare |
$1.11
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.33
|
|
