|
INFLOW PUMP TUBING
|
Facility
|
IP
|
$242.50
|
|
| Hospital Charge Code |
25519689
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Aetna of AZ Commercial |
$218.25
|
| Rate for Payer: Bisbee Police All Plans |
$63.05
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Self Pay Self Pay |
$194.00
|
|
|
INFLOW PUMP TUBING
|
Facility
|
OP
|
$242.50
|
|
| Hospital Charge Code |
25519689
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Aetna of AZ Commercial |
$218.25
|
| Rate for Payer: Aetna of AZ Medicare |
$67.90
|
| Rate for Payer: Allwell Medicare |
$36.38
|
| Rate for Payer: Amerigroup Medicare |
$36.38
|
| Rate for Payer: APIPA Medicare/Medicaid |
$90.57
|
| Rate for Payer: AZCH Complete Medicare |
$36.38
|
| Rate for Payer: Banner UC Health Medicare |
$36.38
|
| Rate for Payer: Bisbee Police All Plans |
$63.05
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$164.90
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna of AZ Commercial |
$169.75
|
| Rate for Payer: Copperpoint Commercial |
$60.02
|
| Rate for Payer: Health Net of AZ Commercial |
$145.50
|
| Rate for Payer: Health Net of AZ Medicare |
$67.90
|
| Rate for Payer: Humana of AZ Medicare |
$36.38
|
| Rate for Payer: Self Pay Self Pay |
$194.00
|
| Rate for Payer: TriWest Medicare |
$36.38
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$141.38
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$43.65
|
|
|
INFLU B SCN
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
22481485
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of AZ Commercial |
$194.40
|
| Rate for Payer: Aetna of AZ Medicare |
$60.48
|
| Rate for Payer: AHCCCS Medicaid |
$16.55
|
| Rate for Payer: Allwell Medicaid |
$16.55
|
| Rate for Payer: Allwell Medicare |
$32.40
|
| Rate for Payer: Amerigroup Medicare |
$32.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$80.68
|
| Rate for Payer: AZCH Complete Medicaid |
$16.55
|
| Rate for Payer: AZCH Complete Medicare |
$32.40
|
| Rate for Payer: Banner UC Health Medicaid |
$16.55
|
| Rate for Payer: Banner UC Health Medicare |
$32.40
|
| Rate for Payer: Bisbee Police All Plans |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$146.88
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna of AZ Commercial |
$140.40
|
| Rate for Payer: Copperpoint Commercial |
$53.46
|
| Rate for Payer: Health Net of AZ Commercial |
$129.60
|
| Rate for Payer: Health Net of AZ Medicare |
$60.48
|
| Rate for Payer: Humana of AZ Medicare |
$32.40
|
| Rate for Payer: Mercy Care Medicaid |
$16.55
|
| Rate for Payer: Self Pay Self Pay |
$172.80
|
| Rate for Payer: TriWest Medicare |
$32.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$125.93
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.88
|
|
|
INFLU B SCN
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
22481485
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.16 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of AZ Commercial |
$194.40
|
| Rate for Payer: Bisbee Police All Plans |
$56.16
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Self Pay Self Pay |
$172.80
|
|
|
Influenza A/B POC
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 87804 QW
|
| Hospital Charge Code |
13407374
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of AZ Commercial |
$117.00
|
| Rate for Payer: Aetna of AZ Medicare |
$36.40
|
| Rate for Payer: Allwell Medicare |
$19.50
|
| Rate for Payer: Amerigroup Medicare |
$19.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$48.56
|
| Rate for Payer: AZCH Complete Medicare |
$19.50
|
| Rate for Payer: Banner UC Health Medicare |
$19.50
|
| Rate for Payer: Bisbee Police All Plans |
$33.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$88.40
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna of AZ Commercial |
$84.50
|
| Rate for Payer: Copperpoint Commercial |
$32.18
|
| Rate for Payer: Health Net of AZ Commercial |
$78.00
|
| Rate for Payer: Health Net of AZ Medicare |
$36.40
|
| Rate for Payer: Humana of AZ Medicare |
$19.50
|
| Rate for Payer: Self Pay Self Pay |
$104.00
|
| Rate for Payer: TriWest Medicare |
$19.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$75.79
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$23.40
|
|
|
Influenza A/B POC
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 87804 QW
|
| Hospital Charge Code |
13407374
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of AZ Commercial |
$117.00
|
| Rate for Payer: Bisbee Police All Plans |
$33.80
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Self Pay Self Pay |
$104.00
|
|
|
Influenza AB Rapid
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
5696971
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna of AZ Commercial |
$185.40
|
| Rate for Payer: Aetna of AZ Medicare |
$57.68
|
| Rate for Payer: AHCCCS Medicaid |
$16.55
|
| Rate for Payer: Allwell Medicaid |
$16.55
|
| Rate for Payer: Allwell Medicare |
$30.90
|
| Rate for Payer: Amerigroup Medicare |
$30.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$76.94
|
| Rate for Payer: AZCH Complete Medicaid |
$16.55
|
| Rate for Payer: AZCH Complete Medicare |
$30.90
|
| Rate for Payer: Banner UC Health Medicaid |
$16.55
|
| Rate for Payer: Banner UC Health Medicare |
$30.90
|
| Rate for Payer: Bisbee Police All Plans |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$140.08
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cigna of AZ Commercial |
$133.90
|
| Rate for Payer: Copperpoint Commercial |
$50.98
|
| Rate for Payer: Health Net of AZ Commercial |
$123.60
|
| Rate for Payer: Health Net of AZ Medicare |
$57.68
|
| Rate for Payer: Humana of AZ Medicare |
$30.90
|
| Rate for Payer: Mercy Care Medicaid |
$16.55
|
| Rate for Payer: Self Pay Self Pay |
$164.80
|
| Rate for Payer: TriWest Medicare |
$30.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$120.10
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$37.08
|
|
|
Influenza AB Rapid
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
5696971
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna of AZ Commercial |
$185.40
|
| Rate for Payer: Bisbee Police All Plans |
$53.56
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Self Pay Self Pay |
$164.80
|
|
|
influenza virus vaccine 2024-2025, inactivated preservative-free trivalent Sus UD[CQCH]
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 19515081052
|
| Hospital Charge Code |
242320050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna of AZ Commercial |
$13.32
|
| Rate for Payer: Bisbee Police All Plans |
$3.85
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Self Pay Self Pay |
$11.84
|
|
|
influenza virus vaccine 2024-2025, inactivated preservative-free trivalent Sus UD[CQCH]
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 19515081052
|
| Hospital Charge Code |
242320050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna of AZ Commercial |
$13.32
|
| Rate for Payer: Aetna of AZ Medicare |
$4.14
|
| Rate for Payer: Allwell Medicare |
$2.22
|
| Rate for Payer: Amerigroup Medicare |
$2.22
|
| Rate for Payer: APIPA Medicare/Medicaid |
$5.53
|
| Rate for Payer: AZCH Complete Medicare |
$2.22
|
| Rate for Payer: Banner UC Health Medicare |
$2.22
|
| Rate for Payer: Bisbee Police All Plans |
$3.85
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$10.06
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cigna of AZ Commercial |
$9.62
|
| Rate for Payer: Copperpoint Commercial |
$3.66
|
| Rate for Payer: Health Net of AZ Commercial |
$8.88
|
| Rate for Payer: Health Net of AZ Medicare |
$4.14
|
| Rate for Payer: Humana of AZ Medicare |
$2.22
|
| Rate for Payer: Self Pay Self Pay |
$11.84
|
| Rate for Payer: TriWest Medicare |
$2.22
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$8.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.66
|
|
|
informaSeq(SM) Prenatal Test LC
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 81420
|
| Hospital Charge Code |
22311195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$759.05 |
| Rate for Payer: Aetna of AZ Commercial |
$208.80
|
| Rate for Payer: Aetna of AZ Medicare |
$64.96
|
| Rate for Payer: AHCCCS Medicaid |
$759.05
|
| Rate for Payer: Allwell Medicaid |
$759.05
|
| Rate for Payer: Allwell Medicare |
$34.80
|
| Rate for Payer: Amerigroup Medicare |
$34.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$86.65
|
| Rate for Payer: AZCH Complete Medicaid |
$759.05
|
| Rate for Payer: AZCH Complete Medicare |
$34.80
|
| Rate for Payer: Banner UC Health Medicaid |
$759.05
|
| Rate for Payer: Banner UC Health Medicare |
$34.80
|
| Rate for Payer: Bisbee Police All Plans |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$157.76
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cigna of AZ Commercial |
$150.80
|
| Rate for Payer: Copperpoint Commercial |
$57.42
|
| Rate for Payer: Health Net of AZ Commercial |
$139.20
|
| Rate for Payer: Health Net of AZ Medicare |
$64.96
|
| Rate for Payer: Humana of AZ Medicare |
$34.80
|
| Rate for Payer: Mercy Care Medicaid |
$759.05
|
| Rate for Payer: Self Pay Self Pay |
$185.60
|
| Rate for Payer: TriWest Medicare |
$34.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$135.26
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.76
|
|
|
informaSeq(SM) Prenatal Test LC
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 81420
|
| Hospital Charge Code |
22311195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.32 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Aetna of AZ Commercial |
$208.80
|
| Rate for Payer: Bisbee Police All Plans |
$60.32
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Self Pay Self Pay |
$185.60
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$11,253.26
|
|
|
Service Code
|
APR-DRG 2283
|
| Hospital Charge Code |
APRDRG2284
|
| Min. Negotiated Rate |
$11,253.26 |
| Max. Negotiated Rate |
$11,253.26 |
| Rate for Payer: AHCCCS Medicaid |
$11,253.26
|
| Rate for Payer: Allwell Medicaid |
$11,253.26
|
| Rate for Payer: AZCH Complete Medicaid |
$11,253.26
|
| Rate for Payer: Banner UC Health Medicaid |
$11,253.26
|
| Rate for Payer: Mercy Care Medicaid |
$11,253.26
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$5,855.99
|
|
|
Service Code
|
APR-DRG 2281
|
| Hospital Charge Code |
APRDRG2281
|
| Min. Negotiated Rate |
$5,855.99 |
| Max. Negotiated Rate |
$5,855.99 |
| Rate for Payer: AHCCCS Medicaid |
$5,855.99
|
| Rate for Payer: Allwell Medicaid |
$5,855.99
|
| Rate for Payer: AZCH Complete Medicaid |
$5,855.99
|
| Rate for Payer: Banner UC Health Medicaid |
$5,855.99
|
| Rate for Payer: Mercy Care Medicaid |
$5,855.99
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$7,529.53
|
|
|
Service Code
|
APR-DRG 2282
|
| Hospital Charge Code |
APRDRG2284
|
| Min. Negotiated Rate |
$7,529.53 |
| Max. Negotiated Rate |
$7,529.53 |
| Rate for Payer: AHCCCS Medicaid |
$7,529.53
|
| Rate for Payer: Allwell Medicaid |
$7,529.53
|
| Rate for Payer: AZCH Complete Medicaid |
$7,529.53
|
| Rate for Payer: Banner UC Health Medicaid |
$7,529.53
|
| Rate for Payer: Mercy Care Medicaid |
$7,529.53
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$11,253.26
|
|
|
Service Code
|
APR-DRG 2283
|
| Hospital Charge Code |
APRDRG2281
|
| Min. Negotiated Rate |
$11,253.26 |
| Max. Negotiated Rate |
$11,253.26 |
| Rate for Payer: AHCCCS Medicaid |
$11,253.26
|
| Rate for Payer: Allwell Medicaid |
$11,253.26
|
| Rate for Payer: AZCH Complete Medicaid |
$11,253.26
|
| Rate for Payer: Banner UC Health Medicaid |
$11,253.26
|
| Rate for Payer: Mercy Care Medicaid |
$11,253.26
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$5,855.99
|
|
|
Service Code
|
APR-DRG 2281
|
| Hospital Charge Code |
APRDRG2284
|
| Min. Negotiated Rate |
$5,855.99 |
| Max. Negotiated Rate |
$5,855.99 |
| Rate for Payer: AHCCCS Medicaid |
$5,855.99
|
| Rate for Payer: Allwell Medicaid |
$5,855.99
|
| Rate for Payer: AZCH Complete Medicaid |
$5,855.99
|
| Rate for Payer: Banner UC Health Medicaid |
$5,855.99
|
| Rate for Payer: Mercy Care Medicaid |
$5,855.99
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$5,855.99
|
|
|
Service Code
|
APR-DRG 2281
|
| Hospital Charge Code |
APRDRG2283
|
| Min. Negotiated Rate |
$5,855.99 |
| Max. Negotiated Rate |
$5,855.99 |
| Rate for Payer: AHCCCS Medicaid |
$5,855.99
|
| Rate for Payer: Allwell Medicaid |
$5,855.99
|
| Rate for Payer: AZCH Complete Medicaid |
$5,855.99
|
| Rate for Payer: Banner UC Health Medicaid |
$5,855.99
|
| Rate for Payer: Mercy Care Medicaid |
$5,855.99
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$21,389.19
|
|
|
Service Code
|
APR-DRG 2284
|
| Hospital Charge Code |
APRDRG2284
|
| Min. Negotiated Rate |
$21,389.19 |
| Max. Negotiated Rate |
$21,389.19 |
| Rate for Payer: AHCCCS Medicaid |
$21,389.19
|
| Rate for Payer: Allwell Medicaid |
$21,389.19
|
| Rate for Payer: AZCH Complete Medicaid |
$21,389.19
|
| Rate for Payer: Banner UC Health Medicaid |
$21,389.19
|
| Rate for Payer: Mercy Care Medicaid |
$21,389.19
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$21,389.19
|
|
|
Service Code
|
APR-DRG 2284
|
| Hospital Charge Code |
APRDRG2283
|
| Min. Negotiated Rate |
$21,389.19 |
| Max. Negotiated Rate |
$21,389.19 |
| Rate for Payer: AHCCCS Medicaid |
$21,389.19
|
| Rate for Payer: Allwell Medicaid |
$21,389.19
|
| Rate for Payer: AZCH Complete Medicaid |
$21,389.19
|
| Rate for Payer: Banner UC Health Medicaid |
$21,389.19
|
| Rate for Payer: Mercy Care Medicaid |
$21,389.19
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$7,529.53
|
|
|
Service Code
|
APR-DRG 2282
|
| Hospital Charge Code |
APRDRG2282
|
| Min. Negotiated Rate |
$7,529.53 |
| Max. Negotiated Rate |
$7,529.53 |
| Rate for Payer: AHCCCS Medicaid |
$7,529.53
|
| Rate for Payer: Allwell Medicaid |
$7,529.53
|
| Rate for Payer: AZCH Complete Medicaid |
$7,529.53
|
| Rate for Payer: Banner UC Health Medicaid |
$7,529.53
|
| Rate for Payer: Mercy Care Medicaid |
$7,529.53
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$11,253.26
|
|
|
Service Code
|
APR-DRG 2283
|
| Hospital Charge Code |
APRDRG2282
|
| Min. Negotiated Rate |
$11,253.26 |
| Max. Negotiated Rate |
$11,253.26 |
| Rate for Payer: AHCCCS Medicaid |
$11,253.26
|
| Rate for Payer: Allwell Medicaid |
$11,253.26
|
| Rate for Payer: AZCH Complete Medicaid |
$11,253.26
|
| Rate for Payer: Banner UC Health Medicaid |
$11,253.26
|
| Rate for Payer: Mercy Care Medicaid |
$11,253.26
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$5,855.99
|
|
|
Service Code
|
APR-DRG 2281
|
| Hospital Charge Code |
APRDRG2282
|
| Min. Negotiated Rate |
$5,855.99 |
| Max. Negotiated Rate |
$5,855.99 |
| Rate for Payer: AHCCCS Medicaid |
$5,855.99
|
| Rate for Payer: Allwell Medicaid |
$5,855.99
|
| Rate for Payer: AZCH Complete Medicaid |
$5,855.99
|
| Rate for Payer: Banner UC Health Medicaid |
$5,855.99
|
| Rate for Payer: Mercy Care Medicaid |
$5,855.99
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$11,253.26
|
|
|
Service Code
|
APR-DRG 2283
|
| Hospital Charge Code |
APRDRG2283
|
| Min. Negotiated Rate |
$11,253.26 |
| Max. Negotiated Rate |
$11,253.26 |
| Rate for Payer: AHCCCS Medicaid |
$11,253.26
|
| Rate for Payer: Allwell Medicaid |
$11,253.26
|
| Rate for Payer: AZCH Complete Medicaid |
$11,253.26
|
| Rate for Payer: Banner UC Health Medicaid |
$11,253.26
|
| Rate for Payer: Mercy Care Medicaid |
$11,253.26
|
|
|
Inguinal, Femoral And Umbilical Hernia Procedures
|
Facility
|
IP
|
$7,529.53
|
|
|
Service Code
|
APR-DRG 2282
|
| Hospital Charge Code |
APRDRG2281
|
| Min. Negotiated Rate |
$7,529.53 |
| Max. Negotiated Rate |
$7,529.53 |
| Rate for Payer: AHCCCS Medicaid |
$7,529.53
|
| Rate for Payer: Allwell Medicaid |
$7,529.53
|
| Rate for Payer: AZCH Complete Medicaid |
$7,529.53
|
| Rate for Payer: Banner UC Health Medicaid |
$7,529.53
|
| Rate for Payer: Mercy Care Medicaid |
$7,529.53
|
|
