|
Mental Illness Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$23,982.97
|
|
|
Service Code
|
APR-DRG 7404
|
| Hospital Charge Code |
APRDRG7401
|
| Min. Negotiated Rate |
$23,982.97 |
| Max. Negotiated Rate |
$23,982.97 |
| Rate for Payer: AHCCCS Medicaid |
$23,982.97
|
| Rate for Payer: Allwell Medicaid |
$23,982.97
|
| Rate for Payer: AZCH Complete Medicaid |
$23,982.97
|
| Rate for Payer: Banner UC Health Medicaid |
$23,982.97
|
| Rate for Payer: Mercy Care Medicaid |
$23,982.97
|
|
|
Mental Illness Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$8,571.11
|
|
|
Service Code
|
APR-DRG 7401
|
| Hospital Charge Code |
APRDRG7404
|
| Min. Negotiated Rate |
$8,571.11 |
| Max. Negotiated Rate |
$8,571.11 |
| Rate for Payer: AHCCCS Medicaid |
$8,571.11
|
| Rate for Payer: Allwell Medicaid |
$8,571.11
|
| Rate for Payer: AZCH Complete Medicaid |
$8,571.11
|
| Rate for Payer: Banner UC Health Medicaid |
$8,571.11
|
| Rate for Payer: Mercy Care Medicaid |
$8,571.11
|
|
|
Mental Illness Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$23,982.97
|
|
|
Service Code
|
APR-DRG 7404
|
| Hospital Charge Code |
APRDRG7402
|
| Min. Negotiated Rate |
$23,982.97 |
| Max. Negotiated Rate |
$23,982.97 |
| Rate for Payer: AHCCCS Medicaid |
$23,982.97
|
| Rate for Payer: Allwell Medicaid |
$23,982.97
|
| Rate for Payer: AZCH Complete Medicaid |
$23,982.97
|
| Rate for Payer: Banner UC Health Medicaid |
$23,982.97
|
| Rate for Payer: Mercy Care Medicaid |
$23,982.97
|
|
|
meperidine 25 mg/ 1 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$1.88
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
105930690
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of AZ Commercial |
$1.69
|
| Rate for Payer: Bisbee Police All Plans |
$0.49
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Self Pay Self Pay |
$1.50
|
|
|
meperidine 25 mg/ 1 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$1.88
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
105930690
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Aetna of AZ Commercial |
$1.69
|
| Rate for Payer: Aetna of AZ Medicare |
$0.53
|
| Rate for Payer: AHCCCS Medicaid |
$18.22
|
| Rate for Payer: Allwell Medicaid |
$18.22
|
| Rate for Payer: Allwell Medicare |
$0.28
|
| Rate for Payer: Amerigroup Medicare |
$0.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.70
|
| Rate for Payer: AZCH Complete Medicaid |
$18.22
|
| Rate for Payer: AZCH Complete Medicare |
$0.28
|
| Rate for Payer: Banner UC Health Medicaid |
$18.22
|
| Rate for Payer: Banner UC Health Medicare |
$0.28
|
| Rate for Payer: Bisbee Police All Plans |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.28
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna of AZ Commercial |
$1.22
|
| Rate for Payer: Copperpoint Commercial |
$0.47
|
| Rate for Payer: Health Net of AZ Commercial |
$1.13
|
| Rate for Payer: Health Net of AZ Medicare |
$0.53
|
| Rate for Payer: Humana of AZ Medicare |
$0.28
|
| Rate for Payer: Mercy Care Medicaid |
$18.22
|
| Rate for Payer: Self Pay Self Pay |
$1.50
|
| Rate for Payer: TriWest Medicare |
$0.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.10
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.34
|
|
|
meperidine 300 mg/30 mL PCA vial [CQCH]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
105930836
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Aetna of AZ Commercial |
$0.22
|
| Rate for Payer: Aetna of AZ Medicare |
$0.07
|
| Rate for Payer: AHCCCS Medicaid |
$18.22
|
| Rate for Payer: Allwell Medicaid |
$18.22
|
| Rate for Payer: Allwell Medicare |
$0.04
|
| Rate for Payer: Amerigroup Medicare |
$0.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.09
|
| Rate for Payer: AZCH Complete Medicaid |
$18.22
|
| Rate for Payer: AZCH Complete Medicare |
$0.04
|
| Rate for Payer: Banner UC Health Medicaid |
$18.22
|
| Rate for Payer: Banner UC Health Medicare |
$0.04
|
| Rate for Payer: Bisbee Police All Plans |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of AZ Commercial |
$0.16
|
| Rate for Payer: Copperpoint Commercial |
$0.06
|
| Rate for Payer: Health Net of AZ Commercial |
$0.14
|
| Rate for Payer: Health Net of AZ Medicare |
$0.07
|
| Rate for Payer: Humana of AZ Medicare |
$0.04
|
| Rate for Payer: Mercy Care Medicaid |
$18.22
|
| Rate for Payer: Self Pay Self Pay |
$0.19
|
| Rate for Payer: TriWest Medicare |
$0.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.14
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.04
|
|
|
meperidine 300 mg/30 mL PCA vial [CQCH]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
105930836
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of AZ Commercial |
$0.22
|
| Rate for Payer: Bisbee Police All Plans |
$0.06
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Self Pay Self Pay |
$0.19
|
|
|
meperidine 50 mg/1 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
105930763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: Aetna of AZ Commercial |
$4.90
|
| Rate for Payer: Bisbee Police All Plans |
$1.42
|
| Rate for Payer: Cash Price |
$4.36
|
| Rate for Payer: Self Pay Self Pay |
$4.36
|
|
|
meperidine 50 mg/1 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$5.45
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
105930763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Aetna of AZ Commercial |
$4.90
|
| Rate for Payer: Aetna of AZ Medicare |
$1.53
|
| Rate for Payer: AHCCCS Medicaid |
$18.22
|
| Rate for Payer: Allwell Medicaid |
$18.22
|
| Rate for Payer: Allwell Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicare |
$0.82
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.04
|
| Rate for Payer: AZCH Complete Medicaid |
$18.22
|
| Rate for Payer: AZCH Complete Medicare |
$0.82
|
| Rate for Payer: Banner UC Health Medicaid |
$18.22
|
| Rate for Payer: Banner UC Health Medicare |
$0.82
|
| Rate for Payer: Bisbee Police All Plans |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.71
|
| Rate for Payer: Cash Price |
$4.36
|
| Rate for Payer: Cash Price |
$4.36
|
| Rate for Payer: Cigna of AZ Commercial |
$3.54
|
| Rate for Payer: Copperpoint Commercial |
$1.35
|
| Rate for Payer: Health Net of AZ Commercial |
$3.27
|
| Rate for Payer: Health Net of AZ Medicare |
$1.53
|
| Rate for Payer: Humana of AZ Medicare |
$0.82
|
| Rate for Payer: Mercy Care Medicaid |
$18.22
|
| Rate for Payer: Self Pay Self Pay |
$4.36
|
| Rate for Payer: TriWest Medicare |
$0.82
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3.18
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.98
|
|
|
MEPITAC DRESSING TAPE 1.5IN X 59IN SILICONE
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
23543503
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of AZ Commercial |
$33.30
|
| Rate for Payer: Aetna of AZ Medicare |
$10.36
|
| Rate for Payer: Allwell Medicare |
$5.55
|
| Rate for Payer: Amerigroup Medicare |
$5.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$13.82
|
| Rate for Payer: AZCH Complete Medicare |
$5.55
|
| Rate for Payer: Banner UC Health Medicare |
$5.55
|
| Rate for Payer: Bisbee Police All Plans |
$9.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$25.16
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cigna of AZ Commercial |
$25.90
|
| Rate for Payer: Copperpoint Commercial |
$9.16
|
| Rate for Payer: Health Net of AZ Commercial |
$22.20
|
| Rate for Payer: Health Net of AZ Medicare |
$10.36
|
| Rate for Payer: Humana of AZ Medicare |
$5.55
|
| Rate for Payer: Self Pay Self Pay |
$29.60
|
| Rate for Payer: TriWest Medicare |
$5.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$21.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.66
|
|
|
MEPITAC DRESSING TAPE 1.5IN X 59IN SILICONE
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
23543503
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of AZ Commercial |
$33.30
|
| Rate for Payer: Bisbee Police All Plans |
$9.62
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Self Pay Self Pay |
$29.60
|
|
|
MERCURY BLOOD
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
22481493
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.26 |
| 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 |
$16.26
|
| Rate for Payer: Allwell Medicaid |
$16.26
|
| 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 |
$16.26
|
| Rate for Payer: AZCH Complete Medicare |
$69.60
|
| Rate for Payer: Banner UC Health Medicaid |
$16.26
|
| 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 |
$16.26
|
| 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
|
|
|
MERCURY BLOOD
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
22481493
|
|
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
|
|
|
Mercury, Blood LC
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
1285592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna of AZ Commercial |
$397.80
|
| Rate for Payer: Aetna of AZ Medicare |
$123.76
|
| Rate for Payer: AHCCCS Medicaid |
$16.26
|
| Rate for Payer: Allwell Medicaid |
$16.26
|
| Rate for Payer: Allwell Medicare |
$66.30
|
| Rate for Payer: Amerigroup Medicare |
$66.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$165.09
|
| Rate for Payer: AZCH Complete Medicaid |
$16.26
|
| Rate for Payer: AZCH Complete Medicare |
$66.30
|
| Rate for Payer: Banner UC Health Medicaid |
$16.26
|
| Rate for Payer: Banner UC Health Medicare |
$66.30
|
| Rate for Payer: Bisbee Police All Plans |
$114.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$300.56
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cigna of AZ Commercial |
$287.30
|
| Rate for Payer: Copperpoint Commercial |
$109.40
|
| Rate for Payer: Health Net of AZ Commercial |
$265.20
|
| Rate for Payer: Health Net of AZ Medicare |
$123.76
|
| Rate for Payer: Humana of AZ Medicare |
$66.30
|
| Rate for Payer: Mercy Care Medicaid |
$16.26
|
| Rate for Payer: Self Pay Self Pay |
$353.60
|
| Rate for Payer: TriWest Medicare |
$66.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$257.69
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$79.56
|
|
|
Mercury, Blood LC
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
1285592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$114.92 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna of AZ Commercial |
$397.80
|
| Rate for Payer: Bisbee Police All Plans |
$114.92
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Self Pay Self Pay |
$353.60
|
|
|
.Mercury, Comment LC
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
22311159
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$114.92 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna of AZ Commercial |
$397.80
|
| Rate for Payer: Bisbee Police All Plans |
$114.92
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Self Pay Self Pay |
$353.60
|
|
|
.Mercury, Comment LC
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
22311159
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna of AZ Commercial |
$397.80
|
| Rate for Payer: Aetna of AZ Medicare |
$123.76
|
| Rate for Payer: AHCCCS Medicaid |
$16.26
|
| Rate for Payer: Allwell Medicaid |
$16.26
|
| Rate for Payer: Allwell Medicare |
$66.30
|
| Rate for Payer: Amerigroup Medicare |
$66.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$165.09
|
| Rate for Payer: AZCH Complete Medicaid |
$16.26
|
| Rate for Payer: AZCH Complete Medicare |
$66.30
|
| Rate for Payer: Banner UC Health Medicaid |
$16.26
|
| Rate for Payer: Banner UC Health Medicare |
$66.30
|
| Rate for Payer: Bisbee Police All Plans |
$114.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$300.56
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cigna of AZ Commercial |
$287.30
|
| Rate for Payer: Copperpoint Commercial |
$109.40
|
| Rate for Payer: Health Net of AZ Commercial |
$265.20
|
| Rate for Payer: Health Net of AZ Medicare |
$123.76
|
| Rate for Payer: Humana of AZ Medicare |
$66.30
|
| Rate for Payer: Mercy Care Medicaid |
$16.26
|
| Rate for Payer: Self Pay Self Pay |
$353.60
|
| Rate for Payer: TriWest Medicare |
$66.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$257.69
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$79.56
|
|
|
MEROCEL POPE EPISTAXIS 10CM
|
Facility
|
IP
|
$171.00
|
|
| Hospital Charge Code |
27555206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna of AZ Commercial |
$153.90
|
| Rate for Payer: Bisbee Police All Plans |
$44.46
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Self Pay Self Pay |
$136.80
|
|
|
MEROCEL POPE EPISTAXIS 10CM
|
Facility
|
OP
|
$171.00
|
|
| Hospital Charge Code |
27555206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna of AZ Commercial |
$153.90
|
| Rate for Payer: Aetna of AZ Medicare |
$47.88
|
| Rate for Payer: Allwell Medicare |
$25.65
|
| Rate for Payer: Amerigroup Medicare |
$25.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$63.87
|
| Rate for Payer: AZCH Complete Medicare |
$25.65
|
| Rate for Payer: Banner UC Health Medicare |
$25.65
|
| Rate for Payer: Bisbee Police All Plans |
$44.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$116.28
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna of AZ Commercial |
$119.70
|
| Rate for Payer: Copperpoint Commercial |
$42.32
|
| Rate for Payer: Health Net of AZ Commercial |
$102.60
|
| Rate for Payer: Health Net of AZ Medicare |
$47.88
|
| Rate for Payer: Humana of AZ Medicare |
$25.65
|
| Rate for Payer: Self Pay Self Pay |
$136.80
|
| Rate for Payer: TriWest Medicare |
$25.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$99.69
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.78
|
|
|
mesalamine 1000 mg Supp [CQCH]
|
Facility
|
IP
|
$22.72
|
|
|
Service Code
|
NDC 58914050156
|
| Hospital Charge Code |
105930976
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna of AZ Commercial |
$20.45
|
| Rate for Payer: Bisbee Police All Plans |
$5.91
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Self Pay Self Pay |
$18.18
|
|
|
mesalamine 1000 mg Supp [CQCH]
|
Facility
|
OP
|
$22.72
|
|
|
Service Code
|
NDC 58914050156
|
| Hospital Charge Code |
105930976
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna of AZ Commercial |
$20.45
|
| Rate for Payer: Aetna of AZ Medicare |
$6.36
|
| Rate for Payer: Allwell Medicare |
$3.41
|
| Rate for Payer: Amerigroup Medicare |
$3.41
|
| Rate for Payer: APIPA Medicare/Medicaid |
$8.49
|
| Rate for Payer: AZCH Complete Medicare |
$3.41
|
| Rate for Payer: Banner UC Health Medicare |
$3.41
|
| Rate for Payer: Bisbee Police All Plans |
$5.91
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$15.45
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cigna of AZ Commercial |
$14.77
|
| Rate for Payer: Copperpoint Commercial |
$5.62
|
| Rate for Payer: Health Net of AZ Commercial |
$13.63
|
| Rate for Payer: Health Net of AZ Medicare |
$6.36
|
| Rate for Payer: Humana of AZ Medicare |
$3.41
|
| Rate for Payer: Self Pay Self Pay |
$18.18
|
| Rate for Payer: TriWest Medicare |
$3.41
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$13.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.09
|
|
|
mesalamine 400 mg DR [CQCH]
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 23585318
|
| Hospital Charge Code |
105930911
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna of AZ Commercial |
$2.97
|
| Rate for Payer: Bisbee Police All Plans |
$0.86
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Self Pay Self Pay |
$2.64
|
|
|
mesalamine 400 mg DR [CQCH]
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 23585318
|
| Hospital Charge Code |
105930911
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna of AZ Commercial |
$2.97
|
| Rate for Payer: Aetna of AZ Medicare |
$0.92
|
| Rate for Payer: Allwell Medicare |
$0.50
|
| Rate for Payer: Amerigroup Medicare |
$0.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.23
|
| Rate for Payer: AZCH Complete Medicare |
$0.50
|
| Rate for Payer: Banner UC Health Medicare |
$0.50
|
| Rate for Payer: Bisbee Police All Plans |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.24
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cigna of AZ Commercial |
$2.14
|
| Rate for Payer: Copperpoint Commercial |
$0.82
|
| Rate for Payer: Health Net of AZ Commercial |
$1.98
|
| Rate for Payer: Health Net of AZ Medicare |
$0.92
|
| Rate for Payer: Humana of AZ Medicare |
$0.50
|
| Rate for Payer: Self Pay Self Pay |
$2.64
|
| Rate for Payer: TriWest Medicare |
$0.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.59
|
|
|
MESH 3D MAX LEFT EXTRA LARGE
|
Facility
|
IP
|
$1,103.00
|
|
| Hospital Charge Code |
27750234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$286.78 |
| Max. Negotiated Rate |
$992.70 |
| Rate for Payer: Aetna of AZ Commercial |
$992.70
|
| Rate for Payer: Bisbee Police All Plans |
$286.78
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Self Pay Self Pay |
$882.40
|
|
|
MESH 3D MAX LEFT EXTRA LARGE
|
Facility
|
OP
|
$1,103.00
|
|
| Hospital Charge Code |
27750234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.45 |
| Max. Negotiated Rate |
$992.70 |
| Rate for Payer: Aetna of AZ Commercial |
$992.70
|
| Rate for Payer: Aetna of AZ Medicare |
$308.84
|
| Rate for Payer: Allwell Medicare |
$165.45
|
| Rate for Payer: Amerigroup Medicare |
$165.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$411.97
|
| Rate for Payer: AZCH Complete Medicare |
$165.45
|
| Rate for Payer: Banner UC Health Medicare |
$165.45
|
| Rate for Payer: Bisbee Police All Plans |
$286.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$750.04
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cigna of AZ Commercial |
$772.10
|
| Rate for Payer: Copperpoint Commercial |
$272.99
|
| Rate for Payer: Health Net of AZ Commercial |
$661.80
|
| Rate for Payer: Health Net of AZ Medicare |
$308.84
|
| Rate for Payer: Humana of AZ Medicare |
$165.45
|
| Rate for Payer: Self Pay Self Pay |
$882.40
|
| Rate for Payer: TriWest Medicare |
$165.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$643.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$198.54
|
|
