|
nitroglycerin 200 mcg/ mL-250ml IV bottle [CQCH]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 338104902
|
| Hospital Charge Code |
105934213
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of AZ Commercial |
$0.07
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
|
|
nitroglycerin 200 mcg/ mL-250ml IV bottle [CQCH]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 338104902
|
| Hospital Charge Code |
105934213
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of AZ Commercial |
$0.07
|
| Rate for Payer: Aetna of AZ Medicare |
$0.02
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.03
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of AZ Commercial |
$0.05
|
| Rate for Payer: Copperpoint Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Commercial |
$0.05
|
| Rate for Payer: Health Net of AZ Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
nitroglycerin 2% Top Oint [CQCH]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 281032608
|
| Hospital Charge Code |
105934148
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna of AZ Commercial |
$1.78
|
| Rate for Payer: Aetna of AZ Medicare |
$0.55
|
| Rate for Payer: Allwell Medicare |
$0.30
|
| Rate for Payer: Amerigroup Medicare |
$0.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.74
|
| Rate for Payer: AZCH Complete Medicare |
$0.30
|
| Rate for Payer: Banner UC Health Medicare |
$0.30
|
| Rate for Payer: Bisbee Police All Plans |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.35
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna of AZ Commercial |
$1.29
|
| Rate for Payer: Copperpoint Commercial |
$0.49
|
| Rate for Payer: Health Net of AZ Commercial |
$1.19
|
| Rate for Payer: Health Net of AZ Medicare |
$0.55
|
| Rate for Payer: Humana of AZ Medicare |
$0.30
|
| Rate for Payer: Self Pay Self Pay |
$1.58
|
| Rate for Payer: TriWest Medicare |
$0.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.36
|
|
|
nitroglycerin 2% Top Oint [CQCH]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 281032608
|
| Hospital Charge Code |
105934148
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna of AZ Commercial |
$1.78
|
| Rate for Payer: Bisbee Police All Plans |
$0.51
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Self Pay Self Pay |
$1.58
|
|
|
nitroprusside 50 mg/ 2 mL IV Sol [CQCH]
|
Facility
|
IP
|
$18.60
|
|
|
Service Code
|
NDC 409302401
|
| Hospital Charge Code |
105934276
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna of AZ Commercial |
$16.74
|
| Rate for Payer: Bisbee Police All Plans |
$4.84
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Self Pay Self Pay |
$14.88
|
|
|
nitroprusside 50 mg/ 2 mL IV Sol [CQCH]
|
Facility
|
OP
|
$18.60
|
|
|
Service Code
|
NDC 409302401
|
| Hospital Charge Code |
105934276
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna of AZ Commercial |
$16.74
|
| Rate for Payer: Aetna of AZ Medicare |
$5.21
|
| Rate for Payer: Allwell Medicare |
$2.79
|
| Rate for Payer: Amerigroup Medicare |
$2.79
|
| Rate for Payer: APIPA Medicare/Medicaid |
$6.95
|
| Rate for Payer: AZCH Complete Medicare |
$2.79
|
| Rate for Payer: Banner UC Health Medicare |
$2.79
|
| Rate for Payer: Bisbee Police All Plans |
$4.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$12.65
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna of AZ Commercial |
$12.09
|
| Rate for Payer: Copperpoint Commercial |
$4.60
|
| Rate for Payer: Health Net of AZ Commercial |
$11.16
|
| Rate for Payer: Health Net of AZ Medicare |
$5.21
|
| Rate for Payer: Humana of AZ Medicare |
$2.79
|
| Rate for Payer: Self Pay Self Pay |
$14.88
|
| Rate for Payer: TriWest Medicare |
$2.79
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$10.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.35
|
|
|
NMR LipoProfile LC
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
2269488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna of AZ Commercial |
$195.30
|
| Rate for Payer: Aetna of AZ Medicare |
$60.76
|
| Rate for Payer: AHCCCS Medicaid |
$13.39
|
| Rate for Payer: Allwell Medicaid |
$13.39
|
| Rate for Payer: Allwell Medicare |
$32.55
|
| Rate for Payer: Amerigroup Medicare |
$32.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$81.05
|
| Rate for Payer: AZCH Complete Medicaid |
$13.39
|
| Rate for Payer: AZCH Complete Medicare |
$32.55
|
| Rate for Payer: Banner UC Health Medicaid |
$13.39
|
| Rate for Payer: Banner UC Health Medicare |
$32.55
|
| Rate for Payer: Bisbee Police All Plans |
$56.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$147.56
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cigna of AZ Commercial |
$141.05
|
| Rate for Payer: Copperpoint Commercial |
$53.71
|
| Rate for Payer: Health Net of AZ Commercial |
$130.20
|
| Rate for Payer: Health Net of AZ Medicare |
$60.76
|
| Rate for Payer: Humana of AZ Medicare |
$32.55
|
| Rate for Payer: Mercy Care Medicaid |
$13.39
|
| Rate for Payer: Self Pay Self Pay |
$173.60
|
| Rate for Payer: TriWest Medicare |
$32.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$126.51
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$39.06
|
|
|
NMR LipoProfile LC
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
2269488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.42 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna of AZ Commercial |
$195.30
|
| Rate for Payer: Bisbee Police All Plans |
$56.42
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Self Pay Self Pay |
$173.60
|
|
|
NOMOLINE HH AIRWAY ADAPTER SET ADULT AND PED 7FT
|
Facility
|
IP
|
$91.00
|
|
| Hospital Charge Code |
27476057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of AZ Commercial |
$81.90
|
| Rate for Payer: Bisbee Police All Plans |
$23.66
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Self Pay Self Pay |
$72.80
|
|
|
NOMOLINE HH AIRWAY ADAPTER SET ADULT AND PED 7FT
|
Facility
|
OP
|
$91.00
|
|
| Hospital Charge Code |
27476057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of AZ Commercial |
$81.90
|
| Rate for Payer: Aetna of AZ Medicare |
$25.48
|
| Rate for Payer: Allwell Medicare |
$13.65
|
| Rate for Payer: Amerigroup Medicare |
$13.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$33.99
|
| Rate for Payer: AZCH Complete Medicare |
$13.65
|
| Rate for Payer: Banner UC Health Medicare |
$13.65
|
| Rate for Payer: Bisbee Police All Plans |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$61.88
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cigna of AZ Commercial |
$63.70
|
| Rate for Payer: Copperpoint Commercial |
$22.52
|
| Rate for Payer: Health Net of AZ Commercial |
$54.60
|
| Rate for Payer: Health Net of AZ Medicare |
$25.48
|
| Rate for Payer: Humana of AZ Medicare |
$13.65
|
| Rate for Payer: Self Pay Self Pay |
$72.80
|
| Rate for Payer: TriWest Medicare |
$13.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$53.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$16.38
|
|
|
NOMOLINE HH NASAL ORAL CO2 CANNULA ADULT
|
Facility
|
OP
|
$68.00
|
|
| Hospital Charge Code |
27548601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of AZ Commercial |
$61.20
|
| Rate for Payer: Aetna of AZ Medicare |
$19.04
|
| Rate for Payer: Allwell Medicare |
$10.20
|
| Rate for Payer: Amerigroup Medicare |
$10.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$25.40
|
| Rate for Payer: AZCH Complete Medicare |
$10.20
|
| Rate for Payer: Banner UC Health Medicare |
$10.20
|
| Rate for Payer: Bisbee Police All Plans |
$17.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$46.24
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cigna of AZ Commercial |
$47.60
|
| Rate for Payer: Copperpoint Commercial |
$16.83
|
| Rate for Payer: Health Net of AZ Commercial |
$40.80
|
| Rate for Payer: Health Net of AZ Medicare |
$19.04
|
| Rate for Payer: Humana of AZ Medicare |
$10.20
|
| Rate for Payer: Self Pay Self Pay |
$54.40
|
| Rate for Payer: TriWest Medicare |
$10.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$39.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.24
|
|
|
NOMOLINE HH NASAL ORAL CO2 CANNULA ADULT
|
Facility
|
IP
|
$68.00
|
|
| Hospital Charge Code |
27548601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of AZ Commercial |
$61.20
|
| Rate for Payer: Bisbee Police All Plans |
$17.68
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Self Pay Self Pay |
$54.40
|
|
|
NOMOLINE LH NASAL ORAL CO2 CANNUAL PED 7FT
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
27476056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna of AZ Commercial |
$66.60
|
| Rate for Payer: Aetna of AZ Medicare |
$20.72
|
| Rate for Payer: Allwell Medicare |
$11.10
|
| Rate for Payer: Amerigroup Medicare |
$11.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$27.64
|
| Rate for Payer: AZCH Complete Medicare |
$11.10
|
| Rate for Payer: Banner UC Health Medicare |
$11.10
|
| Rate for Payer: Bisbee Police All Plans |
$19.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$50.32
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cigna of AZ Commercial |
$51.80
|
| Rate for Payer: Copperpoint Commercial |
$18.32
|
| Rate for Payer: Health Net of AZ Commercial |
$44.40
|
| Rate for Payer: Health Net of AZ Medicare |
$20.72
|
| Rate for Payer: Humana of AZ Medicare |
$11.10
|
| Rate for Payer: Self Pay Self Pay |
$59.20
|
| Rate for Payer: TriWest Medicare |
$11.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$43.14
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.32
|
|
|
NOMOLINE LH NASAL ORAL CO2 CANNUAL PED 7FT
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
27476056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna of AZ Commercial |
$66.60
|
| Rate for Payer: Bisbee Police All Plans |
$19.24
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Self Pay Self Pay |
$59.20
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$8,018.40
|
|
|
Service Code
|
APR-DRG 0502
|
| Hospital Charge Code |
APRDRG0502
|
| Min. Negotiated Rate |
$8,018.40 |
| Max. Negotiated Rate |
$8,018.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,018.40
|
| Rate for Payer: Allwell Medicaid |
$8,018.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,018.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,018.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,018.40
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$4,423.73
|
|
|
Service Code
|
APR-DRG 0501
|
| Hospital Charge Code |
APRDRG0504
|
| Min. Negotiated Rate |
$4,423.73 |
| Max. Negotiated Rate |
$4,423.73 |
| Rate for Payer: AHCCCS Medicaid |
$4,423.73
|
| Rate for Payer: Allwell Medicaid |
$4,423.73
|
| Rate for Payer: AZCH Complete Medicaid |
$4,423.73
|
| Rate for Payer: Banner UC Health Medicaid |
$4,423.73
|
| Rate for Payer: Mercy Care Medicaid |
$4,423.73
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$8,018.40
|
|
|
Service Code
|
APR-DRG 0502
|
| Hospital Charge Code |
APRDRG0501
|
| Min. Negotiated Rate |
$8,018.40 |
| Max. Negotiated Rate |
$8,018.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,018.40
|
| Rate for Payer: Allwell Medicaid |
$8,018.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,018.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,018.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,018.40
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$14,022.39
|
|
|
Service Code
|
APR-DRG 0503
|
| Hospital Charge Code |
APRDRG0504
|
| Min. Negotiated Rate |
$14,022.39 |
| Max. Negotiated Rate |
$14,022.39 |
| Rate for Payer: AHCCCS Medicaid |
$14,022.39
|
| Rate for Payer: Allwell Medicaid |
$14,022.39
|
| Rate for Payer: AZCH Complete Medicaid |
$14,022.39
|
| Rate for Payer: Banner UC Health Medicaid |
$14,022.39
|
| Rate for Payer: Mercy Care Medicaid |
$14,022.39
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$8,018.40
|
|
|
Service Code
|
APR-DRG 0502
|
| Hospital Charge Code |
APRDRG0503
|
| Min. Negotiated Rate |
$8,018.40 |
| Max. Negotiated Rate |
$8,018.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,018.40
|
| Rate for Payer: Allwell Medicaid |
$8,018.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,018.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,018.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,018.40
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$28,429.85
|
|
|
Service Code
|
APR-DRG 0504
|
| Hospital Charge Code |
APRDRG0501
|
| Min. Negotiated Rate |
$28,429.85 |
| Max. Negotiated Rate |
$28,429.85 |
| Rate for Payer: AHCCCS Medicaid |
$28,429.85
|
| Rate for Payer: Allwell Medicaid |
$28,429.85
|
| Rate for Payer: AZCH Complete Medicaid |
$28,429.85
|
| Rate for Payer: Banner UC Health Medicaid |
$28,429.85
|
| Rate for Payer: Mercy Care Medicaid |
$28,429.85
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$14,022.39
|
|
|
Service Code
|
APR-DRG 0503
|
| Hospital Charge Code |
APRDRG0503
|
| Min. Negotiated Rate |
$14,022.39 |
| Max. Negotiated Rate |
$14,022.39 |
| Rate for Payer: AHCCCS Medicaid |
$14,022.39
|
| Rate for Payer: Allwell Medicaid |
$14,022.39
|
| Rate for Payer: AZCH Complete Medicaid |
$14,022.39
|
| Rate for Payer: Banner UC Health Medicaid |
$14,022.39
|
| Rate for Payer: Mercy Care Medicaid |
$14,022.39
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$28,429.85
|
|
|
Service Code
|
APR-DRG 0504
|
| Hospital Charge Code |
APRDRG0502
|
| Min. Negotiated Rate |
$28,429.85 |
| Max. Negotiated Rate |
$28,429.85 |
| Rate for Payer: AHCCCS Medicaid |
$28,429.85
|
| Rate for Payer: Allwell Medicaid |
$28,429.85
|
| Rate for Payer: AZCH Complete Medicaid |
$28,429.85
|
| Rate for Payer: Banner UC Health Medicaid |
$28,429.85
|
| Rate for Payer: Mercy Care Medicaid |
$28,429.85
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$28,429.85
|
|
|
Service Code
|
APR-DRG 0504
|
| Hospital Charge Code |
APRDRG0504
|
| Min. Negotiated Rate |
$28,429.85 |
| Max. Negotiated Rate |
$28,429.85 |
| Rate for Payer: AHCCCS Medicaid |
$28,429.85
|
| Rate for Payer: Allwell Medicaid |
$28,429.85
|
| Rate for Payer: AZCH Complete Medicaid |
$28,429.85
|
| Rate for Payer: Banner UC Health Medicaid |
$28,429.85
|
| Rate for Payer: Mercy Care Medicaid |
$28,429.85
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$28,429.85
|
|
|
Service Code
|
APR-DRG 0504
|
| Hospital Charge Code |
APRDRG0503
|
| Min. Negotiated Rate |
$28,429.85 |
| Max. Negotiated Rate |
$28,429.85 |
| Rate for Payer: AHCCCS Medicaid |
$28,429.85
|
| Rate for Payer: Allwell Medicaid |
$28,429.85
|
| Rate for Payer: AZCH Complete Medicaid |
$28,429.85
|
| Rate for Payer: Banner UC Health Medicaid |
$28,429.85
|
| Rate for Payer: Mercy Care Medicaid |
$28,429.85
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$14,022.39
|
|
|
Service Code
|
APR-DRG 0503
|
| Hospital Charge Code |
APRDRG0501
|
| Min. Negotiated Rate |
$14,022.39 |
| Max. Negotiated Rate |
$14,022.39 |
| Rate for Payer: AHCCCS Medicaid |
$14,022.39
|
| Rate for Payer: Allwell Medicaid |
$14,022.39
|
| Rate for Payer: AZCH Complete Medicaid |
$14,022.39
|
| Rate for Payer: Banner UC Health Medicaid |
$14,022.39
|
| Rate for Payer: Mercy Care Medicaid |
$14,022.39
|
|
