|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$5,311.70
|
|
|
Service Code
|
APR-DRG 5482
|
| Hospital Charge Code |
APRDRG5481
|
| Min. Negotiated Rate |
$5,311.70 |
| Max. Negotiated Rate |
$5,311.70 |
| Rate for Payer: AHCCCS Medicaid |
$5,311.70
|
| Rate for Payer: Allwell Medicaid |
$5,311.70
|
| Rate for Payer: AZCH Complete Medicaid |
$5,311.70
|
| Rate for Payer: Banner UC Health Medicaid |
$5,311.70
|
| Rate for Payer: Mercy Care Medicaid |
$5,311.70
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$5,311.70
|
|
|
Service Code
|
APR-DRG 5482
|
| Hospital Charge Code |
APRDRG5482
|
| Min. Negotiated Rate |
$5,311.70 |
| Max. Negotiated Rate |
$5,311.70 |
| Rate for Payer: AHCCCS Medicaid |
$5,311.70
|
| Rate for Payer: Allwell Medicaid |
$5,311.70
|
| Rate for Payer: AZCH Complete Medicaid |
$5,311.70
|
| Rate for Payer: Banner UC Health Medicaid |
$5,311.70
|
| Rate for Payer: Mercy Care Medicaid |
$5,311.70
|
|
|
Potassium 24 hr urine
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633618
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of AZ Commercial |
$63.90
|
| Rate for Payer: Bisbee Police All Plans |
$18.46
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Self Pay Self Pay |
$56.80
|
|
|
Potassium 24 hr urine
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633618
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of AZ Commercial |
$63.90
|
| Rate for Payer: Aetna of AZ Medicare |
$19.88
|
| Rate for Payer: AHCCCS Medicaid |
$4.73
|
| Rate for Payer: Allwell Medicaid |
$4.73
|
| Rate for Payer: Allwell Medicare |
$10.65
|
| Rate for Payer: Amerigroup Medicare |
$10.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$26.52
|
| Rate for Payer: AZCH Complete Medicaid |
$4.73
|
| Rate for Payer: AZCH Complete Medicare |
$10.65
|
| Rate for Payer: Banner UC Health Medicaid |
$4.73
|
| Rate for Payer: Banner UC Health Medicare |
$10.65
|
| Rate for Payer: Bisbee Police All Plans |
$18.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$48.28
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cigna of AZ Commercial |
$46.15
|
| Rate for Payer: Copperpoint Commercial |
$17.57
|
| Rate for Payer: Health Net of AZ Commercial |
$42.60
|
| Rate for Payer: Health Net of AZ Medicare |
$19.88
|
| Rate for Payer: Humana of AZ Medicare |
$10.65
|
| Rate for Payer: Mercy Care Medicaid |
$4.73
|
| Rate for Payer: Self Pay Self Pay |
$56.80
|
| Rate for Payer: TriWest Medicare |
$10.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$41.39
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.78
|
|
|
potassium 25 mEq (bicarbonate, effervescence tab) [CQCH]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 245532630
|
| Hospital Charge Code |
113056106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of AZ Commercial |
$0.81
|
| Rate for Payer: Aetna of AZ Medicare |
$0.25
|
| Rate for Payer: Allwell Medicare |
$0.14
|
| Rate for Payer: Amerigroup Medicare |
$0.14
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.34
|
| Rate for Payer: AZCH Complete Medicare |
$0.14
|
| Rate for Payer: Banner UC Health Medicare |
$0.14
|
| Rate for Payer: Bisbee Police All Plans |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of AZ Commercial |
$0.59
|
| Rate for Payer: Copperpoint Commercial |
$0.22
|
| Rate for Payer: Health Net of AZ Commercial |
$0.54
|
| Rate for Payer: Health Net of AZ Medicare |
$0.25
|
| Rate for Payer: Humana of AZ Medicare |
$0.14
|
| Rate for Payer: Self Pay Self Pay |
$0.72
|
| Rate for Payer: TriWest Medicare |
$0.14
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.16
|
|
|
potassium 25 mEq (bicarbonate, effervescence tab) [CQCH]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 245532630
|
| Hospital Charge Code |
113056106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of AZ Commercial |
$0.81
|
| Rate for Payer: Bisbee Police All Plans |
$0.23
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Self Pay Self Pay |
$0.72
|
|
|
potassium chloride 10 mEq/50 mL Sol [CQCH]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
204727734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of AZ Commercial |
$0.09
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Self Pay Self Pay |
$0.08
|
|
|
potassium chloride 10 mEq/50 mL Sol [CQCH]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
204727734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of AZ Commercial |
$0.09
|
| Rate for Payer: Aetna of AZ Medicare |
$0.03
|
| Rate for Payer: AHCCCS Medicaid |
$0.26
|
| Rate for Payer: Allwell Medicaid |
$0.26
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.04
|
| Rate for Payer: AZCH Complete Medicaid |
$0.26
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicaid |
$0.26
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of AZ Commercial |
$0.07
|
| Rate for Payer: Copperpoint Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Commercial |
$0.06
|
| Rate for Payer: Health Net of AZ Medicare |
$0.03
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Mercy Care Medicaid |
$0.26
|
| Rate for Payer: Self Pay Self Pay |
$0.08
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
|
potassium chloride 10 mEq ER Tab [CQCH]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 245531601
|
| Hospital Charge Code |
108127557
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of AZ Commercial |
$0.38
|
| Rate for Payer: Aetna of AZ Medicare |
$0.12
|
| Rate for Payer: Allwell Medicare |
$0.06
|
| Rate for Payer: Amerigroup Medicare |
$0.06
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.16
|
| Rate for Payer: AZCH Complete Medicare |
$0.06
|
| Rate for Payer: Banner UC Health Medicare |
$0.06
|
| Rate for Payer: Bisbee Police All Plans |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of AZ Commercial |
$0.27
|
| Rate for Payer: Copperpoint Commercial |
$0.10
|
| Rate for Payer: Health Net of AZ Commercial |
$0.25
|
| Rate for Payer: Health Net of AZ Medicare |
$0.12
|
| Rate for Payer: Humana of AZ Medicare |
$0.06
|
| Rate for Payer: Self Pay Self Pay |
$0.34
|
| Rate for Payer: TriWest Medicare |
$0.06
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.08
|
|
|
potassium chloride 10 mEq ER Tab [CQCH]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 245531601
|
| Hospital Charge Code |
108127557
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of AZ Commercial |
$0.38
|
| Rate for Payer: Bisbee Police All Plans |
$0.11
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Self Pay Self Pay |
$0.34
|
|
|
potassium chloride 20 mEq ER Tab [CQCH]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 68084036009
|
| Hospital Charge Code |
105937370
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of AZ Commercial |
$0.56
|
| Rate for Payer: Bisbee Police All Plans |
$0.16
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Self Pay Self Pay |
$0.50
|
|
|
potassium chloride 20 mEq ER Tab [CQCH]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 68084036009
|
| Hospital Charge Code |
105937370
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of AZ Commercial |
$0.56
|
| 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 |
$0.42
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.50
|
| 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
|
|
|
Potassium Level
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
633616
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna of AZ Commercial |
$67.50
|
| Rate for Payer: Aetna of AZ Medicare |
$21.00
|
| Rate for Payer: AHCCCS Medicaid |
$4.76
|
| Rate for Payer: Allwell Medicaid |
$4.76
|
| Rate for Payer: Allwell Medicare |
$11.25
|
| Rate for Payer: Amerigroup Medicare |
$11.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$28.01
|
| Rate for Payer: AZCH Complete Medicaid |
$4.76
|
| Rate for Payer: AZCH Complete Medicare |
$11.25
|
| Rate for Payer: Banner UC Health Medicaid |
$4.76
|
| Rate for Payer: Banner UC Health Medicare |
$11.25
|
| Rate for Payer: Bisbee Police All Plans |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of AZ Commercial |
$48.75
|
| Rate for Payer: Copperpoint Commercial |
$18.56
|
| Rate for Payer: Health Net of AZ Commercial |
$45.00
|
| Rate for Payer: Health Net of AZ Medicare |
$21.00
|
| Rate for Payer: Humana of AZ Medicare |
$11.25
|
| Rate for Payer: Mercy Care Medicaid |
$4.76
|
| Rate for Payer: Self Pay Self Pay |
$60.00
|
| Rate for Payer: TriWest Medicare |
$11.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$43.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.50
|
|
|
Potassium Level
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
633616
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna of AZ Commercial |
$67.50
|
| Rate for Payer: Bisbee Police All Plans |
$19.50
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Self Pay Self Pay |
$60.00
|
|
|
potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg REC UD[CQCH]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 71351001001
|
| Hospital Charge Code |
163314692
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of AZ Commercial |
$0.29
|
| Rate for Payer: Aetna of AZ Medicare |
$0.09
|
| Rate for Payer: Allwell Medicare |
$0.05
|
| Rate for Payer: Amerigroup Medicare |
$0.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.12
|
| Rate for Payer: AZCH Complete Medicare |
$0.05
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of AZ Commercial |
$0.21
|
| Rate for Payer: Copperpoint Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Commercial |
$0.19
|
| Rate for Payer: Health Net of AZ Medicare |
$0.09
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.26
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.06
|
|
|
potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg REC UD[CQCH]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 71351001001
|
| Hospital Charge Code |
163314692
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of AZ Commercial |
$0.29
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Self Pay Self Pay |
$0.26
|
|
|
Powerpoint SLIM IMPLANTABLE PORT
|
Facility
|
OP
|
$1,650.00
|
|
| Hospital Charge Code |
24325294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,485.00
|
| Rate for Payer: Aetna of AZ Medicare |
$462.00
|
| Rate for Payer: Allwell Medicare |
$247.50
|
| Rate for Payer: Amerigroup Medicare |
$247.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$616.28
|
| Rate for Payer: AZCH Complete Medicare |
$247.50
|
| Rate for Payer: Banner UC Health Medicare |
$247.50
|
| Rate for Payer: Bisbee Police All Plans |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,155.00
|
| Rate for Payer: Copperpoint Commercial |
$408.38
|
| Rate for Payer: Health Net of AZ Commercial |
$990.00
|
| Rate for Payer: Health Net of AZ Medicare |
$462.00
|
| Rate for Payer: Humana of AZ Medicare |
$247.50
|
| Rate for Payer: Self Pay Self Pay |
$1,320.00
|
| Rate for Payer: TriWest Medicare |
$247.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$961.95
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$297.00
|
|
|
Powerpoint SLIM IMPLANTABLE PORT
|
Facility
|
IP
|
$1,650.00
|
|
| Hospital Charge Code |
24325294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,485.00
|
| Rate for Payer: Bisbee Police All Plans |
$429.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Self Pay Self Pay |
$1,320.00
|
|
|
pramipexole 0.5 mg Tab [CQCH]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 68462033290
|
| Hospital Charge Code |
105937512
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of AZ Commercial |
$0.12
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Self Pay Self Pay |
$0.10
|
|
|
pramipexole 0.5 mg Tab [CQCH]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 68462033290
|
| Hospital Charge Code |
105937512
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of AZ Commercial |
$0.12
|
| Rate for Payer: Aetna of AZ Medicare |
$0.04
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.05
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of AZ Commercial |
$0.08
|
| Rate for Payer: Copperpoint Commercial |
$0.03
|
| Rate for Payer: Health Net of AZ Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Medicare |
$0.04
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.10
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
|
prazosin 1 mg Cap [CQCH]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 378110101
|
| Hospital Charge Code |
118000537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of AZ Commercial |
$0.22
|
| Rate for Payer: Aetna of AZ Medicare |
$0.07
|
| 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 Medicare |
$0.04
|
| 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: 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: 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
|
|
|
prazosin 1 mg Cap [CQCH]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 378110101
|
| Hospital Charge Code |
118000537
|
|
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
|
|
|
Prealbumin LC
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
1905830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna of AZ Commercial |
$192.60
|
| Rate for Payer: Aetna of AZ Medicare |
$59.92
|
| Rate for Payer: AHCCCS Medicaid |
$14.59
|
| Rate for Payer: Allwell Medicaid |
$14.59
|
| Rate for Payer: Allwell Medicare |
$32.10
|
| Rate for Payer: Amerigroup Medicare |
$32.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$79.93
|
| Rate for Payer: AZCH Complete Medicaid |
$14.59
|
| Rate for Payer: AZCH Complete Medicare |
$32.10
|
| Rate for Payer: Banner UC Health Medicaid |
$14.59
|
| Rate for Payer: Banner UC Health Medicare |
$32.10
|
| Rate for Payer: Bisbee Police All Plans |
$55.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$145.52
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cigna of AZ Commercial |
$139.10
|
| Rate for Payer: Copperpoint Commercial |
$52.96
|
| Rate for Payer: Health Net of AZ Commercial |
$128.40
|
| Rate for Payer: Health Net of AZ Medicare |
$59.92
|
| Rate for Payer: Humana of AZ Medicare |
$32.10
|
| Rate for Payer: Mercy Care Medicaid |
$14.59
|
| Rate for Payer: Self Pay Self Pay |
$171.20
|
| Rate for Payer: TriWest Medicare |
$32.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$124.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.52
|
|
|
Prealbumin LC
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
1905830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna of AZ Commercial |
$192.60
|
| Rate for Payer: Bisbee Police All Plans |
$55.64
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Self Pay Self Pay |
$171.20
|
|
|
PRE-ANES EXAM/EVAL
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 99231 QZ
|
| Hospital Charge Code |
22789175
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Aetna of AZ Commercial |
$167.40
|
| Rate for Payer: Bisbee Police All Plans |
$48.36
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Self Pay Self Pay |
$148.80
|
|
