|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$11,244.14
|
|
|
Service Code
|
APR-DRG 8501
|
| Hospital Charge Code |
APRDRG8503
|
| Min. Negotiated Rate |
$11,244.14 |
| Max. Negotiated Rate |
$11,244.14 |
| Rate for Payer: AHCCCS Medicaid |
$11,244.14
|
| Rate for Payer: Allwell Medicaid |
$11,244.14
|
| Rate for Payer: AZCH Complete Medicaid |
$11,244.14
|
| Rate for Payer: Banner UC Health Medicaid |
$11,244.14
|
| Rate for Payer: Mercy Care Medicaid |
$11,244.14
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$11,244.14
|
|
|
Service Code
|
APR-DRG 8501
|
| Hospital Charge Code |
APRDRG8502
|
| Min. Negotiated Rate |
$11,244.14 |
| Max. Negotiated Rate |
$11,244.14 |
| Rate for Payer: AHCCCS Medicaid |
$11,244.14
|
| Rate for Payer: Allwell Medicaid |
$11,244.14
|
| Rate for Payer: AZCH Complete Medicaid |
$11,244.14
|
| Rate for Payer: Banner UC Health Medicaid |
$11,244.14
|
| Rate for Payer: Mercy Care Medicaid |
$11,244.14
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$15,397.83
|
|
|
Service Code
|
APR-DRG 8502
|
| Hospital Charge Code |
APRDRG8504
|
| Min. Negotiated Rate |
$15,397.83 |
| Max. Negotiated Rate |
$15,397.83 |
| Rate for Payer: AHCCCS Medicaid |
$15,397.83
|
| Rate for Payer: Allwell Medicaid |
$15,397.83
|
| Rate for Payer: AZCH Complete Medicaid |
$15,397.83
|
| Rate for Payer: Banner UC Health Medicaid |
$15,397.83
|
| Rate for Payer: Mercy Care Medicaid |
$15,397.83
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$19,903.63
|
|
|
Service Code
|
APR-DRG 8503
|
| Hospital Charge Code |
APRDRG8503
|
| Min. Negotiated Rate |
$19,903.63 |
| Max. Negotiated Rate |
$19,903.63 |
| Rate for Payer: AHCCCS Medicaid |
$19,903.63
|
| Rate for Payer: Allwell Medicaid |
$19,903.63
|
| Rate for Payer: AZCH Complete Medicaid |
$19,903.63
|
| Rate for Payer: Banner UC Health Medicaid |
$19,903.63
|
| Rate for Payer: Mercy Care Medicaid |
$19,903.63
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$11,244.14
|
|
|
Service Code
|
APR-DRG 8501
|
| Hospital Charge Code |
APRDRG8504
|
| Min. Negotiated Rate |
$11,244.14 |
| Max. Negotiated Rate |
$11,244.14 |
| Rate for Payer: AHCCCS Medicaid |
$11,244.14
|
| Rate for Payer: Allwell Medicaid |
$11,244.14
|
| Rate for Payer: AZCH Complete Medicaid |
$11,244.14
|
| Rate for Payer: Banner UC Health Medicaid |
$11,244.14
|
| Rate for Payer: Mercy Care Medicaid |
$11,244.14
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$19,903.63
|
|
|
Service Code
|
APR-DRG 8503
|
| Hospital Charge Code |
APRDRG8501
|
| Min. Negotiated Rate |
$19,903.63 |
| Max. Negotiated Rate |
$19,903.63 |
| Rate for Payer: AHCCCS Medicaid |
$19,903.63
|
| Rate for Payer: Allwell Medicaid |
$19,903.63
|
| Rate for Payer: AZCH Complete Medicaid |
$19,903.63
|
| Rate for Payer: Banner UC Health Medicaid |
$19,903.63
|
| Rate for Payer: Mercy Care Medicaid |
$19,903.63
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$44,695.31
|
|
|
Service Code
|
APR-DRG 8504
|
| Hospital Charge Code |
APRDRG8502
|
| Min. Negotiated Rate |
$44,695.31 |
| Max. Negotiated Rate |
$44,695.31 |
| Rate for Payer: AHCCCS Medicaid |
$44,695.31
|
| Rate for Payer: Allwell Medicaid |
$44,695.31
|
| Rate for Payer: AZCH Complete Medicaid |
$44,695.31
|
| Rate for Payer: Banner UC Health Medicaid |
$44,695.31
|
| Rate for Payer: Mercy Care Medicaid |
$44,695.31
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$44,695.31
|
|
|
Service Code
|
APR-DRG 8504
|
| Hospital Charge Code |
APRDRG8501
|
| Min. Negotiated Rate |
$44,695.31 |
| Max. Negotiated Rate |
$44,695.31 |
| Rate for Payer: AHCCCS Medicaid |
$44,695.31
|
| Rate for Payer: Allwell Medicaid |
$44,695.31
|
| Rate for Payer: AZCH Complete Medicaid |
$44,695.31
|
| Rate for Payer: Banner UC Health Medicaid |
$44,695.31
|
| Rate for Payer: Mercy Care Medicaid |
$44,695.31
|
|
|
prochlorperazine 10 mg/2 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
105952781
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of AZ Commercial |
$3.51
|
| Rate for Payer: Aetna of AZ Medicare |
$1.09
|
| Rate for Payer: Allwell Medicare |
$0.62
|
| Rate for Payer: Amerigroup Medicare |
$0.62
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.46
|
| Rate for Payer: AZCH Complete Medicare |
$0.62
|
| Rate for Payer: Banner UC Health Medicare |
$0.62
|
| Rate for Payer: Bisbee Police All Plans |
$1.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cigna of AZ Commercial |
$2.54
|
| Rate for Payer: Copperpoint Commercial |
$0.97
|
| Rate for Payer: Health Net of AZ Commercial |
$2.34
|
| Rate for Payer: Health Net of AZ Medicare |
$1.09
|
| Rate for Payer: Humana of AZ Medicare |
$0.62
|
| Rate for Payer: Self Pay Self Pay |
$3.12
|
| Rate for Payer: TriWest Medicare |
$0.62
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.27
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.70
|
|
|
prochlorperazine 10 mg/2 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$3.90
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
105952781
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of AZ Commercial |
$3.51
|
| Rate for Payer: Bisbee Police All Plans |
$1.01
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Self Pay Self Pay |
$3.12
|
|
|
prochlorperazine 25 mg Supp [CQCH]
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 713013512
|
| Hospital Charge Code |
105938267
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Aetna of AZ Commercial |
$8.11
|
| Rate for Payer: Aetna of AZ Medicare |
$2.52
|
| Rate for Payer: Allwell Medicare |
$1.44
|
| Rate for Payer: Amerigroup Medicare |
$1.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.37
|
| Rate for Payer: AZCH Complete Medicare |
$1.44
|
| Rate for Payer: Banner UC Health Medicare |
$1.44
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6.13
|
| Rate for Payer: Cash Price |
$7.21
|
| Rate for Payer: Cigna of AZ Commercial |
$5.86
|
| Rate for Payer: Copperpoint Commercial |
$2.23
|
| Rate for Payer: Health Net of AZ Commercial |
$5.41
|
| Rate for Payer: Health Net of AZ Medicare |
$2.52
|
| Rate for Payer: Humana of AZ Medicare |
$1.44
|
| Rate for Payer: Self Pay Self Pay |
$7.21
|
| Rate for Payer: TriWest Medicare |
$1.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.62
|
|
|
prochlorperazine 25 mg Supp [CQCH]
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 713013512
|
| Hospital Charge Code |
105938267
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Aetna of AZ Commercial |
$8.11
|
| Rate for Payer: Bisbee Police All Plans |
$2.34
|
| Rate for Payer: Cash Price |
$7.21
|
| Rate for Payer: Self Pay Self Pay |
$7.21
|
|
|
prochlorperazine 5 mg Tab [CQCH]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
HCPCS Q0164
|
| Hospital Charge Code |
105938198
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of AZ Commercial |
$0.26
|
| Rate for Payer: Aetna of AZ Medicare |
$0.08
|
| Rate for Payer: Allwell Medicare |
$0.05
|
| Rate for Payer: Amerigroup Medicare |
$0.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.11
|
| 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 |
$0.20
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of AZ Commercial |
$0.19
|
| Rate for Payer: Copperpoint Commercial |
$0.07
|
| Rate for Payer: Health Net of AZ Commercial |
$0.17
|
| Rate for Payer: Health Net of AZ Medicare |
$0.08
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.23
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.17
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.05
|
|
|
prochlorperazine 5 mg Tab [CQCH]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
HCPCS Q0164
|
| Hospital Charge Code |
105938198
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of AZ Commercial |
$0.26
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Self Pay Self Pay |
$0.23
|
|
|
Progesterone LC
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
1909537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$141.44 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Aetna of AZ Commercial |
$489.60
|
| Rate for Payer: Bisbee Police All Plans |
$141.44
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Self Pay Self Pay |
$435.20
|
|
|
Progesterone LC
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
1909537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.04 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Aetna of AZ Commercial |
$489.60
|
| Rate for Payer: Aetna of AZ Medicare |
$152.32
|
| Rate for Payer: Allwell Medicare |
$87.04
|
| Rate for Payer: Amerigroup Medicare |
$87.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$203.18
|
| Rate for Payer: AZCH Complete Medicare |
$87.04
|
| Rate for Payer: Banner UC Health Medicare |
$87.04
|
| Rate for Payer: Bisbee Police All Plans |
$141.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$369.92
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Cigna of AZ Commercial |
$353.60
|
| Rate for Payer: Copperpoint Commercial |
$134.64
|
| Rate for Payer: Health Net of AZ Commercial |
$326.40
|
| Rate for Payer: Health Net of AZ Medicare |
$152.32
|
| Rate for Payer: Humana of AZ Medicare |
$87.04
|
| Rate for Payer: Self Pay Self Pay |
$435.20
|
| Rate for Payer: TriWest Medicare |
$87.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$317.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$97.92
|
|
|
Programming State II
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
27281906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of AZ Commercial |
$189.00
|
| Rate for Payer: Aetna of AZ Medicare |
$58.80
|
| Rate for Payer: AHCCCS Medicaid |
$72.72
|
| Rate for Payer: Allwell Medicaid |
$72.72
|
| Rate for Payer: Allwell Medicare |
$33.60
|
| Rate for Payer: Amerigroup Medicare |
$33.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$78.44
|
| Rate for Payer: AZCH Complete Medicaid |
$72.72
|
| Rate for Payer: AZCH Complete Medicare |
$33.60
|
| Rate for Payer: Banner UC Health Medicaid |
$72.72
|
| Rate for Payer: Banner UC Health Medicare |
$33.60
|
| Rate for Payer: Bisbee Police All Plans |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$142.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna of AZ Commercial |
$105.00
|
| Rate for Payer: Copperpoint Commercial |
$51.98
|
| Rate for Payer: Health Net of AZ Commercial |
$126.00
|
| Rate for Payer: Health Net of AZ Medicare |
$58.80
|
| Rate for Payer: Humana of AZ Medicare |
$33.60
|
| Rate for Payer: Mercy Care Medicaid |
$72.72
|
| Rate for Payer: Self Pay Self Pay |
$168.00
|
| Rate for Payer: TriWest Medicare |
$33.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$122.43
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$37.80
|
|
|
Programming State II
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
27281906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of AZ Commercial |
$189.00
|
| Rate for Payer: Bisbee Police All Plans |
$54.60
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Self Pay Self Pay |
$168.00
|
|
|
PROINSULIN
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
22576579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of AZ Commercial |
$112.50
|
| Rate for Payer: Aetna of AZ Medicare |
$35.00
|
| Rate for Payer: Allwell Medicare |
$20.00
|
| Rate for Payer: Amerigroup Medicare |
$20.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$46.69
|
| Rate for Payer: AZCH Complete Medicare |
$20.00
|
| Rate for Payer: Banner UC Health Medicare |
$20.00
|
| Rate for Payer: Bisbee Police All Plans |
$32.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$85.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of AZ Commercial |
$81.25
|
| Rate for Payer: Copperpoint Commercial |
$30.94
|
| Rate for Payer: Health Net of AZ Commercial |
$75.00
|
| Rate for Payer: Health Net of AZ Medicare |
$35.00
|
| Rate for Payer: Humana of AZ Medicare |
$20.00
|
| Rate for Payer: Self Pay Self Pay |
$100.00
|
| Rate for Payer: TriWest Medicare |
$20.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$72.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$22.50
|
|
|
PROINSULIN
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
22576579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of AZ Commercial |
$112.50
|
| Rate for Payer: Bisbee Police All Plans |
$32.50
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Self Pay Self Pay |
$100.00
|
|
|
Prolactin LC
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
1285574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of AZ Commercial |
$216.00
|
| Rate for Payer: Bisbee Police All Plans |
$62.40
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Self Pay Self Pay |
$192.00
|
|
|
Prolactin LC
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
1285574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of AZ Commercial |
$216.00
|
| Rate for Payer: Aetna of AZ Medicare |
$67.20
|
| Rate for Payer: Allwell Medicare |
$38.40
|
| Rate for Payer: Amerigroup Medicare |
$38.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$89.64
|
| Rate for Payer: AZCH Complete Medicare |
$38.40
|
| Rate for Payer: Banner UC Health Medicare |
$38.40
|
| Rate for Payer: Bisbee Police All Plans |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$163.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna of AZ Commercial |
$156.00
|
| Rate for Payer: Copperpoint Commercial |
$59.40
|
| Rate for Payer: Health Net of AZ Commercial |
$144.00
|
| Rate for Payer: Health Net of AZ Medicare |
$67.20
|
| Rate for Payer: Humana of AZ Medicare |
$38.40
|
| Rate for Payer: Self Pay Self Pay |
$192.00
|
| Rate for Payer: TriWest Medicare |
$38.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$139.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$43.20
|
|
|
promethazine 25 mg/ 1mL Inj Sol [CQCH]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
105938466
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of AZ Commercial |
$0.76
|
| Rate for Payer: Aetna of AZ Medicare |
$0.24
|
| Rate for Payer: Allwell Medicare |
$0.13
|
| Rate for Payer: Amerigroup Medicare |
$0.13
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.31
|
| Rate for Payer: AZCH Complete Medicare |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$0.13
|
| Rate for Payer: Bisbee Police All Plans |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.57
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cigna of AZ Commercial |
$0.55
|
| Rate for Payer: Copperpoint Commercial |
$0.21
|
| Rate for Payer: Health Net of AZ Commercial |
$0.50
|
| Rate for Payer: Health Net of AZ Medicare |
$0.24
|
| Rate for Payer: Humana of AZ Medicare |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$0.67
|
| Rate for Payer: TriWest Medicare |
$0.13
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.15
|
|
|
promethazine 25 mg/ 1mL Inj Sol [CQCH]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
105938466
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of AZ Commercial |
$0.76
|
| Rate for Payer: Bisbee Police All Plans |
$0.22
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Self Pay Self Pay |
$0.67
|
|
|
promethazine 25 mg Supp [CQCH]
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
NDC 45802075930
|
| Hospital Charge Code |
105938401
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna of AZ Commercial |
$2.73
|
| Rate for Payer: Aetna of AZ Medicare |
$0.85
|
| Rate for Payer: Allwell Medicare |
$0.48
|
| Rate for Payer: Amerigroup Medicare |
$0.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.13
|
| Rate for Payer: AZCH Complete Medicare |
$0.48
|
| Rate for Payer: Banner UC Health Medicare |
$0.48
|
| Rate for Payer: Bisbee Police All Plans |
$0.79
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.06
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna of AZ Commercial |
$1.97
|
| Rate for Payer: Copperpoint Commercial |
$0.75
|
| Rate for Payer: Health Net of AZ Commercial |
$1.82
|
| Rate for Payer: Health Net of AZ Medicare |
$0.85
|
| Rate for Payer: Humana of AZ Medicare |
$0.48
|
| Rate for Payer: Self Pay Self Pay |
$2.42
|
| Rate for Payer: TriWest Medicare |
$0.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.77
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.55
|
|
