|
AIRWAY ORAL SIZE 100MM
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
22355101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of AZ Commercial |
$5.40
|
| Rate for Payer: Bisbee Police All Plans |
$1.56
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Self Pay Self Pay |
$4.80
|
|
|
AIRWAY ORAL SIZE 100MM
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
22355101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of AZ Commercial |
$5.40
|
| Rate for Payer: Aetna of AZ Medicare |
$1.68
|
| Rate for Payer: Allwell Medicare |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.24
|
| Rate for Payer: AZCH Complete Medicare |
$0.90
|
| Rate for Payer: Banner UC Health Medicare |
$0.90
|
| Rate for Payer: Bisbee Police All Plans |
$1.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4.08
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna of AZ Commercial |
$4.20
|
| Rate for Payer: Copperpoint Commercial |
$1.48
|
| Rate for Payer: Health Net of AZ Commercial |
$3.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1.68
|
| Rate for Payer: Humana of AZ Medicare |
$0.90
|
| Rate for Payer: Self Pay Self Pay |
$4.80
|
| Rate for Payer: TriWest Medicare |
$0.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.08
|
|
|
AIRWAY ORAL SIZE 80MM
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
22355099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of AZ Commercial |
$5.40
|
| Rate for Payer: Aetna of AZ Medicare |
$1.68
|
| Rate for Payer: Allwell Medicare |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.24
|
| Rate for Payer: AZCH Complete Medicare |
$0.90
|
| Rate for Payer: Banner UC Health Medicare |
$0.90
|
| Rate for Payer: Bisbee Police All Plans |
$1.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4.08
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna of AZ Commercial |
$4.20
|
| Rate for Payer: Copperpoint Commercial |
$1.48
|
| Rate for Payer: Health Net of AZ Commercial |
$3.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1.68
|
| Rate for Payer: Humana of AZ Medicare |
$0.90
|
| Rate for Payer: Self Pay Self Pay |
$4.80
|
| Rate for Payer: TriWest Medicare |
$0.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.08
|
|
|
AIRWAY ORAL SIZE 80MM
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
22355099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of AZ Commercial |
$5.40
|
| Rate for Payer: Bisbee Police All Plans |
$1.56
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Self Pay Self Pay |
$4.80
|
|
|
Alanine Aminotransferase
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
633632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| 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: AHCCCS Medicaid |
$5.30
|
| Rate for Payer: Allwell Medicaid |
$5.30
|
| 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 Medicaid |
$5.30
|
| Rate for Payer: AZCH Complete Medicare |
$19.50
|
| Rate for Payer: Banner UC Health Medicaid |
$5.30
|
| 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: 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: Mercy Care Medicaid |
$5.30
|
| 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
|
|
|
Alanine Aminotransferase
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
633632
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
ALBUMIN 24 HOUR URINE + TOTAL VOLUME
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
16875114
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
ALBUMIN 24 HOUR URINE + TOTAL VOLUME
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
23294369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| 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: AHCCCS Medicaid |
$5.78
|
| Rate for Payer: Allwell Medicaid |
$5.78
|
| 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 Medicaid |
$5.78
|
| Rate for Payer: AZCH Complete Medicare |
$19.50
|
| Rate for Payer: Banner UC Health Medicaid |
$5.78
|
| 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: 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: Mercy Care Medicaid |
$5.78
|
| 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
|
|
|
ALBUMIN 24 HOUR URINE + TOTAL VOLUME
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
23294369
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
ALBUMIN 24 HOUR URINE + TOTAL VOLUME
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
16875114
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| 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: AHCCCS Medicaid |
$5.78
|
| Rate for Payer: Allwell Medicaid |
$5.78
|
| 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 Medicaid |
$5.78
|
| Rate for Payer: AZCH Complete Medicare |
$19.50
|
| Rate for Payer: Banner UC Health Medicaid |
$5.78
|
| 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: 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: Mercy Care Medicaid |
$5.78
|
| 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
|
|
|
albumin human 5% Sol[CQCH]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
195848457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of AZ Commercial |
$0.14
|
| Rate for Payer: Bisbee Police All Plans |
$0.04
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Self Pay Self Pay |
$0.13
|
|
|
albumin human 5% Sol[CQCH]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
195848457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$84.44 |
| Rate for Payer: Aetna of AZ Commercial |
$0.14
|
| Rate for Payer: Aetna of AZ Medicare |
$0.04
|
| Rate for Payer: AHCCCS Medicaid |
$84.44
|
| Rate for Payer: Allwell Medicaid |
$84.44
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.06
|
| Rate for Payer: AZCH Complete Medicaid |
$84.44
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicaid |
$84.44
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of AZ Commercial |
$0.10
|
| Rate for Payer: Copperpoint Commercial |
$0.04
|
| Rate for Payer: Health Net of AZ Commercial |
$0.10
|
| Rate for Payer: Health Net of AZ Medicare |
$0.04
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Mercy Care Medicaid |
$84.44
|
| Rate for Payer: Self Pay Self Pay |
$0.13
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
|
Albumin Level
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
633634
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of AZ Commercial |
$58.50
|
| Rate for Payer: Bisbee Police All Plans |
$16.90
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Self Pay Self Pay |
$52.00
|
|
|
Albumin Level
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
633634
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of AZ Commercial |
$58.50
|
| Rate for Payer: Aetna of AZ Medicare |
$18.20
|
| Rate for Payer: AHCCCS Medicaid |
$4.95
|
| Rate for Payer: Allwell Medicaid |
$4.95
|
| Rate for Payer: Allwell Medicare |
$9.75
|
| Rate for Payer: Amerigroup Medicare |
$9.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$24.28
|
| Rate for Payer: AZCH Complete Medicaid |
$4.95
|
| Rate for Payer: AZCH Complete Medicare |
$9.75
|
| Rate for Payer: Banner UC Health Medicaid |
$4.95
|
| Rate for Payer: Banner UC Health Medicare |
$9.75
|
| Rate for Payer: Bisbee Police All Plans |
$16.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$44.20
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna of AZ Commercial |
$42.25
|
| Rate for Payer: Copperpoint Commercial |
$16.09
|
| Rate for Payer: Health Net of AZ Commercial |
$39.00
|
| Rate for Payer: Health Net of AZ Medicare |
$18.20
|
| Rate for Payer: Humana of AZ Medicare |
$9.75
|
| Rate for Payer: Mercy Care Medicaid |
$4.95
|
| Rate for Payer: Self Pay Self Pay |
$52.00
|
| Rate for Payer: TriWest Medicare |
$9.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$37.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$11.70
|
|
|
albuterol 0.083% Inh Sol 3 mL [CQCH]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
HCPCS J7609
|
| Hospital Charge Code |
105909534
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of AZ Commercial |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.05
|
|
|
albuterol 0.083% Inh Sol 3 mL [CQCH]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
HCPCS J7609
|
| Hospital Charge Code |
105909534
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of AZ Commercial |
$0.05
|
| Rate for Payer: Aetna of AZ Medicare |
$0.02
|
| Rate for Payer: AHCCCS Medicaid |
$0.24
|
| Rate for Payer: Allwell Medicaid |
$0.24
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.02
|
| Rate for Payer: AZCH Complete Medicaid |
$0.24
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicaid |
$0.24
|
| 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 |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of AZ Commercial |
$0.04
|
| Rate for Payer: Copperpoint Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Commercial |
$0.04
|
| Rate for Payer: Health Net of AZ Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Mercy Care Medicaid |
$0.24
|
| Rate for Payer: Self Pay Self Pay |
$0.05
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.03
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
albuterol 0.5% Inh Sol 0.5 mL [CQCH]
|
Facility
|
OP
|
$0.68
|
|
|
Service Code
|
HCPCS J7609
|
| Hospital Charge Code |
105909609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of AZ Commercial |
$0.61
|
| Rate for Payer: Aetna of AZ Medicare |
$0.19
|
| Rate for Payer: AHCCCS Medicaid |
$0.24
|
| Rate for Payer: Allwell Medicaid |
$0.24
|
| Rate for Payer: Allwell Medicare |
$0.10
|
| Rate for Payer: Amerigroup Medicare |
$0.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.25
|
| Rate for Payer: AZCH Complete Medicaid |
$0.24
|
| Rate for Payer: AZCH Complete Medicare |
$0.10
|
| Rate for Payer: Banner UC Health Medicaid |
$0.24
|
| Rate for Payer: Banner UC Health Medicare |
$0.10
|
| Rate for Payer: Bisbee Police All Plans |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of AZ Commercial |
$0.44
|
| Rate for Payer: Copperpoint Commercial |
$0.17
|
| Rate for Payer: Health Net of AZ Commercial |
$0.41
|
| Rate for Payer: Health Net of AZ Medicare |
$0.19
|
| Rate for Payer: Humana of AZ Medicare |
$0.10
|
| Rate for Payer: Mercy Care Medicaid |
$0.24
|
| Rate for Payer: Self Pay Self Pay |
$0.54
|
| Rate for Payer: TriWest Medicare |
$0.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.12
|
|
|
albuterol 0.5% Inh Sol 0.5 mL [CQCH]
|
Facility
|
IP
|
$0.68
|
|
|
Service Code
|
HCPCS J7609
|
| Hospital Charge Code |
105909609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of AZ Commercial |
$0.61
|
| Rate for Payer: Bisbee Police All Plans |
$0.18
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Self Pay Self Pay |
$0.54
|
|
|
albuterol-ipratropium Inh Sol 3 mL [CQCH]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
HCPCS J7609
|
| Hospital Charge Code |
105909698
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of AZ Commercial |
$0.16
|
| Rate for Payer: Bisbee Police All Plans |
$0.05
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Self Pay Self Pay |
$0.14
|
|
|
albuterol-ipratropium Inh Sol 3 mL [CQCH]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
HCPCS J7609
|
| Hospital Charge Code |
105909698
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of AZ Commercial |
$0.16
|
| Rate for Payer: Aetna of AZ Medicare |
$0.05
|
| Rate for Payer: AHCCCS Medicaid |
$0.24
|
| Rate for Payer: Allwell Medicaid |
$0.24
|
| Rate for Payer: Allwell Medicare |
$0.03
|
| Rate for Payer: Amerigroup Medicare |
$0.03
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.07
|
| Rate for Payer: AZCH Complete Medicaid |
$0.24
|
| Rate for Payer: AZCH Complete Medicare |
$0.03
|
| Rate for Payer: Banner UC Health Medicaid |
$0.24
|
| Rate for Payer: Banner UC Health Medicare |
$0.03
|
| Rate for Payer: Bisbee Police All Plans |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of AZ Commercial |
$0.12
|
| Rate for Payer: Copperpoint Commercial |
$0.04
|
| Rate for Payer: Health Net of AZ Commercial |
$0.11
|
| Rate for Payer: Health Net of AZ Medicare |
$0.05
|
| Rate for Payer: Humana of AZ Medicare |
$0.03
|
| Rate for Payer: Mercy Care Medicaid |
$0.24
|
| Rate for Payer: Self Pay Self Pay |
$0.14
|
| Rate for Payer: TriWest Medicare |
$0.03
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.10
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
|
albuterol MDI-90 mcg/inh 8 gm [CQCH]
|
Facility
|
OP
|
$60.34
|
|
|
Service Code
|
NDC 59310057922
|
| Hospital Charge Code |
105909469
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna of AZ Commercial |
$54.31
|
| Rate for Payer: Aetna of AZ Medicare |
$16.90
|
| Rate for Payer: Allwell Medicare |
$9.05
|
| Rate for Payer: Amerigroup Medicare |
$9.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$22.54
|
| Rate for Payer: AZCH Complete Medicare |
$9.05
|
| Rate for Payer: Banner UC Health Medicare |
$9.05
|
| Rate for Payer: Bisbee Police All Plans |
$15.69
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$41.03
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cigna of AZ Commercial |
$39.22
|
| Rate for Payer: Copperpoint Commercial |
$14.93
|
| Rate for Payer: Health Net of AZ Commercial |
$36.20
|
| Rate for Payer: Health Net of AZ Medicare |
$16.90
|
| Rate for Payer: Humana of AZ Medicare |
$9.05
|
| Rate for Payer: Self Pay Self Pay |
$48.27
|
| Rate for Payer: TriWest Medicare |
$9.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$35.18
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.86
|
|
|
albuterol MDI-90 mcg/inh 8 gm [CQCH]
|
Facility
|
IP
|
$60.34
|
|
|
Service Code
|
NDC 59310057922
|
| Hospital Charge Code |
105909469
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna of AZ Commercial |
$54.31
|
| Rate for Payer: Bisbee Police All Plans |
$15.69
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Self Pay Self Pay |
$48.27
|
|
|
Alcohol Abuse And Dependence
|
Facility
|
IP
|
$3,457.90
|
|
|
Service Code
|
APR-DRG 7752
|
| Hospital Charge Code |
APRDRG7753
|
| Min. Negotiated Rate |
$3,457.90 |
| Max. Negotiated Rate |
$3,457.90 |
| Rate for Payer: AHCCCS Medicaid |
$3,457.90
|
| Rate for Payer: Allwell Medicaid |
$3,457.90
|
| Rate for Payer: AZCH Complete Medicaid |
$3,457.90
|
| Rate for Payer: Banner UC Health Medicaid |
$3,457.90
|
| Rate for Payer: Mercy Care Medicaid |
$3,457.90
|
|
|
Alcohol Abuse And Dependence
|
Facility
|
IP
|
$6,181.44
|
|
|
Service Code
|
APR-DRG 7753
|
| Hospital Charge Code |
APRDRG7751
|
| Min. Negotiated Rate |
$6,181.44 |
| Max. Negotiated Rate |
$6,181.44 |
| Rate for Payer: AHCCCS Medicaid |
$6,181.44
|
| Rate for Payer: Allwell Medicaid |
$6,181.44
|
| Rate for Payer: AZCH Complete Medicaid |
$6,181.44
|
| Rate for Payer: Banner UC Health Medicaid |
$6,181.44
|
| Rate for Payer: Mercy Care Medicaid |
$6,181.44
|
|
|
Alcohol Abuse And Dependence
|
Facility
|
IP
|
$3,457.90
|
|
|
Service Code
|
APR-DRG 7752
|
| Hospital Charge Code |
APRDRG7751
|
| Min. Negotiated Rate |
$3,457.90 |
| Max. Negotiated Rate |
$3,457.90 |
| Rate for Payer: AHCCCS Medicaid |
$3,457.90
|
| Rate for Payer: Allwell Medicaid |
$3,457.90
|
| Rate for Payer: AZCH Complete Medicaid |
$3,457.90
|
| Rate for Payer: Banner UC Health Medicaid |
$3,457.90
|
| Rate for Payer: Mercy Care Medicaid |
$3,457.90
|
|
