|
Thiopurine Methyltransferase LC
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2087652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.68 |
| Max. Negotiated Rate |
$605.70 |
| Rate for Payer: Aetna of AZ Commercial |
$605.70
|
| Rate for Payer: Aetna of AZ Medicare |
$188.44
|
| Rate for Payer: Allwell Medicare |
$107.68
|
| Rate for Payer: Amerigroup Medicare |
$107.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$251.37
|
| Rate for Payer: AZCH Complete Medicare |
$107.68
|
| Rate for Payer: Banner UC Health Medicare |
$107.68
|
| Rate for Payer: Bisbee Police All Plans |
$174.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$457.64
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cigna of AZ Commercial |
$437.45
|
| Rate for Payer: Copperpoint Commercial |
$166.57
|
| Rate for Payer: Health Net of AZ Commercial |
$403.80
|
| Rate for Payer: Health Net of AZ Medicare |
$188.44
|
| Rate for Payer: Humana of AZ Medicare |
$107.68
|
| Rate for Payer: Self Pay Self Pay |
$538.40
|
| Rate for Payer: TriWest Medicare |
$107.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$392.36
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$121.14
|
|
|
THORACENTESIS
|
Facility
|
IP
|
$440.00
|
|
| Hospital Charge Code |
22282949
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna of AZ Commercial |
$396.00
|
| Rate for Payer: Bisbee Police All Plans |
$114.40
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Self Pay Self Pay |
$352.00
|
|
|
THORACENTESIS
|
Facility
|
OP
|
$440.00
|
|
| Hospital Charge Code |
22282949
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna of AZ Commercial |
$396.00
|
| Rate for Payer: Aetna of AZ Medicare |
$123.20
|
| Rate for Payer: Allwell Medicare |
$70.40
|
| Rate for Payer: Amerigroup Medicare |
$70.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$164.34
|
| Rate for Payer: AZCH Complete Medicare |
$70.40
|
| Rate for Payer: Banner UC Health Medicare |
$70.40
|
| Rate for Payer: Bisbee Police All Plans |
$114.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$299.20
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna of AZ Commercial |
$286.00
|
| Rate for Payer: Copperpoint Commercial |
$108.90
|
| Rate for Payer: Health Net of AZ Commercial |
$264.00
|
| Rate for Payer: Health Net of AZ Medicare |
$123.20
|
| Rate for Payer: Humana of AZ Medicare |
$70.40
|
| Rate for Payer: Self Pay Self Pay |
$352.00
|
| Rate for Payer: TriWest Medicare |
$70.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$256.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$79.20
|
|
|
THP albuterol MDI-90 mcg/inh 8 gm [CQCH]
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 99999999968
|
| Hospital Charge Code |
110285600
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of AZ Commercial |
$31.50
|
| Rate for Payer: Bisbee Police All Plans |
$9.10
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Self Pay Self Pay |
$28.00
|
|
|
THP albuterol MDI-90 mcg/inh 8 gm [CQCH]
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 99999999968
|
| Hospital Charge Code |
110285600
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of AZ Commercial |
$31.50
|
| Rate for Payer: Aetna of AZ Medicare |
$9.80
|
| Rate for Payer: Allwell Medicare |
$5.60
|
| Rate for Payer: Amerigroup Medicare |
$5.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$13.07
|
| Rate for Payer: AZCH Complete Medicare |
$5.60
|
| Rate for Payer: Banner UC Health Medicare |
$5.60
|
| Rate for Payer: Bisbee Police All Plans |
$9.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna of AZ Commercial |
$22.75
|
| Rate for Payer: Copperpoint Commercial |
$8.66
|
| Rate for Payer: Health Net of AZ Commercial |
$21.00
|
| Rate for Payer: Health Net of AZ Medicare |
$9.80
|
| Rate for Payer: Humana of AZ Medicare |
$5.60
|
| Rate for Payer: Self Pay Self Pay |
$28.00
|
| Rate for Payer: TriWest Medicare |
$5.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$20.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.30
|
|
|
THP amoxicillin 250 mg/5 mL Oral susp (80 mL after reconst) [CQCH]
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 99999999970
|
| Hospital Charge Code |
110285383
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna of AZ Commercial |
$2.92
|
| Rate for Payer: Bisbee Police All Plans |
$0.84
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Self Pay Self Pay |
$2.59
|
|
|
THP amoxicillin 250 mg/5 mL Oral susp (80 mL after reconst) [CQCH]
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 99999999970
|
| Hospital Charge Code |
110285383
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna of AZ Commercial |
$2.92
|
| Rate for Payer: Aetna of AZ Medicare |
$0.91
|
| Rate for Payer: Allwell Medicare |
$0.52
|
| Rate for Payer: Amerigroup Medicare |
$0.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.21
|
| Rate for Payer: AZCH Complete Medicare |
$0.52
|
| Rate for Payer: Banner UC Health Medicare |
$0.52
|
| Rate for Payer: Bisbee Police All Plans |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cigna of AZ Commercial |
$2.11
|
| Rate for Payer: Copperpoint Commercial |
$0.80
|
| Rate for Payer: Health Net of AZ Commercial |
$1.94
|
| Rate for Payer: Health Net of AZ Medicare |
$0.91
|
| Rate for Payer: Humana of AZ Medicare |
$0.52
|
| Rate for Payer: Self Pay Self Pay |
$2.59
|
| Rate for Payer: TriWest Medicare |
$0.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.89
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.58
|
|
|
THP amoxicillin 500 mg Cap [CQCH]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 99999999972
|
| Hospital Charge Code |
110285149
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of AZ Commercial |
$0.25
|
| Rate for Payer: Aetna of AZ Medicare |
$0.08
|
| Rate for Payer: Allwell Medicare |
$0.04
|
| Rate for Payer: Amerigroup Medicare |
$0.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.10
|
| Rate for Payer: AZCH Complete Medicare |
$0.04
|
| Rate for Payer: Banner UC Health Medicare |
$0.04
|
| Rate for Payer: Bisbee Police All Plans |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of AZ Commercial |
$0.18
|
| 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 |
$0.04
|
| Rate for Payer: Self Pay Self Pay |
$0.22
|
| Rate for Payer: TriWest Medicare |
$0.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.16
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.05
|
|
|
THP amoxicillin 500 mg Cap [CQCH]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 99999999972
|
| Hospital Charge Code |
110285149
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of AZ Commercial |
$0.25
|
| Rate for Payer: Bisbee Police All Plans |
$0.07
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Self Pay Self Pay |
$0.22
|
|
|
THP amoxicillin-clavulanate 600 mg/5 mL Oral Liq (75 mL after reconst.) [CQCH]
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
NDC 99999999969
|
| Hospital Charge Code |
110285455
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna of AZ Commercial |
$22.73
|
| Rate for Payer: Aetna of AZ Medicare |
$7.07
|
| Rate for Payer: Allwell Medicare |
$4.04
|
| Rate for Payer: Amerigroup Medicare |
$4.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$9.43
|
| Rate for Payer: AZCH Complete Medicare |
$4.04
|
| Rate for Payer: Banner UC Health Medicare |
$4.04
|
| Rate for Payer: Bisbee Police All Plans |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$17.18
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cigna of AZ Commercial |
$16.42
|
| Rate for Payer: Copperpoint Commercial |
$6.25
|
| Rate for Payer: Health Net of AZ Commercial |
$15.16
|
| Rate for Payer: Health Net of AZ Medicare |
$7.07
|
| Rate for Payer: Humana of AZ Medicare |
$4.04
|
| Rate for Payer: Self Pay Self Pay |
$20.21
|
| Rate for Payer: TriWest Medicare |
$4.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$14.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.55
|
|
|
THP amoxicillin-clavulanate 600 mg/5 mL Oral Liq (75 mL after reconst.) [CQCH]
|
Facility
|
IP
|
$25.26
|
|
|
Service Code
|
NDC 99999999969
|
| Hospital Charge Code |
110285455
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna of AZ Commercial |
$22.73
|
| Rate for Payer: Bisbee Police All Plans |
$6.57
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Self Pay Self Pay |
$20.21
|
|
|
THP azithromycin 200 mg/5 mL Oral Susp (22.5 mL after reconst) [CQCH]
|
Facility
|
OP
|
$25.88
|
|
|
Service Code
|
NDC 99999999971
|
| Hospital Charge Code |
110285309
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$23.29 |
| Rate for Payer: Aetna of AZ Commercial |
$23.29
|
| Rate for Payer: Aetna of AZ Medicare |
$7.25
|
| Rate for Payer: Allwell Medicare |
$4.14
|
| Rate for Payer: Amerigroup Medicare |
$4.14
|
| Rate for Payer: APIPA Medicare/Medicaid |
$9.67
|
| Rate for Payer: AZCH Complete Medicare |
$4.14
|
| Rate for Payer: Banner UC Health Medicare |
$4.14
|
| Rate for Payer: Bisbee Police All Plans |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of AZ Commercial |
$16.82
|
| Rate for Payer: Copperpoint Commercial |
$6.41
|
| Rate for Payer: Health Net of AZ Commercial |
$15.53
|
| Rate for Payer: Health Net of AZ Medicare |
$7.25
|
| Rate for Payer: Humana of AZ Medicare |
$4.14
|
| Rate for Payer: Self Pay Self Pay |
$20.70
|
| Rate for Payer: TriWest Medicare |
$4.14
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$15.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.66
|
|
|
THP azithromycin 200 mg/5 mL Oral Susp (22.5 mL after reconst) [CQCH]
|
Facility
|
IP
|
$25.88
|
|
|
Service Code
|
NDC 99999999971
|
| Hospital Charge Code |
110285309
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$23.29 |
| Rate for Payer: Aetna of AZ Commercial |
$23.29
|
| Rate for Payer: Bisbee Police All Plans |
$6.73
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Self Pay Self Pay |
$20.70
|
|
|
THP cephalexin 500 mg Cap [CQCH]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 99999999977
|
| Hospital Charge Code |
110283528
|
|
Hospital Revenue Code
|
253
|
| 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
|
|
|
THP cephalexin 500 mg Cap [CQCH]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 99999999977
|
| Hospital Charge Code |
110283528
|
|
Hospital Revenue Code
|
253
|
| 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
|
|
|
THP cephalexin oral susp. 250 mg/5 mL (100 mL) [CQCH]
|
Facility
|
IP
|
$12.93
|
|
|
Service Code
|
NDC 99999999973
|
| Hospital Charge Code |
110285053
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna of AZ Commercial |
$11.64
|
| Rate for Payer: Bisbee Police All Plans |
$3.36
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Self Pay Self Pay |
$10.34
|
|
|
THP cephalexin oral susp. 250 mg/5 mL (100 mL) [CQCH]
|
Facility
|
OP
|
$12.93
|
|
|
Service Code
|
NDC 99999999973
|
| Hospital Charge Code |
110285053
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna of AZ Commercial |
$11.64
|
| Rate for Payer: Aetna of AZ Medicare |
$3.62
|
| Rate for Payer: Allwell Medicare |
$2.07
|
| Rate for Payer: Amerigroup Medicare |
$2.07
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4.83
|
| Rate for Payer: AZCH Complete Medicare |
$2.07
|
| Rate for Payer: Banner UC Health Medicare |
$2.07
|
| Rate for Payer: Bisbee Police All Plans |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$8.79
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cigna of AZ Commercial |
$8.40
|
| Rate for Payer: Copperpoint Commercial |
$3.20
|
| Rate for Payer: Health Net of AZ Commercial |
$7.76
|
| Rate for Payer: Health Net of AZ Medicare |
$3.62
|
| Rate for Payer: Humana of AZ Medicare |
$2.07
|
| Rate for Payer: Self Pay Self Pay |
$10.34
|
| Rate for Payer: TriWest Medicare |
$2.07
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$7.54
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.33
|
|
|
THP ciprofloxacin 500 mg Tab [CQCH]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 99999999978
|
| Hospital Charge Code |
110283248
|
|
Hospital Revenue Code
|
253
|
| 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
|
|
|
THP ciprofloxacin 500 mg Tab [CQCH]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 99999999978
|
| Hospital Charge Code |
110283248
|
|
Hospital Revenue Code
|
253
|
| 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
|
|
|
THP ondansetron 4 mg Dis Tab [CQCH]
|
Facility
|
IP
|
$2.48
|
|
|
Service Code
|
NDC 99999999979
|
| Hospital Charge Code |
110283021
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of AZ Commercial |
$2.23
|
| Rate for Payer: Bisbee Police All Plans |
$0.64
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Self Pay Self Pay |
$1.98
|
|
|
THP ondansetron 4 mg Dis Tab [CQCH]
|
Facility
|
OP
|
$2.48
|
|
|
Service Code
|
NDC 99999999979
|
| Hospital Charge Code |
110283021
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of AZ Commercial |
$2.23
|
| Rate for Payer: Aetna of AZ Medicare |
$0.69
|
| Rate for Payer: Allwell Medicare |
$0.40
|
| Rate for Payer: Amerigroup Medicare |
$0.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.93
|
| Rate for Payer: AZCH Complete Medicare |
$0.40
|
| Rate for Payer: Banner UC Health Medicare |
$0.40
|
| Rate for Payer: Bisbee Police All Plans |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of AZ Commercial |
$1.61
|
| Rate for Payer: Copperpoint Commercial |
$0.61
|
| Rate for Payer: Health Net of AZ Commercial |
$1.49
|
| Rate for Payer: Health Net of AZ Medicare |
$0.69
|
| Rate for Payer: Humana of AZ Medicare |
$0.40
|
| Rate for Payer: Self Pay Self Pay |
$1.98
|
| Rate for Payer: TriWest Medicare |
$0.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.45
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.45
|
|
|
THP Tramadol 50 mg [CQCH]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 99999999981
|
| Hospital Charge Code |
141650147
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of AZ Commercial |
$0.24
|
| Rate for Payer: Aetna of AZ Medicare |
$0.08
|
| Rate for Payer: Allwell Medicare |
$0.04
|
| Rate for Payer: Amerigroup Medicare |
$0.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.10
|
| Rate for Payer: AZCH Complete Medicare |
$0.04
|
| Rate for Payer: Banner UC Health Medicare |
$0.04
|
| Rate for Payer: Bisbee Police All Plans |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of AZ Commercial |
$0.18
|
| Rate for Payer: Copperpoint Commercial |
$0.07
|
| Rate for Payer: Health Net of AZ Commercial |
$0.16
|
| Rate for Payer: Health Net of AZ Medicare |
$0.08
|
| Rate for Payer: Humana of AZ Medicare |
$0.04
|
| Rate for Payer: Self Pay Self Pay |
$0.22
|
| Rate for Payer: TriWest Medicare |
$0.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.16
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.05
|
|
|
THP Tramadol 50 mg [CQCH]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 99999999981
|
| Hospital Charge Code |
141650147
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of AZ Commercial |
$0.24
|
| Rate for Payer: Bisbee Police All Plans |
$0.07
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Self Pay Self Pay |
$0.22
|
|
|
Throat Culture
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
850755
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna of AZ Commercial |
$147.60
|
| Rate for Payer: Aetna of AZ Medicare |
$45.92
|
| Rate for Payer: Allwell Medicare |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.24
|
| Rate for Payer: APIPA Medicare/Medicaid |
$61.25
|
| Rate for Payer: AZCH Complete Medicare |
$26.24
|
| Rate for Payer: Banner UC Health Medicare |
$26.24
|
| Rate for Payer: Bisbee Police All Plans |
$42.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$111.52
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cigna of AZ Commercial |
$106.60
|
| Rate for Payer: Copperpoint Commercial |
$40.59
|
| Rate for Payer: Health Net of AZ Commercial |
$98.40
|
| Rate for Payer: Health Net of AZ Medicare |
$45.92
|
| Rate for Payer: Humana of AZ Medicare |
$26.24
|
| Rate for Payer: Self Pay Self Pay |
$131.20
|
| Rate for Payer: TriWest Medicare |
$26.24
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$95.61
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$29.52
|
|
|
Throat Culture
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
850755
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna of AZ Commercial |
$147.60
|
| Rate for Payer: Bisbee Police All Plans |
$42.64
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Self Pay Self Pay |
$131.20
|
|
