|
Varicella-Zoster V Ab, IgG LC
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
1905871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna of AZ Commercial |
$274.50
|
| Rate for Payer: Aetna of AZ Medicare |
$85.40
|
| Rate for Payer: AHCCCS Medicaid |
$12.88
|
| Rate for Payer: Allwell Medicaid |
$12.88
|
| Rate for Payer: Allwell Medicare |
$45.75
|
| Rate for Payer: Amerigroup Medicare |
$45.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$113.92
|
| Rate for Payer: AZCH Complete Medicaid |
$12.88
|
| Rate for Payer: AZCH Complete Medicare |
$45.75
|
| Rate for Payer: Banner UC Health Medicaid |
$12.88
|
| Rate for Payer: Banner UC Health Medicare |
$45.75
|
| Rate for Payer: Bisbee Police All Plans |
$79.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$207.40
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cigna of AZ Commercial |
$198.25
|
| Rate for Payer: Copperpoint Commercial |
$75.49
|
| Rate for Payer: Health Net of AZ Commercial |
$183.00
|
| Rate for Payer: Health Net of AZ Medicare |
$85.40
|
| Rate for Payer: Humana of AZ Medicare |
$45.75
|
| Rate for Payer: Mercy Care Medicaid |
$12.88
|
| Rate for Payer: Self Pay Self Pay |
$244.00
|
| Rate for Payer: TriWest Medicare |
$45.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$177.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$54.90
|
|
|
Varicella-Zoster V Ab, IgG LC
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
1905871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna of AZ Commercial |
$274.50
|
| Rate for Payer: Bisbee Police All Plans |
$79.30
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Self Pay Self Pay |
$244.00
|
|
|
vasopressin 20 units/1 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$183.23
|
|
|
Service Code
|
NDC 42023016425
|
| Hospital Charge Code |
105944809
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$47.64 |
| Max. Negotiated Rate |
$164.91 |
| Rate for Payer: Aetna of AZ Commercial |
$164.91
|
| Rate for Payer: Bisbee Police All Plans |
$47.64
|
| Rate for Payer: Cash Price |
$146.58
|
| Rate for Payer: Self Pay Self Pay |
$146.58
|
|
|
vasopressin 20 units/1 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$183.23
|
|
|
Service Code
|
NDC 42023016425
|
| Hospital Charge Code |
105944809
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$164.91 |
| Rate for Payer: Aetna of AZ Commercial |
$164.91
|
| Rate for Payer: Aetna of AZ Medicare |
$51.30
|
| Rate for Payer: Allwell Medicare |
$27.48
|
| Rate for Payer: Amerigroup Medicare |
$27.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$68.44
|
| Rate for Payer: AZCH Complete Medicare |
$27.48
|
| Rate for Payer: Banner UC Health Medicare |
$27.48
|
| Rate for Payer: Bisbee Police All Plans |
$47.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$124.60
|
| Rate for Payer: Cash Price |
$146.58
|
| Rate for Payer: Cigna of AZ Commercial |
$119.10
|
| Rate for Payer: Copperpoint Commercial |
$45.35
|
| Rate for Payer: Health Net of AZ Commercial |
$109.94
|
| Rate for Payer: Health Net of AZ Medicare |
$51.30
|
| Rate for Payer: Humana of AZ Medicare |
$27.48
|
| Rate for Payer: Self Pay Self Pay |
$146.58
|
| Rate for Payer: TriWest Medicare |
$27.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$106.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.98
|
|
|
vecuronium 10 mg REC PWD [CQCH]
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 47335093144
|
| Hospital Charge Code |
111168336
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna of AZ Commercial |
$4.17
|
| Rate for Payer: Aetna of AZ Medicare |
$1.30
|
| Rate for Payer: Allwell Medicare |
$0.69
|
| Rate for Payer: Amerigroup Medicare |
$0.69
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.73
|
| Rate for Payer: AZCH Complete Medicare |
$0.69
|
| Rate for Payer: Banner UC Health Medicare |
$0.69
|
| Rate for Payer: Bisbee Police All Plans |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cigna of AZ Commercial |
$3.01
|
| Rate for Payer: Copperpoint Commercial |
$1.15
|
| Rate for Payer: Health Net of AZ Commercial |
$2.78
|
| Rate for Payer: Health Net of AZ Medicare |
$1.30
|
| Rate for Payer: Humana of AZ Medicare |
$0.69
|
| Rate for Payer: Self Pay Self Pay |
$3.70
|
| Rate for Payer: TriWest Medicare |
$0.69
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.70
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.83
|
|
|
vecuronium 10 mg REC PWD [CQCH]
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 47335093144
|
| Hospital Charge Code |
111168336
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna of AZ Commercial |
$4.17
|
| Rate for Payer: Bisbee Police All Plans |
$1.20
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Self Pay Self Pay |
$3.70
|
|
|
vedolizumab 300 mg REC[CQCH]
|
Facility
|
OP
|
$8,666.58
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
228424664
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$7,799.92 |
| Rate for Payer: Aetna of AZ Commercial |
$7,799.92
|
| Rate for Payer: Aetna of AZ Medicare |
$2,426.64
|
| Rate for Payer: AHCCCS Medicaid |
$34.72
|
| Rate for Payer: Allwell Medicaid |
$34.72
|
| Rate for Payer: Allwell Medicare |
$1,299.99
|
| Rate for Payer: Amerigroup Medicare |
$1,299.99
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3,236.97
|
| Rate for Payer: AZCH Complete Medicaid |
$34.72
|
| Rate for Payer: AZCH Complete Medicare |
$1,299.99
|
| Rate for Payer: Banner UC Health Medicaid |
$34.72
|
| Rate for Payer: Banner UC Health Medicare |
$1,299.99
|
| Rate for Payer: Bisbee Police All Plans |
$2,253.31
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5,893.27
|
| Rate for Payer: Cash Price |
$6,933.26
|
| Rate for Payer: Cash Price |
$6,933.26
|
| Rate for Payer: Cigna of AZ Commercial |
$5,633.28
|
| Rate for Payer: Copperpoint Commercial |
$2,144.98
|
| Rate for Payer: Health Net of AZ Commercial |
$5,199.95
|
| Rate for Payer: Health Net of AZ Medicare |
$2,426.64
|
| Rate for Payer: Humana of AZ Medicare |
$1,299.99
|
| Rate for Payer: Mercy Care Medicaid |
$34.72
|
| Rate for Payer: Self Pay Self Pay |
$6,933.26
|
| Rate for Payer: TriWest Medicare |
$1,299.99
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5,052.62
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,559.98
|
|
|
vedolizumab 300 mg REC[CQCH]
|
Facility
|
IP
|
$8,666.58
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
228424664
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,253.31 |
| Max. Negotiated Rate |
$7,799.92 |
| Rate for Payer: Aetna of AZ Commercial |
$7,799.92
|
| Rate for Payer: Bisbee Police All Plans |
$2,253.31
|
| Rate for Payer: Cash Price |
$6,933.26
|
| Rate for Payer: Self Pay Self Pay |
$6,933.26
|
|
|
venlafaxine 75 mg ER Capsule [CQCH]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 904646961
|
| Hospital Charge Code |
160253304
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of AZ Commercial |
$0.32
|
| Rate for Payer: Aetna of AZ Medicare |
$0.10
|
| Rate for Payer: Allwell Medicare |
$0.05
|
| Rate for Payer: Amerigroup Medicare |
$0.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$0.05
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.24
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of AZ Commercial |
$0.23
|
| Rate for Payer: Copperpoint Commercial |
$0.09
|
| Rate for Payer: Health Net of AZ Commercial |
$0.21
|
| Rate for Payer: Health Net of AZ Medicare |
$0.10
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.28
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.06
|
|
|
venlafaxine 75 mg ER Capsule [CQCH]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 904646961
|
| Hospital Charge Code |
160253304
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of AZ Commercial |
$0.32
|
| Rate for Payer: Bisbee Police All Plans |
$0.09
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Self Pay Self Pay |
$0.28
|
|
|
venlafaxine 75 mg Tab IR [CQCH]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 68084085601
|
| Hospital Charge Code |
105944939
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of AZ Commercial |
$0.35
|
| Rate for Payer: Bisbee Police All Plans |
$0.10
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Self Pay Self Pay |
$0.31
|
|
|
venlafaxine 75 mg Tab IR [CQCH]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 68084085601
|
| Hospital Charge Code |
105944939
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of AZ Commercial |
$0.35
|
| Rate for Payer: Aetna of AZ Medicare |
$0.11
|
| Rate for Payer: Allwell Medicare |
$0.06
|
| Rate for Payer: Amerigroup Medicare |
$0.06
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.15
|
| Rate for Payer: AZCH Complete Medicare |
$0.06
|
| Rate for Payer: Banner UC Health Medicare |
$0.06
|
| Rate for Payer: Bisbee Police All Plans |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of AZ Commercial |
$0.25
|
| Rate for Payer: Copperpoint Commercial |
$0.10
|
| Rate for Payer: Health Net of AZ Commercial |
$0.23
|
| Rate for Payer: Health Net of AZ Medicare |
$0.11
|
| Rate for Payer: Humana of AZ Medicare |
$0.06
|
| Rate for Payer: Self Pay Self Pay |
$0.31
|
| Rate for Payer: TriWest Medicare |
$0.06
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.07
|
|
|
Venous Blood Gas..
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
22040456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$278.10 |
| Rate for Payer: Aetna of AZ Commercial |
$278.10
|
| Rate for Payer: Bisbee Police All Plans |
$80.34
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Self Pay Self Pay |
$247.20
|
|
|
Venous Blood Gas..
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
22040456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$278.10 |
| Rate for Payer: Aetna of AZ Commercial |
$278.10
|
| Rate for Payer: Aetna of AZ Medicare |
$86.52
|
| Rate for Payer: AHCCCS Medicaid |
$26.07
|
| Rate for Payer: Allwell Medicaid |
$26.07
|
| Rate for Payer: Allwell Medicare |
$46.35
|
| Rate for Payer: Amerigroup Medicare |
$46.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$115.41
|
| Rate for Payer: AZCH Complete Medicaid |
$26.07
|
| Rate for Payer: AZCH Complete Medicare |
$46.35
|
| Rate for Payer: Banner UC Health Medicaid |
$26.07
|
| Rate for Payer: Banner UC Health Medicare |
$46.35
|
| Rate for Payer: Bisbee Police All Plans |
$80.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$210.12
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna of AZ Commercial |
$200.85
|
| Rate for Payer: Copperpoint Commercial |
$76.48
|
| Rate for Payer: Health Net of AZ Commercial |
$185.40
|
| Rate for Payer: Health Net of AZ Medicare |
$86.52
|
| Rate for Payer: Humana of AZ Medicare |
$46.35
|
| Rate for Payer: Mercy Care Medicaid |
$26.07
|
| Rate for Payer: Self Pay Self Pay |
$247.20
|
| Rate for Payer: TriWest Medicare |
$46.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$180.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.62
|
|
|
Venous Blood Gas...
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
23122859
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.88 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of AZ Commercial |
$304.20
|
| Rate for Payer: Bisbee Police All Plans |
$87.88
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Self Pay Self Pay |
$270.40
|
|
|
Venous Blood Gas...
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
23122859
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of AZ Commercial |
$304.20
|
| Rate for Payer: Aetna of AZ Medicare |
$94.64
|
| Rate for Payer: AHCCCS Medicaid |
$26.07
|
| Rate for Payer: Allwell Medicaid |
$26.07
|
| Rate for Payer: Allwell Medicare |
$50.70
|
| Rate for Payer: Amerigroup Medicare |
$50.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$126.24
|
| Rate for Payer: AZCH Complete Medicaid |
$26.07
|
| Rate for Payer: AZCH Complete Medicare |
$50.70
|
| Rate for Payer: Banner UC Health Medicaid |
$26.07
|
| Rate for Payer: Banner UC Health Medicare |
$50.70
|
| Rate for Payer: Bisbee Police All Plans |
$87.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$229.84
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cigna of AZ Commercial |
$219.70
|
| Rate for Payer: Copperpoint Commercial |
$83.66
|
| Rate for Payer: Health Net of AZ Commercial |
$202.80
|
| Rate for Payer: Health Net of AZ Medicare |
$94.64
|
| Rate for Payer: Humana of AZ Medicare |
$50.70
|
| Rate for Payer: Mercy Care Medicaid |
$26.07
|
| Rate for Payer: Self Pay Self Pay |
$270.40
|
| Rate for Payer: TriWest Medicare |
$50.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$197.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$60.84
|
|
|
Venous Draw Charge
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
2240048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of AZ Commercial |
$32.40
|
| Rate for Payer: Aetna of AZ Medicare |
$10.08
|
| Rate for Payer: AHCCCS Medicaid |
$6.00
|
| Rate for Payer: Allwell Medicaid |
$6.00
|
| Rate for Payer: Allwell Medicare |
$5.40
|
| Rate for Payer: Amerigroup Medicare |
$5.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$13.45
|
| Rate for Payer: AZCH Complete Medicaid |
$6.00
|
| Rate for Payer: AZCH Complete Medicare |
$5.40
|
| Rate for Payer: Banner UC Health Medicaid |
$6.00
|
| Rate for Payer: Banner UC Health Medicare |
$5.40
|
| Rate for Payer: Bisbee Police All Plans |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$24.48
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of AZ Commercial |
$23.40
|
| Rate for Payer: Copperpoint Commercial |
$8.91
|
| Rate for Payer: Health Net of AZ Commercial |
$21.60
|
| Rate for Payer: Health Net of AZ Medicare |
$10.08
|
| Rate for Payer: Humana of AZ Medicare |
$5.40
|
| Rate for Payer: Mercy Care Medicaid |
$6.00
|
| Rate for Payer: Self Pay Self Pay |
$28.80
|
| Rate for Payer: TriWest Medicare |
$5.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$20.99
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.48
|
|
|
Venous Draw Charge
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
2240048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of AZ Commercial |
$32.40
|
| Rate for Payer: Bisbee Police All Plans |
$9.36
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Self Pay Self Pay |
$28.80
|
|
|
Ventilator Services Initial
|
Facility
|
OP
|
$2,051.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
1886947
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$307.65 |
| Max. Negotiated Rate |
$1,845.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,845.90
|
| Rate for Payer: Aetna of AZ Medicare |
$574.28
|
| Rate for Payer: AHCCCS Medicaid |
$703.62
|
| Rate for Payer: Allwell Medicaid |
$703.62
|
| Rate for Payer: Allwell Medicare |
$307.65
|
| Rate for Payer: Amerigroup Medicare |
$307.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$766.05
|
| Rate for Payer: AZCH Complete Medicaid |
$703.62
|
| Rate for Payer: AZCH Complete Medicare |
$307.65
|
| Rate for Payer: Banner UC Health Medicaid |
$703.62
|
| Rate for Payer: Banner UC Health Medicare |
$307.65
|
| Rate for Payer: Bisbee Police All Plans |
$533.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,394.68
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,435.70
|
| Rate for Payer: Copperpoint Commercial |
$507.62
|
| Rate for Payer: Health Net of AZ Commercial |
$1,230.60
|
| Rate for Payer: Health Net of AZ Medicare |
$574.28
|
| Rate for Payer: Humana of AZ Medicare |
$307.65
|
| Rate for Payer: Mercy Care Medicaid |
$703.62
|
| Rate for Payer: Self Pay Self Pay |
$1,640.80
|
| Rate for Payer: TriWest Medicare |
$307.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,195.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$369.18
|
|
|
Ventilator Services Initial
|
Facility
|
IP
|
$2,051.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
1886947
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$533.26 |
| Max. Negotiated Rate |
$1,845.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,845.90
|
| Rate for Payer: Bisbee Police All Plans |
$533.26
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Self Pay Self Pay |
$1,640.80
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$8,652.47
|
|
|
Service Code
|
APR-DRG 0221
|
| Hospital Charge Code |
APRDRG0222
|
| Min. Negotiated Rate |
$8,652.47 |
| Max. Negotiated Rate |
$8,652.47 |
| Rate for Payer: AHCCCS Medicaid |
$8,652.47
|
| Rate for Payer: Allwell Medicaid |
$8,652.47
|
| Rate for Payer: AZCH Complete Medicaid |
$8,652.47
|
| Rate for Payer: Banner UC Health Medicaid |
$8,652.47
|
| Rate for Payer: Mercy Care Medicaid |
$8,652.47
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$40,079.40
|
|
|
Service Code
|
APR-DRG 0224
|
| Hospital Charge Code |
APRDRG0223
|
| Min. Negotiated Rate |
$40,079.40 |
| Max. Negotiated Rate |
$40,079.40 |
| Rate for Payer: AHCCCS Medicaid |
$40,079.40
|
| Rate for Payer: Allwell Medicaid |
$40,079.40
|
| Rate for Payer: AZCH Complete Medicaid |
$40,079.40
|
| Rate for Payer: Banner UC Health Medicaid |
$40,079.40
|
| Rate for Payer: Mercy Care Medicaid |
$40,079.40
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$40,079.40
|
|
|
Service Code
|
APR-DRG 0224
|
| Hospital Charge Code |
APRDRG0222
|
| Min. Negotiated Rate |
$40,079.40 |
| Max. Negotiated Rate |
$40,079.40 |
| Rate for Payer: AHCCCS Medicaid |
$40,079.40
|
| Rate for Payer: Allwell Medicaid |
$40,079.40
|
| Rate for Payer: AZCH Complete Medicaid |
$40,079.40
|
| Rate for Payer: Banner UC Health Medicaid |
$40,079.40
|
| Rate for Payer: Mercy Care Medicaid |
$40,079.40
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$40,079.40
|
|
|
Service Code
|
APR-DRG 0224
|
| Hospital Charge Code |
APRDRG0221
|
| Min. Negotiated Rate |
$40,079.40 |
| Max. Negotiated Rate |
$40,079.40 |
| Rate for Payer: AHCCCS Medicaid |
$40,079.40
|
| Rate for Payer: Allwell Medicaid |
$40,079.40
|
| Rate for Payer: AZCH Complete Medicaid |
$40,079.40
|
| Rate for Payer: Banner UC Health Medicaid |
$40,079.40
|
| Rate for Payer: Mercy Care Medicaid |
$40,079.40
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$11,077.21
|
|
|
Service Code
|
APR-DRG 0222
|
| Hospital Charge Code |
APRDRG0224
|
| Min. Negotiated Rate |
$11,077.21 |
| Max. Negotiated Rate |
$11,077.21 |
| Rate for Payer: AHCCCS Medicaid |
$11,077.21
|
| Rate for Payer: Allwell Medicaid |
$11,077.21
|
| Rate for Payer: AZCH Complete Medicaid |
$11,077.21
|
| Rate for Payer: Banner UC Health Medicaid |
$11,077.21
|
| Rate for Payer: Mercy Care Medicaid |
$11,077.21
|
|
