|
Vitamin A, Serum LC
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
2029227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna of AZ Commercial |
$210.60
|
| Rate for Payer: Aetna of AZ Medicare |
$65.52
|
| Rate for Payer: AHCCCS Medicaid |
$11.61
|
| Rate for Payer: Allwell Medicaid |
$11.61
|
| Rate for Payer: Allwell Medicare |
$35.10
|
| Rate for Payer: Amerigroup Medicare |
$35.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$87.40
|
| Rate for Payer: AZCH Complete Medicaid |
$11.61
|
| Rate for Payer: AZCH Complete Medicare |
$35.10
|
| Rate for Payer: Banner UC Health Medicaid |
$11.61
|
| Rate for Payer: Banner UC Health Medicare |
$35.10
|
| Rate for Payer: Bisbee Police All Plans |
$60.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$159.12
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna of AZ Commercial |
$152.10
|
| Rate for Payer: Copperpoint Commercial |
$57.92
|
| Rate for Payer: Health Net of AZ Commercial |
$140.40
|
| Rate for Payer: Health Net of AZ Medicare |
$65.52
|
| Rate for Payer: Humana of AZ Medicare |
$35.10
|
| Rate for Payer: Mercy Care Medicaid |
$11.61
|
| Rate for Payer: Self Pay Self Pay |
$187.20
|
| Rate for Payer: TriWest Medicare |
$35.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$136.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$42.12
|
|
|
Vitamin A, Serum LC
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
2029227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna of AZ Commercial |
$210.60
|
| Rate for Payer: Bisbee Police All Plans |
$60.84
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Self Pay Self Pay |
$187.20
|
|
|
Vitamin B12
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
22050695
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of AZ Commercial |
$97.20
|
| Rate for Payer: Bisbee Police All Plans |
$28.08
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Self Pay Self Pay |
$86.40
|
|
|
Vitamin B12
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
22050695
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of AZ Commercial |
$97.20
|
| Rate for Payer: Aetna of AZ Medicare |
$30.24
|
| Rate for Payer: AHCCCS Medicaid |
$15.08
|
| Rate for Payer: Allwell Medicaid |
$15.08
|
| Rate for Payer: Allwell Medicare |
$16.20
|
| Rate for Payer: Amerigroup Medicare |
$16.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$40.34
|
| Rate for Payer: AZCH Complete Medicaid |
$15.08
|
| Rate for Payer: AZCH Complete Medicare |
$16.20
|
| Rate for Payer: Banner UC Health Medicaid |
$15.08
|
| Rate for Payer: Banner UC Health Medicare |
$16.20
|
| Rate for Payer: Bisbee Police All Plans |
$28.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$73.44
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of AZ Commercial |
$70.20
|
| Rate for Payer: Copperpoint Commercial |
$26.73
|
| Rate for Payer: Health Net of AZ Commercial |
$64.80
|
| Rate for Payer: Health Net of AZ Medicare |
$30.24
|
| Rate for Payer: Humana of AZ Medicare |
$16.20
|
| Rate for Payer: Mercy Care Medicaid |
$15.08
|
| Rate for Payer: Self Pay Self Pay |
$86.40
|
| Rate for Payer: TriWest Medicare |
$16.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$62.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.44
|
|
|
Vitamin B12/Folate Panel
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
20183520
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna of AZ Commercial |
$170.10
|
| Rate for Payer: Bisbee Police All Plans |
$49.14
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Self Pay Self Pay |
$151.20
|
|
|
Vitamin B12/Folate Panel
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
20183520
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna of AZ Commercial |
$170.10
|
| Rate for Payer: Aetna of AZ Medicare |
$52.92
|
| Rate for Payer: AHCCCS Medicaid |
$15.08
|
| Rate for Payer: Allwell Medicaid |
$15.08
|
| Rate for Payer: Allwell Medicare |
$28.35
|
| Rate for Payer: Amerigroup Medicare |
$28.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$70.59
|
| Rate for Payer: AZCH Complete Medicaid |
$15.08
|
| Rate for Payer: AZCH Complete Medicare |
$28.35
|
| Rate for Payer: Banner UC Health Medicaid |
$15.08
|
| Rate for Payer: Banner UC Health Medicare |
$28.35
|
| Rate for Payer: Bisbee Police All Plans |
$49.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$128.52
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of AZ Commercial |
$122.85
|
| Rate for Payer: Copperpoint Commercial |
$46.78
|
| Rate for Payer: Health Net of AZ Commercial |
$113.40
|
| Rate for Payer: Health Net of AZ Medicare |
$52.92
|
| Rate for Payer: Humana of AZ Medicare |
$28.35
|
| Rate for Payer: Mercy Care Medicaid |
$15.08
|
| Rate for Payer: Self Pay Self Pay |
$151.20
|
| Rate for Payer: TriWest Medicare |
$28.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$110.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$34.02
|
|
|
Vitamin B12 Level
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
633871
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna of AZ Commercial |
$170.10
|
| Rate for Payer: Aetna of AZ Medicare |
$52.92
|
| Rate for Payer: AHCCCS Medicaid |
$15.08
|
| Rate for Payer: Allwell Medicaid |
$15.08
|
| Rate for Payer: Allwell Medicare |
$28.35
|
| Rate for Payer: Amerigroup Medicare |
$28.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$70.59
|
| Rate for Payer: AZCH Complete Medicaid |
$15.08
|
| Rate for Payer: AZCH Complete Medicare |
$28.35
|
| Rate for Payer: Banner UC Health Medicaid |
$15.08
|
| Rate for Payer: Banner UC Health Medicare |
$28.35
|
| Rate for Payer: Bisbee Police All Plans |
$49.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$128.52
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of AZ Commercial |
$122.85
|
| Rate for Payer: Copperpoint Commercial |
$46.78
|
| Rate for Payer: Health Net of AZ Commercial |
$113.40
|
| Rate for Payer: Health Net of AZ Medicare |
$52.92
|
| Rate for Payer: Humana of AZ Medicare |
$28.35
|
| Rate for Payer: Mercy Care Medicaid |
$15.08
|
| Rate for Payer: Self Pay Self Pay |
$151.20
|
| Rate for Payer: TriWest Medicare |
$28.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$110.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$34.02
|
|
|
Vitamin B12 Level
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
633871
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna of AZ Commercial |
$170.10
|
| Rate for Payer: Bisbee Police All Plans |
$49.14
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Self Pay Self Pay |
$151.20
|
|
|
Vitamin B12 Level
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
21254686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of AZ Commercial |
$97.20
|
| Rate for Payer: Aetna of AZ Medicare |
$30.24
|
| Rate for Payer: AHCCCS Medicaid |
$15.08
|
| Rate for Payer: Allwell Medicaid |
$15.08
|
| Rate for Payer: Allwell Medicare |
$16.20
|
| Rate for Payer: Amerigroup Medicare |
$16.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$40.34
|
| Rate for Payer: AZCH Complete Medicaid |
$15.08
|
| Rate for Payer: AZCH Complete Medicare |
$16.20
|
| Rate for Payer: Banner UC Health Medicaid |
$15.08
|
| Rate for Payer: Banner UC Health Medicare |
$16.20
|
| Rate for Payer: Bisbee Police All Plans |
$28.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$73.44
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of AZ Commercial |
$70.20
|
| Rate for Payer: Copperpoint Commercial |
$26.73
|
| Rate for Payer: Health Net of AZ Commercial |
$64.80
|
| Rate for Payer: Health Net of AZ Medicare |
$30.24
|
| Rate for Payer: Humana of AZ Medicare |
$16.20
|
| Rate for Payer: Mercy Care Medicaid |
$15.08
|
| Rate for Payer: Self Pay Self Pay |
$86.40
|
| Rate for Payer: TriWest Medicare |
$16.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$62.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.44
|
|
|
Vitamin B12 Level
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
21254686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of AZ Commercial |
$97.20
|
| Rate for Payer: Bisbee Police All Plans |
$28.08
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Self Pay Self Pay |
$86.40
|
|
|
Vitamin B1 (Thiamine) Whl Blood LC
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
6781596
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.38 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of AZ Commercial |
$326.70
|
| Rate for Payer: Bisbee Police All Plans |
$94.38
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Self Pay Self Pay |
$290.40
|
|
|
Vitamin B1 (Thiamine) Whl Blood LC
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
6781596
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of AZ Commercial |
$326.70
|
| Rate for Payer: Aetna of AZ Medicare |
$101.64
|
| Rate for Payer: AHCCCS Medicaid |
$21.23
|
| Rate for Payer: Allwell Medicaid |
$21.23
|
| Rate for Payer: Allwell Medicare |
$54.45
|
| Rate for Payer: Amerigroup Medicare |
$54.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$135.58
|
| Rate for Payer: AZCH Complete Medicaid |
$21.23
|
| Rate for Payer: AZCH Complete Medicare |
$54.45
|
| Rate for Payer: Banner UC Health Medicaid |
$21.23
|
| Rate for Payer: Banner UC Health Medicare |
$54.45
|
| Rate for Payer: Bisbee Police All Plans |
$94.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$246.84
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna of AZ Commercial |
$235.95
|
| Rate for Payer: Copperpoint Commercial |
$89.84
|
| Rate for Payer: Health Net of AZ Commercial |
$217.80
|
| Rate for Payer: Health Net of AZ Medicare |
$101.64
|
| Rate for Payer: Humana of AZ Medicare |
$54.45
|
| Rate for Payer: Mercy Care Medicaid |
$21.23
|
| Rate for Payer: Self Pay Self Pay |
$290.40
|
| Rate for Payer: TriWest Medicare |
$54.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$211.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$65.34
|
|
|
Vitamin B2 Whole Blood LC
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
6780835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna of AZ Commercial |
$324.00
|
| Rate for Payer: Aetna of AZ Medicare |
$100.80
|
| Rate for Payer: AHCCCS Medicaid |
$20.24
|
| Rate for Payer: Allwell Medicaid |
$20.24
|
| Rate for Payer: Allwell Medicare |
$54.00
|
| Rate for Payer: Amerigroup Medicare |
$54.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$134.46
|
| Rate for Payer: AZCH Complete Medicaid |
$20.24
|
| Rate for Payer: AZCH Complete Medicare |
$54.00
|
| Rate for Payer: Banner UC Health Medicaid |
$20.24
|
| Rate for Payer: Banner UC Health Medicare |
$54.00
|
| Rate for Payer: Bisbee Police All Plans |
$93.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$244.80
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna of AZ Commercial |
$234.00
|
| Rate for Payer: Copperpoint Commercial |
$89.10
|
| Rate for Payer: Health Net of AZ Commercial |
$216.00
|
| Rate for Payer: Health Net of AZ Medicare |
$100.80
|
| Rate for Payer: Humana of AZ Medicare |
$54.00
|
| Rate for Payer: Mercy Care Medicaid |
$20.24
|
| Rate for Payer: Self Pay Self Pay |
$288.00
|
| Rate for Payer: TriWest Medicare |
$54.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$209.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$64.80
|
|
|
Vitamin B2 Whole Blood LC
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
6780835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna of AZ Commercial |
$324.00
|
| Rate for Payer: Bisbee Police All Plans |
$93.60
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Self Pay Self Pay |
$288.00
|
|
|
Vitamin B3 (Niacin+Metabolite) LC
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
6781648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$184.08 |
| Max. Negotiated Rate |
$637.20 |
| Rate for Payer: Aetna of AZ Commercial |
$637.20
|
| Rate for Payer: Bisbee Police All Plans |
$184.08
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Self Pay Self Pay |
$566.40
|
|
|
Vitamin B3 (Niacin+Metabolite) LC
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
6781648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$637.20 |
| Rate for Payer: Aetna of AZ Commercial |
$637.20
|
| Rate for Payer: Aetna of AZ Medicare |
$198.24
|
| Rate for Payer: AHCCCS Medicaid |
$24.09
|
| Rate for Payer: Allwell Medicaid |
$24.09
|
| Rate for Payer: Allwell Medicare |
$106.20
|
| Rate for Payer: Amerigroup Medicare |
$106.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$264.44
|
| Rate for Payer: AZCH Complete Medicaid |
$24.09
|
| Rate for Payer: AZCH Complete Medicare |
$106.20
|
| Rate for Payer: Banner UC Health Medicaid |
$24.09
|
| Rate for Payer: Banner UC Health Medicare |
$106.20
|
| Rate for Payer: Bisbee Police All Plans |
$184.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$481.44
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna of AZ Commercial |
$460.20
|
| Rate for Payer: Copperpoint Commercial |
$175.23
|
| Rate for Payer: Health Net of AZ Commercial |
$424.80
|
| Rate for Payer: Health Net of AZ Medicare |
$198.24
|
| Rate for Payer: Humana of AZ Medicare |
$106.20
|
| Rate for Payer: Mercy Care Medicaid |
$24.09
|
| Rate for Payer: Self Pay Self Pay |
$566.40
|
| Rate for Payer: TriWest Medicare |
$106.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$412.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$127.44
|
|
|
Vitamin B6 LC
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
1909644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Aetna of AZ Commercial |
$548.10
|
| Rate for Payer: Bisbee Police All Plans |
$158.34
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Self Pay Self Pay |
$487.20
|
|
|
Vitamin B6 LC
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
1909644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Aetna of AZ Commercial |
$548.10
|
| Rate for Payer: Aetna of AZ Medicare |
$170.52
|
| Rate for Payer: AHCCCS Medicaid |
$28.10
|
| Rate for Payer: Allwell Medicaid |
$28.10
|
| Rate for Payer: Allwell Medicare |
$91.35
|
| Rate for Payer: Amerigroup Medicare |
$91.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$227.46
|
| Rate for Payer: AZCH Complete Medicaid |
$28.10
|
| Rate for Payer: AZCH Complete Medicare |
$91.35
|
| Rate for Payer: Banner UC Health Medicaid |
$28.10
|
| Rate for Payer: Banner UC Health Medicare |
$91.35
|
| Rate for Payer: Bisbee Police All Plans |
$158.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$414.12
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna of AZ Commercial |
$395.85
|
| Rate for Payer: Copperpoint Commercial |
$150.73
|
| Rate for Payer: Health Net of AZ Commercial |
$365.40
|
| Rate for Payer: Health Net of AZ Medicare |
$170.52
|
| Rate for Payer: Humana of AZ Medicare |
$91.35
|
| Rate for Payer: Mercy Care Medicaid |
$28.10
|
| Rate for Payer: Self Pay Self Pay |
$487.20
|
| Rate for Payer: TriWest Medicare |
$91.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$355.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$109.62
|
|
|
Vitamin D, 25-Hydroxy LC
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
1285623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna of AZ Commercial |
$262.80
|
| Rate for Payer: Bisbee Police All Plans |
$75.92
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Self Pay Self Pay |
$233.60
|
|
|
Vitamin D, 25-Hydroxy LC
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
1285623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna of AZ Commercial |
$262.80
|
| Rate for Payer: Aetna of AZ Medicare |
$81.76
|
| Rate for Payer: AHCCCS Medicaid |
$29.60
|
| Rate for Payer: Allwell Medicaid |
$29.60
|
| Rate for Payer: Allwell Medicare |
$43.80
|
| Rate for Payer: Amerigroup Medicare |
$43.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$109.06
|
| Rate for Payer: AZCH Complete Medicaid |
$29.60
|
| Rate for Payer: AZCH Complete Medicare |
$43.80
|
| Rate for Payer: Banner UC Health Medicaid |
$29.60
|
| Rate for Payer: Banner UC Health Medicare |
$43.80
|
| Rate for Payer: Bisbee Police All Plans |
$75.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$198.56
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cigna of AZ Commercial |
$189.80
|
| Rate for Payer: Copperpoint Commercial |
$72.27
|
| Rate for Payer: Health Net of AZ Commercial |
$175.20
|
| Rate for Payer: Health Net of AZ Medicare |
$81.76
|
| Rate for Payer: Humana of AZ Medicare |
$43.80
|
| Rate for Payer: Mercy Care Medicaid |
$29.60
|
| Rate for Payer: Self Pay Self Pay |
$233.60
|
| Rate for Payer: TriWest Medicare |
$43.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$170.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$52.56
|
|
|
Vitamin D 25 Hydroxy Level
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of AZ Commercial |
$333.00
|
| Rate for Payer: Bisbee Police All Plans |
$96.20
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Self Pay Self Pay |
$296.00
|
|
|
Vitamin D 25 Hydroxy Level
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of AZ Commercial |
$333.00
|
| Rate for Payer: Aetna of AZ Medicare |
$103.60
|
| Rate for Payer: AHCCCS Medicaid |
$29.60
|
| Rate for Payer: Allwell Medicaid |
$29.60
|
| Rate for Payer: Allwell Medicare |
$55.50
|
| Rate for Payer: Amerigroup Medicare |
$55.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$138.20
|
| Rate for Payer: AZCH Complete Medicaid |
$29.60
|
| Rate for Payer: AZCH Complete Medicare |
$55.50
|
| Rate for Payer: Banner UC Health Medicaid |
$29.60
|
| Rate for Payer: Banner UC Health Medicare |
$55.50
|
| Rate for Payer: Bisbee Police All Plans |
$96.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$251.60
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cigna of AZ Commercial |
$240.50
|
| Rate for Payer: Copperpoint Commercial |
$91.58
|
| Rate for Payer: Health Net of AZ Commercial |
$222.00
|
| Rate for Payer: Health Net of AZ Medicare |
$103.60
|
| Rate for Payer: Humana of AZ Medicare |
$55.50
|
| Rate for Payer: Mercy Care Medicaid |
$29.60
|
| Rate for Payer: Self Pay Self Pay |
$296.00
|
| Rate for Payer: TriWest Medicare |
$55.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$215.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$66.60
|
|
|
Vitamin D3 1000 International Unit Tab UD [CQCH]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
107994658
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of AZ Commercial |
$0.04
|
| Rate for Payer: Aetna of AZ Medicare |
$0.01
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.01
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of AZ Commercial |
$0.03
|
| Rate for Payer: Copperpoint Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Medicare |
$0.01
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.03
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
Vitamin D3 1000 International Unit Tab UD [CQCH]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
107994658
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of AZ Commercial |
$0.04
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Self Pay Self Pay |
$0.03
|
|
|
Vitamin D3 400 intl units Tab [CQCH]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 43292055881
|
| Hospital Charge Code |
105916255
|
|
Hospital Revenue Code
|
251
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of AZ Commercial |
$0.02
|
| Rate for Payer: Aetna of AZ Medicare |
$0.01
|
| Rate for Payer: Allwell Medicare |
$0.00
|
| Rate for Payer: Amerigroup Medicare |
$0.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.01
|
| Rate for Payer: AZCH Complete Medicare |
$0.00
|
| Rate for Payer: Banner UC Health Medicare |
$0.00
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of AZ Commercial |
$0.01
|
| Rate for Payer: Copperpoint Commercial |
$0.00
|
| Rate for Payer: Health Net of AZ Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Medicare |
$0.01
|
| Rate for Payer: Humana of AZ Medicare |
$0.00
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
| Rate for Payer: TriWest Medicare |
$0.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.00
|
|
