|
Vitamin D3 400 intl units Tab [CQCH]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 43292055881
|
| Hospital Charge Code |
105916255
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of AZ Commercial |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
|
|
vitamin E 400 units Cap [CQCH]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 904027460
|
| Hospital Charge Code |
105945267
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of AZ Commercial |
$0.14
|
| Rate for Payer: Aetna of AZ Medicare |
$0.04
|
| 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 Medicare |
$0.02
|
| 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 |
$0.13
|
| 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: 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
|
|
|
vitamin E 400 units Cap [CQCH]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 904027460
|
| Hospital Charge Code |
105945267
|
|
Hospital Revenue Code
|
251
|
| 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 |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$0.13
|
|
|
Vitamin E, Serum LC
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
2029231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$209.70 |
| Rate for Payer: Aetna of AZ Commercial |
$209.70
|
| Rate for Payer: Bisbee Police All Plans |
$60.58
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Self Pay Self Pay |
$186.40
|
|
|
Vitamin E, Serum LC
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
2029231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$209.70 |
| Rate for Payer: Aetna of AZ Commercial |
$209.70
|
| Rate for Payer: Aetna of AZ Medicare |
$65.24
|
| Rate for Payer: AHCCCS Medicaid |
$14.18
|
| Rate for Payer: Allwell Medicaid |
$14.18
|
| Rate for Payer: Allwell Medicare |
$34.95
|
| Rate for Payer: Amerigroup Medicare |
$34.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$87.03
|
| Rate for Payer: AZCH Complete Medicaid |
$14.18
|
| Rate for Payer: AZCH Complete Medicare |
$34.95
|
| Rate for Payer: Banner UC Health Medicaid |
$14.18
|
| Rate for Payer: Banner UC Health Medicare |
$34.95
|
| Rate for Payer: Bisbee Police All Plans |
$60.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$158.44
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cigna of AZ Commercial |
$151.45
|
| Rate for Payer: Copperpoint Commercial |
$57.67
|
| Rate for Payer: Health Net of AZ Commercial |
$139.80
|
| Rate for Payer: Health Net of AZ Medicare |
$65.24
|
| Rate for Payer: Humana of AZ Medicare |
$34.95
|
| Rate for Payer: Mercy Care Medicaid |
$14.18
|
| Rate for Payer: Self Pay Self Pay |
$186.40
|
| Rate for Payer: TriWest Medicare |
$34.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$135.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.94
|
|
|
Vitamin K LC
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
6780828
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Aetna of AZ Medicare |
$50.68
|
| Rate for Payer: AHCCCS Medicaid |
$13.72
|
| Rate for Payer: Allwell Medicaid |
$13.72
|
| Rate for Payer: Allwell Medicare |
$27.15
|
| Rate for Payer: Amerigroup Medicare |
$27.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicaid |
$13.72
|
| Rate for Payer: AZCH Complete Medicare |
$27.15
|
| Rate for Payer: Banner UC Health Medicaid |
$13.72
|
| Rate for Payer: Banner UC Health Medicare |
$27.15
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$123.08
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna of AZ Commercial |
$117.65
|
| Rate for Payer: Copperpoint Commercial |
$44.80
|
| Rate for Payer: Health Net of AZ Commercial |
$108.60
|
| Rate for Payer: Health Net of AZ Medicare |
$50.68
|
| Rate for Payer: Humana of AZ Medicare |
$27.15
|
| Rate for Payer: Mercy Care Medicaid |
$13.72
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$27.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
Vitamin K LC
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
6780828
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
|
|
Vit B12 Unsat Binding Capacity LC
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82608
|
| Hospital Charge Code |
6738694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna of AZ Commercial |
$184.50
|
| Rate for Payer: Aetna of AZ Medicare |
$57.40
|
| Rate for Payer: AHCCCS Medicaid |
$14.32
|
| Rate for Payer: Allwell Medicaid |
$14.32
|
| Rate for Payer: Allwell Medicare |
$30.75
|
| Rate for Payer: Amerigroup Medicare |
$30.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$76.57
|
| Rate for Payer: AZCH Complete Medicaid |
$14.32
|
| Rate for Payer: AZCH Complete Medicare |
$30.75
|
| Rate for Payer: Banner UC Health Medicaid |
$14.32
|
| Rate for Payer: Banner UC Health Medicare |
$30.75
|
| Rate for Payer: Bisbee Police All Plans |
$53.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$139.40
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna of AZ Commercial |
$133.25
|
| Rate for Payer: Copperpoint Commercial |
$50.74
|
| Rate for Payer: Health Net of AZ Commercial |
$123.00
|
| Rate for Payer: Health Net of AZ Medicare |
$57.40
|
| Rate for Payer: Humana of AZ Medicare |
$30.75
|
| Rate for Payer: Mercy Care Medicaid |
$14.32
|
| Rate for Payer: Self Pay Self Pay |
$164.00
|
| Rate for Payer: TriWest Medicare |
$30.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$119.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$36.90
|
|
|
Vit B12 Unsat Binding Capacity LC
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 82608
|
| Hospital Charge Code |
6738694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna of AZ Commercial |
$184.50
|
| Rate for Payer: Bisbee Police All Plans |
$53.30
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Self Pay Self Pay |
$164.00
|
|
|
Voiding Pressure Study
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
27291784
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,800.00
|
| Rate for Payer: Aetna of AZ Medicare |
$560.00
|
| Rate for Payer: AHCCCS Medicaid |
$833.42
|
| Rate for Payer: Allwell Medicaid |
$833.42
|
| Rate for Payer: Allwell Medicare |
$300.00
|
| Rate for Payer: Amerigroup Medicare |
$300.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$747.00
|
| Rate for Payer: AZCH Complete Medicaid |
$833.42
|
| Rate for Payer: AZCH Complete Medicare |
$300.00
|
| Rate for Payer: Banner UC Health Medicaid |
$833.42
|
| Rate for Payer: Banner UC Health Medicare |
$300.00
|
| Rate for Payer: Bisbee Police All Plans |
$520.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,000.00
|
| Rate for Payer: Copperpoint Commercial |
$495.00
|
| Rate for Payer: Health Net of AZ Commercial |
$1,200.00
|
| Rate for Payer: Health Net of AZ Medicare |
$560.00
|
| Rate for Payer: Humana of AZ Medicare |
$300.00
|
| Rate for Payer: Mercy Care Medicaid |
$833.42
|
| Rate for Payer: Self Pay Self Pay |
$1,600.00
|
| Rate for Payer: TriWest Medicare |
$300.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$360.00
|
|
|
Voiding Pressure Study
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
27291784
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,800.00
|
| Rate for Payer: Bisbee Police All Plans |
$520.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Self Pay Self Pay |
$1,600.00
|
|
|
Void Press Intraabdominal
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
27281884
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$150.45 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$902.70
|
| Rate for Payer: Aetna of AZ Medicare |
$280.84
|
| Rate for Payer: AHCCCS Medicaid |
$294.60
|
| Rate for Payer: Allwell Medicaid |
$294.60
|
| Rate for Payer: Allwell Medicare |
$150.45
|
| Rate for Payer: Amerigroup Medicare |
$150.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$374.62
|
| Rate for Payer: AZCH Complete Medicaid |
$294.60
|
| Rate for Payer: AZCH Complete Medicare |
$150.45
|
| Rate for Payer: Banner UC Health Medicaid |
$294.60
|
| Rate for Payer: Banner UC Health Medicare |
$150.45
|
| Rate for Payer: Bisbee Police All Plans |
$260.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$682.04
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cigna of AZ Commercial |
$501.50
|
| Rate for Payer: Copperpoint Commercial |
$248.24
|
| Rate for Payer: Health Net of AZ Commercial |
$601.80
|
| Rate for Payer: Health Net of AZ Medicare |
$280.84
|
| Rate for Payer: Humana of AZ Medicare |
$150.45
|
| Rate for Payer: Mercy Care Medicaid |
$294.60
|
| Rate for Payer: Self Pay Self Pay |
$802.40
|
| Rate for Payer: TriWest Medicare |
$150.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$180.54
|
|
|
Void Press Intraabdominal
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
27281884
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$260.78 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Aetna of AZ Commercial |
$902.70
|
| Rate for Payer: Bisbee Police All Plans |
$260.78
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Self Pay Self Pay |
$802.40
|
|
|
Vulvar Abscess incision and draninga
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
27281904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$604.80
|
| Rate for Payer: Aetna of AZ Medicare |
$188.16
|
| Rate for Payer: AHCCCS Medicaid |
$408.14
|
| Rate for Payer: Allwell Medicaid |
$408.14
|
| Rate for Payer: Allwell Medicare |
$100.80
|
| Rate for Payer: Amerigroup Medicare |
$100.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$250.99
|
| Rate for Payer: AZCH Complete Medicaid |
$408.14
|
| Rate for Payer: AZCH Complete Medicare |
$100.80
|
| Rate for Payer: Banner UC Health Medicaid |
$408.14
|
| Rate for Payer: Banner UC Health Medicare |
$100.80
|
| Rate for Payer: Bisbee Police All Plans |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$456.96
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna of AZ Commercial |
$336.00
|
| Rate for Payer: Copperpoint Commercial |
$166.32
|
| Rate for Payer: Health Net of AZ Commercial |
$403.20
|
| Rate for Payer: Health Net of AZ Medicare |
$188.16
|
| Rate for Payer: Humana of AZ Medicare |
$100.80
|
| Rate for Payer: Mercy Care Medicaid |
$408.14
|
| Rate for Payer: Self Pay Self Pay |
$537.60
|
| Rate for Payer: TriWest Medicare |
$100.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$120.96
|
|
|
Vulvar Abscess incision and draninga
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
27281904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna of AZ Commercial |
$604.80
|
| Rate for Payer: Bisbee Police All Plans |
$174.72
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Self Pay Self Pay |
$537.60
|
|
|
vW Antigen LC
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
2769552
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna of AZ Commercial |
$382.50
|
| Rate for Payer: Aetna of AZ Medicare |
$119.00
|
| Rate for Payer: AHCCCS Medicaid |
$22.94
|
| Rate for Payer: Allwell Medicaid |
$22.94
|
| Rate for Payer: Allwell Medicare |
$63.75
|
| Rate for Payer: Amerigroup Medicare |
$63.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$158.74
|
| Rate for Payer: AZCH Complete Medicaid |
$22.94
|
| Rate for Payer: AZCH Complete Medicare |
$63.75
|
| Rate for Payer: Banner UC Health Medicaid |
$22.94
|
| Rate for Payer: Banner UC Health Medicare |
$63.75
|
| Rate for Payer: Bisbee Police All Plans |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$289.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna of AZ Commercial |
$276.25
|
| Rate for Payer: Copperpoint Commercial |
$105.19
|
| Rate for Payer: Health Net of AZ Commercial |
$255.00
|
| Rate for Payer: Health Net of AZ Medicare |
$119.00
|
| Rate for Payer: Humana of AZ Medicare |
$63.75
|
| Rate for Payer: Mercy Care Medicaid |
$22.94
|
| Rate for Payer: Self Pay Self Pay |
$340.00
|
| Rate for Payer: TriWest Medicare |
$63.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$247.78
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$76.50
|
|
|
vW Antigen LC
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
2769552
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna of AZ Commercial |
$382.50
|
| Rate for Payer: Bisbee Police All Plans |
$110.50
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Self Pay Self Pay |
$340.00
|
|
|
vWF Activity LC
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
2769553
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.24 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Aetna of AZ Commercial |
$291.60
|
| Rate for Payer: Bisbee Police All Plans |
$84.24
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Self Pay Self Pay |
$259.20
|
|
|
vWF Activity LC
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
2769553
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Aetna of AZ Commercial |
$291.60
|
| Rate for Payer: Aetna of AZ Medicare |
$90.72
|
| Rate for Payer: AHCCCS Medicaid |
$22.94
|
| Rate for Payer: Allwell Medicaid |
$22.94
|
| Rate for Payer: Allwell Medicare |
$48.60
|
| Rate for Payer: Amerigroup Medicare |
$48.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$121.01
|
| Rate for Payer: AZCH Complete Medicaid |
$22.94
|
| Rate for Payer: AZCH Complete Medicare |
$48.60
|
| Rate for Payer: Banner UC Health Medicaid |
$22.94
|
| Rate for Payer: Banner UC Health Medicare |
$48.60
|
| Rate for Payer: Bisbee Police All Plans |
$84.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$220.32
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna of AZ Commercial |
$210.60
|
| Rate for Payer: Copperpoint Commercial |
$80.19
|
| Rate for Payer: Health Net of AZ Commercial |
$194.40
|
| Rate for Payer: Health Net of AZ Medicare |
$90.72
|
| Rate for Payer: Humana of AZ Medicare |
$48.60
|
| Rate for Payer: Mercy Care Medicaid |
$22.94
|
| Rate for Payer: Self Pay Self Pay |
$259.20
|
| Rate for Payer: TriWest Medicare |
$48.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$188.89
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$58.32
|
|
|
warfarin 1 mg Tab [CQCH]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 56016975
|
| Hospital Charge Code |
105945657
|
|
Hospital Revenue Code
|
251
|
| 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
|
|
|
warfarin 1 mg Tab [CQCH]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 56016975
|
| Hospital Charge Code |
105945657
|
|
Hospital Revenue Code
|
251
|
| 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
|
|
|
warfarin 2 mg Tab [CQCH]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 56017075
|
| Hospital Charge Code |
105945527
|
|
Hospital Revenue Code
|
251
|
| 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
|
|
|
warfarin 2 mg Tab [CQCH]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 56017075
|
| Hospital Charge Code |
105945527
|
|
Hospital Revenue Code
|
251
|
| 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
|
|
|
warfarin 3 mg Tab [CQCH]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 56018875
|
| Hospital Charge Code |
105945462
|
|
Hospital Revenue Code
|
251
|
| 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
|
|
|
warfarin 3 mg Tab [CQCH]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 56018875
|
| Hospital Charge Code |
105945462
|
|
Hospital Revenue Code
|
251
|
| 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
|
|
