|
vancomycin 125 mg Cap UD [CQCH]
|
Facility
|
IP
|
$8.37
|
|
|
Service Code
|
NDC 47781072902
|
| Hospital Charge Code |
108082992
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of AZ Commercial |
$7.53
|
| Rate for Payer: Bisbee Police All Plans |
$2.18
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Self Pay Self Pay |
$6.70
|
|
|
vancomycin 125 mg Cap UD [CQCH]
|
Facility
|
OP
|
$8.37
|
|
|
Service Code
|
NDC 47781072902
|
| Hospital Charge Code |
108082992
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of AZ Commercial |
$7.53
|
| Rate for Payer: Aetna of AZ Medicare |
$2.34
|
| Rate for Payer: Allwell Medicare |
$1.34
|
| Rate for Payer: Amerigroup Medicare |
$1.34
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.13
|
| Rate for Payer: AZCH Complete Medicare |
$1.34
|
| Rate for Payer: Banner UC Health Medicare |
$1.34
|
| Rate for Payer: Bisbee Police All Plans |
$2.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5.69
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Cigna of AZ Commercial |
$5.44
|
| Rate for Payer: Copperpoint Commercial |
$2.07
|
| Rate for Payer: Health Net of AZ Commercial |
$5.02
|
| Rate for Payer: Health Net of AZ Medicare |
$2.34
|
| Rate for Payer: Humana of AZ Medicare |
$1.34
|
| Rate for Payer: Self Pay Self Pay |
$6.70
|
| Rate for Payer: TriWest Medicare |
$1.34
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.51
|
|
|
vancomycin 500 mg IV Inj [CQCH]
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
105944667
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna of AZ Commercial |
$1.85
|
| Rate for Payer: Aetna of AZ Medicare |
$0.58
|
| Rate for Payer: Allwell Medicare |
$0.33
|
| Rate for Payer: Amerigroup Medicare |
$0.33
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.77
|
| Rate for Payer: AZCH Complete Medicare |
$0.33
|
| Rate for Payer: Banner UC Health Medicare |
$0.33
|
| Rate for Payer: Bisbee Police All Plans |
$0.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna of AZ Commercial |
$1.34
|
| Rate for Payer: Copperpoint Commercial |
$0.51
|
| Rate for Payer: Health Net of AZ Commercial |
$1.24
|
| Rate for Payer: Health Net of AZ Medicare |
$0.58
|
| Rate for Payer: Humana of AZ Medicare |
$0.33
|
| Rate for Payer: Self Pay Self Pay |
$1.65
|
| Rate for Payer: TriWest Medicare |
$0.33
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.37
|
|
|
vancomycin 500 mg IV Inj [CQCH]
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
105944667
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna of AZ Commercial |
$1.85
|
| Rate for Payer: Bisbee Police All Plans |
$0.54
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Self Pay Self Pay |
$1.65
|
|
|
Vancomycin Lvl Peak 1
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
9579711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of AZ Commercial |
$158.40
|
| Rate for Payer: Aetna of AZ Medicare |
$49.28
|
| Rate for Payer: Allwell Medicare |
$28.16
|
| Rate for Payer: Amerigroup Medicare |
$28.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$65.74
|
| Rate for Payer: AZCH Complete Medicare |
$28.16
|
| Rate for Payer: Banner UC Health Medicare |
$28.16
|
| Rate for Payer: Bisbee Police All Plans |
$45.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$119.68
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna of AZ Commercial |
$114.40
|
| Rate for Payer: Copperpoint Commercial |
$43.56
|
| Rate for Payer: Health Net of AZ Commercial |
$105.60
|
| Rate for Payer: Health Net of AZ Medicare |
$49.28
|
| Rate for Payer: Humana of AZ Medicare |
$28.16
|
| Rate for Payer: Self Pay Self Pay |
$140.80
|
| Rate for Payer: TriWest Medicare |
$28.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$102.61
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.68
|
|
|
Vancomycin Lvl Peak 1
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
9579711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of AZ Commercial |
$158.40
|
| Rate for Payer: Bisbee Police All Plans |
$45.76
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Self Pay Self Pay |
$140.80
|
|
|
Vancomycin Lvl Random
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Aetna of AZ Commercial |
$166.50
|
| Rate for Payer: Aetna of AZ Medicare |
$51.80
|
| Rate for Payer: Allwell Medicare |
$29.60
|
| Rate for Payer: Amerigroup Medicare |
$29.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$69.10
|
| Rate for Payer: AZCH Complete Medicare |
$29.60
|
| Rate for Payer: Banner UC Health Medicare |
$29.60
|
| Rate for Payer: Bisbee Police All Plans |
$48.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$125.80
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna of AZ Commercial |
$120.25
|
| Rate for Payer: Copperpoint Commercial |
$45.79
|
| Rate for Payer: Health Net of AZ Commercial |
$111.00
|
| Rate for Payer: Health Net of AZ Medicare |
$51.80
|
| Rate for Payer: Humana of AZ Medicare |
$29.60
|
| Rate for Payer: Self Pay Self Pay |
$148.00
|
| Rate for Payer: TriWest Medicare |
$29.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$107.86
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$33.30
|
|
|
Vancomycin Lvl Random
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.10 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Aetna of AZ Commercial |
$166.50
|
| Rate for Payer: Bisbee Police All Plans |
$48.10
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Self Pay Self Pay |
$148.00
|
|
|
Vancomycin Lvl Trough 1
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
9579712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Aetna of AZ Commercial |
$166.50
|
| Rate for Payer: Aetna of AZ Medicare |
$51.80
|
| Rate for Payer: Allwell Medicare |
$29.60
|
| Rate for Payer: Amerigroup Medicare |
$29.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$69.10
|
| Rate for Payer: AZCH Complete Medicare |
$29.60
|
| Rate for Payer: Banner UC Health Medicare |
$29.60
|
| Rate for Payer: Bisbee Police All Plans |
$48.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$125.80
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna of AZ Commercial |
$120.25
|
| Rate for Payer: Copperpoint Commercial |
$45.79
|
| Rate for Payer: Health Net of AZ Commercial |
$111.00
|
| Rate for Payer: Health Net of AZ Medicare |
$51.80
|
| Rate for Payer: Humana of AZ Medicare |
$29.60
|
| Rate for Payer: Self Pay Self Pay |
$148.00
|
| Rate for Payer: TriWest Medicare |
$29.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$107.86
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$33.30
|
|
|
Vancomycin Lvl Trough 1
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
9579712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.10 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Aetna of AZ Commercial |
$166.50
|
| Rate for Payer: Bisbee Police All Plans |
$48.10
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Self Pay Self Pay |
$148.00
|
|
|
Vanillylmandelic Acid, 24-Hr U LC
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
1909573
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna of AZ Commercial |
$154.80
|
| Rate for Payer: Bisbee Police All Plans |
$44.72
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Self Pay Self Pay |
$137.60
|
|
|
Vanillylmandelic Acid, 24-Hr U LC
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
1909573
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna of AZ Commercial |
$154.80
|
| Rate for Payer: Aetna of AZ Medicare |
$48.16
|
| Rate for Payer: Allwell Medicare |
$27.52
|
| Rate for Payer: Amerigroup Medicare |
$27.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$64.24
|
| Rate for Payer: AZCH Complete Medicare |
$27.52
|
| Rate for Payer: Banner UC Health Medicare |
$27.52
|
| Rate for Payer: Bisbee Police All Plans |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$116.96
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cigna of AZ Commercial |
$111.80
|
| Rate for Payer: Copperpoint Commercial |
$42.57
|
| Rate for Payer: Health Net of AZ Commercial |
$103.20
|
| Rate for Payer: Health Net of AZ Medicare |
$48.16
|
| Rate for Payer: Humana of AZ Medicare |
$27.52
|
| Rate for Payer: Self Pay Self Pay |
$137.60
|
| Rate for Payer: TriWest Medicare |
$27.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$100.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.96
|
|
|
VAP Cholesterol Profile LC
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
1909580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Bisbee Police All Plans |
$28.34
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Self Pay Self Pay |
$87.20
|
|
|
VAP Cholesterol Profile LC
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
1909580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of AZ Commercial |
$98.10
|
| Rate for Payer: Aetna of AZ Medicare |
$30.52
|
| Rate for Payer: Allwell Medicare |
$17.44
|
| Rate for Payer: Amerigroup Medicare |
$17.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$40.71
|
| Rate for Payer: AZCH Complete Medicare |
$17.44
|
| Rate for Payer: Banner UC Health Medicare |
$17.44
|
| Rate for Payer: Bisbee Police All Plans |
$28.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$74.12
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cigna of AZ Commercial |
$70.85
|
| Rate for Payer: Copperpoint Commercial |
$26.98
|
| Rate for Payer: Health Net of AZ Commercial |
$65.40
|
| Rate for Payer: Health Net of AZ Medicare |
$30.52
|
| Rate for Payer: Humana of AZ Medicare |
$17.44
|
| Rate for Payer: Self Pay Self Pay |
$87.20
|
| Rate for Payer: TriWest Medicare |
$17.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$63.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.62
|
|
|
Vapotherm Initial
|
Facility
|
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
3882290
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$680.96 |
| Max. Negotiated Rate |
$3,830.40 |
| Rate for Payer: Aetna of AZ Commercial |
$3,830.40
|
| Rate for Payer: Aetna of AZ Medicare |
$1,191.68
|
| Rate for Payer: Allwell Medicare |
$680.96
|
| Rate for Payer: Amerigroup Medicare |
$680.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,589.62
|
| Rate for Payer: AZCH Complete Medicare |
$680.96
|
| Rate for Payer: Banner UC Health Medicare |
$680.96
|
| Rate for Payer: Bisbee Police All Plans |
$1,106.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,894.08
|
| Rate for Payer: Cash Price |
$3,404.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,979.20
|
| Rate for Payer: Copperpoint Commercial |
$1,053.36
|
| Rate for Payer: Health Net of AZ Commercial |
$2,553.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,191.68
|
| Rate for Payer: Humana of AZ Medicare |
$680.96
|
| Rate for Payer: Self Pay Self Pay |
$3,404.80
|
| Rate for Payer: TriWest Medicare |
$680.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,481.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$766.08
|
|
|
Vapotherm Initial
|
Facility
|
IP
|
$4,256.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
3882290
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,106.56 |
| Max. Negotiated Rate |
$3,830.40 |
| Rate for Payer: Aetna of AZ Commercial |
$3,830.40
|
| Rate for Payer: Bisbee Police All Plans |
$1,106.56
|
| Rate for Payer: Cash Price |
$3,404.80
|
| Rate for Payer: Self Pay Self Pay |
$3,404.80
|
|
|
Vapotherm Subsequent
|
Facility
|
IP
|
$2,858.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
3882291
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$743.08 |
| Max. Negotiated Rate |
$2,572.20 |
| Rate for Payer: Aetna of AZ Commercial |
$2,572.20
|
| Rate for Payer: Bisbee Police All Plans |
$743.08
|
| Rate for Payer: Cash Price |
$2,286.40
|
| Rate for Payer: Self Pay Self Pay |
$2,286.40
|
|
|
Vapotherm Subsequent
|
Facility
|
OP
|
$2,858.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
3882291
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$457.28 |
| Max. Negotiated Rate |
$2,572.20 |
| Rate for Payer: Aetna of AZ Commercial |
$2,572.20
|
| Rate for Payer: Aetna of AZ Medicare |
$800.24
|
| Rate for Payer: Allwell Medicare |
$457.28
|
| Rate for Payer: Amerigroup Medicare |
$457.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,067.46
|
| Rate for Payer: AZCH Complete Medicare |
$457.28
|
| Rate for Payer: Banner UC Health Medicare |
$457.28
|
| Rate for Payer: Bisbee Police All Plans |
$743.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,943.44
|
| Rate for Payer: Cash Price |
$2,286.40
|
| Rate for Payer: Cigna of AZ Commercial |
$2,000.60
|
| Rate for Payer: Copperpoint Commercial |
$707.36
|
| Rate for Payer: Health Net of AZ Commercial |
$1,714.80
|
| Rate for Payer: Health Net of AZ Medicare |
$800.24
|
| Rate for Payer: Humana of AZ Medicare |
$457.28
|
| Rate for Payer: Self Pay Self Pay |
$2,286.40
|
| Rate for Payer: TriWest Medicare |
$457.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,666.21
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$514.44
|
|
|
Varicella-Zoster IgM Ab LC
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
6780778
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna of AZ Commercial |
$248.40
|
| Rate for Payer: Bisbee Police All Plans |
$71.76
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Self Pay Self Pay |
$220.80
|
|
|
Varicella-Zoster IgM Ab LC
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
6780778
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna of AZ Commercial |
$248.40
|
| Rate for Payer: Aetna of AZ Medicare |
$77.28
|
| Rate for Payer: Allwell Medicare |
$44.16
|
| Rate for Payer: Amerigroup Medicare |
$44.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$103.09
|
| Rate for Payer: AZCH Complete Medicare |
$44.16
|
| Rate for Payer: Banner UC Health Medicare |
$44.16
|
| Rate for Payer: Bisbee Police All Plans |
$71.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$187.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna of AZ Commercial |
$179.40
|
| Rate for Payer: Copperpoint Commercial |
$68.31
|
| Rate for Payer: Health Net of AZ Commercial |
$165.60
|
| Rate for Payer: Health Net of AZ Medicare |
$77.28
|
| Rate for Payer: Humana of AZ Medicare |
$44.16
|
| Rate for Payer: Self Pay Self Pay |
$220.80
|
| Rate for Payer: TriWest Medicare |
$44.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$160.91
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$49.68
|
|
|
Varicella-Zoster V Ab, IgG LC
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
1905871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of AZ Commercial |
$261.00
|
| Rate for Payer: Bisbee Police All Plans |
$75.40
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Self Pay Self Pay |
$232.00
|
|
|
Varicella-Zoster V Ab, IgG LC
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
1905871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of AZ Commercial |
$261.00
|
| Rate for Payer: Aetna of AZ Medicare |
$81.20
|
| Rate for Payer: Allwell Medicare |
$46.40
|
| Rate for Payer: Amerigroup Medicare |
$46.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$108.31
|
| Rate for Payer: AZCH Complete Medicare |
$46.40
|
| Rate for Payer: Banner UC Health Medicare |
$46.40
|
| Rate for Payer: Bisbee Police All Plans |
$75.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$197.20
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cigna of AZ Commercial |
$188.50
|
| Rate for Payer: Copperpoint Commercial |
$71.78
|
| Rate for Payer: Health Net of AZ Commercial |
$174.00
|
| Rate for Payer: Health Net of AZ Medicare |
$81.20
|
| Rate for Payer: Humana of AZ Medicare |
$46.40
|
| Rate for Payer: Self Pay Self Pay |
$232.00
|
| Rate for Payer: TriWest Medicare |
$46.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$169.07
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$52.20
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INC
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
28068477
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$194.24 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,092.60
|
| Rate for Payer: Aetna of AZ Medicare |
$339.92
|
| Rate for Payer: AHCCCS Medicaid |
$1,299.92
|
| Rate for Payer: Allwell Medicaid |
$1,299.92
|
| Rate for Payer: Allwell Medicare |
$194.24
|
| Rate for Payer: Amerigroup Medicare |
$194.24
|
| Rate for Payer: APIPA Medicare/Medicaid |
$453.43
|
| Rate for Payer: AZCH Complete Medicaid |
$1,299.92
|
| Rate for Payer: AZCH Complete Medicare |
$194.24
|
| Rate for Payer: Banner UC Health Medicaid |
$1,299.92
|
| Rate for Payer: Banner UC Health Medicare |
$194.24
|
| Rate for Payer: Bisbee Police All Plans |
$315.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$825.52
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cigna of AZ Commercial |
$607.00
|
| Rate for Payer: Copperpoint Commercial |
$300.46
|
| Rate for Payer: Health Net of AZ Commercial |
$728.40
|
| Rate for Payer: Health Net of AZ Medicare |
$339.92
|
| Rate for Payer: Humana of AZ Medicare |
$194.24
|
| Rate for Payer: Mercy Care Medicaid |
$1,299.92
|
| Rate for Payer: Self Pay Self Pay |
$971.20
|
| Rate for Payer: TriWest Medicare |
$194.24
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$218.52
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INC
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
28068477
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.64 |
| Max. Negotiated Rate |
$1,092.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,092.60
|
| Rate for Payer: Bisbee Police All Plans |
$315.64
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Self Pay Self Pay |
$971.20
|
|
|
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 |
$29.32 |
| 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 |
$29.32
|
| Rate for Payer: Amerigroup Medicare |
$29.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$68.44
|
| Rate for Payer: AZCH Complete Medicare |
$29.32
|
| Rate for Payer: Banner UC Health Medicare |
$29.32
|
| 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 |
$29.32
|
| Rate for Payer: Self Pay Self Pay |
$146.58
|
| Rate for Payer: TriWest Medicare |
$29.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$106.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.98
|
|
