|
Vitamin E, Serum LC
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
2029231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of AZ Commercial |
$198.90
|
| Rate for Payer: Aetna of AZ Medicare |
$61.88
|
| Rate for Payer: Allwell Medicare |
$35.36
|
| Rate for Payer: Amerigroup Medicare |
$35.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$82.54
|
| Rate for Payer: AZCH Complete Medicare |
$35.36
|
| Rate for Payer: Banner UC Health Medicare |
$35.36
|
| Rate for Payer: Bisbee Police All Plans |
$57.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$150.28
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cigna of AZ Commercial |
$143.65
|
| Rate for Payer: Copperpoint Commercial |
$54.70
|
| Rate for Payer: Health Net of AZ Commercial |
$132.60
|
| Rate for Payer: Health Net of AZ Medicare |
$61.88
|
| Rate for Payer: Humana of AZ Medicare |
$35.36
|
| Rate for Payer: Self Pay Self Pay |
$176.80
|
| Rate for Payer: TriWest Medicare |
$35.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$128.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$39.78
|
|
|
Vitamin E, Serum LC
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
2029231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of AZ Commercial |
$198.90
|
| Rate for Payer: Bisbee Police All Plans |
$57.46
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Self Pay Self Pay |
$176.80
|
|
|
Vitamin K LC
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
6780828
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
|
Vitamin K LC
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
6780828
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
|
Vit B12 Unsat Binding Capacity LC
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 82608
|
| Hospital Charge Code |
6738694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna of AZ Commercial |
$175.50
|
| Rate for Payer: Aetna of AZ Medicare |
$54.60
|
| Rate for Payer: Allwell Medicare |
$31.20
|
| Rate for Payer: Amerigroup Medicare |
$31.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$72.83
|
| Rate for Payer: AZCH Complete Medicare |
$31.20
|
| Rate for Payer: Banner UC Health Medicare |
$31.20
|
| Rate for Payer: Bisbee Police All Plans |
$50.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$132.60
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna of AZ Commercial |
$126.75
|
| Rate for Payer: Copperpoint Commercial |
$48.26
|
| Rate for Payer: Health Net of AZ Commercial |
$117.00
|
| Rate for Payer: Health Net of AZ Medicare |
$54.60
|
| Rate for Payer: Humana of AZ Medicare |
$31.20
|
| Rate for Payer: Self Pay Self Pay |
$156.00
|
| Rate for Payer: TriWest Medicare |
$31.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$113.69
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$35.10
|
|
|
Vit B12 Unsat Binding Capacity LC
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 82608
|
| Hospital Charge Code |
6738694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna of AZ Commercial |
$175.50
|
| Rate for Payer: Bisbee Police All Plans |
$50.70
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Self Pay Self Pay |
$156.00
|
|
|
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
|
|
|
Voiding Pressure Study
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
27291784
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.00 |
| 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 |
$416.71
|
| Rate for Payer: Allwell Medicaid |
$416.71
|
| Rate for Payer: Allwell Medicare |
$320.00
|
| Rate for Payer: Amerigroup Medicare |
$320.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$747.00
|
| Rate for Payer: AZCH Complete Medicaid |
$416.71
|
| Rate for Payer: AZCH Complete Medicare |
$320.00
|
| Rate for Payer: Banner UC Health Medicaid |
$416.71
|
| Rate for Payer: Banner UC Health Medicare |
$320.00
|
| 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 |
$320.00
|
| Rate for Payer: Mercy Care Medicaid |
$416.71
|
| Rate for Payer: Self Pay Self Pay |
$1,600.00
|
| Rate for Payer: TriWest Medicare |
$320.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$360.00
|
|
|
Void Press Intraabdominal
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
27281884
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$147.30 |
| 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 |
$147.30
|
| Rate for Payer: Allwell Medicaid |
$147.30
|
| Rate for Payer: Allwell Medicare |
$160.48
|
| Rate for Payer: Amerigroup Medicare |
$160.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$374.62
|
| Rate for Payer: AZCH Complete Medicaid |
$147.30
|
| Rate for Payer: AZCH Complete Medicare |
$160.48
|
| Rate for Payer: Banner UC Health Medicaid |
$147.30
|
| Rate for Payer: Banner UC Health Medicare |
$160.48
|
| 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 |
$160.48
|
| Rate for Payer: Mercy Care Medicaid |
$147.30
|
| Rate for Payer: Self Pay Self Pay |
$802.40
|
| Rate for Payer: TriWest Medicare |
$160.48
|
| 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
|
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
|
|
|
Vulvar Abscess incision and draninga
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
27281904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$107.52 |
| 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 |
$204.07
|
| Rate for Payer: Allwell Medicaid |
$204.07
|
| Rate for Payer: Allwell Medicare |
$107.52
|
| Rate for Payer: Amerigroup Medicare |
$107.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$250.99
|
| Rate for Payer: AZCH Complete Medicaid |
$204.07
|
| Rate for Payer: AZCH Complete Medicare |
$107.52
|
| Rate for Payer: Banner UC Health Medicaid |
$204.07
|
| Rate for Payer: Banner UC Health Medicare |
$107.52
|
| 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 |
$107.52
|
| Rate for Payer: Mercy Care Medicaid |
$204.07
|
| Rate for Payer: Self Pay Self Pay |
$537.60
|
| Rate for Payer: TriWest Medicare |
$107.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$120.96
|
|
|
vW Antigen LC
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
2769552
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.64 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Aetna of AZ Commercial |
$363.60
|
| Rate for Payer: Aetna of AZ Medicare |
$113.12
|
| Rate for Payer: Allwell Medicare |
$64.64
|
| Rate for Payer: Amerigroup Medicare |
$64.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$150.89
|
| Rate for Payer: AZCH Complete Medicare |
$64.64
|
| Rate for Payer: Banner UC Health Medicare |
$64.64
|
| Rate for Payer: Bisbee Police All Plans |
$105.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$274.72
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cigna of AZ Commercial |
$262.60
|
| Rate for Payer: Copperpoint Commercial |
$99.99
|
| Rate for Payer: Health Net of AZ Commercial |
$242.40
|
| Rate for Payer: Health Net of AZ Medicare |
$113.12
|
| Rate for Payer: Humana of AZ Medicare |
$64.64
|
| Rate for Payer: Self Pay Self Pay |
$323.20
|
| Rate for Payer: TriWest Medicare |
$64.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$235.53
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$72.72
|
|
|
vW Antigen LC
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
2769552
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Aetna of AZ Commercial |
$363.60
|
| Rate for Payer: Bisbee Police All Plans |
$105.04
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Self Pay Self Pay |
$323.20
|
|
|
vWF Activity LC
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
2769553
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna of AZ Commercial |
$277.20
|
| Rate for Payer: Bisbee Police All Plans |
$80.08
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Self Pay Self Pay |
$246.40
|
|
|
vWF Activity LC
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
2769553
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna of AZ Commercial |
$277.20
|
| Rate for Payer: Aetna of AZ Medicare |
$86.24
|
| Rate for Payer: Allwell Medicare |
$49.28
|
| Rate for Payer: Amerigroup Medicare |
$49.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$115.04
|
| Rate for Payer: AZCH Complete Medicare |
$49.28
|
| Rate for Payer: Banner UC Health Medicare |
$49.28
|
| Rate for Payer: Bisbee Police All Plans |
$80.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$209.44
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cigna of AZ Commercial |
$200.20
|
| Rate for Payer: Copperpoint Commercial |
$76.23
|
| Rate for Payer: Health Net of AZ Commercial |
$184.80
|
| Rate for Payer: Health Net of AZ Medicare |
$86.24
|
| Rate for Payer: Humana of AZ Medicare |
$49.28
|
| Rate for Payer: Self Pay Self Pay |
$246.40
|
| Rate for Payer: TriWest Medicare |
$49.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$179.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.44
|
|
|
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
|
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
|
|
|
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 5 mg Tab [CQCH]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 832121601
|
| Hospital Charge Code |
105945397
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of AZ Commercial |
$0.34
|
| Rate for Payer: Bisbee Police All Plans |
$0.10
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Self Pay Self Pay |
$0.30
|
|
|
warfarin 5 mg Tab [CQCH]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 832121601
|
| Hospital Charge Code |
105945397
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of AZ Commercial |
$0.34
|
| 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 |
$0.14
|
| 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 |
$0.26
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of AZ Commercial |
$0.25
|
| Rate for Payer: Copperpoint Commercial |
$0.09
|
| 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 |
$0.30
|
| Rate for Payer: TriWest Medicare |
$0.06
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.07
|
|
|
warfarin 7.5 mg Tab [CQCH]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 56017375
|
| Hospital Charge Code |
105945332
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of AZ Commercial |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.05
|
|
