|
ZACURATE FINGER PULSE OX
|
Facility
IP
|
$70.00
|
|
| Hospital Charge Code |
24335303
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of AZ Commercial |
$63.00
|
| Rate for Payer: Bisbee Police All Plans |
$18.20
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Self Pay Self Pay |
$56.00
|
|
|
ZACURATE FINGER PULSE OX
|
Facility
OP
|
$70.00
|
|
| Hospital Charge Code |
24335303
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of AZ Commercial |
$63.00
|
| Rate for Payer: Aetna of AZ Medicare |
$19.60
|
| Rate for Payer: Allwell Medicare |
$10.50
|
| Rate for Payer: Amerigroup Medicare |
$10.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$26.14
|
| Rate for Payer: AZCH Complete Medicare |
$10.50
|
| Rate for Payer: Banner UC Health Medicare |
$10.50
|
| Rate for Payer: Bisbee Police All Plans |
$18.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$47.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna of AZ Commercial |
$49.00
|
| Rate for Payer: Copperpoint Commercial |
$17.32
|
| Rate for Payer: Health Net of AZ Commercial |
$42.00
|
| Rate for Payer: Health Net of AZ Medicare |
$19.60
|
| Rate for Payer: Humana of AZ Medicare |
$10.50
|
| Rate for Payer: Self Pay Self Pay |
$56.00
|
| Rate for Payer: TriWest Medicare |
$10.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$40.81
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.60
|
|
|
ZEROWET SUPER SHIELD
|
Facility
IP
|
$12.00
|
|
| Hospital Charge Code |
22355773
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of AZ Commercial |
$10.80
|
| Rate for Payer: Bisbee Police All Plans |
$3.12
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Self Pay Self Pay |
$9.60
|
|
|
ZEROWET SUPER SHIELD
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
22355773
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of AZ Commercial |
$10.80
|
| Rate for Payer: Aetna of AZ Medicare |
$3.36
|
| Rate for Payer: Allwell Medicare |
$1.80
|
| Rate for Payer: Amerigroup Medicare |
$1.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4.48
|
| Rate for Payer: AZCH Complete Medicare |
$1.80
|
| Rate for Payer: Banner UC Health Medicare |
$1.80
|
| Rate for Payer: Bisbee Police All Plans |
$3.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$8.16
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna of AZ Commercial |
$8.40
|
| Rate for Payer: Copperpoint Commercial |
$2.97
|
| Rate for Payer: Health Net of AZ Commercial |
$7.20
|
| Rate for Payer: Health Net of AZ Medicare |
$3.36
|
| Rate for Payer: Humana of AZ Medicare |
$1.80
|
| Rate for Payer: Self Pay Self Pay |
$9.60
|
| Rate for Payer: TriWest Medicare |
$1.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$7.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.16
|
|
|
Zika Test
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
22875060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of AZ Commercial |
$143.10
|
| Rate for Payer: Aetna of AZ Medicare |
$44.52
|
| Rate for Payer: AHCCCS Medicaid |
$12.88
|
| Rate for Payer: Allwell Medicaid |
$12.88
|
| Rate for Payer: Allwell Medicare |
$23.85
|
| Rate for Payer: Amerigroup Medicare |
$23.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$59.39
|
| Rate for Payer: AZCH Complete Medicaid |
$12.88
|
| Rate for Payer: AZCH Complete Medicare |
$23.85
|
| Rate for Payer: Banner UC Health Medicaid |
$12.88
|
| Rate for Payer: Banner UC Health Medicare |
$23.85
|
| Rate for Payer: Bisbee Police All Plans |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$108.12
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna of AZ Commercial |
$103.35
|
| Rate for Payer: Copperpoint Commercial |
$39.35
|
| Rate for Payer: Health Net of AZ Commercial |
$95.40
|
| Rate for Payer: Health Net of AZ Medicare |
$44.52
|
| Rate for Payer: Humana of AZ Medicare |
$23.85
|
| Rate for Payer: Mercy Care Medicaid |
$12.88
|
| Rate for Payer: Self Pay Self Pay |
$127.20
|
| Rate for Payer: TriWest Medicare |
$23.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$92.70
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.62
|
|
|
Zika Test
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
22875060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of AZ Commercial |
$143.10
|
| Rate for Payer: Bisbee Police All Plans |
$41.34
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Self Pay Self Pay |
$127.20
|
|
|
Zika Viru NAA
|
Facility
OP
|
$946.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
22929297
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$851.40 |
| Rate for Payer: Aetna of AZ Commercial |
$851.40
|
| Rate for Payer: Aetna of AZ Medicare |
$264.88
|
| Rate for Payer: AHCCCS Medicaid |
$35.09
|
| Rate for Payer: Allwell Medicaid |
$35.09
|
| Rate for Payer: Allwell Medicare |
$141.90
|
| Rate for Payer: Amerigroup Medicare |
$141.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$353.33
|
| Rate for Payer: AZCH Complete Medicaid |
$35.09
|
| Rate for Payer: AZCH Complete Medicare |
$141.90
|
| Rate for Payer: Banner UC Health Medicaid |
$35.09
|
| Rate for Payer: Banner UC Health Medicare |
$141.90
|
| Rate for Payer: Bisbee Police All Plans |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$643.28
|
| Rate for Payer: Cash Price |
$756.80
|
| Rate for Payer: Cash Price |
$756.80
|
| Rate for Payer: Cigna of AZ Commercial |
$614.90
|
| Rate for Payer: Copperpoint Commercial |
$234.14
|
| Rate for Payer: Health Net of AZ Commercial |
$567.60
|
| Rate for Payer: Health Net of AZ Medicare |
$264.88
|
| Rate for Payer: Humana of AZ Medicare |
$141.90
|
| Rate for Payer: Mercy Care Medicaid |
$35.09
|
| Rate for Payer: Self Pay Self Pay |
$756.80
|
| Rate for Payer: TriWest Medicare |
$141.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$551.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$170.28
|
|
|
Zika Viru NAA
|
Facility
IP
|
$946.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
22929297
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$245.96 |
| Max. Negotiated Rate |
$851.40 |
| Rate for Payer: Aetna of AZ Commercial |
$851.40
|
| Rate for Payer: Bisbee Police All Plans |
$245.96
|
| Rate for Payer: Cash Price |
$756.80
|
| Rate for Payer: Self Pay Self Pay |
$756.80
|
|
|
zinc oxide Top Oint 56.7gm [CQCH]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 168006202
|
| Hospital Charge Code |
105945790
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of AZ Commercial |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Self Pay Self Pay |
$0.04
|
|
|
zinc oxide Top Oint 56.7gm [CQCH]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 168006202
|
| Hospital Charge Code |
105945790
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of AZ Commercial |
$0.05
|
| 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 |
$0.02
|
| 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 |
$0.04
|
| Rate for Payer: Cigna of AZ Commercial |
$0.03
|
| Rate for Payer: Copperpoint Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Commercial |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.03
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
Zinc, Plasma or Serum LC
|
Facility
OP
|
$262.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
1285555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Aetna of AZ Commercial |
$235.80
|
| Rate for Payer: Aetna of AZ Medicare |
$73.36
|
| Rate for Payer: AHCCCS Medicaid |
$11.39
|
| Rate for Payer: Allwell Medicaid |
$11.39
|
| Rate for Payer: Allwell Medicare |
$39.30
|
| Rate for Payer: Amerigroup Medicare |
$39.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$97.86
|
| Rate for Payer: AZCH Complete Medicaid |
$11.39
|
| Rate for Payer: AZCH Complete Medicare |
$39.30
|
| Rate for Payer: Banner UC Health Medicaid |
$11.39
|
| Rate for Payer: Banner UC Health Medicare |
$39.30
|
| Rate for Payer: Bisbee Police All Plans |
$68.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$178.16
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Cigna of AZ Commercial |
$170.30
|
| Rate for Payer: Copperpoint Commercial |
$64.84
|
| Rate for Payer: Health Net of AZ Commercial |
$157.20
|
| Rate for Payer: Health Net of AZ Medicare |
$73.36
|
| Rate for Payer: Humana of AZ Medicare |
$39.30
|
| Rate for Payer: Mercy Care Medicaid |
$11.39
|
| Rate for Payer: Self Pay Self Pay |
$209.60
|
| Rate for Payer: TriWest Medicare |
$39.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$152.75
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$47.16
|
|
|
Zinc, Plasma or Serum LC
|
Facility
IP
|
$262.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
1285555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.12 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Aetna of AZ Commercial |
$235.80
|
| Rate for Payer: Bisbee Police All Plans |
$68.12
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Self Pay Self Pay |
$209.60
|
|
|
Zinc, Whole Blood LC
|
Facility
IP
|
$149.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
22242095
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of AZ Commercial |
$134.10
|
| Rate for Payer: Bisbee Police All Plans |
$38.74
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Self Pay Self Pay |
$119.20
|
|
|
Zinc, Whole Blood LC
|
Facility
OP
|
$149.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
22242095
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of AZ Commercial |
$134.10
|
| Rate for Payer: Aetna of AZ Medicare |
$41.72
|
| Rate for Payer: AHCCCS Medicaid |
$11.39
|
| Rate for Payer: Allwell Medicaid |
$11.39
|
| Rate for Payer: Allwell Medicare |
$22.35
|
| Rate for Payer: Amerigroup Medicare |
$22.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.65
|
| Rate for Payer: AZCH Complete Medicaid |
$11.39
|
| Rate for Payer: AZCH Complete Medicare |
$22.35
|
| Rate for Payer: Banner UC Health Medicaid |
$11.39
|
| Rate for Payer: Banner UC Health Medicare |
$22.35
|
| Rate for Payer: Bisbee Police All Plans |
$38.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$101.32
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cigna of AZ Commercial |
$96.85
|
| Rate for Payer: Copperpoint Commercial |
$36.88
|
| Rate for Payer: Health Net of AZ Commercial |
$89.40
|
| Rate for Payer: Health Net of AZ Medicare |
$41.72
|
| Rate for Payer: Humana of AZ Medicare |
$22.35
|
| Rate for Payer: Mercy Care Medicaid |
$11.39
|
| Rate for Payer: Self Pay Self Pay |
$119.20
|
| Rate for Payer: TriWest Medicare |
$22.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$86.87
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.82
|
|
|
ziprasidone 40 mg Cap [CQCH]
|
Facility
OP
|
$2.25
|
|
|
Service Code
|
NDC 904627045
|
| Hospital Charge Code |
105945855
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna of AZ Commercial |
$2.02
|
| Rate for Payer: Aetna of AZ Medicare |
$0.63
|
| Rate for Payer: Allwell Medicare |
$0.34
|
| Rate for Payer: Amerigroup Medicare |
$0.34
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.84
|
| Rate for Payer: AZCH Complete Medicare |
$0.34
|
| Rate for Payer: Banner UC Health Medicare |
$0.34
|
| Rate for Payer: Bisbee Police All Plans |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1.46
|
| Rate for Payer: Copperpoint Commercial |
$0.56
|
| Rate for Payer: Health Net of AZ Commercial |
$1.35
|
| Rate for Payer: Health Net of AZ Medicare |
$0.63
|
| Rate for Payer: Humana of AZ Medicare |
$0.34
|
| Rate for Payer: Self Pay Self Pay |
$1.80
|
| Rate for Payer: TriWest Medicare |
$0.34
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.41
|
|
|
ziprasidone 40 mg Cap [CQCH]
|
Facility
IP
|
$2.25
|
|
|
Service Code
|
NDC 904627045
|
| Hospital Charge Code |
105945855
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna of AZ Commercial |
$2.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.59
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Self Pay Self Pay |
$1.80
|
|
|
zoledronic acid 4 mg/100 mL IVPB [CQCH]
|
Facility
OP
|
$0.24
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
105945920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna of AZ Commercial |
$0.22
|
| Rate for Payer: Aetna of AZ Medicare |
$0.07
|
| Rate for Payer: AHCCCS Medicaid |
$21.16
|
| Rate for Payer: Allwell Medicaid |
$21.16
|
| Rate for Payer: Allwell Medicare |
$0.04
|
| Rate for Payer: Amerigroup Medicare |
$0.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.09
|
| Rate for Payer: AZCH Complete Medicaid |
$21.16
|
| Rate for Payer: AZCH Complete Medicare |
$0.04
|
| Rate for Payer: Banner UC Health Medicaid |
$21.16
|
| Rate for Payer: Banner UC Health Medicare |
$0.04
|
| Rate for Payer: Bisbee Police All Plans |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of AZ Commercial |
$0.16
|
| Rate for Payer: Copperpoint Commercial |
$0.06
|
| Rate for Payer: Health Net of AZ Commercial |
$0.14
|
| Rate for Payer: Health Net of AZ Medicare |
$0.07
|
| Rate for Payer: Humana of AZ Medicare |
$0.04
|
| Rate for Payer: Mercy Care Medicaid |
$21.16
|
| Rate for Payer: Self Pay Self Pay |
$0.19
|
| Rate for Payer: TriWest Medicare |
$0.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.14
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.04
|
|
|
zoledronic acid 4 mg/100 mL IVPB [CQCH]
|
Facility
IP
|
$0.24
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
105945920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of AZ Commercial |
$0.22
|
| Rate for Payer: Bisbee Police All Plans |
$0.06
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Self Pay Self Pay |
$0.19
|
|
|
zoledronic acid 5 mg/100 mL IVPB[CQCH]
|
Facility
IP
|
$0.29
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
223969697
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of AZ Commercial |
$0.26
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Self Pay Self Pay |
$0.23
|
|
|
zoledronic acid 5 mg/100 mL IVPB[CQCH]
|
Facility
OP
|
$0.29
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
223969697
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna of AZ Commercial |
$0.26
|
| Rate for Payer: Aetna of AZ Medicare |
$0.08
|
| Rate for Payer: AHCCCS Medicaid |
$21.16
|
| Rate for Payer: Allwell Medicaid |
$21.16
|
| Rate for Payer: Allwell Medicare |
$0.04
|
| Rate for Payer: Amerigroup Medicare |
$0.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.11
|
| Rate for Payer: AZCH Complete Medicaid |
$21.16
|
| Rate for Payer: AZCH Complete Medicare |
$0.04
|
| Rate for Payer: Banner UC Health Medicaid |
$21.16
|
| Rate for Payer: Banner UC Health Medicare |
$0.04
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of AZ Commercial |
$0.19
|
| Rate for Payer: Copperpoint Commercial |
$0.07
|
| Rate for Payer: Health Net of AZ Commercial |
$0.17
|
| Rate for Payer: Health Net of AZ Medicare |
$0.08
|
| Rate for Payer: Humana of AZ Medicare |
$0.04
|
| Rate for Payer: Mercy Care Medicaid |
$21.16
|
| Rate for Payer: Self Pay Self Pay |
$0.23
|
| Rate for Payer: TriWest Medicare |
$0.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.17
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.05
|
|
|
zolpidem 5 mg Tab [CQCH]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 16714062101
|
| Hospital Charge Code |
105945989
|
|
Hospital Revenue Code
|
251
|
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of AZ Commercial |
$0.03
|
| 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 |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of AZ Commercial |
$0.02
|
| 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 |
$0.00
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
| Rate for Payer: TriWest Medicare |
$0.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
zolpidem 5 mg Tab [CQCH]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 16714062101
|
| Hospital Charge Code |
105945989
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of AZ Commercial |
$0.03
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
|
|
Zonisamide(Zonegran), Serum LC
|
Facility
OP
|
$343.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1285611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$308.70 |
| Rate for Payer: Aetna of AZ Commercial |
$308.70
|
| Rate for Payer: Aetna of AZ Medicare |
$96.04
|
| Rate for Payer: AHCCCS Medicaid |
$24.09
|
| Rate for Payer: Allwell Medicaid |
$24.09
|
| Rate for Payer: Allwell Medicare |
$51.45
|
| Rate for Payer: Amerigroup Medicare |
$51.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$128.11
|
| Rate for Payer: AZCH Complete Medicaid |
$24.09
|
| Rate for Payer: AZCH Complete Medicare |
$51.45
|
| Rate for Payer: Banner UC Health Medicaid |
$24.09
|
| Rate for Payer: Banner UC Health Medicare |
$51.45
|
| Rate for Payer: Bisbee Police All Plans |
$89.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$233.24
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cigna of AZ Commercial |
$222.95
|
| Rate for Payer: Copperpoint Commercial |
$84.89
|
| Rate for Payer: Health Net of AZ Commercial |
$205.80
|
| Rate for Payer: Health Net of AZ Medicare |
$96.04
|
| Rate for Payer: Humana of AZ Medicare |
$51.45
|
| Rate for Payer: Mercy Care Medicaid |
$24.09
|
| Rate for Payer: Self Pay Self Pay |
$274.40
|
| Rate for Payer: TriWest Medicare |
$51.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$199.97
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$61.74
|
|
|
Zonisamide(Zonegran), Serum LC
|
Facility
IP
|
$343.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1285611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$308.70 |
| Rate for Payer: Aetna of AZ Commercial |
$308.70
|
| Rate for Payer: Bisbee Police All Plans |
$89.18
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Self Pay Self Pay |
$274.40
|
|
|
zoster vaccine, inactivated adjuvanted REC[CQCH]
|
Facility
IP
|
$133.99
|
|
|
Service Code
|
NDC 58160082311
|
| Hospital Charge Code |
136004511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Aetna of AZ Commercial |
$120.59
|
| Rate for Payer: Bisbee Police All Plans |
$34.84
|
| Rate for Payer: Cash Price |
$107.19
|
| Rate for Payer: Self Pay Self Pay |
$107.19
|
|
