|
ziprasidone 40 mg Cap [CQCH]
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 904627045
|
| Hospital Charge Code |
105945855
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.36 |
| 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 |
$0.36
|
| Rate for Payer: Amerigroup Medicare |
$0.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.84
|
| Rate for Payer: AZCH Complete Medicare |
$0.36
|
| Rate for Payer: Banner UC Health Medicare |
$0.36
|
| 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 |
$0.36
|
| Rate for Payer: Self Pay Self Pay |
$1.80
|
| Rate for Payer: TriWest Medicare |
$0.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.41
|
|
|
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 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 |
$0.22 |
| Rate for Payer: Aetna of AZ Commercial |
$0.22
|
| Rate for Payer: Aetna of AZ Medicare |
$0.07
|
| 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 Medicare |
$0.04
|
| 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: 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: 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 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 |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of AZ Commercial |
$0.26
|
| Rate for Payer: Aetna of AZ Medicare |
$0.08
|
| Rate for Payer: Allwell Medicare |
$0.05
|
| Rate for Payer: Amerigroup Medicare |
$0.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.11
|
| Rate for Payer: AZCH Complete Medicare |
$0.05
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| 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: 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 |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.23
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.17
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.05
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
Zonisamide(Zonegran), Serum LC
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1285611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.88 |
| 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: Allwell Medicare |
$54.88
|
| Rate for Payer: Amerigroup Medicare |
$54.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$128.11
|
| Rate for Payer: AZCH Complete Medicare |
$54.88
|
| Rate for Payer: Banner UC Health Medicare |
$54.88
|
| 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: 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 |
$54.88
|
| Rate for Payer: Self Pay Self Pay |
$274.40
|
| Rate for Payer: TriWest Medicare |
$54.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$199.97
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$61.74
|
|
|
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
|
|
|
zoster vaccine, inactivated adjuvanted REC[CQCH]
|
Facility
|
OP
|
$133.99
|
|
|
Service Code
|
NDC 58160082311
|
| Hospital Charge Code |
136004511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.44 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Aetna of AZ Commercial |
$120.59
|
| Rate for Payer: Aetna of AZ Medicare |
$37.52
|
| Rate for Payer: Allwell Medicare |
$21.44
|
| Rate for Payer: Amerigroup Medicare |
$21.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$50.05
|
| Rate for Payer: AZCH Complete Medicare |
$21.44
|
| Rate for Payer: Banner UC Health Medicare |
$21.44
|
| Rate for Payer: Bisbee Police All Plans |
$34.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$91.11
|
| Rate for Payer: Cash Price |
$107.19
|
| Rate for Payer: Cigna of AZ Commercial |
$87.09
|
| Rate for Payer: Copperpoint Commercial |
$33.16
|
| Rate for Payer: Health Net of AZ Commercial |
$80.39
|
| Rate for Payer: Health Net of AZ Medicare |
$37.52
|
| Rate for Payer: Humana of AZ Medicare |
$21.44
|
| Rate for Payer: Self Pay Self Pay |
$107.19
|
| Rate for Payer: TriWest Medicare |
$21.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$78.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$24.12
|
|
