|
BULB IRRIG W/TUBING PATH FINDER
|
Facility
|
OP
|
$410.95
|
|
| Hospital Charge Code |
22354307
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$369.86 |
| Rate for Payer: Aetna of AZ Commercial |
$369.86
|
| Rate for Payer: Aetna of AZ Medicare |
$115.07
|
| Rate for Payer: Allwell Medicare |
$61.64
|
| Rate for Payer: Amerigroup Medicare |
$61.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$153.49
|
| Rate for Payer: AZCH Complete Medicare |
$61.64
|
| Rate for Payer: Banner UC Health Medicare |
$61.64
|
| Rate for Payer: Bisbee Police All Plans |
$106.85
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$279.45
|
| Rate for Payer: Cash Price |
$328.76
|
| Rate for Payer: Cigna of AZ Commercial |
$287.66
|
| Rate for Payer: Copperpoint Commercial |
$101.71
|
| Rate for Payer: Health Net of AZ Commercial |
$246.57
|
| Rate for Payer: Health Net of AZ Medicare |
$115.07
|
| Rate for Payer: Humana of AZ Medicare |
$61.64
|
| Rate for Payer: Self Pay Self Pay |
$328.76
|
| Rate for Payer: TriWest Medicare |
$61.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$239.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$73.97
|
|
|
BULB IRRIG W/TUBING PATH FINDER
|
Facility
|
IP
|
$410.95
|
|
| Hospital Charge Code |
22354307
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.85 |
| Max. Negotiated Rate |
$369.86 |
| Rate for Payer: Aetna of AZ Commercial |
$369.86
|
| Rate for Payer: Bisbee Police All Plans |
$106.85
|
| Rate for Payer: Cash Price |
$328.76
|
| Rate for Payer: Self Pay Self Pay |
$328.76
|
|
|
Bulkamid INJECTION OF IMPLANT MATERIAL BENEATH LINING OF BLA
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
26811662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.32 |
| Max. Negotiated Rate |
$973.80 |
| Rate for Payer: Aetna of AZ Commercial |
$973.80
|
| Rate for Payer: Bisbee Police All Plans |
$281.32
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Self Pay Self Pay |
$865.60
|
|
|
Bulkamid INJECTION OF IMPLANT MATERIAL BENEATH LINING OF BLA
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
26811662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$162.30 |
| Max. Negotiated Rate |
$4,460.70 |
| Rate for Payer: Aetna of AZ Commercial |
$973.80
|
| Rate for Payer: Aetna of AZ Medicare |
$302.96
|
| Rate for Payer: AHCCCS Medicaid |
$4,460.70
|
| Rate for Payer: Allwell Medicaid |
$4,460.70
|
| Rate for Payer: Allwell Medicare |
$162.30
|
| Rate for Payer: Amerigroup Medicare |
$162.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$404.13
|
| Rate for Payer: AZCH Complete Medicaid |
$4,460.70
|
| Rate for Payer: AZCH Complete Medicare |
$162.30
|
| Rate for Payer: Banner UC Health Medicaid |
$4,460.70
|
| Rate for Payer: Banner UC Health Medicare |
$162.30
|
| Rate for Payer: Bisbee Police All Plans |
$281.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$735.76
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cigna of AZ Commercial |
$541.00
|
| Rate for Payer: Copperpoint Commercial |
$267.80
|
| Rate for Payer: Health Net of AZ Commercial |
$649.20
|
| Rate for Payer: Health Net of AZ Medicare |
$302.96
|
| Rate for Payer: Humana of AZ Medicare |
$162.30
|
| Rate for Payer: Mercy Care Medicaid |
$4,460.70
|
| Rate for Payer: Self Pay Self Pay |
$865.60
|
| Rate for Payer: TriWest Medicare |
$162.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$194.76
|
|
|
bumetanide 1 mg/ 4 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$0.68
|
|
|
Service Code
|
NDC 641600810
|
| Hospital Charge Code |
105913379
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of AZ Commercial |
$0.61
|
| Rate for Payer: Bisbee Police All Plans |
$0.18
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Self Pay Self Pay |
$0.54
|
|
|
bumetanide 1 mg/ 4 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$0.68
|
|
|
Service Code
|
NDC 641600810
|
| Hospital Charge Code |
105913379
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of AZ Commercial |
$0.61
|
| Rate for Payer: Aetna of AZ Medicare |
$0.19
|
| Rate for Payer: Allwell Medicare |
$0.10
|
| Rate for Payer: Amerigroup Medicare |
$0.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.25
|
| Rate for Payer: AZCH Complete Medicare |
$0.10
|
| Rate for Payer: Banner UC Health Medicare |
$0.10
|
| Rate for Payer: Bisbee Police All Plans |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of AZ Commercial |
$0.44
|
| Rate for Payer: Copperpoint Commercial |
$0.17
|
| Rate for Payer: Health Net of AZ Commercial |
$0.41
|
| Rate for Payer: Health Net of AZ Medicare |
$0.19
|
| Rate for Payer: Humana of AZ Medicare |
$0.10
|
| Rate for Payer: Self Pay Self Pay |
$0.54
|
| Rate for Payer: TriWest Medicare |
$0.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.12
|
|
|
bumetanide 2.5 mg/10 mL Sol [CQCH]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 641600710
|
| Hospital Charge Code |
154090077
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of AZ Commercial |
$0.25
|
| Rate for Payer: Aetna of AZ Medicare |
$0.08
|
| Rate for Payer: Allwell Medicare |
$0.04
|
| Rate for Payer: Amerigroup Medicare |
$0.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.10
|
| Rate for Payer: AZCH Complete Medicare |
$0.04
|
| Rate for Payer: Banner UC Health Medicare |
$0.04
|
| Rate for Payer: Bisbee Police All Plans |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of AZ Commercial |
$0.18
|
| 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: Self Pay Self Pay |
$0.22
|
| Rate for Payer: TriWest Medicare |
$0.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.16
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.05
|
|
|
bumetanide 2.5 mg/10 mL Sol [CQCH]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 641600710
|
| Hospital Charge Code |
154090077
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of AZ Commercial |
$0.25
|
| Rate for Payer: Bisbee Police All Plans |
$0.07
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Self Pay Self Pay |
$0.22
|
|
|
BUN+Creat(Dialysate) LC
|
Facility
|
IP
|
$91.00
|
|
| Hospital Charge Code |
22311179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of AZ Commercial |
$81.90
|
| Rate for Payer: Bisbee Police All Plans |
$23.66
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Self Pay Self Pay |
$72.80
|
|
|
BUN+Creat(Dialysate) LC
|
Facility
|
OP
|
$91.00
|
|
| Hospital Charge Code |
22311179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of AZ Commercial |
$81.90
|
| Rate for Payer: Aetna of AZ Medicare |
$25.48
|
| Rate for Payer: Allwell Medicare |
$13.65
|
| Rate for Payer: Amerigroup Medicare |
$13.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$33.99
|
| Rate for Payer: AZCH Complete Medicare |
$13.65
|
| Rate for Payer: Banner UC Health Medicare |
$13.65
|
| Rate for Payer: Bisbee Police All Plans |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$61.88
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cigna of AZ Commercial |
$59.15
|
| Rate for Payer: Copperpoint Commercial |
$22.52
|
| Rate for Payer: Health Net of AZ Commercial |
$54.60
|
| Rate for Payer: Health Net of AZ Medicare |
$25.48
|
| Rate for Payer: Humana of AZ Medicare |
$13.65
|
| Rate for Payer: Self Pay Self Pay |
$72.80
|
| Rate for Payer: TriWest Medicare |
$13.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$53.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$16.38
|
|
|
BUN/Creat Ratio
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
22146068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna of AZ Commercial |
$60.30
|
| Rate for Payer: Bisbee Police All Plans |
$17.42
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Self Pay Self Pay |
$53.60
|
|
|
BUN/Creat Ratio
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
22146068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna of AZ Commercial |
$60.30
|
| Rate for Payer: Aetna of AZ Medicare |
$18.76
|
| Rate for Payer: AHCCCS Medicaid |
$3.95
|
| Rate for Payer: Allwell Medicaid |
$3.95
|
| Rate for Payer: Allwell Medicare |
$10.05
|
| Rate for Payer: Amerigroup Medicare |
$10.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$25.02
|
| Rate for Payer: AZCH Complete Medicaid |
$3.95
|
| Rate for Payer: AZCH Complete Medicare |
$10.05
|
| Rate for Payer: Banner UC Health Medicaid |
$3.95
|
| Rate for Payer: Banner UC Health Medicare |
$10.05
|
| Rate for Payer: Bisbee Police All Plans |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$45.56
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cigna of AZ Commercial |
$43.55
|
| Rate for Payer: Copperpoint Commercial |
$16.58
|
| Rate for Payer: Health Net of AZ Commercial |
$40.20
|
| Rate for Payer: Health Net of AZ Medicare |
$18.76
|
| Rate for Payer: Humana of AZ Medicare |
$10.05
|
| Rate for Payer: Mercy Care Medicaid |
$3.95
|
| Rate for Payer: Self Pay Self Pay |
$53.60
|
| Rate for Payer: TriWest Medicare |
$10.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$39.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.06
|
|
|
bupivacaine 0.5% PF Inj Sol 30 mL [CQCH]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 409116202
|
| Hospital Charge Code |
105913448
|
|
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 |
$0.02
|
| 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 |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of AZ Commercial |
$0.04
|
| Rate for Payer: Copperpoint Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Commercial |
$0.04
|
| Rate for Payer: Health Net of AZ Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.05
|
| 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
|
|
|
bupivacaine 0.5% PF Inj Sol 30 mL [CQCH]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 409116202
|
| Hospital Charge Code |
105913448
|
|
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
|
|
|
BUPivacaine 0.5% preservative-free Sol[CQCH]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 63323046617
|
| Hospital Charge Code |
215925728
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of AZ Commercial |
$0.09
|
| Rate for Payer: Aetna of AZ Medicare |
$0.03
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.04
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of AZ Commercial |
$0.07
|
| Rate for Payer: Copperpoint Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Commercial |
$0.06
|
| Rate for Payer: Health Net of AZ Medicare |
$0.03
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.08
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
|
BUPivacaine 0.5% preservative-free Sol[CQCH]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 63323046617
|
| Hospital Charge Code |
215925728
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of AZ Commercial |
$0.09
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Self Pay Self Pay |
$0.08
|
|
|
bupivacaine-EPINEPHrine 0.5%-1:200,000 PF Inj Sol 50 mL [CQCH]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 63323046357
|
| Hospital Charge Code |
105913586
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of AZ Commercial |
$0.07
|
| Rate for Payer: Aetna of AZ Medicare |
$0.02
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.03
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of AZ Commercial |
$0.05
|
| Rate for Payer: Copperpoint Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Commercial |
$0.05
|
| Rate for Payer: Health Net of AZ Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
bupivacaine-EPINEPHrine 0.5%-1:200,000 PF Inj Sol 50 mL [CQCH]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 63323046357
|
| Hospital Charge Code |
105913586
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of AZ Commercial |
$0.07
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
|
|
bupivacaine-epinephrine 0.5%-1:200,000 preservative-free Sol[CQCH]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 63323046217
|
| Hospital Charge Code |
156706442
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of AZ Commercial |
$0.32
|
| Rate for Payer: Aetna of AZ Medicare |
$0.10
|
| Rate for Payer: Allwell Medicare |
$0.05
|
| Rate for Payer: Amerigroup Medicare |
$0.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$0.05
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.24
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of AZ Commercial |
$0.23
|
| Rate for Payer: Copperpoint Commercial |
$0.09
|
| Rate for Payer: Health Net of AZ Commercial |
$0.21
|
| Rate for Payer: Health Net of AZ Medicare |
$0.10
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Self Pay Self Pay |
$0.28
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.06
|
|
|
bupivacaine-epinephrine 0.5%-1:200,000 preservative-free Sol[CQCH]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 63323046217
|
| Hospital Charge Code |
156706442
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of AZ Commercial |
$0.32
|
| Rate for Payer: Bisbee Police All Plans |
$0.09
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Self Pay Self Pay |
$0.28
|
|
|
buprenorphine 8 mg Tab [CQCH]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
HCPCS J0571
|
| Hospital Charge Code |
224460214
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of AZ Commercial |
$0.49
|
| Rate for Payer: Aetna of AZ Medicare |
$0.15
|
| Rate for Payer: AHCCCS Medicaid |
$0.98
|
| Rate for Payer: Allwell Medicaid |
$0.98
|
| Rate for Payer: Allwell Medicare |
$0.08
|
| Rate for Payer: Amerigroup Medicare |
$0.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.20
|
| Rate for Payer: AZCH Complete Medicaid |
$0.98
|
| Rate for Payer: AZCH Complete Medicare |
$0.08
|
| Rate for Payer: Banner UC Health Medicaid |
$0.98
|
| Rate for Payer: Banner UC Health Medicare |
$0.08
|
| Rate for Payer: Bisbee Police All Plans |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.37
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of AZ Commercial |
$0.35
|
| Rate for Payer: Copperpoint Commercial |
$0.13
|
| Rate for Payer: Health Net of AZ Commercial |
$0.32
|
| Rate for Payer: Health Net of AZ Medicare |
$0.15
|
| Rate for Payer: Humana of AZ Medicare |
$0.08
|
| Rate for Payer: Mercy Care Medicaid |
$0.98
|
| Rate for Payer: Self Pay Self Pay |
$0.43
|
| Rate for Payer: TriWest Medicare |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.10
|
|
|
buprenorphine 8 mg Tab [CQCH]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
HCPCS J0571
|
| Hospital Charge Code |
224460214
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna of AZ Commercial |
$0.49
|
| Rate for Payer: Bisbee Police All Plans |
$0.14
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Self Pay Self Pay |
$0.43
|
|
|
buPROPion 150 mg DR Tab [CQCH]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 904658561
|
| Hospital Charge Code |
105913649
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of AZ Commercial |
$0.44
|
| Rate for Payer: Bisbee Police All Plans |
$0.13
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Self Pay Self Pay |
$0.39
|
|
|
buPROPion 150 mg DR Tab [CQCH]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 904658561
|
| Hospital Charge Code |
105913649
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of AZ Commercial |
$0.44
|
| Rate for Payer: Aetna of AZ Medicare |
$0.14
|
| Rate for Payer: Allwell Medicare |
$0.07
|
| Rate for Payer: Amerigroup Medicare |
$0.07
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.18
|
| Rate for Payer: AZCH Complete Medicare |
$0.07
|
| Rate for Payer: Banner UC Health Medicare |
$0.07
|
| Rate for Payer: Bisbee Police All Plans |
$0.13
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of AZ Commercial |
$0.32
|
| Rate for Payer: Copperpoint Commercial |
$0.12
|
| Rate for Payer: Health Net of AZ Commercial |
$0.29
|
| Rate for Payer: Health Net of AZ Medicare |
$0.14
|
| Rate for Payer: Humana of AZ Medicare |
$0.07
|
| Rate for Payer: Self Pay Self Pay |
$0.39
|
| Rate for Payer: TriWest Medicare |
$0.07
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.29
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.09
|
|
|
Burch (secondary repair)
|
Facility
|
OP
|
$4,342.00
|
|
|
Service Code
|
CPT 51841
|
| Hospital Charge Code |
27267813
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3,907.80 |
| Rate for Payer: Aetna of AZ Commercial |
$3,907.80
|
| Rate for Payer: Aetna of AZ Medicare |
$1,215.76
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$651.30
|
| Rate for Payer: Amerigroup Medicare |
$651.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,621.74
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$651.30
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$651.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,128.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,952.56
|
| Rate for Payer: Cash Price |
$3,473.60
|
| Rate for Payer: Cash Price |
$3,473.60
|
| Rate for Payer: Cigna of AZ Commercial |
$2,171.00
|
| Rate for Payer: Copperpoint Commercial |
$1,074.64
|
| Rate for Payer: Health Net of AZ Commercial |
$2,605.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,215.76
|
| Rate for Payer: Humana of AZ Medicare |
$651.30
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$3,473.60
|
| Rate for Payer: TriWest Medicare |
$651.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$781.56
|
|
