|
butorphanol 2 mg/mL Sol[CQCH]
|
Facility
|
OP
|
$4.73
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
133556199
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Aetna of AZ Commercial |
$4.26
|
| Rate for Payer: Aetna of AZ Medicare |
$1.32
|
| Rate for Payer: AHCCCS Medicaid |
$6.72
|
| Rate for Payer: Allwell Medicaid |
$6.72
|
| Rate for Payer: Allwell Medicare |
$0.71
|
| Rate for Payer: Amerigroup Medicare |
$0.71
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.77
|
| Rate for Payer: AZCH Complete Medicaid |
$6.72
|
| Rate for Payer: AZCH Complete Medicare |
$0.71
|
| Rate for Payer: Banner UC Health Medicaid |
$6.72
|
| Rate for Payer: Banner UC Health Medicare |
$0.71
|
| Rate for Payer: Bisbee Police All Plans |
$1.23
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.22
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of AZ Commercial |
$3.07
|
| Rate for Payer: Copperpoint Commercial |
$1.17
|
| Rate for Payer: Health Net of AZ Commercial |
$2.84
|
| Rate for Payer: Health Net of AZ Medicare |
$1.32
|
| Rate for Payer: Humana of AZ Medicare |
$0.71
|
| Rate for Payer: Mercy Care Medicaid |
$6.72
|
| Rate for Payer: Self Pay Self Pay |
$3.78
|
| Rate for Payer: TriWest Medicare |
$0.71
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.85
|
|
|
butorphanol 2 mg/mL Sol[CQCH]
|
Facility
|
IP
|
$4.73
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
133556199
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna of AZ Commercial |
$4.26
|
| Rate for Payer: Bisbee Police All Plans |
$1.23
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Self Pay Self Pay |
$3.78
|
|
|
CA 15-3 (Serial Monitor) LC
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
22311180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Aetna of AZ Commercial |
$236.70
|
| Rate for Payer: Aetna of AZ Medicare |
$73.64
|
| Rate for Payer: AHCCCS Medicaid |
$20.81
|
| Rate for Payer: Allwell Medicaid |
$20.81
|
| Rate for Payer: Allwell Medicare |
$39.45
|
| Rate for Payer: Amerigroup Medicare |
$39.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$98.23
|
| Rate for Payer: AZCH Complete Medicaid |
$20.81
|
| Rate for Payer: AZCH Complete Medicare |
$39.45
|
| Rate for Payer: Banner UC Health Medicaid |
$20.81
|
| Rate for Payer: Banner UC Health Medicare |
$39.45
|
| Rate for Payer: Bisbee Police All Plans |
$68.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$178.84
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cigna of AZ Commercial |
$170.95
|
| Rate for Payer: Copperpoint Commercial |
$65.09
|
| Rate for Payer: Health Net of AZ Commercial |
$157.80
|
| Rate for Payer: Health Net of AZ Medicare |
$73.64
|
| Rate for Payer: Humana of AZ Medicare |
$39.45
|
| Rate for Payer: Mercy Care Medicaid |
$20.81
|
| Rate for Payer: Self Pay Self Pay |
$210.40
|
| Rate for Payer: TriWest Medicare |
$39.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$153.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$47.34
|
|
|
CA 15-3 (Serial Monitor) LC
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
22311180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.38 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Aetna of AZ Commercial |
$236.70
|
| Rate for Payer: Bisbee Police All Plans |
$68.38
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Self Pay Self Pay |
$210.40
|
|
|
CA 27.29 LC
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
2270021
|
|
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
|
|
|
CA 27.29 LC
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
2270021
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| 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: AHCCCS Medicaid |
$20.81
|
| Rate for Payer: Allwell Medicaid |
$20.81
|
| Rate for Payer: Allwell Medicare |
$43.50
|
| Rate for Payer: Amerigroup Medicare |
$43.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$108.32
|
| Rate for Payer: AZCH Complete Medicaid |
$20.81
|
| Rate for Payer: AZCH Complete Medicare |
$43.50
|
| Rate for Payer: Banner UC Health Medicaid |
$20.81
|
| Rate for Payer: Banner UC Health Medicare |
$43.50
|
| 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: 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 |
$43.50
|
| Rate for Payer: Mercy Care Medicaid |
$20.81
|
| Rate for Payer: Self Pay Self Pay |
$232.00
|
| Rate for Payer: TriWest Medicare |
$43.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$169.07
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$52.20
|
|
|
calcitonin 200 intl units/inh Nasal Spry [CQCH]
|
Facility
|
OP
|
$9.43
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
105913923
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$8.49 |
| Rate for Payer: Aetna of AZ Commercial |
$8.49
|
| Rate for Payer: Aetna of AZ Medicare |
$2.64
|
| Rate for Payer: Allwell Medicare |
$1.41
|
| Rate for Payer: Amerigroup Medicare |
$1.41
|
| Rate for Payer: APIPA Medicare/Medicaid |
$3.52
|
| Rate for Payer: AZCH Complete Medicare |
$1.41
|
| Rate for Payer: Banner UC Health Medicare |
$1.41
|
| Rate for Payer: Bisbee Police All Plans |
$2.45
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$6.41
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cigna of AZ Commercial |
$6.13
|
| Rate for Payer: Copperpoint Commercial |
$2.33
|
| Rate for Payer: Health Net of AZ Commercial |
$5.66
|
| Rate for Payer: Health Net of AZ Medicare |
$2.64
|
| Rate for Payer: Humana of AZ Medicare |
$1.41
|
| Rate for Payer: Self Pay Self Pay |
$7.54
|
| Rate for Payer: TriWest Medicare |
$1.41
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.70
|
|
|
calcitonin 200 intl units/inh Nasal Spry [CQCH]
|
Facility
|
IP
|
$9.43
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
105913923
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$8.49 |
| Rate for Payer: Aetna of AZ Commercial |
$8.49
|
| Rate for Payer: Bisbee Police All Plans |
$2.45
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Self Pay Self Pay |
$7.54
|
|
|
calcitonin 200 intl units/mL Inj Sol [CQCH]
|
Facility
|
OP
|
$480.12
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
105913850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$3,100.62 |
| Rate for Payer: Aetna of AZ Commercial |
$432.11
|
| Rate for Payer: Aetna of AZ Medicare |
$134.43
|
| Rate for Payer: AHCCCS Medicaid |
$3,100.62
|
| Rate for Payer: Allwell Medicaid |
$3,100.62
|
| Rate for Payer: Allwell Medicare |
$72.02
|
| Rate for Payer: Amerigroup Medicare |
$72.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$179.32
|
| Rate for Payer: AZCH Complete Medicaid |
$3,100.62
|
| Rate for Payer: AZCH Complete Medicare |
$72.02
|
| Rate for Payer: Banner UC Health Medicaid |
$3,100.62
|
| Rate for Payer: Banner UC Health Medicare |
$72.02
|
| Rate for Payer: Bisbee Police All Plans |
$124.83
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$326.48
|
| Rate for Payer: Cash Price |
$384.09
|
| Rate for Payer: Cash Price |
$384.09
|
| Rate for Payer: Cigna of AZ Commercial |
$312.08
|
| Rate for Payer: Copperpoint Commercial |
$118.83
|
| Rate for Payer: Health Net of AZ Commercial |
$288.07
|
| Rate for Payer: Health Net of AZ Medicare |
$134.43
|
| Rate for Payer: Humana of AZ Medicare |
$72.02
|
| Rate for Payer: Mercy Care Medicaid |
$3,100.62
|
| Rate for Payer: Self Pay Self Pay |
$384.10
|
| Rate for Payer: TriWest Medicare |
$72.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$279.91
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$86.42
|
|
|
calcitonin 200 intl units/mL Inj Sol [CQCH]
|
Facility
|
IP
|
$480.12
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
105913850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$124.83 |
| Max. Negotiated Rate |
$432.11 |
| Rate for Payer: Aetna of AZ Commercial |
$432.11
|
| Rate for Payer: Bisbee Police All Plans |
$124.83
|
| Rate for Payer: Cash Price |
$384.09
|
| Rate for Payer: Self Pay Self Pay |
$384.10
|
|
|
calcitriol 0.25 mcg Oral Cap [CQCH]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
105913988
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of AZ Commercial |
$0.50
|
| Rate for Payer: Bisbee Police All Plans |
$0.15
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Self Pay Self Pay |
$0.45
|
|
|
calcitriol 0.25 mcg Oral Cap [CQCH]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
105913988
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of AZ Commercial |
$0.50
|
| Rate for Payer: Aetna of AZ Medicare |
$0.16
|
| Rate for Payer: Allwell Medicare |
$0.08
|
| Rate for Payer: Amerigroup Medicare |
$0.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.21
|
| Rate for Payer: AZCH Complete Medicare |
$0.08
|
| Rate for Payer: Banner UC Health Medicare |
$0.08
|
| Rate for Payer: Bisbee Police All Plans |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of AZ Commercial |
$0.36
|
| Rate for Payer: Copperpoint Commercial |
$0.14
|
| Rate for Payer: Health Net of AZ Commercial |
$0.34
|
| Rate for Payer: Health Net of AZ Medicare |
$0.16
|
| Rate for Payer: Humana of AZ Medicare |
$0.08
|
| Rate for Payer: Self Pay Self Pay |
$0.45
|
| Rate for Payer: TriWest Medicare |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.10
|
|
|
Calcitriol(1,25 di-OH Vit D) LC
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
1905607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$511.20 |
| Rate for Payer: Aetna of AZ Commercial |
$511.20
|
| Rate for Payer: Aetna of AZ Medicare |
$159.04
|
| Rate for Payer: AHCCCS Medicaid |
$38.50
|
| Rate for Payer: Allwell Medicaid |
$38.50
|
| Rate for Payer: Allwell Medicare |
$85.20
|
| Rate for Payer: Amerigroup Medicare |
$85.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$212.15
|
| Rate for Payer: AZCH Complete Medicaid |
$38.50
|
| Rate for Payer: AZCH Complete Medicare |
$85.20
|
| Rate for Payer: Banner UC Health Medicaid |
$38.50
|
| Rate for Payer: Banner UC Health Medicare |
$85.20
|
| Rate for Payer: Bisbee Police All Plans |
$147.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$386.24
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cigna of AZ Commercial |
$369.20
|
| Rate for Payer: Copperpoint Commercial |
$140.58
|
| Rate for Payer: Health Net of AZ Commercial |
$340.80
|
| Rate for Payer: Health Net of AZ Medicare |
$159.04
|
| Rate for Payer: Humana of AZ Medicare |
$85.20
|
| Rate for Payer: Mercy Care Medicaid |
$38.50
|
| Rate for Payer: Self Pay Self Pay |
$454.40
|
| Rate for Payer: TriWest Medicare |
$85.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$331.14
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$102.24
|
|
|
Calcitriol(1,25 di-OH Vit D) LC
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
1905607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$147.68 |
| Max. Negotiated Rate |
$511.20 |
| Rate for Payer: Aetna of AZ Commercial |
$511.20
|
| Rate for Payer: Bisbee Police All Plans |
$147.68
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Self Pay Self Pay |
$454.40
|
|
|
Calcium, 24Hr Urine LC
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
1285720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Bisbee Police All Plans |
$20.28
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
|
|
Calcium, 24Hr Urine LC
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
1285720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Aetna of AZ Medicare |
$21.84
|
| Rate for Payer: AHCCCS Medicaid |
$6.03
|
| Rate for Payer: Allwell Medicaid |
$6.03
|
| Rate for Payer: Allwell Medicare |
$11.70
|
| Rate for Payer: Amerigroup Medicare |
$11.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$29.13
|
| Rate for Payer: AZCH Complete Medicaid |
$6.03
|
| Rate for Payer: AZCH Complete Medicare |
$11.70
|
| Rate for Payer: Banner UC Health Medicaid |
$6.03
|
| Rate for Payer: Banner UC Health Medicare |
$11.70
|
| Rate for Payer: Bisbee Police All Plans |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$53.04
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna of AZ Commercial |
$50.70
|
| Rate for Payer: Copperpoint Commercial |
$19.30
|
| Rate for Payer: Health Net of AZ Commercial |
$46.80
|
| Rate for Payer: Health Net of AZ Medicare |
$21.84
|
| Rate for Payer: Humana of AZ Medicare |
$11.70
|
| Rate for Payer: Mercy Care Medicaid |
$6.03
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
| Rate for Payer: TriWest Medicare |
$11.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$45.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.04
|
|
|
calcium acetate 667 mg Cap UD [CQCH]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 68084047901
|
| Hospital Charge Code |
107994427
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of AZ Commercial |
$0.94
|
| Rate for Payer: Aetna of AZ Medicare |
$0.29
|
| Rate for Payer: Allwell Medicare |
$0.16
|
| Rate for Payer: Amerigroup Medicare |
$0.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.39
|
| Rate for Payer: AZCH Complete Medicare |
$0.16
|
| Rate for Payer: Banner UC Health Medicare |
$0.16
|
| Rate for Payer: Bisbee Police All Plans |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cigna of AZ Commercial |
$0.68
|
| Rate for Payer: Copperpoint Commercial |
$0.26
|
| Rate for Payer: Health Net of AZ Commercial |
$0.62
|
| Rate for Payer: Health Net of AZ Medicare |
$0.29
|
| Rate for Payer: Humana of AZ Medicare |
$0.16
|
| Rate for Payer: Self Pay Self Pay |
$0.83
|
| Rate for Payer: TriWest Medicare |
$0.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.61
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.19
|
|
|
calcium acetate 667 mg Cap UD [CQCH]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 68084047901
|
| Hospital Charge Code |
107994427
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of AZ Commercial |
$0.94
|
| Rate for Payer: Bisbee Police All Plans |
$0.27
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Self Pay Self Pay |
$0.83
|
|
|
calcium carbonate 500 mg Chew Tab [CQCH]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 66553000401
|
| Hospital Charge Code |
105914049
|
|
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
|
|
|
calcium carbonate 500 mg Chew Tab [CQCH]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 66553000401
|
| Hospital Charge Code |
105914049
|
|
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
|
|
|
calcium carbonate 500 mg Tab (Oscal) [CQCH]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 904188361
|
| Hospital Charge Code |
105914116
|
|
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 |
$0.02
|
| 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
|
|
|
calcium carbonate 500 mg Tab (Oscal) [CQCH]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 904188361
|
| Hospital Charge Code |
105914116
|
|
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 |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
|
|
calcium chloride 1 gm/ 10 ml PFS [CQCH]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 409163110
|
| Hospital Charge Code |
105914181
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of AZ Commercial |
$0.56
|
| Rate for Payer: Aetna of AZ Medicare |
$0.17
|
| Rate for Payer: Allwell Medicare |
$0.09
|
| Rate for Payer: Amerigroup Medicare |
$0.09
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.23
|
| Rate for Payer: AZCH Complete Medicare |
$0.09
|
| Rate for Payer: Banner UC Health Medicare |
$0.09
|
| Rate for Payer: Bisbee Police All Plans |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.42
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of AZ Commercial |
$0.40
|
| Rate for Payer: Copperpoint Commercial |
$0.15
|
| Rate for Payer: Health Net of AZ Commercial |
$0.37
|
| Rate for Payer: Health Net of AZ Medicare |
$0.17
|
| Rate for Payer: Humana of AZ Medicare |
$0.09
|
| Rate for Payer: Self Pay Self Pay |
$0.50
|
| Rate for Payer: TriWest Medicare |
$0.09
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.36
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.11
|
|
|
calcium chloride 1 gm/ 10 ml PFS [CQCH]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 409163110
|
| Hospital Charge Code |
105914181
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of AZ Commercial |
$0.56
|
| Rate for Payer: Bisbee Police All Plans |
$0.16
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Self Pay Self Pay |
$0.50
|
|
|
calcium gluconate 1 gm/ 10 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
105914248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Aetna of AZ Commercial |
$0.69
|
| Rate for Payer: Bisbee Police All Plans |
$0.20
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Self Pay Self Pay |
$0.62
|
|
