|
Candida Abs Ql LC
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
6780771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Aetna of AZ Medicare |
$71.40
|
| Rate for Payer: AHCCCS Medicaid |
$12.01
|
| Rate for Payer: Allwell Medicaid |
$12.01
|
| Rate for Payer: Allwell Medicare |
$38.25
|
| Rate for Payer: Amerigroup Medicare |
$38.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$95.24
|
| Rate for Payer: AZCH Complete Medicaid |
$12.01
|
| Rate for Payer: AZCH Complete Medicare |
$38.25
|
| Rate for Payer: Banner UC Health Medicaid |
$12.01
|
| Rate for Payer: Banner UC Health Medicare |
$38.25
|
| Rate for Payer: Bisbee Police All Plans |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna of AZ Commercial |
$165.75
|
| Rate for Payer: Copperpoint Commercial |
$63.11
|
| Rate for Payer: Health Net of AZ Commercial |
$153.00
|
| Rate for Payer: Health Net of AZ Medicare |
$71.40
|
| Rate for Payer: Humana of AZ Medicare |
$38.25
|
| Rate for Payer: Mercy Care Medicaid |
$12.01
|
| Rate for Payer: Self Pay Self Pay |
$204.00
|
| Rate for Payer: TriWest Medicare |
$38.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$148.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$45.90
|
|
|
Candida Abs Ql LC
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
6780771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna of AZ Commercial |
$229.50
|
| Rate for Payer: Bisbee Police All Plans |
$66.30
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Self Pay Self Pay |
$204.00
|
|
|
CANISTER STRYKER REF#502-100-000
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
22355508
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna of AZ Commercial |
$49.50
|
| Rate for Payer: Bisbee Police All Plans |
$14.30
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Self Pay Self Pay |
$44.00
|
|
|
CANISTER STRYKER REF#502-100-000
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
22355508
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna of AZ Commercial |
$49.50
|
| Rate for Payer: Aetna of AZ Medicare |
$15.40
|
| Rate for Payer: Allwell Medicare |
$8.25
|
| Rate for Payer: Amerigroup Medicare |
$8.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$20.54
|
| Rate for Payer: AZCH Complete Medicare |
$8.25
|
| Rate for Payer: Banner UC Health Medicare |
$8.25
|
| Rate for Payer: Bisbee Police All Plans |
$14.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$37.40
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna of AZ Commercial |
$38.50
|
| Rate for Payer: Copperpoint Commercial |
$13.61
|
| Rate for Payer: Health Net of AZ Commercial |
$33.00
|
| Rate for Payer: Health Net of AZ Medicare |
$15.40
|
| Rate for Payer: Humana of AZ Medicare |
$8.25
|
| Rate for Payer: Self Pay Self Pay |
$44.00
|
| Rate for Payer: TriWest Medicare |
$8.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$32.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$9.90
|
|
|
CANNULA NASAL ADULT
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT A7034
|
| Hospital Charge Code |
22355589
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
|
|
CANNULA NASAL ADULT
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT A7034
|
| Hospital Charge Code |
22355589
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$182.62 |
| Rate for Payer: Aetna of AZ Commercial |
$4.50
|
| Rate for Payer: Aetna of AZ Medicare |
$1.40
|
| Rate for Payer: AHCCCS Medicaid |
$182.62
|
| Rate for Payer: Allwell Medicaid |
$182.62
|
| Rate for Payer: Allwell Medicare |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.87
|
| Rate for Payer: AZCH Complete Medicaid |
$182.62
|
| Rate for Payer: AZCH Complete Medicare |
$0.75
|
| Rate for Payer: Banner UC Health Medicaid |
$182.62
|
| Rate for Payer: Banner UC Health Medicare |
$0.75
|
| Rate for Payer: Bisbee Police All Plans |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna of AZ Commercial |
$3.50
|
| Rate for Payer: Copperpoint Commercial |
$1.24
|
| Rate for Payer: Health Net of AZ Commercial |
$3.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1.40
|
| Rate for Payer: Humana of AZ Medicare |
$0.75
|
| Rate for Payer: Mercy Care Medicaid |
$182.62
|
| Rate for Payer: Self Pay Self Pay |
$4.00
|
| Rate for Payer: TriWest Medicare |
$0.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.90
|
|
|
CANNULATED DRILL BIT FS3010
|
Facility
|
IP
|
$2,452.00
|
|
| Hospital Charge Code |
27565273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$637.52 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,206.80
|
| Rate for Payer: Bisbee Police All Plans |
$637.52
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Self Pay Self Pay |
$1,961.60
|
|
|
CANNULATED DRILL BIT FS3010
|
Facility
|
OP
|
$2,452.00
|
|
| Hospital Charge Code |
27565273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,206.80
|
| Rate for Payer: Aetna of AZ Medicare |
$686.56
|
| Rate for Payer: Allwell Medicare |
$367.80
|
| Rate for Payer: Amerigroup Medicare |
$367.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$915.82
|
| Rate for Payer: AZCH Complete Medicare |
$367.80
|
| Rate for Payer: Banner UC Health Medicare |
$367.80
|
| Rate for Payer: Bisbee Police All Plans |
$637.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,667.36
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,716.40
|
| Rate for Payer: Copperpoint Commercial |
$606.87
|
| Rate for Payer: Health Net of AZ Commercial |
$1,471.20
|
| Rate for Payer: Health Net of AZ Medicare |
$686.56
|
| Rate for Payer: Humana of AZ Medicare |
$367.80
|
| Rate for Payer: Self Pay Self Pay |
$1,961.60
|
| Rate for Payer: TriWest Medicare |
$367.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,429.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$441.36
|
|
|
CANNULATED DRILL BIT FS4030
|
Facility
|
IP
|
$1,756.00
|
|
| Hospital Charge Code |
27565272
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$456.56 |
| Max. Negotiated Rate |
$1,580.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,580.40
|
| Rate for Payer: Bisbee Police All Plans |
$456.56
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Self Pay Self Pay |
$1,404.80
|
|
|
CANNULATED DRILL BIT FS4030
|
Facility
|
OP
|
$1,756.00
|
|
| Hospital Charge Code |
27565272
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$263.40 |
| Max. Negotiated Rate |
$1,580.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,580.40
|
| Rate for Payer: Aetna of AZ Medicare |
$491.68
|
| Rate for Payer: Allwell Medicare |
$263.40
|
| Rate for Payer: Amerigroup Medicare |
$263.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$655.87
|
| Rate for Payer: AZCH Complete Medicare |
$263.40
|
| Rate for Payer: Banner UC Health Medicare |
$263.40
|
| Rate for Payer: Bisbee Police All Plans |
$456.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,194.08
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,229.20
|
| Rate for Payer: Copperpoint Commercial |
$434.61
|
| Rate for Payer: Health Net of AZ Commercial |
$1,053.60
|
| Rate for Payer: Health Net of AZ Medicare |
$491.68
|
| Rate for Payer: Humana of AZ Medicare |
$263.40
|
| Rate for Payer: Self Pay Self Pay |
$1,404.80
|
| Rate for Payer: TriWest Medicare |
$263.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,023.75
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$316.08
|
|
|
CAPSULOTOMY; METATARSOPHALANGEAL JOINT WITH OR WITHOUT TENORRHAPHY EACH JOINT
|
Facility
|
IP
|
$1,633.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
24043312
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$424.58 |
| Max. Negotiated Rate |
$1,469.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,469.70
|
| Rate for Payer: Bisbee Police All Plans |
$424.58
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Self Pay Self Pay |
$1,306.40
|
|
|
CAPSULOTOMY; METATARSOPHALANGEAL JOINT WITH OR WITHOUT TENORRHAPHY EACH JOINT
|
Facility
|
OP
|
$1,633.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
24043312
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$244.95 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,469.70
|
| Rate for Payer: Aetna of AZ Medicare |
$457.24
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$244.95
|
| Rate for Payer: Amerigroup Medicare |
$244.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$609.93
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$244.95
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$244.95
|
| Rate for Payer: Bisbee Police All Plans |
$424.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,110.44
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Cigna of AZ Commercial |
$816.50
|
| Rate for Payer: Copperpoint Commercial |
$404.17
|
| Rate for Payer: Health Net of AZ Commercial |
$979.80
|
| Rate for Payer: Health Net of AZ Medicare |
$457.24
|
| Rate for Payer: Humana of AZ Medicare |
$244.95
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,306.40
|
| Rate for Payer: TriWest Medicare |
$244.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$293.94
|
|
|
Ca+PTH Intact LC
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2269455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.16 |
| 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 |
$5.16
|
| Rate for Payer: Allwell Medicaid |
$5.16
|
| 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 |
$5.16
|
| Rate for Payer: AZCH Complete Medicare |
$11.70
|
| Rate for Payer: Banner UC Health Medicaid |
$5.16
|
| 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 |
$5.16
|
| 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
|
|
|
Ca+PTH Intact LC
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2269455
|
|
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
|
|
|
CAPTIVATOR COLD SNARE
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
23833620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of AZ Commercial |
$64.80
|
| Rate for Payer: Aetna of AZ Medicare |
$20.16
|
| Rate for Payer: Allwell Medicare |
$10.80
|
| Rate for Payer: Amerigroup Medicare |
$10.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$26.89
|
| Rate for Payer: AZCH Complete Medicare |
$10.80
|
| Rate for Payer: Banner UC Health Medicare |
$10.80
|
| Rate for Payer: Bisbee Police All Plans |
$18.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$48.96
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of AZ Commercial |
$50.40
|
| Rate for Payer: Copperpoint Commercial |
$17.82
|
| Rate for Payer: Health Net of AZ Commercial |
$43.20
|
| Rate for Payer: Health Net of AZ Medicare |
$20.16
|
| Rate for Payer: Humana of AZ Medicare |
$10.80
|
| Rate for Payer: Self Pay Self Pay |
$57.60
|
| Rate for Payer: TriWest Medicare |
$10.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$41.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.96
|
|
|
CAPTIVATOR COLD SNARE
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
23833620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of AZ Commercial |
$64.80
|
| Rate for Payer: Bisbee Police All Plans |
$18.72
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Self Pay Self Pay |
$57.60
|
|
|
captopril 25 mg Tab [CQCH]
|
Facility
|
IP
|
$0.83
|
|
|
Service Code
|
NDC 51079086420
|
| Hospital Charge Code |
105914325
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna of AZ Commercial |
$0.75
|
| Rate for Payer: Bisbee Police All Plans |
$0.22
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Self Pay Self Pay |
$0.66
|
|
|
captopril 25 mg Tab [CQCH]
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 51079086420
|
| Hospital Charge Code |
105914325
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna of AZ Commercial |
$0.75
|
| Rate for Payer: Aetna of AZ Medicare |
$0.23
|
| Rate for Payer: Allwell Medicare |
$0.12
|
| Rate for Payer: Amerigroup Medicare |
$0.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.31
|
| Rate for Payer: AZCH Complete Medicare |
$0.12
|
| Rate for Payer: Banner UC Health Medicare |
$0.12
|
| Rate for Payer: Bisbee Police All Plans |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.56
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of AZ Commercial |
$0.54
|
| Rate for Payer: Copperpoint Commercial |
$0.21
|
| Rate for Payer: Health Net of AZ Commercial |
$0.50
|
| Rate for Payer: Health Net of AZ Medicare |
$0.23
|
| Rate for Payer: Humana of AZ Medicare |
$0.12
|
| Rate for Payer: Self Pay Self Pay |
$0.66
|
| Rate for Payer: TriWest Medicare |
$0.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.48
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.15
|
|
|
carBAMazepine 200 mg Tab [CQCH]
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
NDC 904617261
|
| Hospital Charge Code |
105914390
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna of AZ Commercial |
$0.41
|
| Rate for Payer: Bisbee Police All Plans |
$0.12
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Self Pay Self Pay |
$0.36
|
|
|
carBAMazepine 200 mg Tab [CQCH]
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
NDC 904617261
|
| Hospital Charge Code |
105914390
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna of AZ Commercial |
$0.41
|
| Rate for Payer: Aetna of AZ Medicare |
$0.13
|
| Rate for Payer: Allwell Medicare |
$0.07
|
| Rate for Payer: Amerigroup Medicare |
$0.07
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.17
|
| Rate for Payer: AZCH Complete Medicare |
$0.07
|
| Rate for Payer: Banner UC Health Medicare |
$0.07
|
| Rate for Payer: Bisbee Police All Plans |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of AZ Commercial |
$0.29
|
| Rate for Payer: Copperpoint Commercial |
$0.11
|
| Rate for Payer: Health Net of AZ Commercial |
$0.27
|
| Rate for Payer: Health Net of AZ Medicare |
$0.13
|
| Rate for Payer: Humana of AZ Medicare |
$0.07
|
| Rate for Payer: Self Pay Self Pay |
$0.36
|
| Rate for Payer: TriWest Medicare |
$0.07
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.26
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.08
|
|
|
Carbamazepine Level
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
633694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$206.10 |
| Rate for Payer: Aetna of AZ Commercial |
$206.10
|
| Rate for Payer: Aetna of AZ Medicare |
$64.12
|
| Rate for Payer: AHCCCS Medicaid |
$14.57
|
| Rate for Payer: Allwell Medicaid |
$14.57
|
| Rate for Payer: Allwell Medicare |
$34.35
|
| Rate for Payer: Amerigroup Medicare |
$34.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$85.53
|
| Rate for Payer: AZCH Complete Medicaid |
$14.57
|
| Rate for Payer: AZCH Complete Medicare |
$34.35
|
| Rate for Payer: Banner UC Health Medicaid |
$14.57
|
| Rate for Payer: Banner UC Health Medicare |
$34.35
|
| Rate for Payer: Bisbee Police All Plans |
$59.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$155.72
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Cigna of AZ Commercial |
$148.85
|
| Rate for Payer: Copperpoint Commercial |
$56.68
|
| Rate for Payer: Health Net of AZ Commercial |
$137.40
|
| Rate for Payer: Health Net of AZ Medicare |
$64.12
|
| Rate for Payer: Humana of AZ Medicare |
$34.35
|
| Rate for Payer: Mercy Care Medicaid |
$14.57
|
| Rate for Payer: Self Pay Self Pay |
$183.20
|
| Rate for Payer: TriWest Medicare |
$34.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$133.51
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.22
|
|
|
Carbamazepine Level
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
633694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$206.10 |
| Rate for Payer: Aetna of AZ Commercial |
$206.10
|
| Rate for Payer: Bisbee Police All Plans |
$59.54
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Self Pay Self Pay |
$183.20
|
|
|
carbidopa-levodopa 10 mg-100 mg Tab [CQCH]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 63739004610
|
| Hospital Charge Code |
105914455
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of AZ Commercial |
$0.18
|
| Rate for Payer: Bisbee Police All Plans |
$0.05
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Self Pay Self Pay |
$0.16
|
|
|
carbidopa-levodopa 10 mg-100 mg Tab [CQCH]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 63739004610
|
| Hospital Charge Code |
105914455
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of AZ Commercial |
$0.18
|
| Rate for Payer: Aetna of AZ Medicare |
$0.06
|
| Rate for Payer: Allwell Medicare |
$0.03
|
| Rate for Payer: Amerigroup Medicare |
$0.03
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.07
|
| Rate for Payer: AZCH Complete Medicare |
$0.03
|
| Rate for Payer: Banner UC Health Medicare |
$0.03
|
| Rate for Payer: Bisbee Police All Plans |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of AZ Commercial |
$0.13
|
| Rate for Payer: Copperpoint Commercial |
$0.05
|
| Rate for Payer: Health Net of AZ Commercial |
$0.12
|
| Rate for Payer: Health Net of AZ Medicare |
$0.06
|
| Rate for Payer: Humana of AZ Medicare |
$0.03
|
| Rate for Payer: Self Pay Self Pay |
$0.16
|
| Rate for Payer: TriWest Medicare |
$0.03
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.04
|
|
|
carbidopa-levodopa 25 mg-100 mg DIS Tablet [CQCH]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 47335018788
|
| Hospital Charge Code |
126238058
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of AZ Commercial |
$0.76
|
| Rate for Payer: Bisbee Police All Plans |
$0.22
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Self Pay Self Pay |
$0.67
|
|
