|
.HBsAg Confirmation LC
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
1285756
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$278.10 |
| Rate for Payer: Aetna of AZ Commercial |
$278.10
|
| Rate for Payer: Aetna of AZ Medicare |
$86.52
|
| Rate for Payer: AHCCCS Medicaid |
$10.33
|
| Rate for Payer: Allwell Medicaid |
$10.33
|
| Rate for Payer: Allwell Medicare |
$46.35
|
| Rate for Payer: Amerigroup Medicare |
$46.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$115.41
|
| Rate for Payer: AZCH Complete Medicaid |
$10.33
|
| Rate for Payer: AZCH Complete Medicare |
$46.35
|
| Rate for Payer: Banner UC Health Medicaid |
$10.33
|
| Rate for Payer: Banner UC Health Medicare |
$46.35
|
| Rate for Payer: Bisbee Police All Plans |
$80.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$210.12
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna of AZ Commercial |
$200.85
|
| Rate for Payer: Copperpoint Commercial |
$76.48
|
| Rate for Payer: Health Net of AZ Commercial |
$185.40
|
| Rate for Payer: Health Net of AZ Medicare |
$86.52
|
| Rate for Payer: Humana of AZ Medicare |
$46.35
|
| Rate for Payer: Mercy Care Medicaid |
$10.33
|
| Rate for Payer: Self Pay Self Pay |
$247.20
|
| Rate for Payer: TriWest Medicare |
$46.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$180.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.62
|
|
|
HBsAg Screen LC
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
1902150
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$278.10 |
| Rate for Payer: Aetna of AZ Commercial |
$278.10
|
| Rate for Payer: Bisbee Police All Plans |
$80.34
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Self Pay Self Pay |
$247.20
|
|
|
HBsAg Screen LC
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
1902150
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$278.10 |
| Rate for Payer: Aetna of AZ Commercial |
$278.10
|
| Rate for Payer: Aetna of AZ Medicare |
$86.52
|
| Rate for Payer: AHCCCS Medicaid |
$10.33
|
| Rate for Payer: Allwell Medicaid |
$10.33
|
| Rate for Payer: Allwell Medicare |
$46.35
|
| Rate for Payer: Amerigroup Medicare |
$46.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$115.41
|
| Rate for Payer: AZCH Complete Medicaid |
$10.33
|
| Rate for Payer: AZCH Complete Medicare |
$46.35
|
| Rate for Payer: Banner UC Health Medicaid |
$10.33
|
| Rate for Payer: Banner UC Health Medicare |
$46.35
|
| Rate for Payer: Bisbee Police All Plans |
$80.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$210.12
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna of AZ Commercial |
$200.85
|
| Rate for Payer: Copperpoint Commercial |
$76.48
|
| Rate for Payer: Health Net of AZ Commercial |
$185.40
|
| Rate for Payer: Health Net of AZ Medicare |
$86.52
|
| Rate for Payer: Humana of AZ Medicare |
$46.35
|
| Rate for Payer: Mercy Care Medicaid |
$10.33
|
| Rate for Payer: Self Pay Self Pay |
$247.20
|
| Rate for Payer: TriWest Medicare |
$46.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$180.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.62
|
|
|
HBV Real-Time PCR Qn LC
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
6782273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$930.60 |
| Rate for Payer: Aetna of AZ Commercial |
$930.60
|
| Rate for Payer: Aetna of AZ Medicare |
$289.52
|
| Rate for Payer: AHCCCS Medicaid |
$42.84
|
| Rate for Payer: Allwell Medicaid |
$42.84
|
| Rate for Payer: Allwell Medicare |
$155.10
|
| Rate for Payer: Amerigroup Medicare |
$155.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$386.20
|
| Rate for Payer: AZCH Complete Medicaid |
$42.84
|
| Rate for Payer: AZCH Complete Medicare |
$155.10
|
| Rate for Payer: Banner UC Health Medicaid |
$42.84
|
| Rate for Payer: Banner UC Health Medicare |
$155.10
|
| Rate for Payer: Bisbee Police All Plans |
$268.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$703.12
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cigna of AZ Commercial |
$672.10
|
| Rate for Payer: Copperpoint Commercial |
$255.92
|
| Rate for Payer: Health Net of AZ Commercial |
$620.40
|
| Rate for Payer: Health Net of AZ Medicare |
$289.52
|
| Rate for Payer: Humana of AZ Medicare |
$155.10
|
| Rate for Payer: Mercy Care Medicaid |
$42.84
|
| Rate for Payer: Self Pay Self Pay |
$827.20
|
| Rate for Payer: TriWest Medicare |
$155.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$602.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$186.12
|
|
|
HBV Real-Time PCR Qn LC
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
6782273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$268.84 |
| Max. Negotiated Rate |
$930.60 |
| Rate for Payer: Aetna of AZ Commercial |
$930.60
|
| Rate for Payer: Bisbee Police All Plans |
$268.84
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Self Pay Self Pay |
$827.20
|
|
|
hCG,Beta Subunit, Qnt, Serum LC
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
1285573
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna of AZ Commercial |
$196.20
|
| Rate for Payer: Aetna of AZ Medicare |
$61.04
|
| Rate for Payer: AHCCCS Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicare |
$32.70
|
| Rate for Payer: Amerigroup Medicare |
$32.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$81.42
|
| Rate for Payer: AZCH Complete Medicaid |
$15.05
|
| Rate for Payer: AZCH Complete Medicare |
$32.70
|
| Rate for Payer: Banner UC Health Medicaid |
$15.05
|
| Rate for Payer: Banner UC Health Medicare |
$32.70
|
| Rate for Payer: Bisbee Police All Plans |
$56.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$148.24
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cigna of AZ Commercial |
$141.70
|
| Rate for Payer: Copperpoint Commercial |
$53.96
|
| Rate for Payer: Health Net of AZ Commercial |
$130.80
|
| Rate for Payer: Health Net of AZ Medicare |
$61.04
|
| Rate for Payer: Humana of AZ Medicare |
$32.70
|
| Rate for Payer: Mercy Care Medicaid |
$15.05
|
| Rate for Payer: Self Pay Self Pay |
$174.40
|
| Rate for Payer: TriWest Medicare |
$32.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$127.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$39.24
|
|
|
hCG,Beta Subunit, Qnt, Serum LC
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
1285573
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.68 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna of AZ Commercial |
$196.20
|
| Rate for Payer: Bisbee Police All Plans |
$56.68
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Self Pay Self Pay |
$174.40
|
|
|
hCG Qual w/ Reflex to Beta hCG
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
24319555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of AZ Commercial |
$14.40
|
| Rate for Payer: Bisbee Police All Plans |
$4.16
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Self Pay Self Pay |
$12.80
|
|
|
hCG Qual w/ Reflex to Beta hCG
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
24319555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of AZ Commercial |
$14.40
|
| Rate for Payer: Aetna of AZ Medicare |
$4.48
|
| Rate for Payer: AHCCCS Medicaid |
$7.52
|
| Rate for Payer: Allwell Medicaid |
$7.52
|
| Rate for Payer: Allwell Medicare |
$2.40
|
| Rate for Payer: Amerigroup Medicare |
$2.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$5.98
|
| Rate for Payer: AZCH Complete Medicaid |
$7.52
|
| Rate for Payer: AZCH Complete Medicare |
$2.40
|
| Rate for Payer: Banner UC Health Medicaid |
$7.52
|
| Rate for Payer: Banner UC Health Medicare |
$2.40
|
| Rate for Payer: Bisbee Police All Plans |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$10.88
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cigna of AZ Commercial |
$10.40
|
| Rate for Payer: Copperpoint Commercial |
$3.96
|
| Rate for Payer: Health Net of AZ Commercial |
$9.60
|
| Rate for Payer: Health Net of AZ Medicare |
$4.48
|
| Rate for Payer: Humana of AZ Medicare |
$2.40
|
| Rate for Payer: Mercy Care Medicaid |
$7.52
|
| Rate for Payer: Self Pay Self Pay |
$12.80
|
| Rate for Payer: TriWest Medicare |
$2.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$9.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.88
|
|
|
hCG Quantitative
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
1019534
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of AZ Commercial |
$193.50
|
| Rate for Payer: Aetna of AZ Medicare |
$60.20
|
| Rate for Payer: AHCCCS Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicare |
$32.25
|
| Rate for Payer: Amerigroup Medicare |
$32.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$80.30
|
| Rate for Payer: AZCH Complete Medicaid |
$15.05
|
| Rate for Payer: AZCH Complete Medicare |
$32.25
|
| Rate for Payer: Banner UC Health Medicaid |
$15.05
|
| Rate for Payer: Banner UC Health Medicare |
$32.25
|
| Rate for Payer: Bisbee Police All Plans |
$55.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$146.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna of AZ Commercial |
$139.75
|
| Rate for Payer: Copperpoint Commercial |
$53.21
|
| Rate for Payer: Health Net of AZ Commercial |
$129.00
|
| Rate for Payer: Health Net of AZ Medicare |
$60.20
|
| Rate for Payer: Humana of AZ Medicare |
$32.25
|
| Rate for Payer: Mercy Care Medicaid |
$15.05
|
| Rate for Payer: Self Pay Self Pay |
$172.00
|
| Rate for Payer: TriWest Medicare |
$32.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$125.34
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.70
|
|
|
hCG Quantitative
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
1019534
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of AZ Commercial |
$193.50
|
| Rate for Payer: Bisbee Police All Plans |
$55.90
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Self Pay Self Pay |
$172.00
|
|
|
HCV Antibody LC
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
1285627
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$357.30 |
| Rate for Payer: Aetna of AZ Commercial |
$357.30
|
| Rate for Payer: Bisbee Police All Plans |
$103.22
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Self Pay Self Pay |
$317.60
|
|
|
HCV Antibody LC
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
1285627
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$357.30 |
| Rate for Payer: Aetna of AZ Commercial |
$357.30
|
| Rate for Payer: Aetna of AZ Medicare |
$111.16
|
| Rate for Payer: AHCCCS Medicaid |
$14.27
|
| Rate for Payer: Allwell Medicaid |
$14.27
|
| Rate for Payer: Allwell Medicare |
$59.55
|
| Rate for Payer: Amerigroup Medicare |
$59.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$148.28
|
| Rate for Payer: AZCH Complete Medicaid |
$14.27
|
| Rate for Payer: AZCH Complete Medicare |
$59.55
|
| Rate for Payer: Banner UC Health Medicaid |
$14.27
|
| Rate for Payer: Banner UC Health Medicare |
$59.55
|
| Rate for Payer: Bisbee Police All Plans |
$103.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$269.96
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Cigna of AZ Commercial |
$258.05
|
| Rate for Payer: Copperpoint Commercial |
$98.26
|
| Rate for Payer: Health Net of AZ Commercial |
$238.20
|
| Rate for Payer: Health Net of AZ Medicare |
$111.16
|
| Rate for Payer: Humana of AZ Medicare |
$59.55
|
| Rate for Payer: Mercy Care Medicaid |
$14.27
|
| Rate for Payer: Self Pay Self Pay |
$317.60
|
| Rate for Payer: TriWest Medicare |
$59.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$231.45
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$71.46
|
|
|
HCV FibroSure LC
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
22200129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna of AZ Commercial |
$142.20
|
| Rate for Payer: Bisbee Police All Plans |
$41.08
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Self Pay Self Pay |
$126.40
|
|
|
HCV FibroSure LC
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
22200129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna of AZ Commercial |
$142.20
|
| Rate for Payer: Aetna of AZ Medicare |
$44.24
|
| Rate for Payer: AHCCCS Medicaid |
$7.20
|
| Rate for Payer: Allwell Medicaid |
$7.20
|
| Rate for Payer: Allwell Medicare |
$23.70
|
| Rate for Payer: Amerigroup Medicare |
$23.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$59.01
|
| Rate for Payer: AZCH Complete Medicaid |
$7.20
|
| Rate for Payer: AZCH Complete Medicare |
$23.70
|
| Rate for Payer: Banner UC Health Medicaid |
$7.20
|
| Rate for Payer: Banner UC Health Medicare |
$23.70
|
| Rate for Payer: Bisbee Police All Plans |
$41.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$107.44
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cigna of AZ Commercial |
$102.70
|
| Rate for Payer: Copperpoint Commercial |
$39.10
|
| Rate for Payer: Health Net of AZ Commercial |
$94.80
|
| Rate for Payer: Health Net of AZ Medicare |
$44.24
|
| Rate for Payer: Humana of AZ Medicare |
$23.70
|
| Rate for Payer: Mercy Care Medicaid |
$7.20
|
| Rate for Payer: Self Pay Self Pay |
$126.40
|
| Rate for Payer: TriWest Medicare |
$23.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$92.11
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.44
|
|
|
HCV Genotyping Non Reflex LC
|
Facility
|
IP
|
$3,199.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
2029260
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$831.74 |
| Max. Negotiated Rate |
$2,879.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,879.10
|
| Rate for Payer: Bisbee Police All Plans |
$831.74
|
| Rate for Payer: Cash Price |
$2,559.20
|
| Rate for Payer: Self Pay Self Pay |
$2,559.20
|
|
|
HCV Genotyping Non Reflex LC
|
Facility
|
OP
|
$3,199.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
2029260
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$2,879.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,879.10
|
| Rate for Payer: Aetna of AZ Medicare |
$895.72
|
| Rate for Payer: AHCCCS Medicaid |
$257.45
|
| Rate for Payer: Allwell Medicaid |
$257.45
|
| Rate for Payer: Allwell Medicare |
$479.85
|
| Rate for Payer: Amerigroup Medicare |
$479.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,194.83
|
| Rate for Payer: AZCH Complete Medicaid |
$257.45
|
| Rate for Payer: AZCH Complete Medicare |
$479.85
|
| Rate for Payer: Banner UC Health Medicaid |
$257.45
|
| Rate for Payer: Banner UC Health Medicare |
$479.85
|
| Rate for Payer: Bisbee Police All Plans |
$831.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,175.32
|
| Rate for Payer: Cash Price |
$2,559.20
|
| Rate for Payer: Cash Price |
$2,559.20
|
| Rate for Payer: Cigna of AZ Commercial |
$2,079.35
|
| Rate for Payer: Copperpoint Commercial |
$791.75
|
| Rate for Payer: Health Net of AZ Commercial |
$1,919.40
|
| Rate for Payer: Health Net of AZ Medicare |
$895.72
|
| Rate for Payer: Humana of AZ Medicare |
$479.85
|
| Rate for Payer: Mercy Care Medicaid |
$257.45
|
| Rate for Payer: Self Pay Self Pay |
$2,559.20
|
| Rate for Payer: TriWest Medicare |
$479.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,865.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$575.82
|
|
|
.HCV RNA (International Units) LC
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
1285759
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$407.70 |
| Rate for Payer: Aetna of AZ Commercial |
$407.70
|
| Rate for Payer: Aetna of AZ Medicare |
$126.84
|
| Rate for Payer: AHCCCS Medicaid |
$35.09
|
| Rate for Payer: Allwell Medicaid |
$35.09
|
| Rate for Payer: Allwell Medicare |
$67.95
|
| Rate for Payer: Amerigroup Medicare |
$67.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$169.20
|
| Rate for Payer: AZCH Complete Medicaid |
$35.09
|
| Rate for Payer: AZCH Complete Medicare |
$67.95
|
| Rate for Payer: Banner UC Health Medicaid |
$35.09
|
| Rate for Payer: Banner UC Health Medicare |
$67.95
|
| Rate for Payer: Bisbee Police All Plans |
$117.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$308.04
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna of AZ Commercial |
$294.45
|
| Rate for Payer: Copperpoint Commercial |
$112.12
|
| Rate for Payer: Health Net of AZ Commercial |
$271.80
|
| Rate for Payer: Health Net of AZ Medicare |
$126.84
|
| Rate for Payer: Humana of AZ Medicare |
$67.95
|
| Rate for Payer: Mercy Care Medicaid |
$35.09
|
| Rate for Payer: Self Pay Self Pay |
$362.40
|
| Rate for Payer: TriWest Medicare |
$67.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$264.10
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$81.54
|
|
|
.HCV RNA (International Units) LC
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
1285759
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$117.78 |
| Max. Negotiated Rate |
$407.70 |
| Rate for Payer: Aetna of AZ Commercial |
$407.70
|
| Rate for Payer: Bisbee Police All Plans |
$117.78
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Self Pay Self Pay |
$362.40
|
|
|
.HCV RNA IU LC
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
6782346
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Aetna of AZ Commercial |
$674.10
|
| Rate for Payer: Aetna of AZ Medicare |
$209.72
|
| Rate for Payer: AHCCCS Medicaid |
$42.84
|
| Rate for Payer: Allwell Medicaid |
$42.84
|
| Rate for Payer: Allwell Medicare |
$112.35
|
| Rate for Payer: Amerigroup Medicare |
$112.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$279.75
|
| Rate for Payer: AZCH Complete Medicaid |
$42.84
|
| Rate for Payer: AZCH Complete Medicare |
$112.35
|
| Rate for Payer: Banner UC Health Medicaid |
$42.84
|
| Rate for Payer: Banner UC Health Medicare |
$112.35
|
| Rate for Payer: Bisbee Police All Plans |
$194.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$509.32
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cigna of AZ Commercial |
$486.85
|
| Rate for Payer: Copperpoint Commercial |
$185.38
|
| Rate for Payer: Health Net of AZ Commercial |
$449.40
|
| Rate for Payer: Health Net of AZ Medicare |
$209.72
|
| Rate for Payer: Humana of AZ Medicare |
$112.35
|
| Rate for Payer: Mercy Care Medicaid |
$42.84
|
| Rate for Payer: Self Pay Self Pay |
$599.20
|
| Rate for Payer: TriWest Medicare |
$112.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$436.67
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$134.82
|
|
|
.HCV RNA IU LC
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
6782346
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$194.74 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Aetna of AZ Commercial |
$674.10
|
| Rate for Payer: Bisbee Police All Plans |
$194.74
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Self Pay Self Pay |
$599.20
|
|
|
HCV RNA, PCR, Quant (Reflex to Genotyping LC
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
6676609
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$616.50 |
| Rate for Payer: Aetna of AZ Commercial |
$616.50
|
| Rate for Payer: Bisbee Police All Plans |
$178.10
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Self Pay Self Pay |
$548.00
|
|
|
HCV RNA, PCR, Quant (Reflex to Genotyping LC
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
6676609
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$616.50 |
| Rate for Payer: Aetna of AZ Commercial |
$616.50
|
| Rate for Payer: Aetna of AZ Medicare |
$191.80
|
| Rate for Payer: AHCCCS Medicaid |
$42.84
|
| Rate for Payer: Allwell Medicaid |
$42.84
|
| Rate for Payer: Allwell Medicare |
$102.75
|
| Rate for Payer: Amerigroup Medicare |
$102.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$255.85
|
| Rate for Payer: AZCH Complete Medicaid |
$42.84
|
| Rate for Payer: AZCH Complete Medicare |
$102.75
|
| Rate for Payer: Banner UC Health Medicaid |
$42.84
|
| Rate for Payer: Banner UC Health Medicare |
$102.75
|
| Rate for Payer: Bisbee Police All Plans |
$178.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$465.80
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cigna of AZ Commercial |
$445.25
|
| Rate for Payer: Copperpoint Commercial |
$169.54
|
| Rate for Payer: Health Net of AZ Commercial |
$411.00
|
| Rate for Payer: Health Net of AZ Medicare |
$191.80
|
| Rate for Payer: Humana of AZ Medicare |
$102.75
|
| Rate for Payer: Mercy Care Medicaid |
$42.84
|
| Rate for Payer: Self Pay Self Pay |
$548.00
|
| Rate for Payer: TriWest Medicare |
$102.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$399.36
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$123.30
|
|
|
HCV RT-PCR, Quant (Graph) LC
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
2029096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Aetna of AZ Commercial |
$674.10
|
| Rate for Payer: Aetna of AZ Medicare |
$209.72
|
| Rate for Payer: AHCCCS Medicaid |
$42.84
|
| Rate for Payer: Allwell Medicaid |
$42.84
|
| Rate for Payer: Allwell Medicare |
$112.35
|
| Rate for Payer: Amerigroup Medicare |
$112.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$279.75
|
| Rate for Payer: AZCH Complete Medicaid |
$42.84
|
| Rate for Payer: AZCH Complete Medicare |
$112.35
|
| Rate for Payer: Banner UC Health Medicaid |
$42.84
|
| Rate for Payer: Banner UC Health Medicare |
$112.35
|
| Rate for Payer: Bisbee Police All Plans |
$194.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$509.32
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cigna of AZ Commercial |
$486.85
|
| Rate for Payer: Copperpoint Commercial |
$185.38
|
| Rate for Payer: Health Net of AZ Commercial |
$449.40
|
| Rate for Payer: Health Net of AZ Medicare |
$209.72
|
| Rate for Payer: Humana of AZ Medicare |
$112.35
|
| Rate for Payer: Mercy Care Medicaid |
$42.84
|
| Rate for Payer: Self Pay Self Pay |
$599.20
|
| Rate for Payer: TriWest Medicare |
$112.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$436.67
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$134.82
|
|
|
HCV RT-PCR, Quant (Graph) LC
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
2029096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$194.74 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Aetna of AZ Commercial |
$674.10
|
| Rate for Payer: Bisbee Police All Plans |
$194.74
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Self Pay Self Pay |
$599.20
|
|
