|
HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION TOE PROXIMAL END
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
CPT 28160
|
| Hospital Charge Code |
24043273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$195.75 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,174.50
|
| Rate for Payer: Aetna of AZ Medicare |
$365.40
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$195.75
|
| Rate for Payer: Amerigroup Medicare |
$195.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$487.42
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$195.75
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$195.75
|
| Rate for Payer: Bisbee Police All Plans |
$339.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$887.40
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cigna of AZ Commercial |
$652.50
|
| Rate for Payer: Copperpoint Commercial |
$322.99
|
| Rate for Payer: Health Net of AZ Commercial |
$783.00
|
| Rate for Payer: Health Net of AZ Medicare |
$365.40
|
| Rate for Payer: Humana of AZ Medicare |
$195.75
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,044.00
|
| Rate for Payer: TriWest Medicare |
$195.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$234.90
|
|
|
HEMO DRAIN 3/16
|
Facility
|
OP
|
$185.00
|
|
| Hospital Charge Code |
22354978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Aetna of AZ Commercial |
$166.50
|
| Rate for Payer: Aetna of AZ Medicare |
$51.80
|
| Rate for Payer: Allwell Medicare |
$27.75
|
| Rate for Payer: Amerigroup Medicare |
$27.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$69.10
|
| Rate for Payer: AZCH Complete Medicare |
$27.75
|
| Rate for Payer: Banner UC Health Medicare |
$27.75
|
| Rate for Payer: Bisbee Police All Plans |
$48.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$125.80
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna of AZ Commercial |
$129.50
|
| Rate for Payer: Copperpoint Commercial |
$45.79
|
| Rate for Payer: Health Net of AZ Commercial |
$111.00
|
| Rate for Payer: Health Net of AZ Medicare |
$51.80
|
| Rate for Payer: Humana of AZ Medicare |
$27.75
|
| Rate for Payer: Self Pay Self Pay |
$148.00
|
| Rate for Payer: TriWest Medicare |
$27.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$107.86
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$33.30
|
|
|
HEMO DRAIN 3/16
|
Facility
|
IP
|
$185.00
|
|
| Hospital Charge Code |
22354978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.10 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Aetna of AZ Commercial |
$166.50
|
| Rate for Payer: Bisbee Police All Plans |
$48.10
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Self Pay Self Pay |
$148.00
|
|
|
Hemoglobin
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of AZ Commercial |
$44.10
|
| Rate for Payer: Aetna of AZ Medicare |
$13.72
|
| Rate for Payer: AHCCCS Medicaid |
$2.37
|
| Rate for Payer: Allwell Medicaid |
$2.37
|
| Rate for Payer: Allwell Medicare |
$7.35
|
| Rate for Payer: Amerigroup Medicare |
$7.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$18.30
|
| Rate for Payer: AZCH Complete Medicaid |
$2.37
|
| Rate for Payer: AZCH Complete Medicare |
$7.35
|
| Rate for Payer: Banner UC Health Medicaid |
$2.37
|
| Rate for Payer: Banner UC Health Medicare |
$7.35
|
| Rate for Payer: Bisbee Police All Plans |
$12.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$33.32
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cigna of AZ Commercial |
$31.85
|
| Rate for Payer: Copperpoint Commercial |
$12.13
|
| Rate for Payer: Health Net of AZ Commercial |
$29.40
|
| Rate for Payer: Health Net of AZ Medicare |
$13.72
|
| Rate for Payer: Humana of AZ Medicare |
$7.35
|
| Rate for Payer: Mercy Care Medicaid |
$2.37
|
| Rate for Payer: Self Pay Self Pay |
$39.20
|
| Rate for Payer: TriWest Medicare |
$7.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$28.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.82
|
|
|
Hemoglobin
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
798796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of AZ Commercial |
$44.10
|
| Rate for Payer: Aetna of AZ Medicare |
$13.72
|
| Rate for Payer: AHCCCS Medicaid |
$2.37
|
| Rate for Payer: Allwell Medicaid |
$2.37
|
| Rate for Payer: Allwell Medicare |
$7.35
|
| Rate for Payer: Amerigroup Medicare |
$7.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$18.30
|
| Rate for Payer: AZCH Complete Medicaid |
$2.37
|
| Rate for Payer: AZCH Complete Medicare |
$7.35
|
| Rate for Payer: Banner UC Health Medicaid |
$2.37
|
| Rate for Payer: Banner UC Health Medicare |
$7.35
|
| Rate for Payer: Bisbee Police All Plans |
$12.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$33.32
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cigna of AZ Commercial |
$31.85
|
| Rate for Payer: Copperpoint Commercial |
$12.13
|
| Rate for Payer: Health Net of AZ Commercial |
$29.40
|
| Rate for Payer: Health Net of AZ Medicare |
$13.72
|
| Rate for Payer: Humana of AZ Medicare |
$7.35
|
| Rate for Payer: Mercy Care Medicaid |
$2.37
|
| Rate for Payer: Self Pay Self Pay |
$39.20
|
| Rate for Payer: TriWest Medicare |
$7.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$28.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.82
|
|
|
Hemoglobin
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of AZ Commercial |
$44.10
|
| Rate for Payer: Bisbee Police All Plans |
$12.74
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Self Pay Self Pay |
$39.20
|
|
|
Hemoglobin
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
798796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of AZ Commercial |
$44.10
|
| Rate for Payer: Bisbee Police All Plans |
$12.74
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Self Pay Self Pay |
$39.20
|
|
|
Hemoglobin A1C
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
633743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of AZ Commercial |
$131.40
|
| Rate for Payer: Aetna of AZ Medicare |
$40.88
|
| Rate for Payer: AHCCCS Medicaid |
$9.71
|
| Rate for Payer: Allwell Medicaid |
$9.71
|
| Rate for Payer: Allwell Medicare |
$21.90
|
| Rate for Payer: Amerigroup Medicare |
$21.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$54.53
|
| Rate for Payer: AZCH Complete Medicaid |
$9.71
|
| Rate for Payer: AZCH Complete Medicare |
$21.90
|
| Rate for Payer: Banner UC Health Medicaid |
$9.71
|
| Rate for Payer: Banner UC Health Medicare |
$21.90
|
| Rate for Payer: Bisbee Police All Plans |
$37.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$99.28
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cigna of AZ Commercial |
$94.90
|
| Rate for Payer: Copperpoint Commercial |
$36.14
|
| Rate for Payer: Health Net of AZ Commercial |
$87.60
|
| Rate for Payer: Health Net of AZ Medicare |
$40.88
|
| Rate for Payer: Humana of AZ Medicare |
$21.90
|
| Rate for Payer: Mercy Care Medicaid |
$9.71
|
| Rate for Payer: Self Pay Self Pay |
$116.80
|
| Rate for Payer: TriWest Medicare |
$21.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$85.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.28
|
|
|
Hemoglobin A1C
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
633743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of AZ Commercial |
$131.40
|
| Rate for Payer: Bisbee Police All Plans |
$37.96
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Self Pay Self Pay |
$116.80
|
|
|
Hemoglobin A1c LC
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
1285548
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna of AZ Commercial |
$210.60
|
| Rate for Payer: Aetna of AZ Medicare |
$65.52
|
| Rate for Payer: AHCCCS Medicaid |
$11.61
|
| Rate for Payer: Allwell Medicaid |
$11.61
|
| Rate for Payer: Allwell Medicare |
$35.10
|
| Rate for Payer: Amerigroup Medicare |
$35.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$87.40
|
| Rate for Payer: AZCH Complete Medicaid |
$11.61
|
| Rate for Payer: AZCH Complete Medicare |
$35.10
|
| Rate for Payer: Banner UC Health Medicaid |
$11.61
|
| Rate for Payer: Banner UC Health Medicare |
$35.10
|
| Rate for Payer: Bisbee Police All Plans |
$60.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$159.12
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna of AZ Commercial |
$152.10
|
| Rate for Payer: Copperpoint Commercial |
$57.92
|
| Rate for Payer: Health Net of AZ Commercial |
$140.40
|
| Rate for Payer: Health Net of AZ Medicare |
$65.52
|
| Rate for Payer: Humana of AZ Medicare |
$35.10
|
| Rate for Payer: Mercy Care Medicaid |
$11.61
|
| Rate for Payer: Self Pay Self Pay |
$187.20
|
| Rate for Payer: TriWest Medicare |
$35.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$136.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$42.12
|
|
|
Hemoglobin A1c LC
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
1285548
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna of AZ Commercial |
$210.60
|
| Rate for Payer: Bisbee Police All Plans |
$60.84
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Self Pay Self Pay |
$187.20
|
|
|
.Hemoglobin A1c, Please Note LC
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
22311148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna of AZ Commercial |
$210.60
|
| Rate for Payer: Aetna of AZ Medicare |
$65.52
|
| Rate for Payer: AHCCCS Medicaid |
$11.61
|
| Rate for Payer: Allwell Medicaid |
$11.61
|
| Rate for Payer: Allwell Medicare |
$35.10
|
| Rate for Payer: Amerigroup Medicare |
$35.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$87.40
|
| Rate for Payer: AZCH Complete Medicaid |
$11.61
|
| Rate for Payer: AZCH Complete Medicare |
$35.10
|
| Rate for Payer: Banner UC Health Medicaid |
$11.61
|
| Rate for Payer: Banner UC Health Medicare |
$35.10
|
| Rate for Payer: Bisbee Police All Plans |
$60.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$159.12
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna of AZ Commercial |
$152.10
|
| Rate for Payer: Copperpoint Commercial |
$57.92
|
| Rate for Payer: Health Net of AZ Commercial |
$140.40
|
| Rate for Payer: Health Net of AZ Medicare |
$65.52
|
| Rate for Payer: Humana of AZ Medicare |
$35.10
|
| Rate for Payer: Mercy Care Medicaid |
$11.61
|
| Rate for Payer: Self Pay Self Pay |
$187.20
|
| Rate for Payer: TriWest Medicare |
$35.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$136.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$42.12
|
|
|
.Hemoglobin A1c, Please Note LC
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
22311148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna of AZ Commercial |
$210.60
|
| Rate for Payer: Bisbee Police All Plans |
$60.84
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Self Pay Self Pay |
$187.20
|
|
|
Hemoglobin A1c Standard
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
22146126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of AZ Commercial |
$131.40
|
| Rate for Payer: Bisbee Police All Plans |
$37.96
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Self Pay Self Pay |
$116.80
|
|
|
Hemoglobin A1c Standard
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
22146126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of AZ Commercial |
$131.40
|
| Rate for Payer: Aetna of AZ Medicare |
$40.88
|
| Rate for Payer: AHCCCS Medicaid |
$9.71
|
| Rate for Payer: Allwell Medicaid |
$9.71
|
| Rate for Payer: Allwell Medicare |
$21.90
|
| Rate for Payer: Amerigroup Medicare |
$21.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$54.53
|
| Rate for Payer: AZCH Complete Medicaid |
$9.71
|
| Rate for Payer: AZCH Complete Medicare |
$21.90
|
| Rate for Payer: Banner UC Health Medicaid |
$9.71
|
| Rate for Payer: Banner UC Health Medicare |
$21.90
|
| Rate for Payer: Bisbee Police All Plans |
$37.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$99.28
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cigna of AZ Commercial |
$94.90
|
| Rate for Payer: Copperpoint Commercial |
$36.14
|
| Rate for Payer: Health Net of AZ Commercial |
$87.60
|
| Rate for Payer: Health Net of AZ Medicare |
$40.88
|
| Rate for Payer: Humana of AZ Medicare |
$21.90
|
| Rate for Payer: Mercy Care Medicaid |
$9.71
|
| Rate for Payer: Self Pay Self Pay |
$116.80
|
| Rate for Payer: TriWest Medicare |
$21.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$85.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.28
|
|
|
HEMOGLOBIN A2
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
22481478
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.26 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna of AZ Commercial |
$225.90
|
| Rate for Payer: Bisbee Police All Plans |
$65.26
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Self Pay Self Pay |
$200.80
|
|
|
HEMOGLOBIN A2
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
22481478
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna of AZ Commercial |
$225.90
|
| Rate for Payer: Aetna of AZ Medicare |
$70.28
|
| Rate for Payer: AHCCCS Medicaid |
$8.10
|
| Rate for Payer: Allwell Medicaid |
$8.10
|
| Rate for Payer: Allwell Medicare |
$37.65
|
| Rate for Payer: Amerigroup Medicare |
$37.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$93.75
|
| Rate for Payer: AZCH Complete Medicaid |
$8.10
|
| Rate for Payer: AZCH Complete Medicare |
$37.65
|
| Rate for Payer: Banner UC Health Medicaid |
$8.10
|
| Rate for Payer: Banner UC Health Medicare |
$37.65
|
| Rate for Payer: Bisbee Police All Plans |
$65.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$170.68
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cigna of AZ Commercial |
$163.15
|
| Rate for Payer: Copperpoint Commercial |
$62.12
|
| Rate for Payer: Health Net of AZ Commercial |
$150.60
|
| Rate for Payer: Health Net of AZ Medicare |
$70.28
|
| Rate for Payer: Humana of AZ Medicare |
$37.65
|
| Rate for Payer: Mercy Care Medicaid |
$8.10
|
| Rate for Payer: Self Pay Self Pay |
$200.80
|
| Rate for Payer: TriWest Medicare |
$37.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$146.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$45.18
|
|
|
Hemoglobin POC
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 83036 QW
|
| Hospital Charge Code |
684350
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of AZ Commercial |
$131.40
|
| Rate for Payer: Aetna of AZ Medicare |
$40.88
|
| Rate for Payer: Allwell Medicare |
$21.90
|
| Rate for Payer: Amerigroup Medicare |
$21.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$54.53
|
| Rate for Payer: AZCH Complete Medicare |
$21.90
|
| Rate for Payer: Banner UC Health Medicare |
$21.90
|
| Rate for Payer: Bisbee Police All Plans |
$37.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$99.28
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cigna of AZ Commercial |
$94.90
|
| Rate for Payer: Copperpoint Commercial |
$36.14
|
| Rate for Payer: Health Net of AZ Commercial |
$87.60
|
| Rate for Payer: Health Net of AZ Medicare |
$40.88
|
| Rate for Payer: Humana of AZ Medicare |
$21.90
|
| Rate for Payer: Self Pay Self Pay |
$116.80
|
| Rate for Payer: TriWest Medicare |
$21.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$85.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.28
|
|
|
Hemoglobin POC
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 83036 QW
|
| Hospital Charge Code |
684350
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of AZ Commercial |
$131.40
|
| Rate for Payer: Bisbee Police All Plans |
$37.96
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Self Pay Self Pay |
$116.80
|
|
|
Hemogram Standard
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
22187849
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna of AZ Commercial |
$91.80
|
| Rate for Payer: Aetna of AZ Medicare |
$28.56
|
| Rate for Payer: AHCCCS Medicaid |
$6.47
|
| Rate for Payer: Allwell Medicaid |
$6.47
|
| Rate for Payer: Allwell Medicare |
$15.30
|
| Rate for Payer: Amerigroup Medicare |
$15.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$38.10
|
| Rate for Payer: AZCH Complete Medicaid |
$6.47
|
| Rate for Payer: AZCH Complete Medicare |
$15.30
|
| Rate for Payer: Banner UC Health Medicaid |
$6.47
|
| Rate for Payer: Banner UC Health Medicare |
$15.30
|
| Rate for Payer: Bisbee Police All Plans |
$26.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$69.36
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna of AZ Commercial |
$66.30
|
| Rate for Payer: Copperpoint Commercial |
$25.24
|
| Rate for Payer: Health Net of AZ Commercial |
$61.20
|
| Rate for Payer: Health Net of AZ Medicare |
$28.56
|
| Rate for Payer: Humana of AZ Medicare |
$15.30
|
| Rate for Payer: Mercy Care Medicaid |
$6.47
|
| Rate for Payer: Self Pay Self Pay |
$81.60
|
| Rate for Payer: TriWest Medicare |
$15.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$59.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.36
|
|
|
Hemogram Standard
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
22187849
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna of AZ Commercial |
$91.80
|
| Rate for Payer: Bisbee Police All Plans |
$26.52
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Self Pay Self Pay |
$81.60
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$7,208.99
|
|
|
Service Code
|
APR-DRG 8103
|
| Hospital Charge Code |
APRDRG8103
|
| Min. Negotiated Rate |
$7,208.99 |
| Max. Negotiated Rate |
$7,208.99 |
| Rate for Payer: AHCCCS Medicaid |
$7,208.99
|
| Rate for Payer: Allwell Medicaid |
$7,208.99
|
| Rate for Payer: AZCH Complete Medicaid |
$7,208.99
|
| Rate for Payer: Banner UC Health Medicaid |
$7,208.99
|
| Rate for Payer: Mercy Care Medicaid |
$7,208.99
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 8102
|
| Hospital Charge Code |
APRDRG8102
|
| Min. Negotiated Rate |
$4,557.00 |
| Max. Negotiated Rate |
$4,557.00 |
| Rate for Payer: AHCCCS Medicaid |
$4,557.00
|
| Rate for Payer: Allwell Medicaid |
$4,557.00
|
| Rate for Payer: AZCH Complete Medicaid |
$4,557.00
|
| Rate for Payer: Banner UC Health Medicaid |
$4,557.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,557.00
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$3,444.58
|
|
|
Service Code
|
APR-DRG 8101
|
| Hospital Charge Code |
APRDRG8103
|
| Min. Negotiated Rate |
$3,444.58 |
| Max. Negotiated Rate |
$3,444.58 |
| Rate for Payer: AHCCCS Medicaid |
$3,444.58
|
| Rate for Payer: Allwell Medicaid |
$3,444.58
|
| Rate for Payer: AZCH Complete Medicaid |
$3,444.58
|
| Rate for Payer: Banner UC Health Medicaid |
$3,444.58
|
| Rate for Payer: Mercy Care Medicaid |
$3,444.58
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 8102
|
| Hospital Charge Code |
APRDRG8103
|
| Min. Negotiated Rate |
$4,557.00 |
| Max. Negotiated Rate |
$4,557.00 |
| Rate for Payer: AHCCCS Medicaid |
$4,557.00
|
| Rate for Payer: Allwell Medicaid |
$4,557.00
|
| Rate for Payer: AZCH Complete Medicaid |
$4,557.00
|
| Rate for Payer: Banner UC Health Medicaid |
$4,557.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,557.00
|
|
