|
.Hemoglobin A1c, Please Note LC
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
22311148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.44 |
| 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: Allwell Medicare |
$37.44
|
| Rate for Payer: Amerigroup Medicare |
$37.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$87.40
|
| Rate for Payer: AZCH Complete Medicare |
$37.44
|
| Rate for Payer: Banner UC Health Medicare |
$37.44
|
| 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: Cigna of AZ Commercial |
$152.10
|
| Rate for Payer: Copperpoint Commercial |
$57.91
|
| 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 |
$37.44
|
| Rate for Payer: Self Pay Self Pay |
$187.20
|
| Rate for Payer: TriWest Medicare |
$37.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$136.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$42.12
|
|
|
Hemoglobin A1c Standard
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
22146126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.92 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna of AZ Commercial |
$168.30
|
| Rate for Payer: Aetna of AZ Medicare |
$52.36
|
| Rate for Payer: Allwell Medicare |
$29.92
|
| Rate for Payer: Amerigroup Medicare |
$29.92
|
| Rate for Payer: APIPA Medicare/Medicaid |
$69.84
|
| Rate for Payer: AZCH Complete Medicare |
$29.92
|
| Rate for Payer: Banner UC Health Medicare |
$29.92
|
| Rate for Payer: Bisbee Police All Plans |
$48.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$127.16
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cigna of AZ Commercial |
$121.55
|
| Rate for Payer: Copperpoint Commercial |
$46.28
|
| Rate for Payer: Health Net of AZ Commercial |
$112.20
|
| Rate for Payer: Health Net of AZ Medicare |
$52.36
|
| Rate for Payer: Humana of AZ Medicare |
$29.92
|
| Rate for Payer: Self Pay Self Pay |
$149.60
|
| Rate for Payer: TriWest Medicare |
$29.92
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$109.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$33.66
|
|
|
Hemoglobin A1c Standard
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
22146126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.62 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna of AZ Commercial |
$168.30
|
| Rate for Payer: Bisbee Police All Plans |
$48.62
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Self Pay Self Pay |
$149.60
|
|
|
HEMOGLOBIN A2
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
22481478
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna of AZ Commercial |
$214.20
|
| Rate for Payer: Aetna of AZ Medicare |
$66.64
|
| Rate for Payer: Allwell Medicare |
$38.08
|
| Rate for Payer: Amerigroup Medicare |
$38.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$88.89
|
| Rate for Payer: AZCH Complete Medicare |
$38.08
|
| Rate for Payer: Banner UC Health Medicare |
$38.08
|
| Rate for Payer: Bisbee Police All Plans |
$61.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$161.84
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cigna of AZ Commercial |
$154.70
|
| Rate for Payer: Copperpoint Commercial |
$58.91
|
| Rate for Payer: Health Net of AZ Commercial |
$142.80
|
| Rate for Payer: Health Net of AZ Medicare |
$66.64
|
| Rate for Payer: Humana of AZ Medicare |
$38.08
|
| Rate for Payer: Self Pay Self Pay |
$190.40
|
| Rate for Payer: TriWest Medicare |
$38.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$138.75
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$42.84
|
|
|
HEMOGLOBIN A2
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
22481478
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna of AZ Commercial |
$214.20
|
| Rate for Payer: Bisbee Police All Plans |
$61.88
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Self Pay Self Pay |
$190.40
|
|
|
Hemoglobin POC
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 83036
|
| 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
|
|
|
Hemoglobin POC
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
684350
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.36 |
| 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 |
$23.36
|
| Rate for Payer: Amerigroup Medicare |
$23.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$54.53
|
| Rate for Payer: AZCH Complete Medicare |
$23.36
|
| Rate for Payer: Banner UC Health Medicare |
$23.36
|
| 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 |
$36.13
|
| 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 |
$23.36
|
| Rate for Payer: Self Pay Self Pay |
$116.80
|
| Rate for Payer: TriWest Medicare |
$23.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$85.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.28
|
|
|
Hemogram Standard
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
22187849
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna of AZ Commercial |
$87.30
|
| Rate for Payer: Bisbee Police All Plans |
$25.22
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Self Pay Self Pay |
$77.60
|
|
|
Hemogram Standard
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
22187849
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna of AZ Commercial |
$87.30
|
| Rate for Payer: Aetna of AZ Medicare |
$27.16
|
| Rate for Payer: Allwell Medicare |
$15.52
|
| Rate for Payer: Amerigroup Medicare |
$15.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$36.23
|
| Rate for Payer: AZCH Complete Medicare |
$15.52
|
| Rate for Payer: Banner UC Health Medicare |
$15.52
|
| Rate for Payer: Bisbee Police All Plans |
$25.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$65.96
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cigna of AZ Commercial |
$63.05
|
| Rate for Payer: Copperpoint Commercial |
$24.01
|
| Rate for Payer: Health Net of AZ Commercial |
$58.20
|
| Rate for Payer: Health Net of AZ Medicare |
$27.16
|
| Rate for Payer: Humana of AZ Medicare |
$15.52
|
| Rate for Payer: Self Pay Self Pay |
$77.60
|
| Rate for Payer: TriWest Medicare |
$15.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$56.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$17.46
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$14,389.22
|
|
|
Service Code
|
APR-DRG 8104
|
| Hospital Charge Code |
APRDRG8101
|
| Min. Negotiated Rate |
$14,389.22 |
| Max. Negotiated Rate |
$14,389.22 |
| Rate for Payer: AHCCCS Medicaid |
$14,389.22
|
| Rate for Payer: Allwell Medicaid |
$14,389.22
|
| Rate for Payer: AZCH Complete Medicaid |
$14,389.22
|
| Rate for Payer: Banner UC Health Medicaid |
$14,389.22
|
| Rate for Payer: Mercy Care Medicaid |
$14,389.22
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$3,444.58
|
|
|
Service Code
|
APR-DRG 8101
|
| Hospital Charge Code |
APRDRG8104
|
| 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
|
$14,389.22
|
|
|
Service Code
|
APR-DRG 8104
|
| Hospital Charge Code |
APRDRG8103
|
| Min. Negotiated Rate |
$14,389.22 |
| Max. Negotiated Rate |
$14,389.22 |
| Rate for Payer: AHCCCS Medicaid |
$14,389.22
|
| Rate for Payer: Allwell Medicaid |
$14,389.22
|
| Rate for Payer: AZCH Complete Medicaid |
$14,389.22
|
| Rate for Payer: Banner UC Health Medicaid |
$14,389.22
|
| Rate for Payer: Mercy Care Medicaid |
$14,389.22
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$3,444.58
|
|
|
Service Code
|
APR-DRG 8101
|
| Hospital Charge Code |
APRDRG8101
|
| 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 |
APRDRG8104
|
| 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
|
$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
|
$14,389.22
|
|
|
Service Code
|
APR-DRG 8104
|
| Hospital Charge Code |
APRDRG8104
|
| Min. Negotiated Rate |
$14,389.22 |
| Max. Negotiated Rate |
$14,389.22 |
| Rate for Payer: AHCCCS Medicaid |
$14,389.22
|
| Rate for Payer: Allwell Medicaid |
$14,389.22
|
| Rate for Payer: AZCH Complete Medicaid |
$14,389.22
|
| Rate for Payer: Banner UC Health Medicaid |
$14,389.22
|
| Rate for Payer: Mercy Care Medicaid |
$14,389.22
|
|
|
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
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$7,208.99
|
|
|
Service Code
|
APR-DRG 8103
|
| Hospital Charge Code |
APRDRG8101
|
| 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
|
$3,444.58
|
|
|
Service Code
|
APR-DRG 8101
|
| Hospital Charge Code |
APRDRG8102
|
| 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
|
$7,208.99
|
|
|
Service Code
|
APR-DRG 8103
|
| Hospital Charge Code |
APRDRG8102
|
| 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
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 8102
|
| Hospital Charge Code |
APRDRG8101
|
| 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
|
$14,389.22
|
|
|
Service Code
|
APR-DRG 8104
|
| Hospital Charge Code |
APRDRG8102
|
| Min. Negotiated Rate |
$14,389.22 |
| Max. Negotiated Rate |
$14,389.22 |
| Rate for Payer: AHCCCS Medicaid |
$14,389.22
|
| Rate for Payer: Allwell Medicaid |
$14,389.22
|
| Rate for Payer: AZCH Complete Medicaid |
$14,389.22
|
| Rate for Payer: Banner UC Health Medicaid |
$14,389.22
|
| Rate for Payer: Mercy Care Medicaid |
$14,389.22
|
|
|
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
|
$7,208.99
|
|
|
Service Code
|
APR-DRG 8103
|
| Hospital Charge Code |
APRDRG8104
|
| 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
|
|
