|
HEMORRHOID BAND
|
Facility
|
OP
|
$405.00
|
|
| Hospital Charge Code |
22354833
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of AZ Commercial |
$364.50
|
| Rate for Payer: Aetna of AZ Medicare |
$113.40
|
| Rate for Payer: Allwell Medicare |
$64.80
|
| Rate for Payer: Amerigroup Medicare |
$64.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$151.27
|
| Rate for Payer: AZCH Complete Medicare |
$64.80
|
| Rate for Payer: Banner UC Health Medicare |
$64.80
|
| Rate for Payer: Bisbee Police All Plans |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$275.40
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of AZ Commercial |
$283.50
|
| Rate for Payer: Copperpoint Commercial |
$100.24
|
| Rate for Payer: Health Net of AZ Commercial |
$243.00
|
| Rate for Payer: Health Net of AZ Medicare |
$113.40
|
| Rate for Payer: Humana of AZ Medicare |
$64.80
|
| Rate for Payer: Self Pay Self Pay |
$324.00
|
| Rate for Payer: TriWest Medicare |
$64.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$236.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$72.90
|
|
|
HEMORRHOID BAND
|
Facility
|
IP
|
$405.00
|
|
| Hospital Charge Code |
22354833
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of AZ Commercial |
$364.50
|
| Rate for Payer: Bisbee Police All Plans |
$105.30
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Self Pay Self Pay |
$324.00
|
|
|
Hep A Ab, IgM LC
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
2087607
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.82 |
| Max. Negotiated Rate |
$231.30 |
| Rate for Payer: Aetna of AZ Commercial |
$231.30
|
| Rate for Payer: Bisbee Police All Plans |
$66.82
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Self Pay Self Pay |
$205.60
|
|
|
Hep A Ab, IgM LC
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
2087607
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$231.30 |
| Rate for Payer: Aetna of AZ Commercial |
$231.30
|
| Rate for Payer: Aetna of AZ Medicare |
$71.96
|
| Rate for Payer: Allwell Medicare |
$41.12
|
| Rate for Payer: Amerigroup Medicare |
$41.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$95.99
|
| Rate for Payer: AZCH Complete Medicare |
$41.12
|
| Rate for Payer: Banner UC Health Medicare |
$41.12
|
| Rate for Payer: Bisbee Police All Plans |
$66.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$174.76
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cigna of AZ Commercial |
$167.05
|
| Rate for Payer: Copperpoint Commercial |
$63.61
|
| Rate for Payer: Health Net of AZ Commercial |
$154.20
|
| Rate for Payer: Health Net of AZ Medicare |
$71.96
|
| Rate for Payer: Humana of AZ Medicare |
$41.12
|
| Rate for Payer: Self Pay Self Pay |
$205.60
|
| Rate for Payer: TriWest Medicare |
$41.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$149.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$46.26
|
|
|
Hep A Ab, Total LC
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
1906884
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of AZ Commercial |
$207.90
|
| Rate for Payer: Aetna of AZ Medicare |
$64.68
|
| Rate for Payer: Allwell Medicare |
$36.96
|
| Rate for Payer: Amerigroup Medicare |
$36.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$86.28
|
| Rate for Payer: AZCH Complete Medicare |
$36.96
|
| Rate for Payer: Banner UC Health Medicare |
$36.96
|
| Rate for Payer: Bisbee Police All Plans |
$60.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$157.08
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna of AZ Commercial |
$150.15
|
| Rate for Payer: Copperpoint Commercial |
$57.17
|
| Rate for Payer: Health Net of AZ Commercial |
$138.60
|
| Rate for Payer: Health Net of AZ Medicare |
$64.68
|
| Rate for Payer: Humana of AZ Medicare |
$36.96
|
| Rate for Payer: Self Pay Self Pay |
$184.80
|
| Rate for Payer: TriWest Medicare |
$36.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$134.67
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.58
|
|
|
Hep A Ab, Total LC
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
1906884
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of AZ Commercial |
$207.90
|
| Rate for Payer: Bisbee Police All Plans |
$60.06
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Self Pay Self Pay |
$184.80
|
|
|
heparin 5000 units/mL Inj Sol [CQCH]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
105925227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of AZ Commercial |
$0.79
|
| Rate for Payer: Bisbee Police All Plans |
$0.23
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Self Pay Self Pay |
$0.70
|
|
|
heparin 5000 units/mL Inj Sol [CQCH]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
105925227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of AZ Commercial |
$0.79
|
| Rate for Payer: Aetna of AZ Medicare |
$0.25
|
| Rate for Payer: Allwell Medicare |
$0.14
|
| Rate for Payer: Amerigroup Medicare |
$0.14
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.33
|
| Rate for Payer: AZCH Complete Medicare |
$0.14
|
| Rate for Payer: Banner UC Health Medicare |
$0.14
|
| Rate for Payer: Bisbee Police All Plans |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of AZ Commercial |
$0.57
|
| Rate for Payer: Copperpoint Commercial |
$0.22
|
| Rate for Payer: Health Net of AZ Commercial |
$0.53
|
| Rate for Payer: Health Net of AZ Medicare |
$0.25
|
| Rate for Payer: Humana of AZ Medicare |
$0.14
|
| Rate for Payer: Self Pay Self Pay |
$0.70
|
| Rate for Payer: TriWest Medicare |
$0.14
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.51
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.16
|
|
|
heparin drip 25000 units/ 250 mL IVPB [CQCH]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
105925296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of AZ Commercial |
$0.04
|
| Rate for Payer: Aetna of AZ Medicare |
$0.01
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.01
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of AZ Commercial |
$0.03
|
| 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 |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.03
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
heparin drip 25000 units/ 250 mL IVPB [CQCH]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
105925296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of AZ Commercial |
$0.04
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Self Pay Self Pay |
$0.03
|
|
|
heparin flush 100 units/mL Sol [CQCH]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
105925367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of AZ Commercial |
$0.06
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
|
|
heparin flush 100 units/mL Sol [CQCH]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
105925367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of AZ Commercial |
$0.06
|
| 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 |
$0.03
|
| 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 |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of AZ Commercial |
$0.05
|
| Rate for Payer: Copperpoint Commercial |
$0.02
|
| 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 |
$0.06
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.04
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
heparin flush 10 units/mL Sol[CQCH]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
153607645
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of AZ Commercial |
$0.53
|
| 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 |
$0.22
|
| Rate for Payer: AZCH Complete Medicare |
$0.09
|
| Rate for Payer: Banner UC Health Medicare |
$0.09
|
| Rate for Payer: Bisbee Police All Plans |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of AZ Commercial |
$0.38
|
| Rate for Payer: Copperpoint Commercial |
$0.15
|
| Rate for Payer: Health Net of AZ Commercial |
$0.35
|
| 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 |
$0.47
|
| Rate for Payer: TriWest Medicare |
$0.09
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.34
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.11
|
|
|
heparin flush 10 units/mL Sol[CQCH]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
153607645
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of AZ Commercial |
$0.53
|
| Rate for Payer: Bisbee Police All Plans |
$0.15
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Self Pay Self Pay |
$0.47
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$4,281.35
|
|
|
Service Code
|
APR-DRG 2792
|
| Hospital Charge Code |
APRDRG2794
|
| Min. Negotiated Rate |
$4,281.35 |
| Max. Negotiated Rate |
$4,281.35 |
| Rate for Payer: AHCCCS Medicaid |
$4,281.35
|
| Rate for Payer: Allwell Medicaid |
$4,281.35
|
| Rate for Payer: AZCH Complete Medicaid |
$4,281.35
|
| Rate for Payer: Banner UC Health Medicaid |
$4,281.35
|
| Rate for Payer: Mercy Care Medicaid |
$4,281.35
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$4,281.35
|
|
|
Service Code
|
APR-DRG 2792
|
| Hospital Charge Code |
APRDRG2793
|
| Min. Negotiated Rate |
$4,281.35 |
| Max. Negotiated Rate |
$4,281.35 |
| Rate for Payer: AHCCCS Medicaid |
$4,281.35
|
| Rate for Payer: Allwell Medicaid |
$4,281.35
|
| Rate for Payer: AZCH Complete Medicaid |
$4,281.35
|
| Rate for Payer: Banner UC Health Medicaid |
$4,281.35
|
| Rate for Payer: Mercy Care Medicaid |
$4,281.35
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$6,830.93
|
|
|
Service Code
|
APR-DRG 2793
|
| Hospital Charge Code |
APRDRG2792
|
| Min. Negotiated Rate |
$6,830.93 |
| Max. Negotiated Rate |
$6,830.93 |
| Rate for Payer: AHCCCS Medicaid |
$6,830.93
|
| Rate for Payer: Allwell Medicaid |
$6,830.93
|
| Rate for Payer: AZCH Complete Medicaid |
$6,830.93
|
| Rate for Payer: Banner UC Health Medicaid |
$6,830.93
|
| Rate for Payer: Mercy Care Medicaid |
$6,830.93
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$3,375.84
|
|
|
Service Code
|
APR-DRG 2791
|
| Hospital Charge Code |
APRDRG2792
|
| Min. Negotiated Rate |
$3,375.84 |
| Max. Negotiated Rate |
$3,375.84 |
| Rate for Payer: AHCCCS Medicaid |
$3,375.84
|
| Rate for Payer: Allwell Medicaid |
$3,375.84
|
| Rate for Payer: AZCH Complete Medicaid |
$3,375.84
|
| Rate for Payer: Banner UC Health Medicaid |
$3,375.84
|
| Rate for Payer: Mercy Care Medicaid |
$3,375.84
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$6,830.93
|
|
|
Service Code
|
APR-DRG 2793
|
| Hospital Charge Code |
APRDRG2793
|
| Min. Negotiated Rate |
$6,830.93 |
| Max. Negotiated Rate |
$6,830.93 |
| Rate for Payer: AHCCCS Medicaid |
$6,830.93
|
| Rate for Payer: Allwell Medicaid |
$6,830.93
|
| Rate for Payer: AZCH Complete Medicaid |
$6,830.93
|
| Rate for Payer: Banner UC Health Medicaid |
$6,830.93
|
| Rate for Payer: Mercy Care Medicaid |
$6,830.93
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$3,375.84
|
|
|
Service Code
|
APR-DRG 2791
|
| Hospital Charge Code |
APRDRG2793
|
| Min. Negotiated Rate |
$3,375.84 |
| Max. Negotiated Rate |
$3,375.84 |
| Rate for Payer: AHCCCS Medicaid |
$3,375.84
|
| Rate for Payer: Allwell Medicaid |
$3,375.84
|
| Rate for Payer: AZCH Complete Medicaid |
$3,375.84
|
| Rate for Payer: Banner UC Health Medicaid |
$3,375.84
|
| Rate for Payer: Mercy Care Medicaid |
$3,375.84
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$4,281.35
|
|
|
Service Code
|
APR-DRG 2792
|
| Hospital Charge Code |
APRDRG2792
|
| Min. Negotiated Rate |
$4,281.35 |
| Max. Negotiated Rate |
$4,281.35 |
| Rate for Payer: AHCCCS Medicaid |
$4,281.35
|
| Rate for Payer: Allwell Medicaid |
$4,281.35
|
| Rate for Payer: AZCH Complete Medicaid |
$4,281.35
|
| Rate for Payer: Banner UC Health Medicaid |
$4,281.35
|
| Rate for Payer: Mercy Care Medicaid |
$4,281.35
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$3,375.84
|
|
|
Service Code
|
APR-DRG 2791
|
| Hospital Charge Code |
APRDRG2794
|
| Min. Negotiated Rate |
$3,375.84 |
| Max. Negotiated Rate |
$3,375.84 |
| Rate for Payer: AHCCCS Medicaid |
$3,375.84
|
| Rate for Payer: Allwell Medicaid |
$3,375.84
|
| Rate for Payer: AZCH Complete Medicaid |
$3,375.84
|
| Rate for Payer: Banner UC Health Medicaid |
$3,375.84
|
| Rate for Payer: Mercy Care Medicaid |
$3,375.84
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$16,093.62
|
|
|
Service Code
|
APR-DRG 2794
|
| Hospital Charge Code |
APRDRG2794
|
| Min. Negotiated Rate |
$16,093.62 |
| Max. Negotiated Rate |
$16,093.62 |
| Rate for Payer: AHCCCS Medicaid |
$16,093.62
|
| Rate for Payer: Allwell Medicaid |
$16,093.62
|
| Rate for Payer: AZCH Complete Medicaid |
$16,093.62
|
| Rate for Payer: Banner UC Health Medicaid |
$16,093.62
|
| Rate for Payer: Mercy Care Medicaid |
$16,093.62
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$16,093.62
|
|
|
Service Code
|
APR-DRG 2794
|
| Hospital Charge Code |
APRDRG2792
|
| Min. Negotiated Rate |
$16,093.62 |
| Max. Negotiated Rate |
$16,093.62 |
| Rate for Payer: AHCCCS Medicaid |
$16,093.62
|
| Rate for Payer: Allwell Medicaid |
$16,093.62
|
| Rate for Payer: AZCH Complete Medicaid |
$16,093.62
|
| Rate for Payer: Banner UC Health Medicaid |
$16,093.62
|
| Rate for Payer: Mercy Care Medicaid |
$16,093.62
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$16,093.62
|
|
|
Service Code
|
APR-DRG 2794
|
| Hospital Charge Code |
APRDRG2791
|
| Min. Negotiated Rate |
$16,093.62 |
| Max. Negotiated Rate |
$16,093.62 |
| Rate for Payer: AHCCCS Medicaid |
$16,093.62
|
| Rate for Payer: Allwell Medicaid |
$16,093.62
|
| Rate for Payer: AZCH Complete Medicaid |
$16,093.62
|
| Rate for Payer: Banner UC Health Medicaid |
$16,093.62
|
| Rate for Payer: Mercy Care Medicaid |
$16,093.62
|
|
