|
Hepatitis B Surf Ab Quant LC
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
22201154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Aetna of AZ Commercial |
$363.60
|
| Rate for Payer: Bisbee Police All Plans |
$105.04
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Self Pay Self Pay |
$323.20
|
|
|
Hepatitis B Surf Ab Quant LC
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
22201154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Aetna of AZ Commercial |
$363.60
|
| Rate for Payer: Aetna of AZ Medicare |
$113.12
|
| Rate for Payer: AHCCCS Medicaid |
$10.74
|
| Rate for Payer: Allwell Medicaid |
$10.74
|
| Rate for Payer: Allwell Medicare |
$60.60
|
| Rate for Payer: Amerigroup Medicare |
$60.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$150.89
|
| Rate for Payer: AZCH Complete Medicaid |
$10.74
|
| Rate for Payer: AZCH Complete Medicare |
$60.60
|
| Rate for Payer: Banner UC Health Medicaid |
$10.74
|
| Rate for Payer: Banner UC Health Medicare |
$60.60
|
| Rate for Payer: Bisbee Police All Plans |
$105.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$274.72
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cigna of AZ Commercial |
$262.60
|
| Rate for Payer: Copperpoint Commercial |
$99.99
|
| Rate for Payer: Health Net of AZ Commercial |
$242.40
|
| Rate for Payer: Health Net of AZ Medicare |
$113.12
|
| Rate for Payer: Humana of AZ Medicare |
$60.60
|
| Rate for Payer: Mercy Care Medicaid |
$10.74
|
| Rate for Payer: Self Pay Self Pay |
$323.20
|
| Rate for Payer: TriWest Medicare |
$60.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$235.53
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$72.72
|
|
|
.Hepatitis C Genotype LC
|
Facility
|
IP
|
$3,199.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
1285769
|
|
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
|
|
|
.Hepatitis C Genotype LC
|
Facility
|
OP
|
$3,199.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
1285769
|
|
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
|
|
|
Hepatitis C Virus (HCV) RNA, Qualitative, NAA, LC
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
22084806
|
|
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
|
|
|
Hepatitis C Virus (HCV) RNA, Qualitative, NAA, LC
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
22084806
|
|
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
|
|
|
Hepatitis E IGG/IGM
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
22589636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of AZ Commercial |
$62.10
|
| Rate for Payer: Aetna of AZ Medicare |
$19.32
|
| Rate for Payer: AHCCCS Medicaid |
$13.60
|
| Rate for Payer: Allwell Medicaid |
$13.60
|
| Rate for Payer: Allwell Medicare |
$10.35
|
| Rate for Payer: Amerigroup Medicare |
$10.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$25.77
|
| Rate for Payer: AZCH Complete Medicaid |
$13.60
|
| Rate for Payer: AZCH Complete Medicare |
$10.35
|
| Rate for Payer: Banner UC Health Medicaid |
$13.60
|
| Rate for Payer: Banner UC Health Medicare |
$10.35
|
| Rate for Payer: Bisbee Police All Plans |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$46.92
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna of AZ Commercial |
$44.85
|
| Rate for Payer: Copperpoint Commercial |
$17.08
|
| Rate for Payer: Health Net of AZ Commercial |
$41.40
|
| Rate for Payer: Health Net of AZ Medicare |
$19.32
|
| Rate for Payer: Humana of AZ Medicare |
$10.35
|
| Rate for Payer: Mercy Care Medicaid |
$13.60
|
| Rate for Payer: Self Pay Self Pay |
$55.20
|
| Rate for Payer: TriWest Medicare |
$10.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$40.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.42
|
|
|
Hepatitis E IGG/IGM
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
22589636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of AZ Commercial |
$62.10
|
| Rate for Payer: Bisbee Police All Plans |
$17.94
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Self Pay Self Pay |
$55.20
|
|
|
Hepatitis E Virus (HEV) IgG/M LC
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
22720193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.60 |
| 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: AHCCCS Medicaid |
$13.60
|
| Rate for Payer: Allwell Medicaid |
$13.60
|
| Rate for Payer: Allwell Medicare |
$38.55
|
| Rate for Payer: Amerigroup Medicare |
$38.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$95.99
|
| Rate for Payer: AZCH Complete Medicaid |
$13.60
|
| Rate for Payer: AZCH Complete Medicare |
$38.55
|
| Rate for Payer: Banner UC Health Medicaid |
$13.60
|
| Rate for Payer: Banner UC Health Medicare |
$38.55
|
| 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: 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 |
$38.55
|
| Rate for Payer: Mercy Care Medicaid |
$13.60
|
| Rate for Payer: Self Pay Self Pay |
$205.60
|
| Rate for Payer: TriWest Medicare |
$38.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$149.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$46.26
|
|
|
Hepatitis E Virus (HEV) IgG/M LC
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
22720193
|
|
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
|
|
|
Hepatitis Panel (4) LC
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
1285754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$314.34 |
| Max. Negotiated Rate |
$1,088.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,088.10
|
| Rate for Payer: Bisbee Police All Plans |
$314.34
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Self Pay Self Pay |
$967.20
|
|
|
Hepatitis Panel (4) LC
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
1285754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$1,088.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,088.10
|
| Rate for Payer: Aetna of AZ Medicare |
$338.52
|
| Rate for Payer: AHCCCS Medicaid |
$47.63
|
| Rate for Payer: Allwell Medicaid |
$47.63
|
| Rate for Payer: Allwell Medicare |
$181.35
|
| Rate for Payer: Amerigroup Medicare |
$181.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$451.56
|
| Rate for Payer: AZCH Complete Medicaid |
$47.63
|
| Rate for Payer: AZCH Complete Medicare |
$181.35
|
| Rate for Payer: Banner UC Health Medicaid |
$47.63
|
| Rate for Payer: Banner UC Health Medicare |
$181.35
|
| Rate for Payer: Bisbee Police All Plans |
$314.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$822.12
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cigna of AZ Commercial |
$785.85
|
| Rate for Payer: Copperpoint Commercial |
$299.23
|
| Rate for Payer: Health Net of AZ Commercial |
$725.40
|
| Rate for Payer: Health Net of AZ Medicare |
$338.52
|
| Rate for Payer: Humana of AZ Medicare |
$181.35
|
| Rate for Payer: Mercy Care Medicaid |
$47.63
|
| Rate for Payer: Self Pay Self Pay |
$967.20
|
| Rate for Payer: TriWest Medicare |
$181.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$704.85
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$217.62
|
|
|
Hep B Core Ab, IgM LC
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
1906888
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna of AZ Commercial |
$205.20
|
| Rate for Payer: Bisbee Police All Plans |
$59.28
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Self Pay Self Pay |
$182.40
|
|
|
Hep B Core Ab, IgM LC
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
1906888
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna of AZ Commercial |
$205.20
|
| Rate for Payer: Aetna of AZ Medicare |
$63.84
|
| Rate for Payer: AHCCCS Medicaid |
$11.77
|
| Rate for Payer: Allwell Medicaid |
$11.77
|
| Rate for Payer: Allwell Medicare |
$34.20
|
| Rate for Payer: Amerigroup Medicare |
$34.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$85.16
|
| Rate for Payer: AZCH Complete Medicaid |
$11.77
|
| Rate for Payer: AZCH Complete Medicare |
$34.20
|
| Rate for Payer: Banner UC Health Medicaid |
$11.77
|
| Rate for Payer: Banner UC Health Medicare |
$34.20
|
| Rate for Payer: Bisbee Police All Plans |
$59.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$155.04
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cigna of AZ Commercial |
$148.20
|
| Rate for Payer: Copperpoint Commercial |
$56.43
|
| Rate for Payer: Health Net of AZ Commercial |
$136.80
|
| Rate for Payer: Health Net of AZ Medicare |
$63.84
|
| Rate for Payer: Humana of AZ Medicare |
$34.20
|
| Rate for Payer: Mercy Care Medicaid |
$11.77
|
| Rate for Payer: Self Pay Self Pay |
$182.40
|
| Rate for Payer: TriWest Medicare |
$34.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$132.92
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.04
|
|
|
Hep B Core Ab, Tot LC
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
2087608
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna of AZ Commercial |
$219.60
|
| Rate for Payer: Aetna of AZ Medicare |
$68.32
|
| Rate for Payer: AHCCCS Medicaid |
$12.05
|
| Rate for Payer: Allwell Medicaid |
$12.05
|
| Rate for Payer: Allwell Medicare |
$36.60
|
| Rate for Payer: Amerigroup Medicare |
$36.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$91.13
|
| Rate for Payer: AZCH Complete Medicaid |
$12.05
|
| Rate for Payer: AZCH Complete Medicare |
$36.60
|
| Rate for Payer: Banner UC Health Medicaid |
$12.05
|
| Rate for Payer: Banner UC Health Medicare |
$36.60
|
| Rate for Payer: Bisbee Police All Plans |
$63.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$165.92
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cigna of AZ Commercial |
$158.60
|
| Rate for Payer: Copperpoint Commercial |
$60.39
|
| Rate for Payer: Health Net of AZ Commercial |
$146.40
|
| Rate for Payer: Health Net of AZ Medicare |
$68.32
|
| Rate for Payer: Humana of AZ Medicare |
$36.60
|
| Rate for Payer: Mercy Care Medicaid |
$12.05
|
| Rate for Payer: Self Pay Self Pay |
$195.20
|
| Rate for Payer: TriWest Medicare |
$36.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$142.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$43.92
|
|
|
Hep B Core Ab, Tot LC
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
2087608
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.44 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna of AZ Commercial |
$219.60
|
| Rate for Payer: Bisbee Police All Plans |
$63.44
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Self Pay Self Pay |
$195.20
|
|
|
Hep Be Ab LC
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
6738654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna of AZ Commercial |
$160.20
|
| Rate for Payer: Bisbee Police All Plans |
$46.28
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Self Pay Self Pay |
$142.40
|
|
|
Hep Be Ab LC
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
6738654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna of AZ Commercial |
$160.20
|
| Rate for Payer: Aetna of AZ Medicare |
$49.84
|
| Rate for Payer: AHCCCS Medicaid |
$11.57
|
| Rate for Payer: Allwell Medicaid |
$11.57
|
| Rate for Payer: Allwell Medicare |
$26.70
|
| Rate for Payer: Amerigroup Medicare |
$26.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$66.48
|
| Rate for Payer: AZCH Complete Medicaid |
$11.57
|
| Rate for Payer: AZCH Complete Medicare |
$26.70
|
| Rate for Payer: Banner UC Health Medicaid |
$11.57
|
| Rate for Payer: Banner UC Health Medicare |
$26.70
|
| Rate for Payer: Bisbee Police All Plans |
$46.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$121.04
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cigna of AZ Commercial |
$115.70
|
| Rate for Payer: Copperpoint Commercial |
$44.06
|
| Rate for Payer: Health Net of AZ Commercial |
$106.80
|
| Rate for Payer: Health Net of AZ Medicare |
$49.84
|
| Rate for Payer: Humana of AZ Medicare |
$26.70
|
| Rate for Payer: Mercy Care Medicaid |
$11.57
|
| Rate for Payer: Self Pay Self Pay |
$142.40
|
| Rate for Payer: TriWest Medicare |
$26.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$103.77
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.04
|
|
|
Hep B Surface Ab LC
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1285784
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of AZ Commercial |
$126.00
|
| Rate for Payer: Bisbee Police All Plans |
$36.40
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Self Pay Self Pay |
$112.00
|
|
|
Hep B Surface Ab LC
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1285784
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of AZ Commercial |
$126.00
|
| Rate for Payer: Aetna of AZ Medicare |
$39.20
|
| Rate for Payer: AHCCCS Medicaid |
$10.74
|
| Rate for Payer: Allwell Medicaid |
$10.74
|
| Rate for Payer: Allwell Medicare |
$21.00
|
| Rate for Payer: Amerigroup Medicare |
$21.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$52.29
|
| Rate for Payer: AZCH Complete Medicaid |
$10.74
|
| Rate for Payer: AZCH Complete Medicare |
$21.00
|
| Rate for Payer: Banner UC Health Medicaid |
$10.74
|
| Rate for Payer: Banner UC Health Medicare |
$21.00
|
| Rate for Payer: Bisbee Police All Plans |
$36.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$95.20
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna of AZ Commercial |
$91.00
|
| Rate for Payer: Copperpoint Commercial |
$34.65
|
| Rate for Payer: Health Net of AZ Commercial |
$84.00
|
| Rate for Payer: Health Net of AZ Medicare |
$39.20
|
| Rate for Payer: Humana of AZ Medicare |
$21.00
|
| Rate for Payer: Mercy Care Medicaid |
$10.74
|
| Rate for Payer: Self Pay Self Pay |
$112.00
|
| Rate for Payer: TriWest Medicare |
$21.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$81.62
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.20
|
|
|
.Hered Hemochroma, Please Note LC
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
22311149
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.36 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna of AZ Commercial |
$579.60
|
| Rate for Payer: Aetna of AZ Medicare |
$180.32
|
| Rate for Payer: AHCCCS Medicaid |
$65.36
|
| Rate for Payer: Allwell Medicaid |
$65.36
|
| Rate for Payer: Allwell Medicare |
$96.60
|
| Rate for Payer: Amerigroup Medicare |
$96.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$240.53
|
| Rate for Payer: AZCH Complete Medicaid |
$65.36
|
| Rate for Payer: AZCH Complete Medicare |
$96.60
|
| Rate for Payer: Banner UC Health Medicaid |
$65.36
|
| Rate for Payer: Banner UC Health Medicare |
$96.60
|
| Rate for Payer: Bisbee Police All Plans |
$167.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$437.92
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cigna of AZ Commercial |
$418.60
|
| Rate for Payer: Copperpoint Commercial |
$159.39
|
| Rate for Payer: Health Net of AZ Commercial |
$386.40
|
| Rate for Payer: Health Net of AZ Medicare |
$180.32
|
| Rate for Payer: Humana of AZ Medicare |
$96.60
|
| Rate for Payer: Mercy Care Medicaid |
$65.36
|
| Rate for Payer: Self Pay Self Pay |
$515.20
|
| Rate for Payer: TriWest Medicare |
$96.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$375.45
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$115.92
|
|
|
.Hered Hemochroma, Please Note LC
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
22311149
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna of AZ Commercial |
$579.60
|
| Rate for Payer: Bisbee Police All Plans |
$167.44
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Self Pay Self Pay |
$515.20
|
|
|
Hered.Hemochromatosis, DNA LC
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
2087610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$211.38 |
| Max. Negotiated Rate |
$731.70 |
| Rate for Payer: Aetna of AZ Commercial |
$731.70
|
| Rate for Payer: Bisbee Police All Plans |
$211.38
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Self Pay Self Pay |
$650.40
|
|
|
Hered.Hemochromatosis, DNA LC
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
2087610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.36 |
| Max. Negotiated Rate |
$731.70 |
| Rate for Payer: Aetna of AZ Commercial |
$731.70
|
| Rate for Payer: Aetna of AZ Medicare |
$227.64
|
| Rate for Payer: AHCCCS Medicaid |
$65.36
|
| Rate for Payer: Allwell Medicaid |
$65.36
|
| Rate for Payer: Allwell Medicare |
$121.95
|
| Rate for Payer: Amerigroup Medicare |
$121.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$303.66
|
| Rate for Payer: AZCH Complete Medicaid |
$65.36
|
| Rate for Payer: AZCH Complete Medicare |
$121.95
|
| Rate for Payer: Banner UC Health Medicaid |
$65.36
|
| Rate for Payer: Banner UC Health Medicare |
$121.95
|
| Rate for Payer: Bisbee Police All Plans |
$211.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$552.84
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cigna of AZ Commercial |
$528.45
|
| Rate for Payer: Copperpoint Commercial |
$201.22
|
| Rate for Payer: Health Net of AZ Commercial |
$487.80
|
| Rate for Payer: Health Net of AZ Medicare |
$227.64
|
| Rate for Payer: Humana of AZ Medicare |
$121.95
|
| Rate for Payer: Mercy Care Medicaid |
$65.36
|
| Rate for Payer: Self Pay Self Pay |
$650.40
|
| Rate for Payer: TriWest Medicare |
$121.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$473.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$146.34
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$7,520.41
|
|
|
Service Code
|
APR-DRG 2271
|
| Hospital Charge Code |
APRDRG2274
|
| Min. Negotiated Rate |
$7,520.41 |
| Max. Negotiated Rate |
$7,520.41 |
| Rate for Payer: AHCCCS Medicaid |
$7,520.41
|
| Rate for Payer: Allwell Medicaid |
$7,520.41
|
| Rate for Payer: AZCH Complete Medicaid |
$7,520.41
|
| Rate for Payer: Banner UC Health Medicaid |
$7,520.41
|
| Rate for Payer: Mercy Care Medicaid |
$7,520.41
|
|
