|
Hepatitis Panel (4) LC
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
1285754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$183.04 |
| Max. Negotiated Rate |
$1,029.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,029.60
|
| Rate for Payer: Aetna of AZ Medicare |
$320.32
|
| Rate for Payer: Allwell Medicare |
$183.04
|
| Rate for Payer: Amerigroup Medicare |
$183.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$427.28
|
| Rate for Payer: AZCH Complete Medicare |
$183.04
|
| Rate for Payer: Banner UC Health Medicare |
$183.04
|
| Rate for Payer: Bisbee Police All Plans |
$297.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$777.92
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cigna of AZ Commercial |
$743.60
|
| Rate for Payer: Copperpoint Commercial |
$283.14
|
| Rate for Payer: Health Net of AZ Commercial |
$686.40
|
| Rate for Payer: Health Net of AZ Medicare |
$320.32
|
| Rate for Payer: Humana of AZ Medicare |
$183.04
|
| Rate for Payer: Self Pay Self Pay |
$915.20
|
| Rate for Payer: TriWest Medicare |
$183.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$666.95
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$205.92
|
|
|
Hepatitis Panel (4) LC
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
1285754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$297.44 |
| Max. Negotiated Rate |
$1,029.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,029.60
|
| Rate for Payer: Bisbee Police All Plans |
$297.44
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Self Pay Self Pay |
$915.20
|
|
|
Hep B Core Ab, IgM LC
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
1906888
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.42 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna of AZ Commercial |
$195.30
|
| Rate for Payer: Bisbee Police All Plans |
$56.42
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Self Pay Self Pay |
$173.60
|
|
|
Hep B Core Ab, IgM LC
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
1906888
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna of AZ Commercial |
$195.30
|
| Rate for Payer: Aetna of AZ Medicare |
$60.76
|
| Rate for Payer: Allwell Medicare |
$34.72
|
| Rate for Payer: Amerigroup Medicare |
$34.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$81.05
|
| Rate for Payer: AZCH Complete Medicare |
$34.72
|
| Rate for Payer: Banner UC Health Medicare |
$34.72
|
| Rate for Payer: Bisbee Police All Plans |
$56.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$147.56
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cigna of AZ Commercial |
$141.05
|
| Rate for Payer: Copperpoint Commercial |
$53.71
|
| Rate for Payer: Health Net of AZ Commercial |
$130.20
|
| Rate for Payer: Health Net of AZ Medicare |
$60.76
|
| Rate for Payer: Humana of AZ Medicare |
$34.72
|
| Rate for Payer: Self Pay Self Pay |
$173.60
|
| Rate for Payer: TriWest Medicare |
$34.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$126.51
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$39.06
|
|
|
Hep B Core Ab, Tot LC
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
2087608
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.32 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Aetna of AZ Commercial |
$208.80
|
| Rate for Payer: Bisbee Police All Plans |
$60.32
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Self Pay Self Pay |
$185.60
|
|
|
Hep B Core Ab, Tot LC
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
2087608
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Aetna of AZ Commercial |
$208.80
|
| Rate for Payer: Aetna of AZ Medicare |
$64.96
|
| Rate for Payer: Allwell Medicare |
$37.12
|
| Rate for Payer: Amerigroup Medicare |
$37.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$86.65
|
| Rate for Payer: AZCH Complete Medicare |
$37.12
|
| Rate for Payer: Banner UC Health Medicare |
$37.12
|
| Rate for Payer: Bisbee Police All Plans |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$157.76
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cigna of AZ Commercial |
$150.80
|
| Rate for Payer: Copperpoint Commercial |
$57.42
|
| Rate for Payer: Health Net of AZ Commercial |
$139.20
|
| Rate for Payer: Health Net of AZ Medicare |
$64.96
|
| Rate for Payer: Humana of AZ Medicare |
$37.12
|
| Rate for Payer: Self Pay Self Pay |
$185.60
|
| Rate for Payer: TriWest Medicare |
$37.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$135.26
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.76
|
|
|
Hep Be Ab LC
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
6738654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna of AZ Commercial |
$152.10
|
| Rate for Payer: Bisbee Police All Plans |
$43.94
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Self Pay Self Pay |
$135.20
|
|
|
Hep Be Ab LC
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
6738654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna of AZ Commercial |
$152.10
|
| Rate for Payer: Aetna of AZ Medicare |
$47.32
|
| Rate for Payer: Allwell Medicare |
$27.04
|
| Rate for Payer: Amerigroup Medicare |
$27.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$63.12
|
| Rate for Payer: AZCH Complete Medicare |
$27.04
|
| Rate for Payer: Banner UC Health Medicare |
$27.04
|
| Rate for Payer: Bisbee Police All Plans |
$43.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$114.92
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cigna of AZ Commercial |
$109.85
|
| Rate for Payer: Copperpoint Commercial |
$41.83
|
| Rate for Payer: Health Net of AZ Commercial |
$101.40
|
| Rate for Payer: Health Net of AZ Medicare |
$47.32
|
| Rate for Payer: Humana of AZ Medicare |
$27.04
|
| Rate for Payer: Self Pay Self Pay |
$135.20
|
| Rate for Payer: TriWest Medicare |
$27.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$98.53
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.42
|
|
|
Hep B Surface Ab LC
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1285784
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna of AZ Commercial |
$119.70
|
| Rate for Payer: Aetna of AZ Medicare |
$37.24
|
| Rate for Payer: Allwell Medicare |
$21.28
|
| Rate for Payer: Amerigroup Medicare |
$21.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$49.68
|
| Rate for Payer: AZCH Complete Medicare |
$21.28
|
| Rate for Payer: Banner UC Health Medicare |
$21.28
|
| Rate for Payer: Bisbee Police All Plans |
$34.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$90.44
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cigna of AZ Commercial |
$86.45
|
| Rate for Payer: Copperpoint Commercial |
$32.92
|
| Rate for Payer: Health Net of AZ Commercial |
$79.80
|
| Rate for Payer: Health Net of AZ Medicare |
$37.24
|
| Rate for Payer: Humana of AZ Medicare |
$21.28
|
| Rate for Payer: Self Pay Self Pay |
$106.40
|
| Rate for Payer: TriWest Medicare |
$21.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$77.54
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$23.94
|
|
|
Hep B Surface Ab LC
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1285784
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna of AZ Commercial |
$119.70
|
| Rate for Payer: Bisbee Police All Plans |
$34.58
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Self Pay Self Pay |
$106.40
|
|
|
.Hered Hemochroma, Please Note LC
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
22311149
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.04 |
| 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: Allwell Medicare |
$103.04
|
| Rate for Payer: Amerigroup Medicare |
$103.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$240.53
|
| Rate for Payer: AZCH Complete Medicare |
$103.04
|
| Rate for Payer: Banner UC Health Medicare |
$103.04
|
| 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: 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 |
$103.04
|
| Rate for Payer: Self Pay Self Pay |
$515.20
|
| Rate for Payer: TriWest Medicare |
$103.04
|
| 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
|
$751.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
2087610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$195.26 |
| Max. Negotiated Rate |
$675.90 |
| Rate for Payer: Aetna of AZ Commercial |
$675.90
|
| Rate for Payer: Bisbee Police All Plans |
$195.26
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Self Pay Self Pay |
$600.80
|
|
|
Hered.Hemochromatosis, DNA LC
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
2087610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.16 |
| Max. Negotiated Rate |
$675.90 |
| Rate for Payer: Aetna of AZ Commercial |
$675.90
|
| Rate for Payer: Aetna of AZ Medicare |
$210.28
|
| Rate for Payer: Allwell Medicare |
$120.16
|
| Rate for Payer: Amerigroup Medicare |
$120.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$280.50
|
| Rate for Payer: AZCH Complete Medicare |
$120.16
|
| Rate for Payer: Banner UC Health Medicare |
$120.16
|
| Rate for Payer: Bisbee Police All Plans |
$195.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$510.68
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cigna of AZ Commercial |
$488.15
|
| Rate for Payer: Copperpoint Commercial |
$185.87
|
| Rate for Payer: Health Net of AZ Commercial |
$450.60
|
| Rate for Payer: Health Net of AZ Medicare |
$210.28
|
| Rate for Payer: Humana of AZ Medicare |
$120.16
|
| Rate for Payer: Self Pay Self Pay |
$600.80
|
| Rate for Payer: TriWest Medicare |
$120.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$437.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$135.18
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$9,499.76
|
|
|
Service Code
|
APR-DRG 2272
|
| Hospital Charge Code |
APRDRG2274
|
| Min. Negotiated Rate |
$9,499.76 |
| Max. Negotiated Rate |
$9,499.76 |
| Rate for Payer: AHCCCS Medicaid |
$9,499.76
|
| Rate for Payer: Allwell Medicaid |
$9,499.76
|
| Rate for Payer: AZCH Complete Medicaid |
$9,499.76
|
| Rate for Payer: Banner UC Health Medicaid |
$9,499.76
|
| Rate for Payer: Mercy Care Medicaid |
$9,499.76
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$14,697.84
|
|
|
Service Code
|
APR-DRG 2273
|
| Hospital Charge Code |
APRDRG2272
|
| Min. Negotiated Rate |
$14,697.84 |
| Max. Negotiated Rate |
$14,697.84 |
| Rate for Payer: AHCCCS Medicaid |
$14,697.84
|
| Rate for Payer: Allwell Medicaid |
$14,697.84
|
| Rate for Payer: AZCH Complete Medicaid |
$14,697.84
|
| Rate for Payer: Banner UC Health Medicaid |
$14,697.84
|
| Rate for Payer: Mercy Care Medicaid |
$14,697.84
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$7,520.41
|
|
|
Service Code
|
APR-DRG 2271
|
| Hospital Charge Code |
APRDRG2271
|
| 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
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$26,146.09
|
|
|
Service Code
|
APR-DRG 2274
|
| Hospital Charge Code |
APRDRG2272
|
| Min. Negotiated Rate |
$26,146.09 |
| Max. Negotiated Rate |
$26,146.09 |
| Rate for Payer: AHCCCS Medicaid |
$26,146.09
|
| Rate for Payer: Allwell Medicaid |
$26,146.09
|
| Rate for Payer: AZCH Complete Medicaid |
$26,146.09
|
| Rate for Payer: Banner UC Health Medicaid |
$26,146.09
|
| Rate for Payer: Mercy Care Medicaid |
$26,146.09
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$7,520.41
|
|
|
Service Code
|
APR-DRG 2271
|
| Hospital Charge Code |
APRDRG2272
|
| 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
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$9,499.76
|
|
|
Service Code
|
APR-DRG 2272
|
| Hospital Charge Code |
APRDRG2272
|
| Min. Negotiated Rate |
$9,499.76 |
| Max. Negotiated Rate |
$9,499.76 |
| Rate for Payer: AHCCCS Medicaid |
$9,499.76
|
| Rate for Payer: Allwell Medicaid |
$9,499.76
|
| Rate for Payer: AZCH Complete Medicaid |
$9,499.76
|
| Rate for Payer: Banner UC Health Medicaid |
$9,499.76
|
| Rate for Payer: Mercy Care Medicaid |
$9,499.76
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$14,697.84
|
|
|
Service Code
|
APR-DRG 2273
|
| Hospital Charge Code |
APRDRG2273
|
| Min. Negotiated Rate |
$14,697.84 |
| Max. Negotiated Rate |
$14,697.84 |
| Rate for Payer: AHCCCS Medicaid |
$14,697.84
|
| Rate for Payer: Allwell Medicaid |
$14,697.84
|
| Rate for Payer: AZCH Complete Medicaid |
$14,697.84
|
| Rate for Payer: Banner UC Health Medicaid |
$14,697.84
|
| Rate for Payer: Mercy Care Medicaid |
$14,697.84
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$7,520.41
|
|
|
Service Code
|
APR-DRG 2271
|
| Hospital Charge Code |
APRDRG2273
|
| 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
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$26,146.09
|
|
|
Service Code
|
APR-DRG 2274
|
| Hospital Charge Code |
APRDRG2274
|
| Min. Negotiated Rate |
$26,146.09 |
| Max. Negotiated Rate |
$26,146.09 |
| Rate for Payer: AHCCCS Medicaid |
$26,146.09
|
| Rate for Payer: Allwell Medicaid |
$26,146.09
|
| Rate for Payer: AZCH Complete Medicaid |
$26,146.09
|
| Rate for Payer: Banner UC Health Medicaid |
$26,146.09
|
| Rate for Payer: Mercy Care Medicaid |
$26,146.09
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$14,697.84
|
|
|
Service Code
|
APR-DRG 2273
|
| Hospital Charge Code |
APRDRG2271
|
| Min. Negotiated Rate |
$14,697.84 |
| Max. Negotiated Rate |
$14,697.84 |
| Rate for Payer: AHCCCS Medicaid |
$14,697.84
|
| Rate for Payer: Allwell Medicaid |
$14,697.84
|
| Rate for Payer: AZCH Complete Medicaid |
$14,697.84
|
| Rate for Payer: Banner UC Health Medicaid |
$14,697.84
|
| Rate for Payer: Mercy Care Medicaid |
$14,697.84
|
|
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
Facility
|
IP
|
$9,499.76
|
|
|
Service Code
|
APR-DRG 2272
|
| Hospital Charge Code |
APRDRG2273
|
| Min. Negotiated Rate |
$9,499.76 |
| Max. Negotiated Rate |
$9,499.76 |
| Rate for Payer: AHCCCS Medicaid |
$9,499.76
|
| Rate for Payer: Allwell Medicaid |
$9,499.76
|
| Rate for Payer: AZCH Complete Medicaid |
$9,499.76
|
| Rate for Payer: Banner UC Health Medicaid |
$9,499.76
|
| Rate for Payer: Mercy Care Medicaid |
$9,499.76
|
|
