|
Immunofixation (IFE) Urine LC
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
3451611
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of AZ Commercial |
$855.00
|
| Rate for Payer: Aetna of AZ Medicare |
$266.00
|
| Rate for Payer: AHCCCS Medicaid |
$29.35
|
| Rate for Payer: Allwell Medicaid |
$29.35
|
| Rate for Payer: Allwell Medicare |
$142.50
|
| Rate for Payer: Amerigroup Medicare |
$142.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$354.82
|
| Rate for Payer: AZCH Complete Medicaid |
$29.35
|
| Rate for Payer: AZCH Complete Medicare |
$142.50
|
| Rate for Payer: Banner UC Health Medicaid |
$29.35
|
| Rate for Payer: Banner UC Health Medicare |
$142.50
|
| Rate for Payer: Bisbee Police All Plans |
$247.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$646.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna of AZ Commercial |
$617.50
|
| Rate for Payer: Copperpoint Commercial |
$235.12
|
| Rate for Payer: Health Net of AZ Commercial |
$570.00
|
| Rate for Payer: Health Net of AZ Medicare |
$266.00
|
| Rate for Payer: Humana of AZ Medicare |
$142.50
|
| Rate for Payer: Mercy Care Medicaid |
$29.35
|
| Rate for Payer: Self Pay Self Pay |
$760.00
|
| Rate for Payer: TriWest Medicare |
$142.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$553.85
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$171.00
|
|
|
Immunofixation (IFE) Urine LC
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
3451611
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of AZ Commercial |
$855.00
|
| Rate for Payer: Bisbee Police All Plans |
$247.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Self Pay Self Pay |
$760.00
|
|
|
Immunofixation, Serum LC
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
2269421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna of AZ Commercial |
$777.60
|
| Rate for Payer: Bisbee Police All Plans |
$224.64
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Self Pay Self Pay |
$691.20
|
|
|
Immunofixation, Serum LC
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
2269421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna of AZ Commercial |
$777.60
|
| Rate for Payer: Aetna of AZ Medicare |
$241.92
|
| Rate for Payer: AHCCCS Medicaid |
$22.34
|
| Rate for Payer: Allwell Medicaid |
$22.34
|
| Rate for Payer: Allwell Medicare |
$129.60
|
| Rate for Payer: Amerigroup Medicare |
$129.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$322.70
|
| Rate for Payer: AZCH Complete Medicaid |
$22.34
|
| Rate for Payer: AZCH Complete Medicare |
$129.60
|
| Rate for Payer: Banner UC Health Medicaid |
$22.34
|
| Rate for Payer: Banner UC Health Medicare |
$129.60
|
| Rate for Payer: Bisbee Police All Plans |
$224.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$587.52
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna of AZ Commercial |
$561.60
|
| Rate for Payer: Copperpoint Commercial |
$213.84
|
| Rate for Payer: Health Net of AZ Commercial |
$518.40
|
| Rate for Payer: Health Net of AZ Medicare |
$241.92
|
| Rate for Payer: Humana of AZ Medicare |
$129.60
|
| Rate for Payer: Mercy Care Medicaid |
$22.34
|
| Rate for Payer: Self Pay Self Pay |
$691.20
|
| Rate for Payer: TriWest Medicare |
$129.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$503.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$155.52
|
|
|
IMMUNOGLOB A
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
22481481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
|
|
IMMUNOGLOB A
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
22481481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Aetna of AZ Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicare |
$18.00
|
| Rate for Payer: Amerigroup Medicare |
$18.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicaid |
$9.30
|
| Rate for Payer: AZCH Complete Medicare |
$18.00
|
| Rate for Payer: Banner UC Health Medicaid |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of AZ Commercial |
$78.00
|
| Rate for Payer: Copperpoint Commercial |
$29.70
|
| Rate for Payer: Health Net of AZ Commercial |
$72.00
|
| Rate for Payer: Health Net of AZ Medicare |
$33.60
|
| Rate for Payer: Humana of AZ Medicare |
$18.00
|
| Rate for Payer: Mercy Care Medicaid |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$18.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.60
|
|
|
IMMUNOGLOB E
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
22481482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna of AZ Commercial |
$185.40
|
| Rate for Payer: Bisbee Police All Plans |
$53.56
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Self Pay Self Pay |
$164.80
|
|
|
IMMUNOGLOB E
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
22481482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna of AZ Commercial |
$185.40
|
| Rate for Payer: Aetna of AZ Medicare |
$57.68
|
| Rate for Payer: AHCCCS Medicaid |
$16.46
|
| Rate for Payer: Allwell Medicaid |
$16.46
|
| Rate for Payer: Allwell Medicare |
$30.90
|
| Rate for Payer: Amerigroup Medicare |
$30.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$76.94
|
| Rate for Payer: AZCH Complete Medicaid |
$16.46
|
| Rate for Payer: AZCH Complete Medicare |
$30.90
|
| Rate for Payer: Banner UC Health Medicaid |
$16.46
|
| Rate for Payer: Banner UC Health Medicare |
$30.90
|
| Rate for Payer: Bisbee Police All Plans |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$140.08
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cigna of AZ Commercial |
$133.90
|
| Rate for Payer: Copperpoint Commercial |
$50.98
|
| Rate for Payer: Health Net of AZ Commercial |
$123.60
|
| Rate for Payer: Health Net of AZ Medicare |
$57.68
|
| Rate for Payer: Humana of AZ Medicare |
$30.90
|
| Rate for Payer: Mercy Care Medicaid |
$16.46
|
| Rate for Payer: Self Pay Self Pay |
$164.80
|
| Rate for Payer: TriWest Medicare |
$30.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$120.10
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$37.08
|
|
|
IMMUNOGLOB G
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
22481483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Aetna of AZ Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicare |
$18.00
|
| Rate for Payer: Amerigroup Medicare |
$18.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicaid |
$9.30
|
| Rate for Payer: AZCH Complete Medicare |
$18.00
|
| Rate for Payer: Banner UC Health Medicaid |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of AZ Commercial |
$78.00
|
| Rate for Payer: Copperpoint Commercial |
$29.70
|
| Rate for Payer: Health Net of AZ Commercial |
$72.00
|
| Rate for Payer: Health Net of AZ Medicare |
$33.60
|
| Rate for Payer: Humana of AZ Medicare |
$18.00
|
| Rate for Payer: Mercy Care Medicaid |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$18.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.60
|
|
|
IMMUNOGLOB G
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
22481483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
|
|
IMMUNOGLOB M
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
22481484
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
|
|
IMMUNOGLOB M
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
22481484
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Aetna of AZ Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicare |
$18.00
|
| Rate for Payer: Amerigroup Medicare |
$18.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicaid |
$9.30
|
| Rate for Payer: AZCH Complete Medicare |
$18.00
|
| Rate for Payer: Banner UC Health Medicaid |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of AZ Commercial |
$78.00
|
| Rate for Payer: Copperpoint Commercial |
$29.70
|
| Rate for Payer: Health Net of AZ Commercial |
$72.00
|
| Rate for Payer: Health Net of AZ Medicare |
$33.60
|
| Rate for Payer: Humana of AZ Medicare |
$18.00
|
| Rate for Payer: Mercy Care Medicaid |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$18.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.60
|
|
|
Immunoglobulin A, Quant. Serum LC
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3658179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Aetna of AZ Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicare |
$18.00
|
| Rate for Payer: Amerigroup Medicare |
$18.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicaid |
$9.30
|
| Rate for Payer: AZCH Complete Medicare |
$18.00
|
| Rate for Payer: Banner UC Health Medicaid |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of AZ Commercial |
$78.00
|
| Rate for Payer: Copperpoint Commercial |
$29.70
|
| Rate for Payer: Health Net of AZ Commercial |
$72.00
|
| Rate for Payer: Health Net of AZ Medicare |
$33.60
|
| Rate for Payer: Humana of AZ Medicare |
$18.00
|
| Rate for Payer: Mercy Care Medicaid |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$18.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.60
|
|
|
Immunoglobulin A, Quant. Serum LC
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3658179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
|
|
Immunoglobulin E, Total LC
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
1906908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna of AZ Commercial |
$185.40
|
| Rate for Payer: Aetna of AZ Medicare |
$57.68
|
| Rate for Payer: AHCCCS Medicaid |
$16.46
|
| Rate for Payer: Allwell Medicaid |
$16.46
|
| Rate for Payer: Allwell Medicare |
$30.90
|
| Rate for Payer: Amerigroup Medicare |
$30.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$76.94
|
| Rate for Payer: AZCH Complete Medicaid |
$16.46
|
| Rate for Payer: AZCH Complete Medicare |
$30.90
|
| Rate for Payer: Banner UC Health Medicaid |
$16.46
|
| Rate for Payer: Banner UC Health Medicare |
$30.90
|
| Rate for Payer: Bisbee Police All Plans |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$140.08
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cigna of AZ Commercial |
$133.90
|
| Rate for Payer: Copperpoint Commercial |
$50.98
|
| Rate for Payer: Health Net of AZ Commercial |
$123.60
|
| Rate for Payer: Health Net of AZ Medicare |
$57.68
|
| Rate for Payer: Humana of AZ Medicare |
$30.90
|
| Rate for Payer: Mercy Care Medicaid |
$16.46
|
| Rate for Payer: Self Pay Self Pay |
$164.80
|
| Rate for Payer: TriWest Medicare |
$30.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$120.10
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$37.08
|
|
|
Immunoglobulin E, Total LC
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
1906908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna of AZ Commercial |
$185.40
|
| Rate for Payer: Bisbee Police All Plans |
$53.56
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Self Pay Self Pay |
$164.80
|
|
|
Immunoglobulin G, Qn, Serum LC
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2029176
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Aetna of AZ Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicare |
$18.00
|
| Rate for Payer: Amerigroup Medicare |
$18.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicaid |
$9.30
|
| Rate for Payer: AZCH Complete Medicare |
$18.00
|
| Rate for Payer: Banner UC Health Medicaid |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of AZ Commercial |
$78.00
|
| Rate for Payer: Copperpoint Commercial |
$29.70
|
| Rate for Payer: Health Net of AZ Commercial |
$72.00
|
| Rate for Payer: Health Net of AZ Medicare |
$33.60
|
| Rate for Payer: Humana of AZ Medicare |
$18.00
|
| Rate for Payer: Mercy Care Medicaid |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$18.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.60
|
|
|
Immunoglobulin G, Qn, Serum LC
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2029176
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
|
|
Immunoglobulin M, Qn, Serum LC
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1906912
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
|
|
Immunoglobulin M, Qn, Serum LC
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1906912
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Aetna of AZ Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicare |
$18.00
|
| Rate for Payer: Amerigroup Medicare |
$18.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicaid |
$9.30
|
| Rate for Payer: AZCH Complete Medicare |
$18.00
|
| Rate for Payer: Banner UC Health Medicaid |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of AZ Commercial |
$78.00
|
| Rate for Payer: Copperpoint Commercial |
$29.70
|
| Rate for Payer: Health Net of AZ Commercial |
$72.00
|
| Rate for Payer: Health Net of AZ Medicare |
$33.60
|
| Rate for Payer: Humana of AZ Medicare |
$18.00
|
| Rate for Payer: Mercy Care Medicaid |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$18.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.60
|
|
|
Immunoglobulins A/E/G/M, Serum LC
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2087616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Aetna of AZ Medicare |
$33.60
|
| Rate for Payer: AHCCCS Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicare |
$18.00
|
| Rate for Payer: Amerigroup Medicare |
$18.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.82
|
| Rate for Payer: AZCH Complete Medicaid |
$9.30
|
| Rate for Payer: AZCH Complete Medicare |
$18.00
|
| Rate for Payer: Banner UC Health Medicaid |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$18.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of AZ Commercial |
$78.00
|
| Rate for Payer: Copperpoint Commercial |
$29.70
|
| Rate for Payer: Health Net of AZ Commercial |
$72.00
|
| Rate for Payer: Health Net of AZ Medicare |
$33.60
|
| Rate for Payer: Humana of AZ Medicare |
$18.00
|
| Rate for Payer: Mercy Care Medicaid |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
| Rate for Payer: TriWest Medicare |
$18.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.60
|
|
|
Immunoglobulins A/E/G/M, Serum LC
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2087616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of AZ Commercial |
$108.00
|
| Rate for Payer: Bisbee Police All Plans |
$31.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Self Pay Self Pay |
$96.00
|
|
|
Immunoglobulins A/G/M, Qn, Ser LC
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2087617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna of AZ Commercial |
$113.40
|
| Rate for Payer: Bisbee Police All Plans |
$32.76
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Self Pay Self Pay |
$100.80
|
|
|
Immunoglobulins A/G/M, Qn, Ser LC
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2087617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna of AZ Commercial |
$113.40
|
| Rate for Payer: Aetna of AZ Medicare |
$35.28
|
| Rate for Payer: AHCCCS Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicaid |
$9.30
|
| Rate for Payer: Allwell Medicare |
$18.90
|
| Rate for Payer: Amerigroup Medicare |
$18.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$47.06
|
| Rate for Payer: AZCH Complete Medicaid |
$9.30
|
| Rate for Payer: AZCH Complete Medicare |
$18.90
|
| Rate for Payer: Banner UC Health Medicaid |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$18.90
|
| Rate for Payer: Bisbee Police All Plans |
$32.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$85.68
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna of AZ Commercial |
$81.90
|
| Rate for Payer: Copperpoint Commercial |
$31.18
|
| Rate for Payer: Health Net of AZ Commercial |
$75.60
|
| Rate for Payer: Health Net of AZ Medicare |
$35.28
|
| Rate for Payer: Humana of AZ Medicare |
$18.90
|
| Rate for Payer: Mercy Care Medicaid |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$100.80
|
| Rate for Payer: TriWest Medicare |
$18.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$73.46
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$22.68
|
|
|
IMMUNOHISTOCHEM ADD ANTI STAIN
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
22545751
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: Aetna of AZ Commercial |
$1,178.10
|
| Rate for Payer: Aetna of AZ Medicare |
$366.52
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$196.35
|
| Rate for Payer: Amerigroup Medicare |
$196.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$488.91
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$196.35
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$196.35
|
| Rate for Payer: Bisbee Police All Plans |
$340.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$890.12
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cigna of AZ Commercial |
$850.85
|
| Rate for Payer: Copperpoint Commercial |
$323.98
|
| Rate for Payer: Health Net of AZ Commercial |
$785.40
|
| Rate for Payer: Health Net of AZ Medicare |
$366.52
|
| Rate for Payer: Humana of AZ Medicare |
$196.35
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$1,047.20
|
| Rate for Payer: TriWest Medicare |
$196.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$763.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$235.62
|
|
