|
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
|
|
|
IMMUNOHISTOCHEMISTRY
|
Facility
|
OP
|
$1,645.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
22545725
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.14 |
| Max. Negotiated Rate |
$1,480.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,480.50
|
| Rate for Payer: Aetna of AZ Medicare |
$460.60
|
| Rate for Payer: AHCCCS Medicaid |
$108.14
|
| Rate for Payer: Allwell Medicaid |
$108.14
|
| Rate for Payer: Allwell Medicare |
$246.75
|
| Rate for Payer: Amerigroup Medicare |
$246.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$614.41
|
| Rate for Payer: AZCH Complete Medicaid |
$108.14
|
| Rate for Payer: AZCH Complete Medicare |
$246.75
|
| Rate for Payer: Banner UC Health Medicaid |
$108.14
|
| Rate for Payer: Banner UC Health Medicare |
$246.75
|
| Rate for Payer: Bisbee Police All Plans |
$427.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,118.60
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,069.25
|
| Rate for Payer: Copperpoint Commercial |
$407.14
|
| Rate for Payer: Health Net of AZ Commercial |
$987.00
|
| Rate for Payer: Health Net of AZ Medicare |
$460.60
|
| Rate for Payer: Humana of AZ Medicare |
$246.75
|
| Rate for Payer: Mercy Care Medicaid |
$108.14
|
| Rate for Payer: Self Pay Self Pay |
$1,316.00
|
| Rate for Payer: TriWest Medicare |
$246.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$959.04
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$296.10
|
|
|
IMMUNOHISTOCHEMISTRY
|
Facility
|
IP
|
$1,645.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
22545725
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$427.70 |
| Max. Negotiated Rate |
$1,480.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,480.50
|
| Rate for Payer: Bisbee Police All Plans |
$427.70
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Self Pay Self Pay |
$1,316.00
|
|
|
.IMMUNO INFAB
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
22481446
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of AZ Commercial |
$65.70
|
| Rate for Payer: Bisbee Police All Plans |
$18.98
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Self Pay Self Pay |
$58.40
|
|
|
.IMMUNO INFAB
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
22481446
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of AZ Commercial |
$65.70
|
| Rate for Payer: Aetna of AZ Medicare |
$20.44
|
| Rate for Payer: AHCCCS Medicaid |
$14.99
|
| Rate for Payer: Allwell Medicaid |
$14.99
|
| Rate for Payer: Allwell Medicare |
$10.95
|
| Rate for Payer: Amerigroup Medicare |
$10.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$27.27
|
| Rate for Payer: AZCH Complete Medicaid |
$14.99
|
| Rate for Payer: AZCH Complete Medicare |
$10.95
|
| Rate for Payer: Banner UC Health Medicaid |
$14.99
|
| Rate for Payer: Banner UC Health Medicare |
$10.95
|
| Rate for Payer: Bisbee Police All Plans |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$49.64
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cigna of AZ Commercial |
$47.45
|
| Rate for Payer: Copperpoint Commercial |
$18.07
|
| Rate for Payer: Health Net of AZ Commercial |
$43.80
|
| Rate for Payer: Health Net of AZ Medicare |
$20.44
|
| Rate for Payer: Humana of AZ Medicare |
$10.95
|
| Rate for Payer: Mercy Care Medicaid |
$14.99
|
| Rate for Payer: Self Pay Self Pay |
$58.40
|
| Rate for Payer: TriWest Medicare |
$10.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$42.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.14
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$78,199.79
|
|
|
Service Code
|
APR-DRG 1611
|
| Hospital Charge Code |
APRDRG1612
|
| Min. Negotiated Rate |
$78,199.79 |
| Max. Negotiated Rate |
$78,199.79 |
| Rate for Payer: AHCCCS Medicaid |
$78,199.79
|
| Rate for Payer: Allwell Medicaid |
$78,199.79
|
| Rate for Payer: AZCH Complete Medicaid |
$78,199.79
|
| Rate for Payer: Banner UC Health Medicaid |
$78,199.79
|
| Rate for Payer: Mercy Care Medicaid |
$78,199.79
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$78,199.79
|
|
|
Service Code
|
APR-DRG 1611
|
| Hospital Charge Code |
APRDRG1613
|
| Min. Negotiated Rate |
$78,199.79 |
| Max. Negotiated Rate |
$78,199.79 |
| Rate for Payer: AHCCCS Medicaid |
$78,199.79
|
| Rate for Payer: Allwell Medicaid |
$78,199.79
|
| Rate for Payer: AZCH Complete Medicaid |
$78,199.79
|
| Rate for Payer: Banner UC Health Medicaid |
$78,199.79
|
| Rate for Payer: Mercy Care Medicaid |
$78,199.79
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$111,650.96
|
|
|
Service Code
|
APR-DRG 1613
|
| Hospital Charge Code |
APRDRG1614
|
| Min. Negotiated Rate |
$111,650.96 |
| Max. Negotiated Rate |
$111,650.96 |
| Rate for Payer: AHCCCS Medicaid |
$111,650.96
|
| Rate for Payer: Allwell Medicaid |
$111,650.96
|
| Rate for Payer: AZCH Complete Medicaid |
$111,650.96
|
| Rate for Payer: Banner UC Health Medicaid |
$111,650.96
|
| Rate for Payer: Mercy Care Medicaid |
$111,650.96
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$78,199.79
|
|
|
Service Code
|
APR-DRG 1611
|
| Hospital Charge Code |
APRDRG1611
|
| Min. Negotiated Rate |
$78,199.79 |
| Max. Negotiated Rate |
$78,199.79 |
| Rate for Payer: AHCCCS Medicaid |
$78,199.79
|
| Rate for Payer: Allwell Medicaid |
$78,199.79
|
| Rate for Payer: AZCH Complete Medicaid |
$78,199.79
|
| Rate for Payer: Banner UC Health Medicaid |
$78,199.79
|
| Rate for Payer: Mercy Care Medicaid |
$78,199.79
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$111,650.96
|
|
|
Service Code
|
APR-DRG 1613
|
| Hospital Charge Code |
APRDRG1611
|
| Min. Negotiated Rate |
$111,650.96 |
| Max. Negotiated Rate |
$111,650.96 |
| Rate for Payer: AHCCCS Medicaid |
$111,650.96
|
| Rate for Payer: Allwell Medicaid |
$111,650.96
|
| Rate for Payer: AZCH Complete Medicaid |
$111,650.96
|
| Rate for Payer: Banner UC Health Medicaid |
$111,650.96
|
| Rate for Payer: Mercy Care Medicaid |
$111,650.96
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$78,199.79
|
|
|
Service Code
|
APR-DRG 1612
|
| Hospital Charge Code |
APRDRG1614
|
| Min. Negotiated Rate |
$78,199.79 |
| Max. Negotiated Rate |
$78,199.79 |
| Rate for Payer: AHCCCS Medicaid |
$78,199.79
|
| Rate for Payer: Allwell Medicaid |
$78,199.79
|
| Rate for Payer: AZCH Complete Medicaid |
$78,199.79
|
| Rate for Payer: Banner UC Health Medicaid |
$78,199.79
|
| Rate for Payer: Mercy Care Medicaid |
$78,199.79
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$111,650.96
|
|
|
Service Code
|
APR-DRG 1613
|
| Hospital Charge Code |
APRDRG1613
|
| Min. Negotiated Rate |
$111,650.96 |
| Max. Negotiated Rate |
$111,650.96 |
| Rate for Payer: AHCCCS Medicaid |
$111,650.96
|
| Rate for Payer: Allwell Medicaid |
$111,650.96
|
| Rate for Payer: AZCH Complete Medicaid |
$111,650.96
|
| Rate for Payer: Banner UC Health Medicaid |
$111,650.96
|
| Rate for Payer: Mercy Care Medicaid |
$111,650.96
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$78,199.79
|
|
|
Service Code
|
APR-DRG 1612
|
| Hospital Charge Code |
APRDRG1612
|
| Min. Negotiated Rate |
$78,199.79 |
| Max. Negotiated Rate |
$78,199.79 |
| Rate for Payer: AHCCCS Medicaid |
$78,199.79
|
| Rate for Payer: Allwell Medicaid |
$78,199.79
|
| Rate for Payer: AZCH Complete Medicaid |
$78,199.79
|
| Rate for Payer: Banner UC Health Medicaid |
$78,199.79
|
| Rate for Payer: Mercy Care Medicaid |
$78,199.79
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$111,650.96
|
|
|
Service Code
|
APR-DRG 1613
|
| Hospital Charge Code |
APRDRG1612
|
| Min. Negotiated Rate |
$111,650.96 |
| Max. Negotiated Rate |
$111,650.96 |
| Rate for Payer: AHCCCS Medicaid |
$111,650.96
|
| Rate for Payer: Allwell Medicaid |
$111,650.96
|
| Rate for Payer: AZCH Complete Medicaid |
$111,650.96
|
| Rate for Payer: Banner UC Health Medicaid |
$111,650.96
|
| Rate for Payer: Mercy Care Medicaid |
$111,650.96
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$78,199.79
|
|
|
Service Code
|
APR-DRG 1612
|
| Hospital Charge Code |
APRDRG1611
|
| Min. Negotiated Rate |
$78,199.79 |
| Max. Negotiated Rate |
$78,199.79 |
| Rate for Payer: AHCCCS Medicaid |
$78,199.79
|
| Rate for Payer: Allwell Medicaid |
$78,199.79
|
| Rate for Payer: AZCH Complete Medicaid |
$78,199.79
|
| Rate for Payer: Banner UC Health Medicaid |
$78,199.79
|
| Rate for Payer: Mercy Care Medicaid |
$78,199.79
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$160,146.45
|
|
|
Service Code
|
APR-DRG 1614
|
| Hospital Charge Code |
APRDRG1611
|
| Min. Negotiated Rate |
$160,146.45 |
| Max. Negotiated Rate |
$160,146.45 |
| Rate for Payer: AHCCCS Medicaid |
$160,146.45
|
| Rate for Payer: Allwell Medicaid |
$160,146.45
|
| Rate for Payer: AZCH Complete Medicaid |
$160,146.45
|
| Rate for Payer: Banner UC Health Medicaid |
$160,146.45
|
| Rate for Payer: Mercy Care Medicaid |
$160,146.45
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$160,146.45
|
|
|
Service Code
|
APR-DRG 1614
|
| Hospital Charge Code |
APRDRG1614
|
| Min. Negotiated Rate |
$160,146.45 |
| Max. Negotiated Rate |
$160,146.45 |
| Rate for Payer: AHCCCS Medicaid |
$160,146.45
|
| Rate for Payer: Allwell Medicaid |
$160,146.45
|
| Rate for Payer: AZCH Complete Medicaid |
$160,146.45
|
| Rate for Payer: Banner UC Health Medicaid |
$160,146.45
|
| Rate for Payer: Mercy Care Medicaid |
$160,146.45
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$78,199.79
|
|
|
Service Code
|
APR-DRG 1612
|
| Hospital Charge Code |
APRDRG1613
|
| Min. Negotiated Rate |
$78,199.79 |
| Max. Negotiated Rate |
$78,199.79 |
| Rate for Payer: AHCCCS Medicaid |
$78,199.79
|
| Rate for Payer: Allwell Medicaid |
$78,199.79
|
| Rate for Payer: AZCH Complete Medicaid |
$78,199.79
|
| Rate for Payer: Banner UC Health Medicaid |
$78,199.79
|
| Rate for Payer: Mercy Care Medicaid |
$78,199.79
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$78,199.79
|
|
|
Service Code
|
APR-DRG 1611
|
| Hospital Charge Code |
APRDRG1614
|
| Min. Negotiated Rate |
$78,199.79 |
| Max. Negotiated Rate |
$78,199.79 |
| Rate for Payer: AHCCCS Medicaid |
$78,199.79
|
| Rate for Payer: Allwell Medicaid |
$78,199.79
|
| Rate for Payer: AZCH Complete Medicaid |
$78,199.79
|
| Rate for Payer: Banner UC Health Medicaid |
$78,199.79
|
| Rate for Payer: Mercy Care Medicaid |
$78,199.79
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$160,146.45
|
|
|
Service Code
|
APR-DRG 1614
|
| Hospital Charge Code |
APRDRG1613
|
| Min. Negotiated Rate |
$160,146.45 |
| Max. Negotiated Rate |
$160,146.45 |
| Rate for Payer: AHCCCS Medicaid |
$160,146.45
|
| Rate for Payer: Allwell Medicaid |
$160,146.45
|
| Rate for Payer: AZCH Complete Medicaid |
$160,146.45
|
| Rate for Payer: Banner UC Health Medicaid |
$160,146.45
|
| Rate for Payer: Mercy Care Medicaid |
$160,146.45
|
|
|
Implantable Heart Assist Systems
|
Facility
|
IP
|
$160,146.45
|
|
|
Service Code
|
APR-DRG 1614
|
| Hospital Charge Code |
APRDRG1612
|
| Min. Negotiated Rate |
$160,146.45 |
| Max. Negotiated Rate |
$160,146.45 |
| Rate for Payer: AHCCCS Medicaid |
$160,146.45
|
| Rate for Payer: Allwell Medicaid |
$160,146.45
|
| Rate for Payer: AZCH Complete Medicaid |
$160,146.45
|
| Rate for Payer: Banner UC Health Medicaid |
$160,146.45
|
| Rate for Payer: Mercy Care Medicaid |
$160,146.45
|
|
|
IMUNNOHISTOCHEMIST 1ST
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT G0461
|
| Hospital Charge Code |
22545749
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna of AZ Commercial |
$277.20
|
| Rate for Payer: Bisbee Police All Plans |
$80.08
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Self Pay Self Pay |
$246.40
|
|
|
IMUNNOHISTOCHEMIST 1ST
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT G0461
|
| Hospital Charge Code |
22545749
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna of AZ Commercial |
$277.20
|
| Rate for Payer: Aetna of AZ Medicare |
$86.24
|
| Rate for Payer: Allwell Medicare |
$46.20
|
| Rate for Payer: Amerigroup Medicare |
$46.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$115.04
|
| Rate for Payer: AZCH Complete Medicare |
$46.20
|
| Rate for Payer: Banner UC Health Medicare |
$46.20
|
| Rate for Payer: Bisbee Police All Plans |
$80.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$209.44
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cigna of AZ Commercial |
$200.20
|
| Rate for Payer: Copperpoint Commercial |
$76.23
|
| Rate for Payer: Health Net of AZ Commercial |
$184.80
|
| Rate for Payer: Health Net of AZ Medicare |
$86.24
|
| Rate for Payer: Humana of AZ Medicare |
$46.20
|
| Rate for Payer: Self Pay Self Pay |
$246.40
|
| Rate for Payer: TriWest Medicare |
$46.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$179.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.44
|
|
|
IMUNNOHISTOCHEMIST 2ND
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT G0462
|
| Hospital Charge Code |
22545750
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna of AZ Commercial |
$280.80
|
| Rate for Payer: Aetna of AZ Medicare |
$87.36
|
| Rate for Payer: Allwell Medicare |
$46.80
|
| Rate for Payer: Amerigroup Medicare |
$46.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$116.53
|
| Rate for Payer: AZCH Complete Medicare |
$46.80
|
| Rate for Payer: Banner UC Health Medicare |
$46.80
|
| Rate for Payer: Bisbee Police All Plans |
$81.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$212.16
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna of AZ Commercial |
$202.80
|
| Rate for Payer: Copperpoint Commercial |
$77.22
|
| Rate for Payer: Health Net of AZ Commercial |
$187.20
|
| Rate for Payer: Health Net of AZ Medicare |
$87.36
|
| Rate for Payer: Humana of AZ Medicare |
$46.80
|
| Rate for Payer: Self Pay Self Pay |
$249.60
|
| Rate for Payer: TriWest Medicare |
$46.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$181.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$56.16
|
|
|
IMUNNOHISTOCHEMIST 2ND
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT G0462
|
| Hospital Charge Code |
22545750
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.12 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna of AZ Commercial |
$280.80
|
| Rate for Payer: Bisbee Police All Plans |
$81.12
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Self Pay Self Pay |
$249.60
|
|
