|
Hemoglobin POC
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
684350
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of AZ Commercial |
$131.40
|
| Rate for Payer: Cash Price |
$116.80
|
|
|
Hemogram Standard
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
22187849
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna of AZ Commercial |
$87.30
|
| Rate for Payer: Aetna of AZ Commercial |
$123.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$21.92
|
| Rate for Payer: Arizona Complete Health Allwell |
$15.52
|
| Rate for Payer: Banner UC Health Medicare |
$21.92
|
| Rate for Payer: Banner UC Health Medicare |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$65.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$93.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$21.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$15.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$21.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$15.52
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cigna of AZ Commercial |
$63.05
|
| Rate for Payer: Cigna of AZ Commercial |
$89.05
|
| Rate for Payer: Devoted Health Medicare |
$17.46
|
| Rate for Payer: Devoted Health Medicare |
$24.66
|
| Rate for Payer: Humana of AZ Medicare |
$21.92
|
| Rate for Payer: Humana of AZ Medicare |
$15.52
|
| Rate for Payer: Seven Corners Travel Insurance |
$9.38
|
| Rate for Payer: Seven Corners Travel Insurance |
$9.38
|
| Rate for Payer: Southwest Service Administrators UFCW |
$93.16
|
| Rate for Payer: Southwest Service Administrators UFCW |
$65.96
|
| Rate for Payer: TriWest Medicare |
$21.92
|
| Rate for Payer: TriWest Medicare |
$15.52
|
| Rate for Payer: United Healthcare Commercial |
$55.48
|
| Rate for Payer: United Healthcare Commercial |
$78.36
|
| Rate for Payer: United Healthcare Medicare |
$21.92
|
| Rate for Payer: United Healthcare Medicare |
$15.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$15.36
|
| Rate for Payer: Veterans Affairs TRICARE |
$21.70
|
|
|
Hemogram Standard
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
22187849
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$123.30 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of AZ Commercial |
$123.30
|
| Rate for Payer: Aetna of AZ Commercial |
$87.30
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$77.60
|
|
|
Hemophilus Influenza B Vaccine (Hib), PRP-OMP conj. 3-dose IM use POC
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
749062
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$13.92
|
| Rate for Payer: Banner UC Health Medicare |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$59.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$13.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$13.92
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna of AZ Commercial |
$60.90
|
| Rate for Payer: Devoted Health Medicare |
$15.66
|
| Rate for Payer: Humana of AZ Medicare |
$13.92
|
| Rate for Payer: Southwest Service Administrators UFCW |
$59.16
|
| Rate for Payer: TriWest Medicare |
$13.92
|
| Rate for Payer: United Healthcare Commercial |
$49.76
|
| Rate for Payer: United Healthcare Medicare |
$13.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.78
|
|
|
Hemophilus Influenza B Vaccine (Hib), PRP-OMP conj. 3-dose IM use POC
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
749062
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Cash Price |
$69.60
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$3,444.58
|
|
|
Service Code
|
APR-DRG 8101
|
| Hospital Charge Code |
APRDRG8104
|
| Min. Negotiated Rate |
$3,444.58 |
| Max. Negotiated Rate |
$3,444.58 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,444.58
|
| Rate for Payer: Mercy Care Medicaid |
$3,444.58
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,444.58
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$14,389.22
|
|
|
Service Code
|
APR-DRG 8104
|
| Hospital Charge Code |
APRDRG8103
|
| Min. Negotiated Rate |
$14,389.22 |
| Max. Negotiated Rate |
$14,389.22 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,389.22
|
| Rate for Payer: Mercy Care Medicaid |
$14,389.22
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,389.22
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$3,444.58
|
|
|
Service Code
|
APR-DRG 8101
|
| Hospital Charge Code |
APRDRG8102
|
| Min. Negotiated Rate |
$3,444.58 |
| Max. Negotiated Rate |
$3,444.58 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,444.58
|
| Rate for Payer: Mercy Care Medicaid |
$3,444.58
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,444.58
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$14,389.22
|
|
|
Service Code
|
APR-DRG 8104
|
| Hospital Charge Code |
APRDRG8102
|
| Min. Negotiated Rate |
$14,389.22 |
| Max. Negotiated Rate |
$14,389.22 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,389.22
|
| Rate for Payer: Mercy Care Medicaid |
$14,389.22
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,389.22
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$14,389.22
|
|
|
Service Code
|
APR-DRG 8104
|
| Hospital Charge Code |
APRDRG8101
|
| Min. Negotiated Rate |
$14,389.22 |
| Max. Negotiated Rate |
$14,389.22 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,389.22
|
| Rate for Payer: Mercy Care Medicaid |
$14,389.22
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,389.22
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$3,444.58
|
|
|
Service Code
|
APR-DRG 8101
|
| Hospital Charge Code |
APRDRG8103
|
| Min. Negotiated Rate |
$3,444.58 |
| Max. Negotiated Rate |
$3,444.58 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,444.58
|
| Rate for Payer: Mercy Care Medicaid |
$3,444.58
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,444.58
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$14,389.22
|
|
|
Service Code
|
APR-DRG 8104
|
| Hospital Charge Code |
APRDRG8104
|
| Min. Negotiated Rate |
$14,389.22 |
| Max. Negotiated Rate |
$14,389.22 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,389.22
|
| Rate for Payer: Mercy Care Medicaid |
$14,389.22
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,389.22
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$3,444.58
|
|
|
Service Code
|
APR-DRG 8101
|
| Hospital Charge Code |
APRDRG8101
|
| Min. Negotiated Rate |
$3,444.58 |
| Max. Negotiated Rate |
$3,444.58 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,444.58
|
| Rate for Payer: Mercy Care Medicaid |
$3,444.58
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,444.58
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 8102
|
| Hospital Charge Code |
APRDRG8101
|
| Min. Negotiated Rate |
$4,557.00 |
| Max. Negotiated Rate |
$4,557.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,557.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,557.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,557.00
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 8102
|
| Hospital Charge Code |
APRDRG8104
|
| Min. Negotiated Rate |
$4,557.00 |
| Max. Negotiated Rate |
$4,557.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,557.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,557.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,557.00
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$7,208.99
|
|
|
Service Code
|
APR-DRG 8103
|
| Hospital Charge Code |
APRDRG8103
|
| Min. Negotiated Rate |
$7,208.99 |
| Max. Negotiated Rate |
$7,208.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,208.99
|
| Rate for Payer: Mercy Care Medicaid |
$7,208.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,208.99
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$7,208.99
|
|
|
Service Code
|
APR-DRG 8103
|
| Hospital Charge Code |
APRDRG8101
|
| Min. Negotiated Rate |
$7,208.99 |
| Max. Negotiated Rate |
$7,208.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,208.99
|
| Rate for Payer: Mercy Care Medicaid |
$7,208.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,208.99
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 8102
|
| Hospital Charge Code |
APRDRG8102
|
| Min. Negotiated Rate |
$4,557.00 |
| Max. Negotiated Rate |
$4,557.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,557.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,557.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,557.00
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$7,208.99
|
|
|
Service Code
|
APR-DRG 8103
|
| Hospital Charge Code |
APRDRG8104
|
| Min. Negotiated Rate |
$7,208.99 |
| Max. Negotiated Rate |
$7,208.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,208.99
|
| Rate for Payer: Mercy Care Medicaid |
$7,208.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,208.99
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 8102
|
| Hospital Charge Code |
APRDRG8103
|
| Min. Negotiated Rate |
$4,557.00 |
| Max. Negotiated Rate |
$4,557.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,557.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,557.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,557.00
|
|
|
Hemorrhage Or Hematoma Due To Complication
|
Facility
|
IP
|
$7,208.99
|
|
|
Service Code
|
APR-DRG 8103
|
| Hospital Charge Code |
APRDRG8102
|
| Min. Negotiated Rate |
$7,208.99 |
| Max. Negotiated Rate |
$7,208.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,208.99
|
| Rate for Payer: Mercy Care Medicaid |
$7,208.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,208.99
|
|
|
HEMORRHOID BAND
|
Facility
|
IP
|
$405.00
|
|
| Hospital Charge Code |
22354833
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$364.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of AZ Commercial |
$364.50
|
| Rate for Payer: Cash Price |
$324.00
|
|
|
HEMORRHOID BAND
|
Facility
|
OP
|
$405.00
|
|
| Hospital Charge Code |
22354833
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.15 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna of AZ Commercial |
$364.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$64.80
|
| Rate for Payer: Banner UC Health Medicare |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$64.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$64.80
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of AZ Commercial |
$283.50
|
| Rate for Payer: Devoted Health Medicare |
$72.90
|
| Rate for Payer: Humana of AZ Medicare |
$64.80
|
| Rate for Payer: Southwest Service Administrators UFCW |
$275.40
|
| Rate for Payer: TriWest Medicare |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$231.66
|
| Rate for Payer: United Healthcare Medicare |
$64.80
|
| Rate for Payer: Veterans Affairs TRICARE |
$64.15
|
|
|
HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)
|
Facility
|
OP
|
$3,098.00
|
|
|
Service Code
|
CPT 46221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$3,098.00 |
| Rate for Payer: Banner UC Health Medicare |
$130.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$92.75
|
| Rate for Payer: Mercy Care Medicaid |
$92.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$130.40
|
| Rate for Payer: Seven Corners Travel Insurance |
$1,438.89
|
| Rate for Payer: United Healthcare Commercial |
$3,098.00
|
|
|
HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)
|
Facility
|
OP
|
$3,098.00
|
|
|
Service Code
|
CPT 46221
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$3,098.00 |
| Rate for Payer: Banner UC Health Medicare |
$130.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$92.75
|
| Rate for Payer: Mercy Care Medicaid |
$92.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$130.40
|
| Rate for Payer: Seven Corners Travel Insurance |
$1,438.89
|
| Rate for Payer: United Healthcare Commercial |
$3,098.00
|
|
