|
Hep A Ab, IgM LC
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
2087607
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$231.30 |
| Max. Negotiated Rate |
$231.30 |
| Rate for Payer: Aetna of AZ Commercial |
$231.30
|
| Rate for Payer: Cash Price |
$205.60
|
|
|
Hep A Ab, IgM LC
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
2087607
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$231.30 |
| Rate for Payer: Aetna of AZ Commercial |
$231.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$41.12
|
| Rate for Payer: Banner UC Health Medicare |
$41.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$174.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$41.12
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$41.12
|
| 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: Devoted Health Medicare |
$46.26
|
| Rate for Payer: Humana of AZ Medicare |
$41.12
|
| Rate for Payer: Seven Corners Travel Insurance |
$16.33
|
| Rate for Payer: Southwest Service Administrators UFCW |
$174.76
|
| Rate for Payer: TriWest Medicare |
$41.12
|
| Rate for Payer: United Healthcare Commercial |
$147.00
|
| Rate for Payer: United Healthcare Medicare |
$41.12
|
| Rate for Payer: Veterans Affairs TRICARE |
$40.71
|
|
|
Hep A Ab, Total LC
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
1906884
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of AZ Commercial |
$207.90
|
| Rate for Payer: Aetna of AZ Commercial |
$277.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$49.28
|
| Rate for Payer: Arizona Complete Health Allwell |
$36.96
|
| Rate for Payer: Banner UC Health Medicare |
$49.28
|
| Rate for Payer: Banner UC Health Medicare |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$157.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$209.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$49.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$36.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$49.28
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cigna of AZ Commercial |
$200.20
|
| Rate for Payer: Cigna of AZ Commercial |
$150.15
|
| Rate for Payer: Devoted Health Medicare |
$55.44
|
| Rate for Payer: Devoted Health Medicare |
$41.58
|
| Rate for Payer: Humana of AZ Medicare |
$36.96
|
| Rate for Payer: Humana of AZ Medicare |
$49.28
|
| Rate for Payer: Seven Corners Travel Insurance |
$17.97
|
| Rate for Payer: Seven Corners Travel Insurance |
$17.97
|
| Rate for Payer: Southwest Service Administrators UFCW |
$209.44
|
| Rate for Payer: Southwest Service Administrators UFCW |
$157.08
|
| Rate for Payer: TriWest Medicare |
$36.96
|
| Rate for Payer: TriWest Medicare |
$49.28
|
| Rate for Payer: United Healthcare Commercial |
$132.13
|
| Rate for Payer: United Healthcare Commercial |
$176.18
|
| Rate for Payer: United Healthcare Medicare |
$36.96
|
| Rate for Payer: United Healthcare Medicare |
$49.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$48.79
|
| Rate for Payer: Veterans Affairs TRICARE |
$36.59
|
|
|
Hep A Ab, Total LC
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
1906884
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna of AZ Commercial |
$277.20
|
| Rate for Payer: Aetna of AZ Commercial |
$207.90
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$184.80
|
|
|
heparin 5000 units/mL Inj Sol [CQCH]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
105925227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of AZ Commercial |
$0.79
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.14
|
| Rate for Payer: Banner UC Health Medicare |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.14
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.14
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of AZ Commercial |
$0.57
|
| Rate for Payer: Devoted Health Medicare |
$0.16
|
| Rate for Payer: Humana of AZ Medicare |
$0.14
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.60
|
| Rate for Payer: TriWest Medicare |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.14
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.14
|
|
|
heparin 5000 units/mL Inj Sol [CQCH]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
105925227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of AZ Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.71
|
|
|
heparin drip 25000 units/ 250 mL IVPB [CQCH]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
105925296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of AZ Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
|
|
heparin drip 25000 units/ 250 mL IVPB [CQCH]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
105925296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of AZ Commercial |
$0.04
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.01
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.01
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of AZ Commercial |
$0.03
|
| Rate for Payer: Devoted Health Medicare |
$0.01
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.03
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.01
|
|
|
heparin flush 100 units/mL Sol [CQCH]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
105925367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of AZ Commercial |
$0.06
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.01
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.01
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of AZ Commercial |
$0.05
|
| Rate for Payer: Devoted Health Medicare |
$0.01
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.05
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.04
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.01
|
|
|
heparin flush 100 units/mL Sol [CQCH]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
105925367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of AZ Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
|
|
heparin flush 10 units/mL Sol[CQCH]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
153607645
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of AZ Commercial |
$0.53
|
| Rate for Payer: Cash Price |
$0.47
|
|
|
heparin flush 10 units/mL Sol[CQCH]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
153607645
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of AZ Commercial |
$0.53
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.09
|
| Rate for Payer: Banner UC Health Medicare |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.09
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.09
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of AZ Commercial |
$0.38
|
| Rate for Payer: Devoted Health Medicare |
$0.11
|
| Rate for Payer: Humana of AZ Medicare |
$0.09
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.40
|
| Rate for Payer: TriWest Medicare |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.34
|
| Rate for Payer: United Healthcare Medicare |
$0.09
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.09
|
|
|
HEPARIN PER 1000 UNI
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
1170064
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna of AZ Commercial |
$3.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.64
|
| Rate for Payer: Banner UC Health Medicare |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$2.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.64
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.64
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cigna of AZ Commercial |
$2.80
|
| Rate for Payer: Devoted Health Medicare |
$0.72
|
| Rate for Payer: Humana of AZ Medicare |
$0.64
|
| Rate for Payer: Southwest Service Administrators UFCW |
$2.72
|
| Rate for Payer: TriWest Medicare |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
| Rate for Payer: United Healthcare Medicare |
$0.64
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.63
|
|
|
HEPARIN PER 1000 UNI
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
1170064
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna of AZ Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$3.20
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$16,093.62
|
|
|
Service Code
|
APR-DRG 2794
|
| Hospital Charge Code |
APRDRG2792
|
| Min. Negotiated Rate |
$16,093.62 |
| Max. Negotiated Rate |
$16,093.62 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,093.62
|
| Rate for Payer: Mercy Care Medicaid |
$16,093.62
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,093.62
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$6,830.93
|
|
|
Service Code
|
APR-DRG 2793
|
| Hospital Charge Code |
APRDRG2794
|
| Min. Negotiated Rate |
$6,830.93 |
| Max. Negotiated Rate |
$6,830.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,830.93
|
| Rate for Payer: Mercy Care Medicaid |
$6,830.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,830.93
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$3,375.84
|
|
|
Service Code
|
APR-DRG 2791
|
| Hospital Charge Code |
APRDRG2792
|
| Min. Negotiated Rate |
$3,375.84 |
| Max. Negotiated Rate |
$3,375.84 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,375.84
|
| Rate for Payer: Mercy Care Medicaid |
$3,375.84
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,375.84
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$4,281.35
|
|
|
Service Code
|
APR-DRG 2792
|
| Hospital Charge Code |
APRDRG2792
|
| Min. Negotiated Rate |
$4,281.35 |
| Max. Negotiated Rate |
$4,281.35 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,281.35
|
| Rate for Payer: Mercy Care Medicaid |
$4,281.35
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,281.35
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$16,093.62
|
|
|
Service Code
|
APR-DRG 2794
|
| Hospital Charge Code |
APRDRG2791
|
| Min. Negotiated Rate |
$16,093.62 |
| Max. Negotiated Rate |
$16,093.62 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,093.62
|
| Rate for Payer: Mercy Care Medicaid |
$16,093.62
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,093.62
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$4,281.35
|
|
|
Service Code
|
APR-DRG 2792
|
| Hospital Charge Code |
APRDRG2793
|
| Min. Negotiated Rate |
$4,281.35 |
| Max. Negotiated Rate |
$4,281.35 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,281.35
|
| Rate for Payer: Mercy Care Medicaid |
$4,281.35
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,281.35
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$3,375.84
|
|
|
Service Code
|
APR-DRG 2791
|
| Hospital Charge Code |
APRDRG2794
|
| Min. Negotiated Rate |
$3,375.84 |
| Max. Negotiated Rate |
$3,375.84 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,375.84
|
| Rate for Payer: Mercy Care Medicaid |
$3,375.84
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,375.84
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$4,281.35
|
|
|
Service Code
|
APR-DRG 2792
|
| Hospital Charge Code |
APRDRG2791
|
| Min. Negotiated Rate |
$4,281.35 |
| Max. Negotiated Rate |
$4,281.35 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,281.35
|
| Rate for Payer: Mercy Care Medicaid |
$4,281.35
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,281.35
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$16,093.62
|
|
|
Service Code
|
APR-DRG 2794
|
| Hospital Charge Code |
APRDRG2793
|
| Min. Negotiated Rate |
$16,093.62 |
| Max. Negotiated Rate |
$16,093.62 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,093.62
|
| Rate for Payer: Mercy Care Medicaid |
$16,093.62
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,093.62
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$6,830.93
|
|
|
Service Code
|
APR-DRG 2793
|
| Hospital Charge Code |
APRDRG2793
|
| Min. Negotiated Rate |
$6,830.93 |
| Max. Negotiated Rate |
$6,830.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,830.93
|
| Rate for Payer: Mercy Care Medicaid |
$6,830.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,830.93
|
|
|
Hepatic Coma And Other Major Acute Liver Disorders
|
Facility
|
IP
|
$6,830.93
|
|
|
Service Code
|
APR-DRG 2793
|
| Hospital Charge Code |
APRDRG2792
|
| Min. Negotiated Rate |
$6,830.93 |
| Max. Negotiated Rate |
$6,830.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,830.93
|
| Rate for Payer: Mercy Care Medicaid |
$6,830.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,830.93
|
|
