|
Lower Extremity Arterial Procedures
|
Facility
|
IP
|
$22,058.33
|
|
|
Service Code
|
APR-DRG 1813
|
| Hospital Charge Code |
APRDRG1811
|
| Min. Negotiated Rate |
$22,058.33 |
| Max. Negotiated Rate |
$22,058.33 |
| Rate for Payer: AHCCCS Medicaid |
$22,058.33
|
| Rate for Payer: Allwell Medicaid |
$22,058.33
|
| Rate for Payer: AZCH Complete Medicaid |
$22,058.33
|
| Rate for Payer: Banner UC Health Medicaid |
$22,058.33
|
| Rate for Payer: Mercy Care Medicaid |
$22,058.33
|
|
|
Lower Extremity Arterial Procedures
|
Facility
|
IP
|
$22,058.33
|
|
|
Service Code
|
APR-DRG 1813
|
| Hospital Charge Code |
APRDRG1812
|
| Min. Negotiated Rate |
$22,058.33 |
| Max. Negotiated Rate |
$22,058.33 |
| Rate for Payer: AHCCCS Medicaid |
$22,058.33
|
| Rate for Payer: Allwell Medicaid |
$22,058.33
|
| Rate for Payer: AZCH Complete Medicaid |
$22,058.33
|
| Rate for Payer: Banner UC Health Medicaid |
$22,058.33
|
| Rate for Payer: Mercy Care Medicaid |
$22,058.33
|
|
|
Lower Extremity Arterial Procedures
|
Facility
|
IP
|
$37,239.43
|
|
|
Service Code
|
APR-DRG 1814
|
| Hospital Charge Code |
APRDRG1813
|
| Min. Negotiated Rate |
$37,239.43 |
| Max. Negotiated Rate |
$37,239.43 |
| Rate for Payer: AHCCCS Medicaid |
$37,239.43
|
| Rate for Payer: Allwell Medicaid |
$37,239.43
|
| Rate for Payer: AZCH Complete Medicaid |
$37,239.43
|
| Rate for Payer: Banner UC Health Medicaid |
$37,239.43
|
| Rate for Payer: Mercy Care Medicaid |
$37,239.43
|
|
|
Lower Extremity Arterial Procedures
|
Facility
|
IP
|
$13,613.47
|
|
|
Service Code
|
APR-DRG 1812
|
| Hospital Charge Code |
APRDRG1813
|
| Min. Negotiated Rate |
$13,613.47 |
| Max. Negotiated Rate |
$13,613.47 |
| Rate for Payer: AHCCCS Medicaid |
$13,613.47
|
| Rate for Payer: Allwell Medicaid |
$13,613.47
|
| Rate for Payer: AZCH Complete Medicaid |
$13,613.47
|
| Rate for Payer: Banner UC Health Medicaid |
$13,613.47
|
| Rate for Payer: Mercy Care Medicaid |
$13,613.47
|
|
|
Lp-PLA2 Activity
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
23092587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Aetna of AZ Commercial |
$556.20
|
| Rate for Payer: Aetna of AZ Medicare |
$173.04
|
| Rate for Payer: AHCCCS Medicaid |
$63.96
|
| Rate for Payer: Allwell Medicaid |
$63.96
|
| Rate for Payer: Allwell Medicare |
$92.70
|
| Rate for Payer: Amerigroup Medicare |
$92.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$230.82
|
| Rate for Payer: AZCH Complete Medicaid |
$63.96
|
| Rate for Payer: AZCH Complete Medicare |
$92.70
|
| Rate for Payer: Banner UC Health Medicaid |
$63.96
|
| Rate for Payer: Banner UC Health Medicare |
$92.70
|
| Rate for Payer: Bisbee Police All Plans |
$160.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$420.24
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cigna of AZ Commercial |
$401.70
|
| Rate for Payer: Copperpoint Commercial |
$152.96
|
| Rate for Payer: Health Net of AZ Commercial |
$370.80
|
| Rate for Payer: Health Net of AZ Medicare |
$173.04
|
| Rate for Payer: Humana of AZ Medicare |
$92.70
|
| Rate for Payer: Mercy Care Medicaid |
$63.96
|
| Rate for Payer: Self Pay Self Pay |
$494.40
|
| Rate for Payer: TriWest Medicare |
$92.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$360.29
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$111.24
|
|
|
Lp-PLA2 Activity
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
23092587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$160.68 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Aetna of AZ Commercial |
$556.20
|
| Rate for Payer: Bisbee Police All Plans |
$160.68
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Self Pay Self Pay |
$494.40
|
|
|
L/S supracerv hyst uter > 250G with USO/BSO
|
Facility
|
OP
|
$4,951.00
|
|
|
Service Code
|
CPT 58544
|
| Hospital Charge Code |
27267833
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$742.65 |
| Max. Negotiated Rate |
$12,916.10 |
| Rate for Payer: Aetna of AZ Commercial |
$4,455.90
|
| Rate for Payer: Aetna of AZ Medicare |
$1,386.28
|
| Rate for Payer: AHCCCS Medicaid |
$12,916.10
|
| Rate for Payer: Allwell Medicaid |
$12,916.10
|
| Rate for Payer: Allwell Medicare |
$742.65
|
| Rate for Payer: Amerigroup Medicare |
$742.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,849.20
|
| Rate for Payer: AZCH Complete Medicaid |
$12,916.10
|
| Rate for Payer: AZCH Complete Medicare |
$742.65
|
| Rate for Payer: Banner UC Health Medicaid |
$12,916.10
|
| Rate for Payer: Banner UC Health Medicare |
$742.65
|
| Rate for Payer: Bisbee Police All Plans |
$1,287.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,366.68
|
| Rate for Payer: Cash Price |
$3,960.80
|
| Rate for Payer: Cash Price |
$3,960.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,475.50
|
| Rate for Payer: Copperpoint Commercial |
$1,225.37
|
| Rate for Payer: Health Net of AZ Commercial |
$2,970.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,386.28
|
| Rate for Payer: Humana of AZ Medicare |
$742.65
|
| Rate for Payer: Mercy Care Medicaid |
$12,916.10
|
| Rate for Payer: Self Pay Self Pay |
$3,960.80
|
| Rate for Payer: TriWest Medicare |
$742.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5,265.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$891.18
|
|
|
L/S supracerv hyst uter > 250G with USO/BSO
|
Facility
|
IP
|
$4,951.00
|
|
|
Service Code
|
CPT 58544
|
| Hospital Charge Code |
27267833
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,287.26 |
| Max. Negotiated Rate |
$4,455.90 |
| Rate for Payer: Aetna of AZ Commercial |
$4,455.90
|
| Rate for Payer: Bisbee Police All Plans |
$1,287.26
|
| Rate for Payer: Cash Price |
$3,960.80
|
| Rate for Payer: Self Pay Self Pay |
$3,960.80
|
|
|
L/S supracerv hyst uter < 250G w USO BSO
|
Facility
|
OP
|
$4,531.00
|
|
|
Service Code
|
CPT 58542
|
| Hospital Charge Code |
27291804
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$679.65 |
| Max. Negotiated Rate |
$12,916.10 |
| Rate for Payer: Aetna of AZ Commercial |
$4,077.90
|
| Rate for Payer: Aetna of AZ Medicare |
$1,268.68
|
| Rate for Payer: AHCCCS Medicaid |
$12,916.10
|
| Rate for Payer: Allwell Medicaid |
$12,916.10
|
| Rate for Payer: Allwell Medicare |
$679.65
|
| Rate for Payer: Amerigroup Medicare |
$679.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,692.33
|
| Rate for Payer: AZCH Complete Medicaid |
$12,916.10
|
| Rate for Payer: AZCH Complete Medicare |
$679.65
|
| Rate for Payer: Banner UC Health Medicaid |
$12,916.10
|
| Rate for Payer: Banner UC Health Medicare |
$679.65
|
| Rate for Payer: Bisbee Police All Plans |
$1,178.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3,081.08
|
| Rate for Payer: Cash Price |
$3,624.80
|
| Rate for Payer: Cash Price |
$3,624.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,265.50
|
| Rate for Payer: Copperpoint Commercial |
$1,121.42
|
| Rate for Payer: Health Net of AZ Commercial |
$2,718.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,268.68
|
| Rate for Payer: Humana of AZ Medicare |
$679.65
|
| Rate for Payer: Mercy Care Medicaid |
$12,916.10
|
| Rate for Payer: Self Pay Self Pay |
$3,624.80
|
| Rate for Payer: TriWest Medicare |
$679.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5,265.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$815.58
|
|
|
L/S supracerv hyst uter < 250G w USO BSO
|
Facility
|
IP
|
$4,531.00
|
|
|
Service Code
|
CPT 58542
|
| Hospital Charge Code |
27291804
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,178.06 |
| Max. Negotiated Rate |
$4,077.90 |
| Rate for Payer: Aetna of AZ Commercial |
$4,077.90
|
| Rate for Payer: Bisbee Police All Plans |
$1,178.06
|
| Rate for Payer: Cash Price |
$3,624.80
|
| Rate for Payer: Self Pay Self Pay |
$3,624.80
|
|
|
L/S supracervical hyst for uterus > 250g
|
Facility
|
IP
|
$4,380.00
|
|
|
Service Code
|
CPT 58543
|
| Hospital Charge Code |
27281900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,138.80 |
| Max. Negotiated Rate |
$3,942.00 |
| Rate for Payer: Aetna of AZ Commercial |
$3,942.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,138.80
|
| Rate for Payer: Cash Price |
$3,504.00
|
| Rate for Payer: Self Pay Self Pay |
$3,504.00
|
|
|
L/S supracervical hyst for uterus > 250g
|
Facility
|
OP
|
$4,380.00
|
|
|
Service Code
|
CPT 58543
|
| Hospital Charge Code |
27281900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$657.00 |
| Max. Negotiated Rate |
$12,916.10 |
| Rate for Payer: Aetna of AZ Commercial |
$3,942.00
|
| Rate for Payer: Aetna of AZ Medicare |
$1,226.40
|
| Rate for Payer: AHCCCS Medicaid |
$12,916.10
|
| Rate for Payer: Allwell Medicaid |
$12,916.10
|
| Rate for Payer: Allwell Medicare |
$657.00
|
| Rate for Payer: Amerigroup Medicare |
$657.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,635.93
|
| Rate for Payer: AZCH Complete Medicaid |
$12,916.10
|
| Rate for Payer: AZCH Complete Medicare |
$657.00
|
| Rate for Payer: Banner UC Health Medicaid |
$12,916.10
|
| Rate for Payer: Banner UC Health Medicare |
$657.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,138.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,978.40
|
| Rate for Payer: Cash Price |
$3,504.00
|
| Rate for Payer: Cash Price |
$3,504.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,190.00
|
| Rate for Payer: Copperpoint Commercial |
$1,084.05
|
| Rate for Payer: Health Net of AZ Commercial |
$2,628.00
|
| Rate for Payer: Health Net of AZ Medicare |
$1,226.40
|
| Rate for Payer: Humana of AZ Medicare |
$657.00
|
| Rate for Payer: Mercy Care Medicaid |
$12,916.10
|
| Rate for Payer: Self Pay Self Pay |
$3,504.00
|
| Rate for Payer: TriWest Medicare |
$657.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$5,265.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$788.40
|
|
|
LUBRICANT SURGILUBE 4.25 OZ
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
22355262
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of AZ Commercial |
$14.40
|
| Rate for Payer: Aetna of AZ Medicare |
$4.48
|
| Rate for Payer: Allwell Medicare |
$2.40
|
| Rate for Payer: Amerigroup Medicare |
$2.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$5.98
|
| Rate for Payer: AZCH Complete Medicare |
$2.40
|
| Rate for Payer: Banner UC Health Medicare |
$2.40
|
| Rate for Payer: Bisbee Police All Plans |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$10.88
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cigna of AZ Commercial |
$11.20
|
| Rate for Payer: Copperpoint Commercial |
$3.96
|
| Rate for Payer: Health Net of AZ Commercial |
$9.60
|
| Rate for Payer: Health Net of AZ Medicare |
$4.48
|
| Rate for Payer: Humana of AZ Medicare |
$2.40
|
| Rate for Payer: Self Pay Self Pay |
$12.80
|
| Rate for Payer: TriWest Medicare |
$2.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$9.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.88
|
|
|
LUBRICANT SURGILUBE 4.25 OZ
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
22355262
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of AZ Commercial |
$14.40
|
| Rate for Payer: Bisbee Police All Plans |
$4.16
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Self Pay Self Pay |
$12.80
|
|
|
Lupus Anticoagulant Comp LC
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
1285803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of AZ Commercial |
$201.60
|
| Rate for Payer: Aetna of AZ Medicare |
$62.72
|
| Rate for Payer: AHCCCS Medicaid |
$17.98
|
| Rate for Payer: Allwell Medicaid |
$17.98
|
| Rate for Payer: Allwell Medicare |
$33.60
|
| Rate for Payer: Amerigroup Medicare |
$33.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$83.66
|
| Rate for Payer: AZCH Complete Medicaid |
$17.98
|
| Rate for Payer: AZCH Complete Medicare |
$33.60
|
| Rate for Payer: Banner UC Health Medicaid |
$17.98
|
| Rate for Payer: Banner UC Health Medicare |
$33.60
|
| Rate for Payer: Bisbee Police All Plans |
$58.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$152.32
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cigna of AZ Commercial |
$145.60
|
| Rate for Payer: Copperpoint Commercial |
$55.44
|
| Rate for Payer: Health Net of AZ Commercial |
$134.40
|
| Rate for Payer: Health Net of AZ Medicare |
$62.72
|
| Rate for Payer: Humana of AZ Medicare |
$33.60
|
| Rate for Payer: Mercy Care Medicaid |
$17.98
|
| Rate for Payer: Self Pay Self Pay |
$179.20
|
| Rate for Payer: TriWest Medicare |
$33.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$130.59
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.32
|
|
|
Lupus Anticoagulant Comp LC
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
1285803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of AZ Commercial |
$201.60
|
| Rate for Payer: Bisbee Police All Plans |
$58.24
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Self Pay Self Pay |
$179.20
|
|
|
Luteinizing Hormone(LH), S LC
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
2029219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna of AZ Commercial |
$444.60
|
| Rate for Payer: Aetna of AZ Medicare |
$138.32
|
| Rate for Payer: AHCCCS Medicaid |
$18.52
|
| Rate for Payer: Allwell Medicaid |
$18.52
|
| Rate for Payer: Allwell Medicare |
$74.10
|
| Rate for Payer: Amerigroup Medicare |
$74.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$184.51
|
| Rate for Payer: AZCH Complete Medicaid |
$18.52
|
| Rate for Payer: AZCH Complete Medicare |
$74.10
|
| Rate for Payer: Banner UC Health Medicaid |
$18.52
|
| Rate for Payer: Banner UC Health Medicare |
$74.10
|
| Rate for Payer: Bisbee Police All Plans |
$128.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$335.92
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Cigna of AZ Commercial |
$321.10
|
| Rate for Payer: Copperpoint Commercial |
$122.26
|
| Rate for Payer: Health Net of AZ Commercial |
$296.40
|
| Rate for Payer: Health Net of AZ Medicare |
$138.32
|
| Rate for Payer: Humana of AZ Medicare |
$74.10
|
| Rate for Payer: Mercy Care Medicaid |
$18.52
|
| Rate for Payer: Self Pay Self Pay |
$395.20
|
| Rate for Payer: TriWest Medicare |
$74.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$288.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$88.92
|
|
|
Luteinizing Hormone(LH), S LC
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
2029219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna of AZ Commercial |
$444.60
|
| Rate for Payer: Bisbee Police All Plans |
$128.44
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Self Pay Self Pay |
$395.20
|
|
|
LYME AB IGM
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
22481491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna of AZ Commercial |
$316.80
|
| Rate for Payer: Bisbee Police All Plans |
$91.52
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Self Pay Self Pay |
$281.60
|
|
|
LYME AB IGM
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
22481491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna of AZ Commercial |
$316.80
|
| Rate for Payer: Aetna of AZ Medicare |
$98.56
|
| Rate for Payer: AHCCCS Medicaid |
$17.03
|
| Rate for Payer: Allwell Medicaid |
$17.03
|
| Rate for Payer: Allwell Medicare |
$52.80
|
| Rate for Payer: Amerigroup Medicare |
$52.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$131.47
|
| Rate for Payer: AZCH Complete Medicaid |
$17.03
|
| Rate for Payer: AZCH Complete Medicare |
$52.80
|
| Rate for Payer: Banner UC Health Medicaid |
$17.03
|
| Rate for Payer: Banner UC Health Medicare |
$52.80
|
| Rate for Payer: Bisbee Police All Plans |
$91.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$239.36
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cigna of AZ Commercial |
$228.80
|
| Rate for Payer: Copperpoint Commercial |
$87.12
|
| Rate for Payer: Health Net of AZ Commercial |
$211.20
|
| Rate for Payer: Health Net of AZ Medicare |
$98.56
|
| Rate for Payer: Humana of AZ Medicare |
$52.80
|
| Rate for Payer: Mercy Care Medicaid |
$17.03
|
| Rate for Payer: Self Pay Self Pay |
$281.60
|
| Rate for Payer: TriWest Medicare |
$52.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$205.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$63.36
|
|
|
Lyme Ab, Total/IgM Responses LC
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
10864420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$98.02 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna of AZ Commercial |
$339.30
|
| Rate for Payer: Bisbee Police All Plans |
$98.02
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Self Pay Self Pay |
$301.60
|
|
|
Lyme Ab, Total/IgM Responses LC
|
Facility
|
OP
|
$377.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
10864420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna of AZ Commercial |
$339.30
|
| Rate for Payer: Aetna of AZ Medicare |
$105.56
|
| Rate for Payer: AHCCCS Medicaid |
$17.03
|
| Rate for Payer: Allwell Medicaid |
$17.03
|
| Rate for Payer: Allwell Medicare |
$56.55
|
| Rate for Payer: Amerigroup Medicare |
$56.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$140.81
|
| Rate for Payer: AZCH Complete Medicaid |
$17.03
|
| Rate for Payer: AZCH Complete Medicare |
$56.55
|
| Rate for Payer: Banner UC Health Medicaid |
$17.03
|
| Rate for Payer: Banner UC Health Medicare |
$56.55
|
| Rate for Payer: Bisbee Police All Plans |
$98.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$256.36
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cigna of AZ Commercial |
$245.05
|
| Rate for Payer: Copperpoint Commercial |
$93.31
|
| Rate for Payer: Health Net of AZ Commercial |
$226.20
|
| Rate for Payer: Health Net of AZ Medicare |
$105.56
|
| Rate for Payer: Humana of AZ Medicare |
$56.55
|
| Rate for Payer: Mercy Care Medicaid |
$17.03
|
| Rate for Payer: Self Pay Self Pay |
$301.60
|
| Rate for Payer: TriWest Medicare |
$56.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$219.79
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$67.86
|
|
|
Lyme AB Total w Reflex LC
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
6782288
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Aetna of AZ Commercial |
$191.70
|
| Rate for Payer: Aetna of AZ Medicare |
$59.64
|
| Rate for Payer: AHCCCS Medicaid |
$17.03
|
| Rate for Payer: Allwell Medicaid |
$17.03
|
| Rate for Payer: Allwell Medicare |
$31.95
|
| Rate for Payer: Amerigroup Medicare |
$31.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$79.56
|
| Rate for Payer: AZCH Complete Medicaid |
$17.03
|
| Rate for Payer: AZCH Complete Medicare |
$31.95
|
| Rate for Payer: Banner UC Health Medicaid |
$17.03
|
| Rate for Payer: Banner UC Health Medicare |
$31.95
|
| Rate for Payer: Bisbee Police All Plans |
$55.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$144.84
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna of AZ Commercial |
$138.45
|
| Rate for Payer: Copperpoint Commercial |
$52.72
|
| Rate for Payer: Health Net of AZ Commercial |
$127.80
|
| Rate for Payer: Health Net of AZ Medicare |
$59.64
|
| Rate for Payer: Humana of AZ Medicare |
$31.95
|
| Rate for Payer: Mercy Care Medicaid |
$17.03
|
| Rate for Payer: Self Pay Self Pay |
$170.40
|
| Rate for Payer: TriWest Medicare |
$31.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$124.18
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.34
|
|
|
Lyme AB Total w Reflex LC
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
6782288
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Aetna of AZ Commercial |
$191.70
|
| Rate for Payer: Bisbee Police All Plans |
$55.38
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Self Pay Self Pay |
$170.40
|
|
|
Lyme, IgM, Early Test/Reflex LC
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
22311198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna of AZ Commercial |
$316.80
|
| Rate for Payer: Aetna of AZ Medicare |
$98.56
|
| Rate for Payer: AHCCCS Medicaid |
$17.03
|
| Rate for Payer: Allwell Medicaid |
$17.03
|
| Rate for Payer: Allwell Medicare |
$52.80
|
| Rate for Payer: Amerigroup Medicare |
$52.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$131.47
|
| Rate for Payer: AZCH Complete Medicaid |
$17.03
|
| Rate for Payer: AZCH Complete Medicare |
$52.80
|
| Rate for Payer: Banner UC Health Medicaid |
$17.03
|
| Rate for Payer: Banner UC Health Medicare |
$52.80
|
| Rate for Payer: Bisbee Police All Plans |
$91.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$239.36
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cigna of AZ Commercial |
$228.80
|
| Rate for Payer: Copperpoint Commercial |
$87.12
|
| Rate for Payer: Health Net of AZ Commercial |
$211.20
|
| Rate for Payer: Health Net of AZ Medicare |
$98.56
|
| Rate for Payer: Humana of AZ Medicare |
$52.80
|
| Rate for Payer: Mercy Care Medicaid |
$17.03
|
| Rate for Payer: Self Pay Self Pay |
$281.60
|
| Rate for Payer: TriWest Medicare |
$52.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$205.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$63.36
|
|
