|
LYME AB IGM
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
22481491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.32 |
| 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: Allwell Medicare |
$56.32
|
| Rate for Payer: Amerigroup Medicare |
$56.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$131.47
|
| Rate for Payer: AZCH Complete Medicare |
$56.32
|
| Rate for Payer: Banner UC Health Medicare |
$56.32
|
| 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: 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 |
$56.32
|
| Rate for Payer: Self Pay Self Pay |
$281.60
|
| Rate for Payer: TriWest Medicare |
$56.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$205.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$63.36
|
|
|
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, 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 |
$60.32 |
| 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: Allwell Medicare |
$60.32
|
| Rate for Payer: Amerigroup Medicare |
$60.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$140.81
|
| Rate for Payer: AZCH Complete Medicare |
$60.32
|
| Rate for Payer: Banner UC Health Medicare |
$60.32
|
| 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: 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 |
$60.32
|
| Rate for Payer: Self Pay Self Pay |
$301.60
|
| Rate for Payer: TriWest Medicare |
$60.32
|
| 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
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
6782288
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.52 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of AZ Commercial |
$181.80
|
| Rate for Payer: Bisbee Police All Plans |
$52.52
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Self Pay Self Pay |
$161.60
|
|
|
Lyme AB Total w Reflex LC
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
6782288
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Aetna of AZ Commercial |
$181.80
|
| Rate for Payer: Aetna of AZ Medicare |
$56.56
|
| Rate for Payer: Allwell Medicare |
$32.32
|
| Rate for Payer: Amerigroup Medicare |
$32.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$75.45
|
| Rate for Payer: AZCH Complete Medicare |
$32.32
|
| Rate for Payer: Banner UC Health Medicare |
$32.32
|
| Rate for Payer: Bisbee Police All Plans |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cigna of AZ Commercial |
$131.30
|
| Rate for Payer: Copperpoint Commercial |
$49.99
|
| Rate for Payer: Health Net of AZ Commercial |
$121.20
|
| Rate for Payer: Health Net of AZ Medicare |
$56.56
|
| Rate for Payer: Humana of AZ Medicare |
$32.32
|
| Rate for Payer: Self Pay Self Pay |
$161.60
|
| Rate for Payer: TriWest Medicare |
$32.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$117.77
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$36.36
|
|
|
Lyme, IgM, Early Test/Reflex LC
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
22311198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.44 |
| Max. Negotiated Rate |
$300.60 |
| Rate for Payer: Aetna of AZ Commercial |
$300.60
|
| Rate for Payer: Aetna of AZ Medicare |
$93.52
|
| Rate for Payer: Allwell Medicare |
$53.44
|
| Rate for Payer: Amerigroup Medicare |
$53.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$124.75
|
| Rate for Payer: AZCH Complete Medicare |
$53.44
|
| Rate for Payer: Banner UC Health Medicare |
$53.44
|
| Rate for Payer: Bisbee Police All Plans |
$86.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$227.12
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cigna of AZ Commercial |
$217.10
|
| Rate for Payer: Copperpoint Commercial |
$82.67
|
| Rate for Payer: Health Net of AZ Commercial |
$200.40
|
| Rate for Payer: Health Net of AZ Medicare |
$93.52
|
| Rate for Payer: Humana of AZ Medicare |
$53.44
|
| Rate for Payer: Self Pay Self Pay |
$267.20
|
| Rate for Payer: TriWest Medicare |
$53.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$194.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$60.12
|
|
|
Lyme, IgM, Early Test/Reflex LC
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
22311198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.84 |
| Max. Negotiated Rate |
$300.60 |
| Rate for Payer: Aetna of AZ Commercial |
$300.60
|
| Rate for Payer: Bisbee Police All Plans |
$86.84
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Self Pay Self Pay |
$267.20
|
|
|
Lyme, Western Blot, Serum LC
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
1285773
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of AZ Commercial |
$299.70
|
| Rate for Payer: Bisbee Police All Plans |
$86.58
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Self Pay Self Pay |
$266.40
|
|
|
Lyme, Western Blot, Serum LC
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
1285773
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of AZ Commercial |
$299.70
|
| Rate for Payer: Aetna of AZ Medicare |
$93.24
|
| Rate for Payer: Allwell Medicare |
$53.28
|
| Rate for Payer: Amerigroup Medicare |
$53.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$124.38
|
| Rate for Payer: AZCH Complete Medicare |
$53.28
|
| Rate for Payer: Banner UC Health Medicare |
$53.28
|
| Rate for Payer: Bisbee Police All Plans |
$86.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$226.44
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna of AZ Commercial |
$216.45
|
| Rate for Payer: Copperpoint Commercial |
$82.42
|
| Rate for Payer: Health Net of AZ Commercial |
$199.80
|
| Rate for Payer: Health Net of AZ Medicare |
$93.24
|
| Rate for Payer: Humana of AZ Medicare |
$53.28
|
| Rate for Payer: Self Pay Self Pay |
$266.40
|
| Rate for Payer: TriWest Medicare |
$53.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$194.14
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$59.94
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$16,510.25
|
|
|
Service Code
|
APR-DRG 6944
|
| Hospital Charge Code |
APRDRG6944
|
| Min. Negotiated Rate |
$16,510.25 |
| Max. Negotiated Rate |
$16,510.25 |
| Rate for Payer: AHCCCS Medicaid |
$16,510.25
|
| Rate for Payer: Allwell Medicaid |
$16,510.25
|
| Rate for Payer: AZCH Complete Medicaid |
$16,510.25
|
| Rate for Payer: Banner UC Health Medicaid |
$16,510.25
|
| Rate for Payer: Mercy Care Medicaid |
$16,510.25
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$8,651.77
|
|
|
Service Code
|
APR-DRG 6943
|
| Hospital Charge Code |
APRDRG6942
|
| Min. Negotiated Rate |
$8,651.77 |
| Max. Negotiated Rate |
$8,651.77 |
| Rate for Payer: AHCCCS Medicaid |
$8,651.77
|
| Rate for Payer: Allwell Medicaid |
$8,651.77
|
| Rate for Payer: AZCH Complete Medicaid |
$8,651.77
|
| Rate for Payer: Banner UC Health Medicaid |
$8,651.77
|
| Rate for Payer: Mercy Care Medicaid |
$8,651.77
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$16,510.25
|
|
|
Service Code
|
APR-DRG 6944
|
| Hospital Charge Code |
APRDRG6941
|
| Min. Negotiated Rate |
$16,510.25 |
| Max. Negotiated Rate |
$16,510.25 |
| Rate for Payer: AHCCCS Medicaid |
$16,510.25
|
| Rate for Payer: Allwell Medicaid |
$16,510.25
|
| Rate for Payer: AZCH Complete Medicaid |
$16,510.25
|
| Rate for Payer: Banner UC Health Medicaid |
$16,510.25
|
| Rate for Payer: Mercy Care Medicaid |
$16,510.25
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$5,717.11
|
|
|
Service Code
|
APR-DRG 6942
|
| Hospital Charge Code |
APRDRG6941
|
| Min. Negotiated Rate |
$5,717.11 |
| Max. Negotiated Rate |
$5,717.11 |
| Rate for Payer: AHCCCS Medicaid |
$5,717.11
|
| Rate for Payer: Allwell Medicaid |
$5,717.11
|
| Rate for Payer: AZCH Complete Medicaid |
$5,717.11
|
| Rate for Payer: Banner UC Health Medicaid |
$5,717.11
|
| Rate for Payer: Mercy Care Medicaid |
$5,717.11
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$5,717.11
|
|
|
Service Code
|
APR-DRG 6942
|
| Hospital Charge Code |
APRDRG6943
|
| Min. Negotiated Rate |
$5,717.11 |
| Max. Negotiated Rate |
$5,717.11 |
| Rate for Payer: AHCCCS Medicaid |
$5,717.11
|
| Rate for Payer: Allwell Medicaid |
$5,717.11
|
| Rate for Payer: AZCH Complete Medicaid |
$5,717.11
|
| Rate for Payer: Banner UC Health Medicaid |
$5,717.11
|
| Rate for Payer: Mercy Care Medicaid |
$5,717.11
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$8,651.77
|
|
|
Service Code
|
APR-DRG 6943
|
| Hospital Charge Code |
APRDRG6941
|
| Min. Negotiated Rate |
$8,651.77 |
| Max. Negotiated Rate |
$8,651.77 |
| Rate for Payer: AHCCCS Medicaid |
$8,651.77
|
| Rate for Payer: Allwell Medicaid |
$8,651.77
|
| Rate for Payer: AZCH Complete Medicaid |
$8,651.77
|
| Rate for Payer: Banner UC Health Medicaid |
$8,651.77
|
| Rate for Payer: Mercy Care Medicaid |
$8,651.77
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$8,651.77
|
|
|
Service Code
|
APR-DRG 6943
|
| Hospital Charge Code |
APRDRG6944
|
| Min. Negotiated Rate |
$8,651.77 |
| Max. Negotiated Rate |
$8,651.77 |
| Rate for Payer: AHCCCS Medicaid |
$8,651.77
|
| Rate for Payer: Allwell Medicaid |
$8,651.77
|
| Rate for Payer: AZCH Complete Medicaid |
$8,651.77
|
| Rate for Payer: Banner UC Health Medicaid |
$8,651.77
|
| Rate for Payer: Mercy Care Medicaid |
$8,651.77
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$4,371.12
|
|
|
Service Code
|
APR-DRG 6941
|
| Hospital Charge Code |
APRDRG6944
|
| Min. Negotiated Rate |
$4,371.12 |
| Max. Negotiated Rate |
$4,371.12 |
| Rate for Payer: AHCCCS Medicaid |
$4,371.12
|
| Rate for Payer: Allwell Medicaid |
$4,371.12
|
| Rate for Payer: AZCH Complete Medicaid |
$4,371.12
|
| Rate for Payer: Banner UC Health Medicaid |
$4,371.12
|
| Rate for Payer: Mercy Care Medicaid |
$4,371.12
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$5,717.11
|
|
|
Service Code
|
APR-DRG 6942
|
| Hospital Charge Code |
APRDRG6944
|
| Min. Negotiated Rate |
$5,717.11 |
| Max. Negotiated Rate |
$5,717.11 |
| Rate for Payer: AHCCCS Medicaid |
$5,717.11
|
| Rate for Payer: Allwell Medicaid |
$5,717.11
|
| Rate for Payer: AZCH Complete Medicaid |
$5,717.11
|
| Rate for Payer: Banner UC Health Medicaid |
$5,717.11
|
| Rate for Payer: Mercy Care Medicaid |
$5,717.11
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$4,371.12
|
|
|
Service Code
|
APR-DRG 6941
|
| Hospital Charge Code |
APRDRG6943
|
| Min. Negotiated Rate |
$4,371.12 |
| Max. Negotiated Rate |
$4,371.12 |
| Rate for Payer: AHCCCS Medicaid |
$4,371.12
|
| Rate for Payer: Allwell Medicaid |
$4,371.12
|
| Rate for Payer: AZCH Complete Medicaid |
$4,371.12
|
| Rate for Payer: Banner UC Health Medicaid |
$4,371.12
|
| Rate for Payer: Mercy Care Medicaid |
$4,371.12
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$4,371.12
|
|
|
Service Code
|
APR-DRG 6941
|
| Hospital Charge Code |
APRDRG6941
|
| Min. Negotiated Rate |
$4,371.12 |
| Max. Negotiated Rate |
$4,371.12 |
| Rate for Payer: AHCCCS Medicaid |
$4,371.12
|
| Rate for Payer: Allwell Medicaid |
$4,371.12
|
| Rate for Payer: AZCH Complete Medicaid |
$4,371.12
|
| Rate for Payer: Banner UC Health Medicaid |
$4,371.12
|
| Rate for Payer: Mercy Care Medicaid |
$4,371.12
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$8,651.77
|
|
|
Service Code
|
APR-DRG 6943
|
| Hospital Charge Code |
APRDRG6943
|
| Min. Negotiated Rate |
$8,651.77 |
| Max. Negotiated Rate |
$8,651.77 |
| Rate for Payer: AHCCCS Medicaid |
$8,651.77
|
| Rate for Payer: Allwell Medicaid |
$8,651.77
|
| Rate for Payer: AZCH Complete Medicaid |
$8,651.77
|
| Rate for Payer: Banner UC Health Medicaid |
$8,651.77
|
| Rate for Payer: Mercy Care Medicaid |
$8,651.77
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$5,717.11
|
|
|
Service Code
|
APR-DRG 6942
|
| Hospital Charge Code |
APRDRG6942
|
| Min. Negotiated Rate |
$5,717.11 |
| Max. Negotiated Rate |
$5,717.11 |
| Rate for Payer: AHCCCS Medicaid |
$5,717.11
|
| Rate for Payer: Allwell Medicaid |
$5,717.11
|
| Rate for Payer: AZCH Complete Medicaid |
$5,717.11
|
| Rate for Payer: Banner UC Health Medicaid |
$5,717.11
|
| Rate for Payer: Mercy Care Medicaid |
$5,717.11
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$16,510.25
|
|
|
Service Code
|
APR-DRG 6944
|
| Hospital Charge Code |
APRDRG6942
|
| Min. Negotiated Rate |
$16,510.25 |
| Max. Negotiated Rate |
$16,510.25 |
| Rate for Payer: AHCCCS Medicaid |
$16,510.25
|
| Rate for Payer: Allwell Medicaid |
$16,510.25
|
| Rate for Payer: AZCH Complete Medicaid |
$16,510.25
|
| Rate for Payer: Banner UC Health Medicaid |
$16,510.25
|
| Rate for Payer: Mercy Care Medicaid |
$16,510.25
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
IP
|
$16,510.25
|
|
|
Service Code
|
APR-DRG 6944
|
| Hospital Charge Code |
APRDRG6943
|
| Min. Negotiated Rate |
$16,510.25 |
| Max. Negotiated Rate |
$16,510.25 |
| Rate for Payer: AHCCCS Medicaid |
$16,510.25
|
| Rate for Payer: Allwell Medicaid |
$16,510.25
|
| Rate for Payer: AZCH Complete Medicaid |
$16,510.25
|
| Rate for Payer: Banner UC Health Medicaid |
$16,510.25
|
| Rate for Payer: Mercy Care Medicaid |
$16,510.25
|
|
