|
HIV 4th Gen Screen w Reflex LC
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
22305596
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of AZ Commercial |
$270.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$48.00
|
| Rate for Payer: Banner UC Health Medicare |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$48.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$48.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna of AZ Commercial |
$195.00
|
| Rate for Payer: Devoted Health Medicare |
$54.00
|
| Rate for Payer: Humana of AZ Medicare |
$48.00
|
| Rate for Payer: Seven Corners Travel Insurance |
$34.92
|
| Rate for Payer: Southwest Service Administrators UFCW |
$204.00
|
| Rate for Payer: TriWest Medicare |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$171.60
|
| Rate for Payer: United Healthcare Medicare |
$48.00
|
| Rate for Payer: Veterans Affairs TRICARE |
$47.52
|
|
|
HIV 4th Gen Screen w Reflex LC
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
22305596
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of AZ Commercial |
$270.00
|
| Rate for Payer: Cash Price |
$240.00
|
|
|
.HIV GenoSure(R) MG LC
|
Facility
|
OP
|
$1,502.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
22311150
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$237.92 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,351.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$240.32
|
| Rate for Payer: Banner UC Health Medicare |
$240.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,021.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$240.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$240.32
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Cigna of AZ Commercial |
$976.30
|
| Rate for Payer: Devoted Health Medicare |
$270.36
|
| Rate for Payer: Humana of AZ Medicare |
$240.32
|
| Rate for Payer: Seven Corners Travel Insurance |
$373.30
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,021.36
|
| Rate for Payer: TriWest Medicare |
$240.32
|
| Rate for Payer: United Healthcare Commercial |
$859.14
|
| Rate for Payer: United Healthcare Medicare |
$240.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$237.92
|
|
|
.HIV GenoSure(R) MG LC
|
Facility
|
IP
|
$1,502.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
23173793
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,351.80 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,201.60
|
|
|
.HIV GenoSure(R) MG LC
|
Facility
|
IP
|
$1,502.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
22311150
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,351.80 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,201.60
|
|
|
.HIV GenoSure(R) MG LC
|
Facility
|
OP
|
$1,502.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
23173793
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$237.92 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,351.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$240.32
|
| Rate for Payer: Banner UC Health Medicare |
$240.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,021.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$240.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$240.32
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Cigna of AZ Commercial |
$976.30
|
| Rate for Payer: Devoted Health Medicare |
$270.36
|
| Rate for Payer: Humana of AZ Medicare |
$240.32
|
| Rate for Payer: Seven Corners Travel Insurance |
$373.30
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,021.36
|
| Rate for Payer: TriWest Medicare |
$240.32
|
| Rate for Payer: United Healthcare Commercial |
$859.14
|
| Rate for Payer: United Healthcare Medicare |
$240.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$237.92
|
|
|
HIV Quant, LC
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
2269440
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$904.50 |
| Max. Negotiated Rate |
$904.50 |
| Rate for Payer: Aetna of AZ Commercial |
$904.50
|
| Rate for Payer: Cash Price |
$804.00
|
|
|
HIV Quant, LC
|
Facility
|
OP
|
$1,005.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
2269440
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$123.39 |
| Max. Negotiated Rate |
$904.50 |
| Rate for Payer: Aetna of AZ Commercial |
$904.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$160.80
|
| Rate for Payer: Banner UC Health Medicare |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$683.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$160.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$160.80
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cigna of AZ Commercial |
$653.25
|
| Rate for Payer: Devoted Health Medicare |
$180.90
|
| Rate for Payer: Humana of AZ Medicare |
$160.80
|
| Rate for Payer: Seven Corners Travel Insurance |
$123.39
|
| Rate for Payer: Southwest Service Administrators UFCW |
$683.40
|
| Rate for Payer: TriWest Medicare |
$160.80
|
| Rate for Payer: United Healthcare Commercial |
$574.86
|
| Rate for Payer: United Healthcare Medicare |
$160.80
|
| Rate for Payer: Veterans Affairs TRICARE |
$159.19
|
|
|
HIV RNA, PCR (Graph) rfx/Geno LC
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
22240940
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$904.50 |
| Max. Negotiated Rate |
$904.50 |
| Rate for Payer: Aetna of AZ Commercial |
$904.50
|
| Rate for Payer: Cash Price |
$804.00
|
|
|
HIV RNA, PCR (Graph) rfx/Geno LC
|
Facility
|
OP
|
$1,005.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
22240940
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.39 |
| Max. Negotiated Rate |
$904.50 |
| Rate for Payer: Aetna of AZ Commercial |
$904.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$160.80
|
| Rate for Payer: Banner UC Health Medicare |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$683.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$160.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$160.80
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cigna of AZ Commercial |
$653.25
|
| Rate for Payer: Devoted Health Medicare |
$180.90
|
| Rate for Payer: Humana of AZ Medicare |
$160.80
|
| Rate for Payer: Seven Corners Travel Insurance |
$123.39
|
| Rate for Payer: Southwest Service Administrators UFCW |
$683.40
|
| Rate for Payer: TriWest Medicare |
$160.80
|
| Rate for Payer: United Healthcare Commercial |
$574.86
|
| Rate for Payer: United Healthcare Medicare |
$160.80
|
| Rate for Payer: Veterans Affairs TRICARE |
$159.19
|
|
|
.HIV RNA Ql LC
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
22530964
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$479.70 |
| Rate for Payer: Aetna of AZ Commercial |
$479.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$85.28
|
| Rate for Payer: Banner UC Health Medicare |
$85.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$362.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$85.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$85.28
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cigna of AZ Commercial |
$346.45
|
| Rate for Payer: Devoted Health Medicare |
$95.94
|
| Rate for Payer: Humana of AZ Medicare |
$85.28
|
| Rate for Payer: Seven Corners Travel Insurance |
$50.88
|
| Rate for Payer: Southwest Service Administrators UFCW |
$362.44
|
| Rate for Payer: TriWest Medicare |
$85.28
|
| Rate for Payer: United Healthcare Commercial |
$304.88
|
| Rate for Payer: United Healthcare Medicare |
$85.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$84.43
|
|
|
.HIV RNA Ql LC
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
22530964
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$479.70 |
| Max. Negotiated Rate |
$479.70 |
| Rate for Payer: Aetna of AZ Commercial |
$479.70
|
| Rate for Payer: Cash Price |
$426.40
|
|
|
.HIV RNA Qual LC
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
22305598
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Aetna of AZ Commercial |
$455.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$80.96
|
| Rate for Payer: Banner UC Health Medicare |
$80.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$344.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$80.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$80.96
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cigna of AZ Commercial |
$328.90
|
| Rate for Payer: Devoted Health Medicare |
$91.08
|
| Rate for Payer: Humana of AZ Medicare |
$80.96
|
| Rate for Payer: Seven Corners Travel Insurance |
$50.88
|
| Rate for Payer: Southwest Service Administrators UFCW |
$344.08
|
| Rate for Payer: TriWest Medicare |
$80.96
|
| Rate for Payer: United Healthcare Commercial |
$289.43
|
| Rate for Payer: United Healthcare Medicare |
$80.96
|
| Rate for Payer: Veterans Affairs TRICARE |
$80.15
|
|
|
.HIV RNA Qual LC
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
22305598
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$455.40 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Aetna of AZ Commercial |
$455.40
|
| Rate for Payer: Cash Price |
$404.80
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$79,112.57
|
|
|
Service Code
|
MSDRG 969
|
| Min. Negotiated Rate |
$79,112.57 |
| Max. Negotiated Rate |
$79,112.57 |
| Rate for Payer: Seven Corners Travel Insurance |
$79,112.57
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$34,086.14
|
|
|
Service Code
|
MSDRG 970
|
| Min. Negotiated Rate |
$34,086.14 |
| Max. Negotiated Rate |
$34,086.14 |
| Rate for Payer: Seven Corners Travel Insurance |
$34,086.14
|
|
|
Hiv With Major Hiv Related Condition
|
Facility
|
IP
|
$5,410.60
|
|
|
Service Code
|
APR-DRG 8922
|
| Hospital Charge Code |
APRDRG8923
|
| Min. Negotiated Rate |
$5,410.60 |
| Max. Negotiated Rate |
$5,410.60 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,410.60
|
| Rate for Payer: Mercy Care Medicaid |
$5,410.60
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,410.60
|
|
|
Hiv With Major Hiv Related Condition
|
Facility
|
IP
|
$13,882.81
|
|
|
Service Code
|
APR-DRG 8924
|
| Hospital Charge Code |
APRDRG8922
|
| Min. Negotiated Rate |
$13,882.81 |
| Max. Negotiated Rate |
$13,882.81 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,882.81
|
| Rate for Payer: Mercy Care Medicaid |
$13,882.81
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,882.81
|
|
|
Hiv With Major Hiv Related Condition
|
Facility
|
IP
|
$5,410.60
|
|
|
Service Code
|
APR-DRG 8922
|
| Hospital Charge Code |
APRDRG8924
|
| Min. Negotiated Rate |
$5,410.60 |
| Max. Negotiated Rate |
$5,410.60 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,410.60
|
| Rate for Payer: Mercy Care Medicaid |
$5,410.60
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,410.60
|
|
|
Hiv With Major Hiv Related Condition
|
Facility
|
IP
|
$8,022.61
|
|
|
Service Code
|
APR-DRG 8923
|
| Hospital Charge Code |
APRDRG8924
|
| Min. Negotiated Rate |
$8,022.61 |
| Max. Negotiated Rate |
$8,022.61 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,022.61
|
| Rate for Payer: Mercy Care Medicaid |
$8,022.61
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,022.61
|
|
|
Hiv With Major Hiv Related Condition
|
Facility
|
IP
|
$13,882.81
|
|
|
Service Code
|
APR-DRG 8924
|
| Hospital Charge Code |
APRDRG8923
|
| Min. Negotiated Rate |
$13,882.81 |
| Max. Negotiated Rate |
$13,882.81 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,882.81
|
| Rate for Payer: Mercy Care Medicaid |
$13,882.81
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,882.81
|
|
|
Hiv With Major Hiv Related Condition
|
Facility
|
IP
|
$8,022.61
|
|
|
Service Code
|
APR-DRG 8923
|
| Hospital Charge Code |
APRDRG8923
|
| Min. Negotiated Rate |
$8,022.61 |
| Max. Negotiated Rate |
$8,022.61 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,022.61
|
| Rate for Payer: Mercy Care Medicaid |
$8,022.61
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,022.61
|
|
|
Hiv With Major Hiv Related Condition
|
Facility
|
IP
|
$13,882.81
|
|
|
Service Code
|
APR-DRG 8924
|
| Hospital Charge Code |
APRDRG8921
|
| Min. Negotiated Rate |
$13,882.81 |
| Max. Negotiated Rate |
$13,882.81 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,882.81
|
| Rate for Payer: Mercy Care Medicaid |
$13,882.81
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,882.81
|
|
|
Hiv With Major Hiv Related Condition
|
Facility
|
IP
|
$4,266.62
|
|
|
Service Code
|
APR-DRG 8921
|
| Hospital Charge Code |
APRDRG8923
|
| Min. Negotiated Rate |
$4,266.62 |
| Max. Negotiated Rate |
$4,266.62 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,266.62
|
| Rate for Payer: Mercy Care Medicaid |
$4,266.62
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,266.62
|
|
|
Hiv With Major Hiv Related Condition
|
Facility
|
IP
|
$13,882.81
|
|
|
Service Code
|
APR-DRG 8924
|
| Hospital Charge Code |
APRDRG8924
|
| Min. Negotiated Rate |
$13,882.81 |
| Max. Negotiated Rate |
$13,882.81 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,882.81
|
| Rate for Payer: Mercy Care Medicaid |
$13,882.81
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,882.81
|
|
