|
Hiv With One Significant Hiv Condition Or Without Significant Related Conditions
|
Facility
|
IP
|
$5,054.99
|
|
|
Service Code
|
APR-DRG 8942
|
| Hospital Charge Code |
APRDRG8941
|
| Min. Negotiated Rate |
$5,054.99 |
| Max. Negotiated Rate |
$5,054.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,054.99
|
| Rate for Payer: Mercy Care Medicaid |
$5,054.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,054.99
|
|
|
Hiv With One Significant Hiv Condition Or Without Significant Related Conditions
|
Facility
|
IP
|
$6,836.55
|
|
|
Service Code
|
APR-DRG 8943
|
| Hospital Charge Code |
APRDRG8942
|
| Min. Negotiated Rate |
$6,836.55 |
| Max. Negotiated Rate |
$6,836.55 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,836.55
|
| Rate for Payer: Mercy Care Medicaid |
$6,836.55
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,836.55
|
|
|
Hiv With One Significant Hiv Condition Or Without Significant Related Conditions
|
Facility
|
IP
|
$3,979.74
|
|
|
Service Code
|
APR-DRG 8941
|
| Hospital Charge Code |
APRDRG8944
|
| Min. Negotiated Rate |
$3,979.74 |
| Max. Negotiated Rate |
$3,979.74 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,979.74
|
| Rate for Payer: Mercy Care Medicaid |
$3,979.74
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,979.74
|
|
|
Hiv With One Significant Hiv Condition Or Without Significant Related Conditions
|
Facility
|
IP
|
$6,836.55
|
|
|
Service Code
|
APR-DRG 8943
|
| Hospital Charge Code |
APRDRG8944
|
| Min. Negotiated Rate |
$6,836.55 |
| Max. Negotiated Rate |
$6,836.55 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,836.55
|
| Rate for Payer: Mercy Care Medicaid |
$6,836.55
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,836.55
|
|
|
Hiv With One Significant Hiv Condition Or Without Significant Related Conditions
|
Facility
|
IP
|
$6,836.55
|
|
|
Service Code
|
APR-DRG 8943
|
| Hospital Charge Code |
APRDRG8943
|
| Min. Negotiated Rate |
$6,836.55 |
| Max. Negotiated Rate |
$6,836.55 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,836.55
|
| Rate for Payer: Mercy Care Medicaid |
$6,836.55
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,836.55
|
|
|
Hiv With One Significant Hiv Condition Or Without Significant Related Conditions
|
Facility
|
IP
|
$5,054.99
|
|
|
Service Code
|
APR-DRG 8942
|
| Hospital Charge Code |
APRDRG8943
|
| Min. Negotiated Rate |
$5,054.99 |
| Max. Negotiated Rate |
$5,054.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,054.99
|
| Rate for Payer: Mercy Care Medicaid |
$5,054.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,054.99
|
|
|
Hiv With One Significant Hiv Condition Or Without Significant Related Conditions
|
Facility
|
IP
|
$10,390.54
|
|
|
Service Code
|
APR-DRG 8944
|
| Hospital Charge Code |
APRDRG8942
|
| Min. Negotiated Rate |
$10,390.54 |
| Max. Negotiated Rate |
$10,390.54 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,390.54
|
| Rate for Payer: Mercy Care Medicaid |
$10,390.54
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,390.54
|
|
|
Hiv With One Significant Hiv Condition Or Without Significant Related Conditions
|
Facility
|
IP
|
$5,054.99
|
|
|
Service Code
|
APR-DRG 8942
|
| Hospital Charge Code |
APRDRG8944
|
| Min. Negotiated Rate |
$5,054.99 |
| Max. Negotiated Rate |
$5,054.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,054.99
|
| Rate for Payer: Mercy Care Medicaid |
$5,054.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,054.99
|
|
|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$16,798.83
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$16,798.83 |
| Max. Negotiated Rate |
$16,798.83 |
| Rate for Payer: Seven Corners Travel Insurance |
$16,798.83
|
|
|
HLA B 27 Disease Association LC
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
1906894
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.42 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna of AZ Commercial |
$306.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$54.40
|
| Rate for Payer: Banner UC Health Medicare |
$54.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$231.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$54.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$54.40
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna of AZ Commercial |
$221.00
|
| Rate for Payer: Devoted Health Medicare |
$61.20
|
| Rate for Payer: Humana of AZ Medicare |
$54.40
|
| Rate for Payer: Seven Corners Travel Insurance |
$37.42
|
| Rate for Payer: Southwest Service Administrators UFCW |
$231.20
|
| Rate for Payer: TriWest Medicare |
$54.40
|
| Rate for Payer: United Healthcare Commercial |
$194.48
|
| Rate for Payer: United Healthcare Medicare |
$54.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$53.86
|
|
|
HLA B 27 Disease Association LC
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
1906894
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna of AZ Commercial |
$306.00
|
| Rate for Payer: Cash Price |
$272.00
|
|
|
HLA B5701 Test LC
|
Facility
|
OP
|
$2,217.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
22311194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$246.35 |
| Max. Negotiated Rate |
$1,995.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,995.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$354.72
|
| Rate for Payer: Banner UC Health Medicare |
$354.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,507.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$354.72
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$354.72
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,441.05
|
| Rate for Payer: Devoted Health Medicare |
$399.06
|
| Rate for Payer: Humana of AZ Medicare |
$354.72
|
| Rate for Payer: Seven Corners Travel Insurance |
$246.35
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,507.56
|
| Rate for Payer: TriWest Medicare |
$354.72
|
| Rate for Payer: United Healthcare Commercial |
$1,268.12
|
| Rate for Payer: United Healthcare Medicare |
$354.72
|
| Rate for Payer: Veterans Affairs TRICARE |
$351.17
|
|
|
HLA B5701 Test LC
|
Facility
|
IP
|
$2,217.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
22311194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1,995.30 |
| Max. Negotiated Rate |
$1,995.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,995.30
|
| Rate for Payer: Cash Price |
$1,773.60
|
|
|
HOLDER ENDO NEOFIT
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
22926451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna of AZ Commercial |
$91.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$16.32
|
| Rate for Payer: Banner UC Health Medicare |
$16.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$69.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$16.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$16.32
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna of AZ Commercial |
$71.40
|
| Rate for Payer: Devoted Health Medicare |
$18.36
|
| Rate for Payer: Humana of AZ Medicare |
$16.32
|
| Rate for Payer: Southwest Service Administrators UFCW |
$69.36
|
| Rate for Payer: TriWest Medicare |
$16.32
|
| Rate for Payer: United Healthcare Commercial |
$58.34
|
| Rate for Payer: United Healthcare Medicare |
$16.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$16.16
|
|
|
HOLDER ENDO NEOFIT
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
22926451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna of AZ Commercial |
$91.80
|
| Rate for Payer: Cash Price |
$81.60
|
|
|
Home Health Aide or certified nurse assistand providing care
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS S9122
|
| Hospital Charge Code |
27342350
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Cash Price |
$62.40
|
|
|
Home Health Aide or certified nurse assistand providing care
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS S9122
|
| Hospital Charge Code |
27342350
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$12.48
|
| Rate for Payer: Banner UC Health Medicare |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$53.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$12.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$12.48
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna of AZ Commercial |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$14.04
|
| Rate for Payer: Humana of AZ Medicare |
$12.48
|
| Rate for Payer: Southwest Service Administrators UFCW |
$53.04
|
| Rate for Payer: TriWest Medicare |
$12.48
|
| Rate for Payer: United Healthcare Commercial |
$44.62
|
| Rate for Payer: United Healthcare Medicare |
$12.48
|
| Rate for Payer: Veterans Affairs TRICARE |
$12.36
|
|
|
Home Visit Level 2 Established - 99348
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
631627
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$49.58 |
| Max. Negotiated Rate |
$281.70 |
| Rate for Payer: Aetna of AZ Commercial |
$281.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$50.08
|
| Rate for Payer: Banner UC Health Medicare |
$50.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$212.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$50.08
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$50.08
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cigna of AZ Commercial |
$219.10
|
| Rate for Payer: Devoted Health Medicare |
$56.34
|
| Rate for Payer: Humana of AZ Medicare |
$50.08
|
| Rate for Payer: Southwest Service Administrators UFCW |
$212.84
|
| Rate for Payer: TriWest Medicare |
$50.08
|
| Rate for Payer: United Healthcare Commercial |
$179.04
|
| Rate for Payer: United Healthcare Medicare |
$50.08
|
| Rate for Payer: Veterans Affairs TRICARE |
$49.58
|
|
|
Home Visit Level 2 Established - 99348
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
631627
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$281.70 |
| Max. Negotiated Rate |
$281.70 |
| Rate for Payer: Aetna of AZ Commercial |
$281.70
|
| Rate for Payer: Cash Price |
$250.40
|
|
|
Home Visit Level 3 Established - 99349
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
631629
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna of AZ Commercial |
$436.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$77.60
|
| Rate for Payer: Banner UC Health Medicare |
$77.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$329.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$77.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$77.60
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cigna of AZ Commercial |
$339.50
|
| Rate for Payer: Devoted Health Medicare |
$87.30
|
| Rate for Payer: Humana of AZ Medicare |
$77.60
|
| Rate for Payer: Southwest Service Administrators UFCW |
$329.80
|
| Rate for Payer: TriWest Medicare |
$77.60
|
| Rate for Payer: United Healthcare Commercial |
$277.42
|
| Rate for Payer: United Healthcare Medicare |
$77.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$76.82
|
|
|
Home Visit Level 3 Established - 99349
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
631629
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$436.50 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna of AZ Commercial |
$436.50
|
| Rate for Payer: Cash Price |
$388.00
|
|
|
Home Visit Level 4 Established - 99350
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
631631
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$669.60 |
| Rate for Payer: Aetna of AZ Commercial |
$669.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$119.04
|
| Rate for Payer: Banner UC Health Medicare |
$119.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$505.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$119.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$119.04
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cigna of AZ Commercial |
$520.80
|
| Rate for Payer: Devoted Health Medicare |
$133.92
|
| Rate for Payer: Humana of AZ Medicare |
$119.04
|
| Rate for Payer: Southwest Service Administrators UFCW |
$505.92
|
| Rate for Payer: TriWest Medicare |
$119.04
|
| Rate for Payer: United Healthcare Commercial |
$425.57
|
| Rate for Payer: United Healthcare Medicare |
$119.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$117.85
|
|
|
Home Visit Level 4 Established - 99350
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
631631
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$669.60 |
| Max. Negotiated Rate |
$669.60 |
| Rate for Payer: Aetna of AZ Commercial |
$669.60
|
| Rate for Payer: Cash Price |
$595.20
|
|
|
Homocyst(e)ine, Plasma LC
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
1905630
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$436.50 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna of AZ Commercial |
$436.50
|
| Rate for Payer: Cash Price |
$388.00
|
|
|
Homocyst(e)ine, Plasma LC
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
1905630
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.98 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna of AZ Commercial |
$436.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$77.60
|
| Rate for Payer: Banner UC Health Medicare |
$77.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$329.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$77.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$77.60
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cigna of AZ Commercial |
$315.25
|
| Rate for Payer: Devoted Health Medicare |
$87.30
|
| Rate for Payer: Humana of AZ Medicare |
$77.60
|
| Rate for Payer: Seven Corners Travel Insurance |
$25.98
|
| Rate for Payer: Southwest Service Administrators UFCW |
$329.80
|
| Rate for Payer: TriWest Medicare |
$77.60
|
| Rate for Payer: United Healthcare Commercial |
$277.42
|
| Rate for Payer: United Healthcare Medicare |
$77.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$76.82
|
|
