|
Urethrovaginal Fistual closure
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT 57310
|
| Hospital Charge Code |
27267835
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$796.50 |
| Rate for Payer: Aetna of AZ Commercial |
$796.50
|
| Rate for Payer: Bisbee Police All Plans |
$230.10
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Self Pay Self Pay |
$708.00
|
|
|
Uric Acid
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
633858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of AZ Commercial |
$68.40
|
| Rate for Payer: Bisbee Police All Plans |
$19.76
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Self Pay Self Pay |
$60.80
|
|
|
Uric Acid
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
633858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of AZ Commercial |
$68.40
|
| Rate for Payer: Aetna of AZ Medicare |
$21.28
|
| Rate for Payer: Allwell Medicare |
$12.16
|
| Rate for Payer: Amerigroup Medicare |
$12.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$28.39
|
| Rate for Payer: AZCH Complete Medicare |
$12.16
|
| Rate for Payer: Banner UC Health Medicare |
$12.16
|
| Rate for Payer: Bisbee Police All Plans |
$19.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$51.68
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cigna of AZ Commercial |
$49.40
|
| Rate for Payer: Copperpoint Commercial |
$18.81
|
| Rate for Payer: Health Net of AZ Commercial |
$45.60
|
| Rate for Payer: Health Net of AZ Medicare |
$21.28
|
| Rate for Payer: Humana of AZ Medicare |
$12.16
|
| Rate for Payer: Self Pay Self Pay |
$60.80
|
| Rate for Payer: TriWest Medicare |
$12.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$44.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.68
|
|
|
Uric Acid, 24 hr Urine LC
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
1905864
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of AZ Commercial |
$54.90
|
| Rate for Payer: Aetna of AZ Medicare |
$17.08
|
| Rate for Payer: Allwell Medicare |
$9.76
|
| Rate for Payer: Amerigroup Medicare |
$9.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$22.78
|
| Rate for Payer: AZCH Complete Medicare |
$9.76
|
| Rate for Payer: Banner UC Health Medicare |
$9.76
|
| Rate for Payer: Bisbee Police All Plans |
$15.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$41.48
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cigna of AZ Commercial |
$39.65
|
| Rate for Payer: Copperpoint Commercial |
$15.10
|
| Rate for Payer: Health Net of AZ Commercial |
$36.60
|
| Rate for Payer: Health Net of AZ Medicare |
$17.08
|
| Rate for Payer: Humana of AZ Medicare |
$9.76
|
| Rate for Payer: Self Pay Self Pay |
$48.80
|
| Rate for Payer: TriWest Medicare |
$9.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$35.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.98
|
|
|
Uric Acid, 24 hr Urine LC
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
1905864
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of AZ Commercial |
$54.90
|
| Rate for Payer: Bisbee Police All Plans |
$15.86
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Self Pay Self Pay |
$48.80
|
|
|
.Uric Acid, Please Note LC
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
22311170
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Bisbee Police All Plans |
$21.84
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Self Pay Self Pay |
$67.20
|
|
|
.Uric Acid, Please Note LC
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
22311170
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Aetna of AZ Medicare |
$23.52
|
| Rate for Payer: Allwell Medicare |
$13.44
|
| Rate for Payer: Amerigroup Medicare |
$13.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$31.37
|
| Rate for Payer: AZCH Complete Medicare |
$13.44
|
| Rate for Payer: Banner UC Health Medicare |
$13.44
|
| Rate for Payer: Bisbee Police All Plans |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$57.12
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna of AZ Commercial |
$54.60
|
| Rate for Payer: Copperpoint Commercial |
$20.79
|
| Rate for Payer: Health Net of AZ Commercial |
$50.40
|
| Rate for Payer: Health Net of AZ Medicare |
$23.52
|
| Rate for Payer: Humana of AZ Medicare |
$13.44
|
| Rate for Payer: Self Pay Self Pay |
$67.20
|
| Rate for Payer: TriWest Medicare |
$13.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$48.97
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.12
|
|
|
Urinalysis Dipstick
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22141057
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Aetna of AZ Medicare |
$11.48
|
| Rate for Payer: Allwell Medicare |
$6.56
|
| Rate for Payer: Amerigroup Medicare |
$6.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.31
|
| Rate for Payer: AZCH Complete Medicare |
$6.56
|
| Rate for Payer: Banner UC Health Medicare |
$6.56
|
| Rate for Payer: Bisbee Police All Plans |
$10.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$27.88
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cigna of AZ Commercial |
$26.65
|
| Rate for Payer: Copperpoint Commercial |
$10.15
|
| Rate for Payer: Health Net of AZ Commercial |
$24.60
|
| Rate for Payer: Health Net of AZ Medicare |
$11.48
|
| Rate for Payer: Humana of AZ Medicare |
$6.56
|
| Rate for Payer: Self Pay Self Pay |
$32.80
|
| Rate for Payer: TriWest Medicare |
$6.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$23.90
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.38
|
|
|
Urinalysis Dipstick
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22141057
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Bisbee Police All Plans |
$10.66
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Self Pay Self Pay |
$32.80
|
|
|
URINALYSIS DIPSTICK
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22422558
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna of AZ Commercial |
$24.30
|
| Rate for Payer: Aetna of AZ Medicare |
$7.56
|
| Rate for Payer: Allwell Medicare |
$4.32
|
| Rate for Payer: Amerigroup Medicare |
$4.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$10.08
|
| Rate for Payer: AZCH Complete Medicare |
$4.32
|
| Rate for Payer: Banner UC Health Medicare |
$4.32
|
| Rate for Payer: Bisbee Police All Plans |
$7.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$18.36
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of AZ Commercial |
$17.55
|
| Rate for Payer: Copperpoint Commercial |
$6.68
|
| Rate for Payer: Health Net of AZ Commercial |
$16.20
|
| Rate for Payer: Health Net of AZ Medicare |
$7.56
|
| Rate for Payer: Humana of AZ Medicare |
$4.32
|
| Rate for Payer: Self Pay Self Pay |
$21.60
|
| Rate for Payer: TriWest Medicare |
$4.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$15.74
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.86
|
|
|
URINALYSIS DIPSTICK
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22422558
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna of AZ Commercial |
$24.30
|
| Rate for Payer: Bisbee Police All Plans |
$7.02
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Self Pay Self Pay |
$21.60
|
|
|
Urinalysis with Culture, if indicated Standard
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
22266196
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of AZ Commercial |
$68.40
|
| Rate for Payer: Bisbee Police All Plans |
$19.76
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Self Pay Self Pay |
$60.80
|
|
|
Urinalysis with Culture, if indicated Standard
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
22266196
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of AZ Commercial |
$68.40
|
| Rate for Payer: Aetna of AZ Medicare |
$21.28
|
| Rate for Payer: Allwell Medicare |
$12.16
|
| Rate for Payer: Amerigroup Medicare |
$12.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$28.39
|
| Rate for Payer: AZCH Complete Medicare |
$12.16
|
| Rate for Payer: Banner UC Health Medicare |
$12.16
|
| Rate for Payer: Bisbee Police All Plans |
$19.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$51.68
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cigna of AZ Commercial |
$49.40
|
| Rate for Payer: Copperpoint Commercial |
$18.81
|
| Rate for Payer: Health Net of AZ Commercial |
$45.60
|
| Rate for Payer: Health Net of AZ Medicare |
$21.28
|
| Rate for Payer: Humana of AZ Medicare |
$12.16
|
| Rate for Payer: Self Pay Self Pay |
$60.80
|
| Rate for Payer: TriWest Medicare |
$12.16
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$44.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.68
|
|
|
Urinalysis with Microscopic, if indicated Standard
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22323531
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of AZ Commercial |
$38.70
|
| Rate for Payer: Bisbee Police All Plans |
$11.18
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Self Pay Self Pay |
$34.40
|
|
|
Urinalysis with Microscopic, if indicated Standard
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22323531
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of AZ Commercial |
$38.70
|
| Rate for Payer: Aetna of AZ Medicare |
$12.04
|
| Rate for Payer: Allwell Medicare |
$6.88
|
| Rate for Payer: Amerigroup Medicare |
$6.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$16.06
|
| Rate for Payer: AZCH Complete Medicare |
$6.88
|
| Rate for Payer: Banner UC Health Medicare |
$6.88
|
| Rate for Payer: Bisbee Police All Plans |
$11.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$29.24
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cigna of AZ Commercial |
$27.95
|
| Rate for Payer: Copperpoint Commercial |
$10.64
|
| Rate for Payer: Health Net of AZ Commercial |
$25.80
|
| Rate for Payer: Health Net of AZ Medicare |
$12.04
|
| Rate for Payer: Humana of AZ Medicare |
$6.88
|
| Rate for Payer: Self Pay Self Pay |
$34.40
|
| Rate for Payer: TriWest Medicare |
$6.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$25.07
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.74
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$3,523.83
|
|
|
Service Code
|
APR-DRG 4651
|
| Hospital Charge Code |
APRDRG4652
|
| Min. Negotiated Rate |
$3,523.83 |
| Max. Negotiated Rate |
$3,523.83 |
| Rate for Payer: AHCCCS Medicaid |
$3,523.83
|
| Rate for Payer: Allwell Medicaid |
$3,523.83
|
| Rate for Payer: AZCH Complete Medicaid |
$3,523.83
|
| Rate for Payer: Banner UC Health Medicaid |
$3,523.83
|
| Rate for Payer: Mercy Care Medicaid |
$3,523.83
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$3,523.83
|
|
|
Service Code
|
APR-DRG 4651
|
| Hospital Charge Code |
APRDRG4651
|
| Min. Negotiated Rate |
$3,523.83 |
| Max. Negotiated Rate |
$3,523.83 |
| Rate for Payer: AHCCCS Medicaid |
$3,523.83
|
| Rate for Payer: Allwell Medicaid |
$3,523.83
|
| Rate for Payer: AZCH Complete Medicaid |
$3,523.83
|
| Rate for Payer: Banner UC Health Medicaid |
$3,523.83
|
| Rate for Payer: Mercy Care Medicaid |
$3,523.83
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$6,990.85
|
|
|
Service Code
|
APR-DRG 4653
|
| Hospital Charge Code |
APRDRG4654
|
| Min. Negotiated Rate |
$6,990.85 |
| Max. Negotiated Rate |
$6,990.85 |
| Rate for Payer: AHCCCS Medicaid |
$6,990.85
|
| Rate for Payer: Allwell Medicaid |
$6,990.85
|
| Rate for Payer: AZCH Complete Medicaid |
$6,990.85
|
| Rate for Payer: Banner UC Health Medicaid |
$6,990.85
|
| Rate for Payer: Mercy Care Medicaid |
$6,990.85
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$4,278.54
|
|
|
Service Code
|
APR-DRG 4652
|
| Hospital Charge Code |
APRDRG4651
|
| Min. Negotiated Rate |
$4,278.54 |
| Max. Negotiated Rate |
$4,278.54 |
| Rate for Payer: AHCCCS Medicaid |
$4,278.54
|
| Rate for Payer: Allwell Medicaid |
$4,278.54
|
| Rate for Payer: AZCH Complete Medicaid |
$4,278.54
|
| Rate for Payer: Banner UC Health Medicaid |
$4,278.54
|
| Rate for Payer: Mercy Care Medicaid |
$4,278.54
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$3,523.83
|
|
|
Service Code
|
APR-DRG 4651
|
| Hospital Charge Code |
APRDRG4654
|
| Min. Negotiated Rate |
$3,523.83 |
| Max. Negotiated Rate |
$3,523.83 |
| Rate for Payer: AHCCCS Medicaid |
$3,523.83
|
| Rate for Payer: Allwell Medicaid |
$3,523.83
|
| Rate for Payer: AZCH Complete Medicaid |
$3,523.83
|
| Rate for Payer: Banner UC Health Medicaid |
$3,523.83
|
| Rate for Payer: Mercy Care Medicaid |
$3,523.83
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$6,990.85
|
|
|
Service Code
|
APR-DRG 4653
|
| Hospital Charge Code |
APRDRG4651
|
| Min. Negotiated Rate |
$6,990.85 |
| Max. Negotiated Rate |
$6,990.85 |
| Rate for Payer: AHCCCS Medicaid |
$6,990.85
|
| Rate for Payer: Allwell Medicaid |
$6,990.85
|
| Rate for Payer: AZCH Complete Medicaid |
$6,990.85
|
| Rate for Payer: Banner UC Health Medicaid |
$6,990.85
|
| Rate for Payer: Mercy Care Medicaid |
$6,990.85
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$12,378.31
|
|
|
Service Code
|
APR-DRG 4654
|
| Hospital Charge Code |
APRDRG4653
|
| Min. Negotiated Rate |
$12,378.31 |
| Max. Negotiated Rate |
$12,378.31 |
| Rate for Payer: AHCCCS Medicaid |
$12,378.31
|
| Rate for Payer: Allwell Medicaid |
$12,378.31
|
| Rate for Payer: AZCH Complete Medicaid |
$12,378.31
|
| Rate for Payer: Banner UC Health Medicaid |
$12,378.31
|
| Rate for Payer: Mercy Care Medicaid |
$12,378.31
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$12,378.31
|
|
|
Service Code
|
APR-DRG 4654
|
| Hospital Charge Code |
APRDRG4654
|
| Min. Negotiated Rate |
$12,378.31 |
| Max. Negotiated Rate |
$12,378.31 |
| Rate for Payer: AHCCCS Medicaid |
$12,378.31
|
| Rate for Payer: Allwell Medicaid |
$12,378.31
|
| Rate for Payer: AZCH Complete Medicaid |
$12,378.31
|
| Rate for Payer: Banner UC Health Medicaid |
$12,378.31
|
| Rate for Payer: Mercy Care Medicaid |
$12,378.31
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$6,990.85
|
|
|
Service Code
|
APR-DRG 4653
|
| Hospital Charge Code |
APRDRG4652
|
| Min. Negotiated Rate |
$6,990.85 |
| Max. Negotiated Rate |
$6,990.85 |
| Rate for Payer: AHCCCS Medicaid |
$6,990.85
|
| Rate for Payer: Allwell Medicaid |
$6,990.85
|
| Rate for Payer: AZCH Complete Medicaid |
$6,990.85
|
| Rate for Payer: Banner UC Health Medicaid |
$6,990.85
|
| Rate for Payer: Mercy Care Medicaid |
$6,990.85
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$12,378.31
|
|
|
Service Code
|
APR-DRG 4654
|
| Hospital Charge Code |
APRDRG4651
|
| Min. Negotiated Rate |
$12,378.31 |
| Max. Negotiated Rate |
$12,378.31 |
| Rate for Payer: AHCCCS Medicaid |
$12,378.31
|
| Rate for Payer: Allwell Medicaid |
$12,378.31
|
| Rate for Payer: AZCH Complete Medicaid |
$12,378.31
|
| Rate for Payer: Banner UC Health Medicaid |
$12,378.31
|
| Rate for Payer: Mercy Care Medicaid |
$12,378.31
|
|
