|
.Uric Acid, Please Note LC
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
22311170
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$13.44
|
| Rate for Payer: Banner UC Health Medicare |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$13.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$13.44
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna of AZ Commercial |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$15.12
|
| Rate for Payer: Humana of AZ Medicare |
$13.44
|
| Rate for Payer: Seven Corners Travel Insurance |
$6.55
|
| Rate for Payer: Southwest Service Administrators UFCW |
$57.12
|
| Rate for Payer: TriWest Medicare |
$13.44
|
| Rate for Payer: United Healthcare Commercial |
$48.05
|
| Rate for Payer: United Healthcare Medicare |
$13.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.31
|
|
|
.Uric Acid, Please Note LC
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
22311170
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of AZ Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$67.20
|
|
|
Urinalysis Dipstick
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22141057
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Cash Price |
$32.80
|
|
|
Urinalysis Dipstick
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22141057
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of AZ Commercial |
$36.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$6.56
|
| Rate for Payer: Banner UC Health Medicare |
$6.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$27.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$6.56
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$6.56
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cigna of AZ Commercial |
$26.65
|
| Rate for Payer: Devoted Health Medicare |
$7.38
|
| Rate for Payer: Humana of AZ Medicare |
$6.56
|
| Rate for Payer: Seven Corners Travel Insurance |
$5.05
|
| Rate for Payer: Southwest Service Administrators UFCW |
$27.88
|
| Rate for Payer: TriWest Medicare |
$6.56
|
| Rate for Payer: United Healthcare Commercial |
$23.45
|
| Rate for Payer: United Healthcare Medicare |
$6.56
|
| Rate for Payer: Veterans Affairs TRICARE |
$6.49
|
|
|
URINALYSIS DIPSTICK
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22422558
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna of AZ Commercial |
$24.30
|
| Rate for Payer: Cash Price |
$21.60
|
|
|
URINALYSIS DIPSTICK
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
22422558
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna of AZ Commercial |
$24.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$4.32
|
| Rate for Payer: Banner UC Health Medicare |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$4.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$4.32
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of AZ Commercial |
$17.55
|
| Rate for Payer: Devoted Health Medicare |
$4.86
|
| Rate for Payer: Humana of AZ Medicare |
$4.32
|
| Rate for Payer: Seven Corners Travel Insurance |
$5.05
|
| Rate for Payer: Southwest Service Administrators UFCW |
$18.36
|
| Rate for Payer: TriWest Medicare |
$4.32
|
| Rate for Payer: United Healthcare Commercial |
$15.44
|
| Rate for Payer: United Healthcare Medicare |
$4.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$4.28
|
|
|
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 |
$4.60 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of AZ Commercial |
$68.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$12.16
|
| Rate for Payer: Banner UC Health Medicare |
$12.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$51.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$12.16
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$12.16
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cigna of AZ Commercial |
$49.40
|
| Rate for Payer: Devoted Health Medicare |
$13.68
|
| Rate for Payer: Humana of AZ Medicare |
$12.16
|
| Rate for Payer: Seven Corners Travel Insurance |
$4.60
|
| Rate for Payer: Southwest Service Administrators UFCW |
$51.68
|
| Rate for Payer: TriWest Medicare |
$12.16
|
| Rate for Payer: United Healthcare Commercial |
$43.47
|
| Rate for Payer: United Healthcare Medicare |
$12.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$12.04
|
|
|
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 |
$68.40 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of AZ Commercial |
$68.40
|
| Rate for Payer: Cash Price |
$60.80
|
|
|
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 |
$5.05 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of AZ Commercial |
$38.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$6.88
|
| Rate for Payer: Banner UC Health Medicare |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$6.88
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$6.88
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cigna of AZ Commercial |
$27.95
|
| Rate for Payer: Devoted Health Medicare |
$7.74
|
| Rate for Payer: Humana of AZ Medicare |
$6.88
|
| Rate for Payer: Seven Corners Travel Insurance |
$5.05
|
| Rate for Payer: Southwest Service Administrators UFCW |
$29.24
|
| Rate for Payer: TriWest Medicare |
$6.88
|
| Rate for Payer: United Healthcare Commercial |
$24.60
|
| Rate for Payer: United Healthcare Medicare |
$6.88
|
| Rate for Payer: Veterans Affairs TRICARE |
$6.81
|
|
|
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 |
$38.70 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of AZ Commercial |
$38.70
|
| Rate for Payer: Cash Price |
$34.40
|
|
|
Urinary Leg Bag Vinyl W/wo Tub
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS A4358
|
| Hospital Charge Code |
1902147
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of AZ Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$19.20
|
|
|
Urinary Leg Bag Vinyl W/wo Tub
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS A4358
|
| Hospital Charge Code |
1902147
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of AZ Commercial |
$21.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$3.84
|
| Rate for Payer: Banner UC Health Medicare |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$16.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$3.84
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$3.84
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna of AZ Commercial |
$16.80
|
| Rate for Payer: Devoted Health Medicare |
$4.32
|
| Rate for Payer: Humana of AZ Medicare |
$3.84
|
| Rate for Payer: Southwest Service Administrators UFCW |
$16.32
|
| Rate for Payer: TriWest Medicare |
$3.84
|
| Rate for Payer: United Healthcare Commercial |
$13.73
|
| Rate for Payer: United Healthcare Medicare |
$3.84
|
| Rate for Payer: Veterans Affairs TRICARE |
$3.80
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$4,278.54
|
|
|
Service Code
|
APR-DRG 4652
|
| Hospital Charge Code |
APRDRG4652
|
| Min. Negotiated Rate |
$4,278.54 |
| Max. Negotiated Rate |
$4,278.54 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,278.54
|
| Rate for Payer: Mercy Care Medicaid |
$4,278.54
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$3,523.83
|
| Rate for Payer: Mercy Care Medicaid |
$3,523.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,523.83
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$12,378.31
|
| Rate for Payer: Mercy Care Medicaid |
$12,378.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,378.31
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$4,278.54
|
|
|
Service Code
|
APR-DRG 4652
|
| Hospital Charge Code |
APRDRG4653
|
| Min. Negotiated Rate |
$4,278.54 |
| Max. Negotiated Rate |
$4,278.54 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,278.54
|
| Rate for Payer: Mercy Care Medicaid |
$4,278.54
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,278.54
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$3,523.83
|
| Rate for Payer: Mercy Care Medicaid |
$3,523.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,523.83
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$6,990.85
|
| Rate for Payer: Mercy Care Medicaid |
$6,990.85
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,990.85
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$6,990.85
|
|
|
Service Code
|
APR-DRG 4653
|
| Hospital Charge Code |
APRDRG4653
|
| Min. Negotiated Rate |
$6,990.85 |
| Max. Negotiated Rate |
$6,990.85 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,990.85
|
| Rate for Payer: Mercy Care Medicaid |
$6,990.85
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,990.85
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$12,378.31
|
| Rate for Payer: Mercy Care Medicaid |
$12,378.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,378.31
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$3,523.83
|
|
|
Service Code
|
APR-DRG 4651
|
| Hospital Charge Code |
APRDRG4653
|
| Min. Negotiated Rate |
$3,523.83 |
| Max. Negotiated Rate |
$3,523.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,523.83
|
| Rate for Payer: Mercy Care Medicaid |
$3,523.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$6,990.85
|
| Rate for Payer: Mercy Care Medicaid |
$6,990.85
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$4,278.54
|
| Rate for Payer: Mercy Care Medicaid |
$4,278.54
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,278.54
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$6,990.85
|
| Rate for Payer: Mercy Care Medicaid |
$6,990.85
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,990.85
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
IP
|
$4,278.54
|
|
|
Service Code
|
APR-DRG 4652
|
| Hospital Charge Code |
APRDRG4654
|
| Min. Negotiated Rate |
$4,278.54 |
| Max. Negotiated Rate |
$4,278.54 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,278.54
|
| Rate for Payer: Mercy Care Medicaid |
$4,278.54
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,278.54
|
|
