|
ANTI 68 KD
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
23298042
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna of AZ Commercial |
$367.20
|
| Rate for Payer: Bisbee Police All Plans |
$106.08
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Self Pay Self Pay |
$326.40
|
|
|
ANTI 68 KD
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
23298042
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna of AZ Commercial |
$367.20
|
| Rate for Payer: Aetna of AZ Medicare |
$114.24
|
| Rate for Payer: AHCCCS Medicaid |
$17.03
|
| Rate for Payer: Allwell Medicaid |
$17.03
|
| Rate for Payer: Allwell Medicare |
$61.20
|
| Rate for Payer: Amerigroup Medicare |
$61.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$152.39
|
| Rate for Payer: AZCH Complete Medicaid |
$17.03
|
| Rate for Payer: AZCH Complete Medicare |
$61.20
|
| Rate for Payer: Banner UC Health Medicaid |
$17.03
|
| Rate for Payer: Banner UC Health Medicare |
$61.20
|
| Rate for Payer: Bisbee Police All Plans |
$106.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$277.44
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna of AZ Commercial |
$265.20
|
| Rate for Payer: Copperpoint Commercial |
$100.98
|
| Rate for Payer: Health Net of AZ Commercial |
$244.80
|
| Rate for Payer: Health Net of AZ Medicare |
$114.24
|
| Rate for Payer: Humana of AZ Medicare |
$61.20
|
| Rate for Payer: Mercy Care Medicaid |
$17.03
|
| Rate for Payer: Self Pay Self Pay |
$326.40
|
| Rate for Payer: TriWest Medicare |
$61.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$237.86
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$73.44
|
|
|
ANTIBODY; ACTINOMYCES
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 86602
|
| Hospital Charge Code |
23298037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Aetna of AZ Medicare |
$21.84
|
| Rate for Payer: AHCCCS Medicaid |
$10.18
|
| Rate for Payer: Allwell Medicaid |
$10.18
|
| Rate for Payer: Allwell Medicare |
$11.70
|
| Rate for Payer: Amerigroup Medicare |
$11.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$29.13
|
| Rate for Payer: AZCH Complete Medicaid |
$10.18
|
| Rate for Payer: AZCH Complete Medicare |
$11.70
|
| Rate for Payer: Banner UC Health Medicaid |
$10.18
|
| Rate for Payer: Banner UC Health Medicare |
$11.70
|
| Rate for Payer: Bisbee Police All Plans |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$53.04
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna of AZ Commercial |
$50.70
|
| Rate for Payer: Copperpoint Commercial |
$19.30
|
| Rate for Payer: Health Net of AZ Commercial |
$46.80
|
| Rate for Payer: Health Net of AZ Medicare |
$21.84
|
| Rate for Payer: Humana of AZ Medicare |
$11.70
|
| Rate for Payer: Mercy Care Medicaid |
$10.18
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
| Rate for Payer: TriWest Medicare |
$11.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$45.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.04
|
|
|
ANTIBODY; ACTINOMYCES
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 86602
|
| Hospital Charge Code |
23298037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Bisbee Police All Plans |
$20.28
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
|
|
ANTIBODY; ASPERGILLUS
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
23298038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of AZ Commercial |
$104.40
|
| Rate for Payer: Bisbee Police All Plans |
$30.16
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Self Pay Self Pay |
$92.80
|
|
|
ANTIBODY; ASPERGILLUS
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
23298038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of AZ Commercial |
$104.40
|
| Rate for Payer: Aetna of AZ Medicare |
$32.48
|
| Rate for Payer: AHCCCS Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicare |
$17.40
|
| Rate for Payer: Amerigroup Medicare |
$17.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$43.33
|
| Rate for Payer: AZCH Complete Medicaid |
$15.05
|
| Rate for Payer: AZCH Complete Medicare |
$17.40
|
| Rate for Payer: Banner UC Health Medicaid |
$15.05
|
| Rate for Payer: Banner UC Health Medicare |
$17.40
|
| Rate for Payer: Bisbee Police All Plans |
$30.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$78.88
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cigna of AZ Commercial |
$75.40
|
| Rate for Payer: Copperpoint Commercial |
$28.71
|
| Rate for Payer: Health Net of AZ Commercial |
$69.60
|
| Rate for Payer: Health Net of AZ Medicare |
$32.48
|
| Rate for Payer: Humana of AZ Medicare |
$17.40
|
| Rate for Payer: Mercy Care Medicaid |
$15.05
|
| Rate for Payer: Self Pay Self Pay |
$92.80
|
| Rate for Payer: TriWest Medicare |
$17.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$67.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$20.88
|
|
|
Antibody Screen Tube
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
1137983
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna of AZ Commercial |
$113.40
|
| Rate for Payer: Aetna of AZ Medicare |
$35.28
|
| Rate for Payer: AHCCCS Medicaid |
$9.77
|
| Rate for Payer: Allwell Medicaid |
$9.77
|
| Rate for Payer: Allwell Medicare |
$18.90
|
| Rate for Payer: Amerigroup Medicare |
$18.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$47.06
|
| Rate for Payer: AZCH Complete Medicaid |
$9.77
|
| Rate for Payer: AZCH Complete Medicare |
$18.90
|
| Rate for Payer: Banner UC Health Medicaid |
$9.77
|
| Rate for Payer: Banner UC Health Medicare |
$18.90
|
| Rate for Payer: Bisbee Police All Plans |
$32.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$85.68
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna of AZ Commercial |
$81.90
|
| Rate for Payer: Copperpoint Commercial |
$31.18
|
| Rate for Payer: Health Net of AZ Commercial |
$75.60
|
| Rate for Payer: Health Net of AZ Medicare |
$35.28
|
| Rate for Payer: Humana of AZ Medicare |
$18.90
|
| Rate for Payer: Mercy Care Medicaid |
$9.77
|
| Rate for Payer: Self Pay Self Pay |
$100.80
|
| Rate for Payer: TriWest Medicare |
$18.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$73.46
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$22.68
|
|
|
Antibody Screen Tube
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
1137983
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna of AZ Commercial |
$113.40
|
| Rate for Payer: Bisbee Police All Plans |
$32.76
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Self Pay Self Pay |
$100.80
|
|
|
ANTICARD IGA
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22481460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna of AZ Commercial |
$376.20
|
| Rate for Payer: Bisbee Police All Plans |
$108.68
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Self Pay Self Pay |
$334.40
|
|
|
ANTICARD IGA
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22481460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna of AZ Commercial |
$376.20
|
| Rate for Payer: Aetna of AZ Medicare |
$117.04
|
| Rate for Payer: AHCCCS Medicaid |
$25.45
|
| Rate for Payer: Allwell Medicaid |
$25.45
|
| Rate for Payer: Allwell Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicare |
$62.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$156.12
|
| Rate for Payer: AZCH Complete Medicaid |
$25.45
|
| Rate for Payer: AZCH Complete Medicare |
$62.70
|
| Rate for Payer: Banner UC Health Medicaid |
$25.45
|
| Rate for Payer: Banner UC Health Medicare |
$62.70
|
| Rate for Payer: Bisbee Police All Plans |
$108.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$284.24
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cigna of AZ Commercial |
$271.70
|
| Rate for Payer: Copperpoint Commercial |
$103.46
|
| Rate for Payer: Health Net of AZ Commercial |
$250.80
|
| Rate for Payer: Health Net of AZ Medicare |
$117.04
|
| Rate for Payer: Humana of AZ Medicare |
$62.70
|
| Rate for Payer: Mercy Care Medicaid |
$25.45
|
| Rate for Payer: Self Pay Self Pay |
$334.40
|
| Rate for Payer: TriWest Medicare |
$62.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$243.69
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$75.24
|
|
|
ANTICARD IGG
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22481461
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna of AZ Commercial |
$376.20
|
| Rate for Payer: Aetna of AZ Medicare |
$117.04
|
| Rate for Payer: AHCCCS Medicaid |
$25.45
|
| Rate for Payer: Allwell Medicaid |
$25.45
|
| Rate for Payer: Allwell Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicare |
$62.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$156.12
|
| Rate for Payer: AZCH Complete Medicaid |
$25.45
|
| Rate for Payer: AZCH Complete Medicare |
$62.70
|
| Rate for Payer: Banner UC Health Medicaid |
$25.45
|
| Rate for Payer: Banner UC Health Medicare |
$62.70
|
| Rate for Payer: Bisbee Police All Plans |
$108.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$284.24
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cigna of AZ Commercial |
$271.70
|
| Rate for Payer: Copperpoint Commercial |
$103.46
|
| Rate for Payer: Health Net of AZ Commercial |
$250.80
|
| Rate for Payer: Health Net of AZ Medicare |
$117.04
|
| Rate for Payer: Humana of AZ Medicare |
$62.70
|
| Rate for Payer: Mercy Care Medicaid |
$25.45
|
| Rate for Payer: Self Pay Self Pay |
$334.40
|
| Rate for Payer: TriWest Medicare |
$62.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$243.69
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$75.24
|
|
|
ANTICARD IGG
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22481461
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna of AZ Commercial |
$376.20
|
| Rate for Payer: Bisbee Police All Plans |
$108.68
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Self Pay Self Pay |
$334.40
|
|
|
ANTICARD IGM
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22481462
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna of AZ Commercial |
$376.20
|
| Rate for Payer: Aetna of AZ Medicare |
$117.04
|
| Rate for Payer: AHCCCS Medicaid |
$25.45
|
| Rate for Payer: Allwell Medicaid |
$25.45
|
| Rate for Payer: Allwell Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicare |
$62.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$156.12
|
| Rate for Payer: AZCH Complete Medicaid |
$25.45
|
| Rate for Payer: AZCH Complete Medicare |
$62.70
|
| Rate for Payer: Banner UC Health Medicaid |
$25.45
|
| Rate for Payer: Banner UC Health Medicare |
$62.70
|
| Rate for Payer: Bisbee Police All Plans |
$108.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$284.24
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cigna of AZ Commercial |
$271.70
|
| Rate for Payer: Copperpoint Commercial |
$103.46
|
| Rate for Payer: Health Net of AZ Commercial |
$250.80
|
| Rate for Payer: Health Net of AZ Medicare |
$117.04
|
| Rate for Payer: Humana of AZ Medicare |
$62.70
|
| Rate for Payer: Mercy Care Medicaid |
$25.45
|
| Rate for Payer: Self Pay Self Pay |
$334.40
|
| Rate for Payer: TriWest Medicare |
$62.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$243.69
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$75.24
|
|
|
ANTICARD IGM
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22481462
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna of AZ Commercial |
$376.20
|
| Rate for Payer: Bisbee Police All Plans |
$108.68
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Self Pay Self Pay |
$334.40
|
|
|
Anticardiolip Ab, IgA/G/M, Qn LC
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
1905982
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna of AZ Commercial |
$376.20
|
| Rate for Payer: Aetna of AZ Medicare |
$117.04
|
| Rate for Payer: AHCCCS Medicaid |
$25.45
|
| Rate for Payer: Allwell Medicaid |
$25.45
|
| Rate for Payer: Allwell Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicare |
$62.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$156.12
|
| Rate for Payer: AZCH Complete Medicaid |
$25.45
|
| Rate for Payer: AZCH Complete Medicare |
$62.70
|
| Rate for Payer: Banner UC Health Medicaid |
$25.45
|
| Rate for Payer: Banner UC Health Medicare |
$62.70
|
| Rate for Payer: Bisbee Police All Plans |
$108.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$284.24
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cigna of AZ Commercial |
$271.70
|
| Rate for Payer: Copperpoint Commercial |
$103.46
|
| Rate for Payer: Health Net of AZ Commercial |
$250.80
|
| Rate for Payer: Health Net of AZ Medicare |
$117.04
|
| Rate for Payer: Humana of AZ Medicare |
$62.70
|
| Rate for Payer: Mercy Care Medicaid |
$25.45
|
| Rate for Payer: Self Pay Self Pay |
$334.40
|
| Rate for Payer: TriWest Medicare |
$62.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$243.69
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$75.24
|
|
|
Anticardiolip Ab, IgA/G/M, Qn LC
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
1905982
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna of AZ Commercial |
$376.20
|
| Rate for Payer: Bisbee Police All Plans |
$108.68
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Self Pay Self Pay |
$334.40
|
|
|
.Anti-Centromere B Abs LC
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22531164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of AZ Commercial |
$190.80
|
| Rate for Payer: Aetna of AZ Medicare |
$59.36
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicare |
$31.80
|
| Rate for Payer: Amerigroup Medicare |
$31.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$79.18
|
| Rate for Payer: AZCH Complete Medicaid |
$17.93
|
| Rate for Payer: AZCH Complete Medicare |
$31.80
|
| Rate for Payer: Banner UC Health Medicaid |
$17.93
|
| Rate for Payer: Banner UC Health Medicare |
$31.80
|
| Rate for Payer: Bisbee Police All Plans |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$144.16
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cigna of AZ Commercial |
$137.80
|
| Rate for Payer: Copperpoint Commercial |
$52.47
|
| Rate for Payer: Health Net of AZ Commercial |
$127.20
|
| Rate for Payer: Health Net of AZ Medicare |
$59.36
|
| Rate for Payer: Humana of AZ Medicare |
$31.80
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: Self Pay Self Pay |
$169.60
|
| Rate for Payer: TriWest Medicare |
$31.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$123.60
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.16
|
|
|
.Anti-Centromere B Abs LC
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22531164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.12 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of AZ Commercial |
$190.80
|
| Rate for Payer: Bisbee Police All Plans |
$55.12
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Self Pay Self Pay |
$169.60
|
|
|
Anti-Centromere B Antibodies LC
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
7328630
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of AZ Commercial |
$201.60
|
| Rate for Payer: Bisbee Police All Plans |
$58.24
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Self Pay Self Pay |
$179.20
|
|
|
Anti-Centromere B Antibodies LC
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
7328630
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of AZ Commercial |
$201.60
|
| Rate for Payer: Aetna of AZ Medicare |
$62.72
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicare |
$33.60
|
| Rate for Payer: Amerigroup Medicare |
$33.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$83.66
|
| Rate for Payer: AZCH Complete Medicaid |
$17.93
|
| Rate for Payer: AZCH Complete Medicare |
$33.60
|
| Rate for Payer: Banner UC Health Medicaid |
$17.93
|
| Rate for Payer: Banner UC Health Medicare |
$33.60
|
| Rate for Payer: Bisbee Police All Plans |
$58.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$152.32
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cigna of AZ Commercial |
$145.60
|
| Rate for Payer: Copperpoint Commercial |
$55.44
|
| Rate for Payer: Health Net of AZ Commercial |
$134.40
|
| Rate for Payer: Health Net of AZ Medicare |
$62.72
|
| Rate for Payer: Humana of AZ Medicare |
$33.60
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: Self Pay Self Pay |
$179.20
|
| Rate for Payer: TriWest Medicare |
$33.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$130.59
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$40.32
|
|
|
.Antichromatin Abs LC
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22531156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of AZ Commercial |
$107.10
|
| Rate for Payer: Aetna of AZ Medicare |
$33.32
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicaid |
$17.93
|
| Rate for Payer: Allwell Medicare |
$17.85
|
| Rate for Payer: Amerigroup Medicare |
$17.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.45
|
| Rate for Payer: AZCH Complete Medicaid |
$17.93
|
| Rate for Payer: AZCH Complete Medicare |
$17.85
|
| Rate for Payer: Banner UC Health Medicaid |
$17.93
|
| Rate for Payer: Banner UC Health Medicare |
$17.85
|
| Rate for Payer: Bisbee Police All Plans |
$30.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$80.92
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cigna of AZ Commercial |
$77.35
|
| Rate for Payer: Copperpoint Commercial |
$29.45
|
| Rate for Payer: Health Net of AZ Commercial |
$71.40
|
| Rate for Payer: Health Net of AZ Medicare |
$33.32
|
| Rate for Payer: Humana of AZ Medicare |
$17.85
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: Self Pay Self Pay |
$95.20
|
| Rate for Payer: TriWest Medicare |
$17.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.38
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.42
|
|
|
.Antichromatin Abs LC
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22531156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of AZ Commercial |
$107.10
|
| Rate for Payer: Bisbee Police All Plans |
$30.94
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Self Pay Self Pay |
$95.20
|
|
|
Anti-DNA(SS)IgG, Ab, Qn LC
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
22311175
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna of AZ Commercial |
$285.30
|
| Rate for Payer: Aetna of AZ Medicare |
$88.76
|
| Rate for Payer: AHCCCS Medicaid |
$12.11
|
| Rate for Payer: Allwell Medicaid |
$12.11
|
| Rate for Payer: Allwell Medicare |
$47.55
|
| Rate for Payer: Amerigroup Medicare |
$47.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$118.40
|
| Rate for Payer: AZCH Complete Medicaid |
$12.11
|
| Rate for Payer: AZCH Complete Medicare |
$47.55
|
| Rate for Payer: Banner UC Health Medicaid |
$12.11
|
| Rate for Payer: Banner UC Health Medicare |
$47.55
|
| Rate for Payer: Bisbee Police All Plans |
$82.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$215.56
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cigna of AZ Commercial |
$206.05
|
| Rate for Payer: Copperpoint Commercial |
$78.46
|
| Rate for Payer: Health Net of AZ Commercial |
$190.20
|
| Rate for Payer: Health Net of AZ Medicare |
$88.76
|
| Rate for Payer: Humana of AZ Medicare |
$47.55
|
| Rate for Payer: Mercy Care Medicaid |
$12.11
|
| Rate for Payer: Self Pay Self Pay |
$253.60
|
| Rate for Payer: TriWest Medicare |
$47.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$184.81
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$57.06
|
|
|
Anti-DNA(SS)IgG, Ab, Qn LC
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
22311175
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna of AZ Commercial |
$285.30
|
| Rate for Payer: Bisbee Police All Plans |
$82.42
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Self Pay Self Pay |
$253.60
|
|
|
.Anti-dsDNA Antibodies LC
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
3033504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of AZ Commercial |
$107.10
|
| Rate for Payer: Aetna of AZ Medicare |
$33.32
|
| Rate for Payer: AHCCCS Medicaid |
$13.74
|
| Rate for Payer: Allwell Medicaid |
$13.74
|
| Rate for Payer: Allwell Medicare |
$17.85
|
| Rate for Payer: Amerigroup Medicare |
$17.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$44.45
|
| Rate for Payer: AZCH Complete Medicaid |
$13.74
|
| Rate for Payer: AZCH Complete Medicare |
$17.85
|
| Rate for Payer: Banner UC Health Medicaid |
$13.74
|
| Rate for Payer: Banner UC Health Medicare |
$17.85
|
| Rate for Payer: Bisbee Police All Plans |
$30.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$80.92
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cigna of AZ Commercial |
$77.35
|
| Rate for Payer: Copperpoint Commercial |
$29.45
|
| Rate for Payer: Health Net of AZ Commercial |
$71.40
|
| Rate for Payer: Health Net of AZ Medicare |
$33.32
|
| Rate for Payer: Humana of AZ Medicare |
$17.85
|
| Rate for Payer: Mercy Care Medicaid |
$13.74
|
| Rate for Payer: Self Pay Self Pay |
$95.20
|
| Rate for Payer: TriWest Medicare |
$17.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$69.38
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$21.42
|
|
