|
AMS SKW RETRACTION KIT
|
Facility
|
IP
|
$1,111.00
|
|
| Hospital Charge Code |
22354148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$999.90 |
| Max. Negotiated Rate |
$999.90 |
| Rate for Payer: Aetna of AZ Commercial |
$999.90
|
| Rate for Payer: Cash Price |
$888.80
|
|
|
Amylase Level
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
631567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Aetna of AZ Commercial |
$235.80
|
| Rate for Payer: Aetna of AZ Commercial |
$170.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$30.24
|
| Rate for Payer: Arizona Complete Health Allwell |
$41.92
|
| Rate for Payer: Banner UC Health Medicare |
$30.24
|
| Rate for Payer: Banner UC Health Medicare |
$41.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$178.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$128.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$41.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$30.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$41.92
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of AZ Commercial |
$170.30
|
| Rate for Payer: Cigna of AZ Commercial |
$122.85
|
| Rate for Payer: Devoted Health Medicare |
$47.16
|
| Rate for Payer: Devoted Health Medicare |
$34.02
|
| Rate for Payer: Humana of AZ Medicare |
$30.24
|
| Rate for Payer: Humana of AZ Medicare |
$41.92
|
| Rate for Payer: Seven Corners Travel Insurance |
$9.40
|
| Rate for Payer: Seven Corners Travel Insurance |
$9.40
|
| Rate for Payer: Southwest Service Administrators UFCW |
$128.52
|
| Rate for Payer: Southwest Service Administrators UFCW |
$178.16
|
| Rate for Payer: TriWest Medicare |
$30.24
|
| Rate for Payer: TriWest Medicare |
$41.92
|
| Rate for Payer: United Healthcare Commercial |
$149.86
|
| Rate for Payer: United Healthcare Commercial |
$108.11
|
| Rate for Payer: United Healthcare Medicare |
$30.24
|
| Rate for Payer: United Healthcare Medicare |
$41.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$41.50
|
| Rate for Payer: Veterans Affairs TRICARE |
$29.94
|
|
|
Amylase Level
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
631567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna of AZ Commercial |
$170.10
|
| Rate for Payer: Aetna of AZ Commercial |
$235.80
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$209.60
|
|
|
ANA Ab Reflex Cascade LC
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
2269416
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of AZ Commercial |
$136.80
|
| Rate for Payer: Cash Price |
$121.60
|
|
|
ANA Ab Reflex Cascade LC
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
2269416
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.53 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of AZ Commercial |
$136.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$24.32
|
| Rate for Payer: Banner UC Health Medicare |
$24.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$103.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$24.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$24.32
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cigna of AZ Commercial |
$98.80
|
| Rate for Payer: Devoted Health Medicare |
$27.36
|
| Rate for Payer: Humana of AZ Medicare |
$24.32
|
| Rate for Payer: Seven Corners Travel Insurance |
$17.53
|
| Rate for Payer: Southwest Service Administrators UFCW |
$103.36
|
| Rate for Payer: TriWest Medicare |
$24.32
|
| Rate for Payer: United Healthcare Commercial |
$86.94
|
| Rate for Payer: United Healthcare Medicare |
$24.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$24.08
|
|
|
ANA Comprehensive Panel LC
|
Facility
|
OP
|
$1,422.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
1285648
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.92 |
| Max. Negotiated Rate |
$1,279.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,279.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$227.52
|
| Rate for Payer: Banner UC Health Medicare |
$227.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$966.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$227.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$227.52
|
| Rate for Payer: Cash Price |
$1,137.60
|
| Rate for Payer: Cash Price |
$1,137.60
|
| Rate for Payer: Cigna of AZ Commercial |
$924.30
|
| Rate for Payer: Devoted Health Medicare |
$255.96
|
| Rate for Payer: Humana of AZ Medicare |
$227.52
|
| Rate for Payer: Seven Corners Travel Insurance |
$19.92
|
| Rate for Payer: Southwest Service Administrators UFCW |
$966.96
|
| Rate for Payer: TriWest Medicare |
$227.52
|
| Rate for Payer: United Healthcare Commercial |
$813.38
|
| Rate for Payer: United Healthcare Medicare |
$227.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$225.24
|
|
|
ANA Comprehensive Panel LC
|
Facility
|
IP
|
$1,422.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
1285648
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1,279.80 |
| Max. Negotiated Rate |
$1,279.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,279.80
|
| Rate for Payer: Cash Price |
$1,137.60
|
|
|
ANA Comprehensive Plus Profile LC
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
28103154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of AZ Commercial |
$97.20
|
| Rate for Payer: Cash Price |
$86.40
|
|
|
ANA Comprehensive Plus Profile LC
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
22713595
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1,339.20 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,339.20
|
| Rate for Payer: Cash Price |
$1,190.40
|
|
|
ANA Comprehensive Plus Profile LC
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
28094013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of AZ Commercial |
$107.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$19.04
|
| Rate for Payer: Banner UC Health Medicare |
$19.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$80.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$19.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$19.04
|
| 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: Devoted Health Medicare |
$21.42
|
| Rate for Payer: Humana of AZ Medicare |
$19.04
|
| Rate for Payer: Seven Corners Travel Insurance |
$19.92
|
| Rate for Payer: Southwest Service Administrators UFCW |
$80.92
|
| Rate for Payer: TriWest Medicare |
$19.04
|
| Rate for Payer: United Healthcare Commercial |
$68.07
|
| Rate for Payer: United Healthcare Medicare |
$19.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$18.85
|
|
|
ANA Comprehensive Plus Profile LC
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
28094013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of AZ Commercial |
$107.10
|
| Rate for Payer: Cash Price |
$95.20
|
|
|
ANA Comprehensive Plus Profile LC
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
28103154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.11 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of AZ Commercial |
$97.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$17.28
|
| Rate for Payer: Banner UC Health Medicare |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$17.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$17.28
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of AZ Commercial |
$70.20
|
| Rate for Payer: Devoted Health Medicare |
$19.44
|
| Rate for Payer: Humana of AZ Medicare |
$17.28
|
| Rate for Payer: Seven Corners Travel Insurance |
$26.00
|
| Rate for Payer: Southwest Service Administrators UFCW |
$73.44
|
| Rate for Payer: TriWest Medicare |
$17.28
|
| Rate for Payer: United Healthcare Commercial |
$61.78
|
| Rate for Payer: United Healthcare Medicare |
$17.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$17.11
|
|
|
ANA Comprehensive Plus Profile LC
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
22713595
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,339.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$238.08
|
| Rate for Payer: Banner UC Health Medicare |
$238.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,011.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$238.08
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$238.08
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cigna of AZ Commercial |
$967.20
|
| Rate for Payer: Devoted Health Medicare |
$267.84
|
| Rate for Payer: Humana of AZ Medicare |
$238.08
|
| Rate for Payer: Seven Corners Travel Insurance |
$16.72
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,011.84
|
| Rate for Payer: TriWest Medicare |
$238.08
|
| Rate for Payer: United Healthcare Commercial |
$851.14
|
| Rate for Payer: United Healthcare Medicare |
$238.08
|
| Rate for Payer: Veterans Affairs TRICARE |
$235.70
|
|
|
Anaerobic Culture
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
1053537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$377.10 |
| Rate for Payer: Aetna of AZ Commercial |
$377.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$67.04
|
| Rate for Payer: Banner UC Health Medicare |
$67.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$284.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$67.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$67.04
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cigna of AZ Commercial |
$272.35
|
| Rate for Payer: Devoted Health Medicare |
$75.42
|
| Rate for Payer: Humana of AZ Medicare |
$67.04
|
| Rate for Payer: Seven Corners Travel Insurance |
$13.73
|
| Rate for Payer: Southwest Service Administrators UFCW |
$284.92
|
| Rate for Payer: TriWest Medicare |
$67.04
|
| Rate for Payer: United Healthcare Commercial |
$239.67
|
| Rate for Payer: United Healthcare Medicare |
$67.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$66.37
|
|
|
Anaerobic Culture
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
1053537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$377.10 |
| Max. Negotiated Rate |
$377.10 |
| Rate for Payer: Aetna of AZ Commercial |
$377.10
|
| Rate for Payer: Cash Price |
$335.20
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
|
IP
|
$16,939.48
|
|
|
Service Code
|
MSDRG 348
|
| Min. Negotiated Rate |
$16,939.48 |
| Max. Negotiated Rate |
$16,939.48 |
| Rate for Payer: Seven Corners Travel Insurance |
$16,939.48
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$29,668.65
|
|
|
Service Code
|
MSDRG 347
|
| Min. Negotiated Rate |
$29,668.65 |
| Max. Negotiated Rate |
$29,668.65 |
| Rate for Payer: Seven Corners Travel Insurance |
$29,668.65
|
|
|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$11,386.97
|
|
|
Service Code
|
MSDRG 349
|
| Min. Negotiated Rate |
$11,386.97 |
| Max. Negotiated Rate |
$11,386.97 |
| Rate for Payer: Seven Corners Travel Insurance |
$11,386.97
|
|
|
Anal Procedures
|
Facility
|
IP
|
$11,389.33
|
|
|
Service Code
|
APR-DRG 2263
|
| Hospital Charge Code |
APRDRG2263
|
| Min. Negotiated Rate |
$11,389.33 |
| Max. Negotiated Rate |
$11,389.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,389.33
|
| Rate for Payer: Mercy Care Medicaid |
$11,389.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,389.33
|
|
|
Anal Procedures
|
Facility
|
IP
|
$11,389.33
|
|
|
Service Code
|
APR-DRG 2263
|
| Hospital Charge Code |
APRDRG2262
|
| Min. Negotiated Rate |
$11,389.33 |
| Max. Negotiated Rate |
$11,389.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,389.33
|
| Rate for Payer: Mercy Care Medicaid |
$11,389.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,389.33
|
|
|
Anal Procedures
|
Facility
|
IP
|
$7,831.83
|
|
|
Service Code
|
APR-DRG 2262
|
| Hospital Charge Code |
APRDRG2263
|
| Min. Negotiated Rate |
$7,831.83 |
| Max. Negotiated Rate |
$7,831.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,831.83
|
| Rate for Payer: Mercy Care Medicaid |
$7,831.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,831.83
|
|
|
Anal Procedures
|
Facility
|
IP
|
$7,831.83
|
|
|
Service Code
|
APR-DRG 2262
|
| Hospital Charge Code |
APRDRG2262
|
| Min. Negotiated Rate |
$7,831.83 |
| Max. Negotiated Rate |
$7,831.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,831.83
|
| Rate for Payer: Mercy Care Medicaid |
$7,831.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,831.83
|
|
|
Anal Procedures
|
Facility
|
IP
|
$26,716.33
|
|
|
Service Code
|
APR-DRG 2264
|
| Hospital Charge Code |
APRDRG2263
|
| Min. Negotiated Rate |
$26,716.33 |
| Max. Negotiated Rate |
$26,716.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$26,716.33
|
| Rate for Payer: Mercy Care Medicaid |
$26,716.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$26,716.33
|
|
|
Anal Procedures
|
Facility
|
IP
|
$7,831.83
|
|
|
Service Code
|
APR-DRG 2262
|
| Hospital Charge Code |
APRDRG2261
|
| Min. Negotiated Rate |
$7,831.83 |
| Max. Negotiated Rate |
$7,831.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,831.83
|
| Rate for Payer: Mercy Care Medicaid |
$7,831.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,831.83
|
|
|
Anal Procedures
|
Facility
|
IP
|
$26,716.33
|
|
|
Service Code
|
APR-DRG 2264
|
| Hospital Charge Code |
APRDRG2262
|
| Min. Negotiated Rate |
$26,716.33 |
| Max. Negotiated Rate |
$26,716.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$26,716.33
|
| Rate for Payer: Mercy Care Medicaid |
$26,716.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$26,716.33
|
|
