|
calcium gluconate 1 gm/ 10 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
105914248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Aetna of AZ Commercial |
$0.69
|
| Rate for Payer: Bisbee Police All Plans |
$0.20
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Self Pay Self Pay |
$0.62
|
|
|
Calcium, Ionized, Serum LC
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
1285782
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna of AZ Commercial |
$154.80
|
| Rate for Payer: Aetna of AZ Medicare |
$48.16
|
| Rate for Payer: AHCCCS Medicaid |
$13.68
|
| Rate for Payer: Allwell Medicaid |
$13.68
|
| Rate for Payer: Allwell Medicare |
$25.80
|
| Rate for Payer: Amerigroup Medicare |
$25.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$64.24
|
| Rate for Payer: AZCH Complete Medicaid |
$13.68
|
| Rate for Payer: AZCH Complete Medicare |
$25.80
|
| Rate for Payer: Banner UC Health Medicaid |
$13.68
|
| Rate for Payer: Banner UC Health Medicare |
$25.80
|
| Rate for Payer: Bisbee Police All Plans |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$116.96
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cigna of AZ Commercial |
$111.80
|
| Rate for Payer: Copperpoint Commercial |
$42.57
|
| Rate for Payer: Health Net of AZ Commercial |
$103.20
|
| Rate for Payer: Health Net of AZ Medicare |
$48.16
|
| Rate for Payer: Humana of AZ Medicare |
$25.80
|
| Rate for Payer: Mercy Care Medicaid |
$13.68
|
| Rate for Payer: Self Pay Self Pay |
$137.60
|
| Rate for Payer: TriWest Medicare |
$25.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$100.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.96
|
|
|
Calcium, Ionized, Serum LC
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
1285782
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna of AZ Commercial |
$154.80
|
| Rate for Payer: Bisbee Police All Plans |
$44.72
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Self Pay Self Pay |
$137.60
|
|
|
Calcium Level Total
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
633690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.16 |
| 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 |
$5.16
|
| Rate for Payer: Allwell Medicaid |
$5.16
|
| 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 |
$5.16
|
| Rate for Payer: AZCH Complete Medicare |
$11.70
|
| Rate for Payer: Banner UC Health Medicaid |
$5.16
|
| 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 |
$5.16
|
| 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
|
|
|
Calcium Level Total
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
633690
|
|
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
|
|
|
CALCUCATCH
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
22355206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of AZ Commercial |
$16.20
|
| Rate for Payer: Bisbee Police All Plans |
$4.68
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Self Pay Self Pay |
$14.40
|
|
|
CALCUCATCH
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
22355206
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of AZ Commercial |
$16.20
|
| Rate for Payer: Aetna of AZ Medicare |
$5.04
|
| Rate for Payer: Allwell Medicare |
$2.70
|
| Rate for Payer: Amerigroup Medicare |
$2.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$6.72
|
| Rate for Payer: AZCH Complete Medicare |
$2.70
|
| Rate for Payer: Banner UC Health Medicare |
$2.70
|
| Rate for Payer: Bisbee Police All Plans |
$4.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$12.24
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of AZ Commercial |
$12.60
|
| Rate for Payer: Copperpoint Commercial |
$4.46
|
| Rate for Payer: Health Net of AZ Commercial |
$10.80
|
| Rate for Payer: Health Net of AZ Medicare |
$5.04
|
| Rate for Payer: Humana of AZ Medicare |
$2.70
|
| Rate for Payer: Self Pay Self Pay |
$14.40
|
| Rate for Payer: TriWest Medicare |
$2.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$10.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.24
|
|
|
CALCULI, URIN
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
22481465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of AZ Commercial |
$136.80
|
| Rate for Payer: Bisbee Police All Plans |
$39.52
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Self Pay Self Pay |
$121.60
|
|
|
CALCULI, URIN
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
22481465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of AZ Commercial |
$136.80
|
| Rate for Payer: Aetna of AZ Medicare |
$42.56
|
| Rate for Payer: AHCCCS Medicaid |
$6.03
|
| Rate for Payer: Allwell Medicaid |
$6.03
|
| Rate for Payer: Allwell Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicare |
$22.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$56.77
|
| Rate for Payer: AZCH Complete Medicaid |
$6.03
|
| Rate for Payer: AZCH Complete Medicare |
$22.80
|
| Rate for Payer: Banner UC Health Medicaid |
$6.03
|
| Rate for Payer: Banner UC Health Medicare |
$22.80
|
| Rate for Payer: Bisbee Police All Plans |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$103.36
|
| 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: Copperpoint Commercial |
$37.62
|
| Rate for Payer: Health Net of AZ Commercial |
$91.20
|
| Rate for Payer: Health Net of AZ Medicare |
$42.56
|
| Rate for Payer: Humana of AZ Medicare |
$22.80
|
| Rate for Payer: Mercy Care Medicaid |
$6.03
|
| Rate for Payer: Self Pay Self Pay |
$121.60
|
| Rate for Payer: TriWest Medicare |
$22.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$88.62
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$27.36
|
|
|
Calculi, Urinary LC
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
2029217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of AZ Commercial |
$130.50
|
| Rate for Payer: Aetna of AZ Medicare |
$40.60
|
| Rate for Payer: AHCCCS Medicaid |
$6.03
|
| Rate for Payer: Allwell Medicaid |
$6.03
|
| Rate for Payer: Allwell Medicare |
$21.75
|
| Rate for Payer: Amerigroup Medicare |
$21.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$54.16
|
| Rate for Payer: AZCH Complete Medicaid |
$6.03
|
| Rate for Payer: AZCH Complete Medicare |
$21.75
|
| Rate for Payer: Banner UC Health Medicaid |
$6.03
|
| Rate for Payer: Banner UC Health Medicare |
$21.75
|
| Rate for Payer: Bisbee Police All Plans |
$37.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna of AZ Commercial |
$94.25
|
| Rate for Payer: Copperpoint Commercial |
$35.89
|
| Rate for Payer: Health Net of AZ Commercial |
$87.00
|
| Rate for Payer: Health Net of AZ Medicare |
$40.60
|
| Rate for Payer: Humana of AZ Medicare |
$21.75
|
| Rate for Payer: Mercy Care Medicaid |
$6.03
|
| Rate for Payer: Self Pay Self Pay |
$116.00
|
| Rate for Payer: TriWest Medicare |
$21.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$84.54
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.10
|
|
|
Calculi, Urinary LC
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
2029217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of AZ Commercial |
$130.50
|
| Rate for Payer: Bisbee Police All Plans |
$37.70
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Self Pay Self Pay |
$116.00
|
|
|
CALMOSEPTINE 2.50Z
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
23288844
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of AZ Commercial |
$27.00
|
| Rate for Payer: Bisbee Police All Plans |
$7.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Self Pay Self Pay |
$24.00
|
|
|
CALMOSEPTINE 2.50Z
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
23288844
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of AZ Commercial |
$27.00
|
| Rate for Payer: Aetna of AZ Medicare |
$8.40
|
| Rate for Payer: Allwell Medicare |
$4.50
|
| Rate for Payer: Amerigroup Medicare |
$4.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$11.20
|
| Rate for Payer: AZCH Complete Medicare |
$4.50
|
| Rate for Payer: Banner UC Health Medicare |
$4.50
|
| Rate for Payer: Bisbee Police All Plans |
$7.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$20.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna of AZ Commercial |
$21.00
|
| Rate for Payer: Copperpoint Commercial |
$7.42
|
| Rate for Payer: Health Net of AZ Commercial |
$18.00
|
| Rate for Payer: Health Net of AZ Medicare |
$8.40
|
| Rate for Payer: Humana of AZ Medicare |
$4.50
|
| Rate for Payer: Self Pay Self Pay |
$24.00
|
| Rate for Payer: TriWest Medicare |
$4.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$17.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.40
|
|
|
Calprotectin Fecal LC
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
6780842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Aetna of AZ Commercial |
$336.60
|
| Rate for Payer: Bisbee Police All Plans |
$97.24
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Self Pay Self Pay |
$299.20
|
|
|
Calprotectin Fecal LC
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
6780842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Aetna of AZ Commercial |
$336.60
|
| Rate for Payer: Aetna of AZ Medicare |
$104.72
|
| Rate for Payer: AHCCCS Medicaid |
$19.63
|
| Rate for Payer: Allwell Medicaid |
$19.63
|
| Rate for Payer: Allwell Medicare |
$56.10
|
| Rate for Payer: Amerigroup Medicare |
$56.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$139.69
|
| Rate for Payer: AZCH Complete Medicaid |
$19.63
|
| Rate for Payer: AZCH Complete Medicare |
$56.10
|
| Rate for Payer: Banner UC Health Medicaid |
$19.63
|
| Rate for Payer: Banner UC Health Medicare |
$56.10
|
| Rate for Payer: Bisbee Police All Plans |
$97.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$254.32
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cigna of AZ Commercial |
$243.10
|
| Rate for Payer: Copperpoint Commercial |
$92.56
|
| Rate for Payer: Health Net of AZ Commercial |
$224.40
|
| Rate for Payer: Health Net of AZ Medicare |
$104.72
|
| Rate for Payer: Humana of AZ Medicare |
$56.10
|
| Rate for Payer: Mercy Care Medicaid |
$19.63
|
| Rate for Payer: Self Pay Self Pay |
$299.20
|
| Rate for Payer: TriWest Medicare |
$56.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$218.04
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$67.32
|
|
|
CALR Mutation Analysis LC
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
22311181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Aetna of AZ Commercial |
$664.20
|
| Rate for Payer: Aetna of AZ Medicare |
$206.64
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$110.70
|
| Rate for Payer: Amerigroup Medicare |
$110.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$275.64
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$110.70
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$110.70
|
| Rate for Payer: Bisbee Police All Plans |
$191.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$501.84
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna of AZ Commercial |
$479.70
|
| Rate for Payer: Copperpoint Commercial |
$182.66
|
| Rate for Payer: Health Net of AZ Commercial |
$442.80
|
| Rate for Payer: Health Net of AZ Medicare |
$206.64
|
| Rate for Payer: Humana of AZ Medicare |
$110.70
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$590.40
|
| Rate for Payer: TriWest Medicare |
$110.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$430.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$132.84
|
|
|
CALR Mutation Analysis LC
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
22311181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$191.88 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Aetna of AZ Commercial |
$664.20
|
| Rate for Payer: Bisbee Police All Plans |
$191.88
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Self Pay Self Pay |
$590.40
|
|
|
CAMPYLOBACTER AG
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
22422554
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of AZ Commercial |
$178.20
|
| Rate for Payer: Bisbee Police All Plans |
$51.48
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Self Pay Self Pay |
$158.40
|
|
|
CAMPYLOBACTER AG
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
22422554
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of AZ Commercial |
$178.20
|
| Rate for Payer: Aetna of AZ Medicare |
$55.44
|
| Rate for Payer: AHCCCS Medicaid |
$16.07
|
| Rate for Payer: Allwell Medicaid |
$16.07
|
| Rate for Payer: Allwell Medicare |
$29.70
|
| Rate for Payer: Amerigroup Medicare |
$29.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$73.95
|
| Rate for Payer: AZCH Complete Medicaid |
$16.07
|
| Rate for Payer: AZCH Complete Medicare |
$29.70
|
| Rate for Payer: Banner UC Health Medicaid |
$16.07
|
| Rate for Payer: Banner UC Health Medicare |
$29.70
|
| Rate for Payer: Bisbee Police All Plans |
$51.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$134.64
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna of AZ Commercial |
$128.70
|
| Rate for Payer: Copperpoint Commercial |
$49.00
|
| Rate for Payer: Health Net of AZ Commercial |
$118.80
|
| Rate for Payer: Health Net of AZ Medicare |
$55.44
|
| Rate for Payer: Humana of AZ Medicare |
$29.70
|
| Rate for Payer: Mercy Care Medicaid |
$16.07
|
| Rate for Payer: Self Pay Self Pay |
$158.40
|
| Rate for Payer: TriWest Medicare |
$29.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$115.43
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$35.64
|
|
|
.Campylobacter Cult Result LC
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
1294563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of AZ Commercial |
$74.70
|
| Rate for Payer: Bisbee Police All Plans |
$21.58
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Self Pay Self Pay |
$66.40
|
|
|
.Campylobacter Cult Result LC
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
1294563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of AZ Commercial |
$74.70
|
| Rate for Payer: Aetna of AZ Medicare |
$23.24
|
| Rate for Payer: AHCCCS Medicaid |
$16.07
|
| Rate for Payer: Allwell Medicaid |
$16.07
|
| Rate for Payer: Allwell Medicare |
$12.45
|
| Rate for Payer: Amerigroup Medicare |
$12.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$31.00
|
| Rate for Payer: AZCH Complete Medicaid |
$16.07
|
| Rate for Payer: AZCH Complete Medicare |
$12.45
|
| Rate for Payer: Banner UC Health Medicaid |
$16.07
|
| Rate for Payer: Banner UC Health Medicare |
$12.45
|
| Rate for Payer: Bisbee Police All Plans |
$21.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$56.44
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cigna of AZ Commercial |
$53.95
|
| Rate for Payer: Copperpoint Commercial |
$20.54
|
| Rate for Payer: Health Net of AZ Commercial |
$49.80
|
| Rate for Payer: Health Net of AZ Medicare |
$23.24
|
| Rate for Payer: Humana of AZ Medicare |
$12.45
|
| Rate for Payer: Mercy Care Medicaid |
$16.07
|
| Rate for Payer: Self Pay Self Pay |
$66.40
|
| Rate for Payer: TriWest Medicare |
$12.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$48.39
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.94
|
|
|
Cancer Antigen (CA) 125 LC
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
1285563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Aetna of AZ Commercial |
$614.70
|
| Rate for Payer: Aetna of AZ Medicare |
$191.24
|
| Rate for Payer: AHCCCS Medicaid |
$20.81
|
| Rate for Payer: Allwell Medicaid |
$20.81
|
| Rate for Payer: Allwell Medicare |
$102.45
|
| Rate for Payer: Amerigroup Medicare |
$102.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$255.10
|
| Rate for Payer: AZCH Complete Medicaid |
$20.81
|
| Rate for Payer: AZCH Complete Medicare |
$102.45
|
| Rate for Payer: Banner UC Health Medicaid |
$20.81
|
| Rate for Payer: Banner UC Health Medicare |
$102.45
|
| Rate for Payer: Bisbee Police All Plans |
$177.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$464.44
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cigna of AZ Commercial |
$443.95
|
| Rate for Payer: Copperpoint Commercial |
$169.04
|
| Rate for Payer: Health Net of AZ Commercial |
$409.80
|
| Rate for Payer: Health Net of AZ Medicare |
$191.24
|
| Rate for Payer: Humana of AZ Medicare |
$102.45
|
| Rate for Payer: Mercy Care Medicaid |
$20.81
|
| Rate for Payer: Self Pay Self Pay |
$546.40
|
| Rate for Payer: TriWest Medicare |
$102.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$398.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$122.94
|
|
|
Cancer Antigen (CA) 125 LC
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
1285563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$177.58 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Aetna of AZ Commercial |
$614.70
|
| Rate for Payer: Bisbee Police All Plans |
$177.58
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Self Pay Self Pay |
$546.40
|
|
|
CANDIDA AB IGG, IGA, IGM, ELISA
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
23294373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
|
|
CANDIDA AB IGG, IGA, IGM, ELISA
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
23294373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Aetna of AZ Medicare |
$75.04
|
| Rate for Payer: AHCCCS Medicaid |
$12.01
|
| Rate for Payer: Allwell Medicaid |
$12.01
|
| Rate for Payer: Allwell Medicare |
$40.20
|
| Rate for Payer: Amerigroup Medicare |
$40.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$100.10
|
| Rate for Payer: AZCH Complete Medicaid |
$12.01
|
| Rate for Payer: AZCH Complete Medicare |
$40.20
|
| Rate for Payer: Banner UC Health Medicaid |
$12.01
|
| Rate for Payer: Banner UC Health Medicare |
$40.20
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$182.24
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cigna of AZ Commercial |
$174.20
|
| Rate for Payer: Copperpoint Commercial |
$66.33
|
| Rate for Payer: Health Net of AZ Commercial |
$160.80
|
| Rate for Payer: Health Net of AZ Medicare |
$75.04
|
| Rate for Payer: Humana of AZ Medicare |
$40.20
|
| Rate for Payer: Mercy Care Medicaid |
$12.01
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
| Rate for Payer: TriWest Medicare |
$40.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$156.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.24
|
|
