|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$7,028.73
|
|
|
Service Code
|
APR-DRG 1323
|
| Hospital Charge Code |
APRDRG1323
|
| Min. Negotiated Rate |
$7,028.73 |
| Max. Negotiated Rate |
$7,028.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,028.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,028.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,028.73
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$7,028.73
|
|
|
Service Code
|
APR-DRG 1323
|
| Hospital Charge Code |
APRDRG1324
|
| Min. Negotiated Rate |
$7,028.73 |
| Max. Negotiated Rate |
$7,028.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,028.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,028.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,028.73
|
|
|
B.pertussisB.parapertussis PCR LC
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2087564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of AZ Commercial |
$360.00
|
| Rate for Payer: Cash Price |
$320.00
|
|
|
B.pertussisB.parapertussis PCR LC
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2087564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of AZ Commercial |
$360.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$64.00
|
| Rate for Payer: Banner UC Health Medicare |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$64.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$64.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna of AZ Commercial |
$260.00
|
| Rate for Payer: Devoted Health Medicare |
$72.00
|
| Rate for Payer: Humana of AZ Medicare |
$64.00
|
| Rate for Payer: Seven Corners Travel Insurance |
$50.88
|
| Rate for Payer: Southwest Service Administrators UFCW |
$272.00
|
| Rate for Payer: TriWest Medicare |
$64.00
|
| Rate for Payer: United Healthcare Commercial |
$228.80
|
| Rate for Payer: United Healthcare Medicare |
$64.00
|
| Rate for Payer: Veterans Affairs TRICARE |
$63.36
|
|
|
B pertussis IgA Ab LC
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
22311176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of AZ Commercial |
$222.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$39.52
|
| Rate for Payer: Banner UC Health Medicare |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$167.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$39.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$39.52
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cigna of AZ Commercial |
$160.55
|
| Rate for Payer: Devoted Health Medicare |
$44.46
|
| Rate for Payer: Humana of AZ Medicare |
$39.52
|
| Rate for Payer: Seven Corners Travel Insurance |
$19.13
|
| Rate for Payer: Southwest Service Administrators UFCW |
$167.96
|
| Rate for Payer: TriWest Medicare |
$39.52
|
| Rate for Payer: United Healthcare Commercial |
$141.28
|
| Rate for Payer: United Healthcare Medicare |
$39.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$39.12
|
|
|
B pertussis IgA Ab LC
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
22311176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of AZ Commercial |
$222.30
|
| Rate for Payer: Cash Price |
$197.60
|
|
|
B pertussis IgG Ab LC
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
2087563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna of AZ Commercial |
$228.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$40.64
|
| Rate for Payer: Banner UC Health Medicare |
$40.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$172.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$40.64
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$40.64
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cigna of AZ Commercial |
$165.10
|
| Rate for Payer: Devoted Health Medicare |
$45.72
|
| Rate for Payer: Humana of AZ Medicare |
$40.64
|
| Rate for Payer: Seven Corners Travel Insurance |
$19.13
|
| Rate for Payer: Southwest Service Administrators UFCW |
$172.72
|
| Rate for Payer: TriWest Medicare |
$40.64
|
| Rate for Payer: United Healthcare Commercial |
$145.29
|
| Rate for Payer: United Healthcare Medicare |
$40.64
|
| Rate for Payer: Veterans Affairs TRICARE |
$40.23
|
|
|
B pertussis IgG Ab LC
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
2087563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$228.60 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna of AZ Commercial |
$228.60
|
| Rate for Payer: Cash Price |
$203.20
|
|
|
B pertussis IgG/IgM Ab LC
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
22201710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$342.90 |
| Rate for Payer: Aetna of AZ Commercial |
$342.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$60.96
|
| Rate for Payer: Banner UC Health Medicare |
$60.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$60.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$60.96
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna of AZ Commercial |
$247.65
|
| Rate for Payer: Devoted Health Medicare |
$68.58
|
| Rate for Payer: Humana of AZ Medicare |
$60.96
|
| Rate for Payer: Seven Corners Travel Insurance |
$50.88
|
| Rate for Payer: Southwest Service Administrators UFCW |
$259.08
|
| Rate for Payer: TriWest Medicare |
$60.96
|
| Rate for Payer: United Healthcare Commercial |
$217.93
|
| Rate for Payer: United Healthcare Medicare |
$60.96
|
| Rate for Payer: Veterans Affairs TRICARE |
$60.35
|
|
|
B pertussis IgG/IgM Ab LC
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
22201710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$342.90 |
| Max. Negotiated Rate |
$342.90 |
| Rate for Payer: Aetna of AZ Commercial |
$342.90
|
| Rate for Payer: Cash Price |
$304.80
|
|
|
B pertussis IgM Ab LC
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
22311177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of AZ Commercial |
$249.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$44.32
|
| Rate for Payer: Banner UC Health Medicare |
$44.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$188.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$44.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$44.32
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cigna of AZ Commercial |
$180.05
|
| Rate for Payer: Devoted Health Medicare |
$49.86
|
| Rate for Payer: Humana of AZ Medicare |
$44.32
|
| Rate for Payer: Seven Corners Travel Insurance |
$19.13
|
| Rate for Payer: Southwest Service Administrators UFCW |
$188.36
|
| Rate for Payer: TriWest Medicare |
$44.32
|
| Rate for Payer: United Healthcare Commercial |
$158.44
|
| Rate for Payer: United Healthcare Medicare |
$44.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$43.88
|
|
|
B pertussis IgM Ab LC
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
22311177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$249.30 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Aetna of AZ Commercial |
$249.30
|
| Rate for Payer: Cash Price |
$221.60
|
|
|
B Pertussis, Nasophar Culture
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
2269430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of AZ Commercial |
$190.80
|
| Rate for Payer: Cash Price |
$169.60
|
|
|
B Pertussis, Nasophar Culture
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
2269430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of AZ Commercial |
$190.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$33.92
|
| Rate for Payer: Banner UC Health Medicare |
$33.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$144.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$33.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$33.92
|
| 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: Devoted Health Medicare |
$38.16
|
| Rate for Payer: Humana of AZ Medicare |
$33.92
|
| Rate for Payer: Seven Corners Travel Insurance |
$12.50
|
| Rate for Payer: Southwest Service Administrators UFCW |
$144.16
|
| Rate for Payer: TriWest Medicare |
$33.92
|
| Rate for Payer: United Healthcare Commercial |
$121.26
|
| Rate for Payer: United Healthcare Medicare |
$33.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$33.58
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$18,725.28
|
|
|
Service Code
|
APR-DRG 0564
|
| Hospital Charge Code |
APRDRG0564
|
| Min. Negotiated Rate |
$18,725.28 |
| Max. Negotiated Rate |
$18,725.28 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$18,725.28
|
| Rate for Payer: Mercy Care Medicaid |
$18,725.28
|
| Rate for Payer: NaphCare Correctional Healthcare |
$18,725.28
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$6,264.90
|
|
|
Service Code
|
APR-DRG 0562
|
| Hospital Charge Code |
APRDRG0563
|
| Min. Negotiated Rate |
$6,264.90 |
| Max. Negotiated Rate |
$6,264.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,264.90
|
| Rate for Payer: Mercy Care Medicaid |
$6,264.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,264.90
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$18,725.28
|
|
|
Service Code
|
APR-DRG 0564
|
| Hospital Charge Code |
APRDRG0562
|
| Min. Negotiated Rate |
$18,725.28 |
| Max. Negotiated Rate |
$18,725.28 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$18,725.28
|
| Rate for Payer: Mercy Care Medicaid |
$18,725.28
|
| Rate for Payer: NaphCare Correctional Healthcare |
$18,725.28
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$6,264.90
|
|
|
Service Code
|
APR-DRG 0562
|
| Hospital Charge Code |
APRDRG0564
|
| Min. Negotiated Rate |
$6,264.90 |
| Max. Negotiated Rate |
$6,264.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,264.90
|
| Rate for Payer: Mercy Care Medicaid |
$6,264.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,264.90
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,353.59
|
|
|
Service Code
|
APR-DRG 0561
|
| Hospital Charge Code |
APRDRG0564
|
| Min. Negotiated Rate |
$4,353.59 |
| Max. Negotiated Rate |
$4,353.59 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,353.59
|
| Rate for Payer: Mercy Care Medicaid |
$4,353.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,353.59
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$9,988.64
|
|
|
Service Code
|
APR-DRG 0563
|
| Hospital Charge Code |
APRDRG0564
|
| Min. Negotiated Rate |
$9,988.64 |
| Max. Negotiated Rate |
$9,988.64 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,988.64
|
| Rate for Payer: Mercy Care Medicaid |
$9,988.64
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,988.64
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,353.59
|
|
|
Service Code
|
APR-DRG 0561
|
| Hospital Charge Code |
APRDRG0562
|
| Min. Negotiated Rate |
$4,353.59 |
| Max. Negotiated Rate |
$4,353.59 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,353.59
|
| Rate for Payer: Mercy Care Medicaid |
$4,353.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,353.59
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$18,725.28
|
|
|
Service Code
|
APR-DRG 0564
|
| Hospital Charge Code |
APRDRG0561
|
| Min. Negotiated Rate |
$18,725.28 |
| Max. Negotiated Rate |
$18,725.28 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$18,725.28
|
| Rate for Payer: Mercy Care Medicaid |
$18,725.28
|
| Rate for Payer: NaphCare Correctional Healthcare |
$18,725.28
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$9,988.64
|
|
|
Service Code
|
APR-DRG 0563
|
| Hospital Charge Code |
APRDRG0563
|
| Min. Negotiated Rate |
$9,988.64 |
| Max. Negotiated Rate |
$9,988.64 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,988.64
|
| Rate for Payer: Mercy Care Medicaid |
$9,988.64
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,988.64
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$6,264.90
|
|
|
Service Code
|
APR-DRG 0562
|
| Hospital Charge Code |
APRDRG0562
|
| Min. Negotiated Rate |
$6,264.90 |
| Max. Negotiated Rate |
$6,264.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,264.90
|
| Rate for Payer: Mercy Care Medicaid |
$6,264.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,264.90
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,353.59
|
|
|
Service Code
|
APR-DRG 0561
|
| Hospital Charge Code |
APRDRG0563
|
| Min. Negotiated Rate |
$4,353.59 |
| Max. Negotiated Rate |
$4,353.59 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,353.59
|
| Rate for Payer: Mercy Care Medicaid |
$4,353.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,353.59
|
|
