|
.CHROMOSOM IN SITU HYB <300 CELLS
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
22481444
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna of AZ Commercial |
$152.10
|
| Rate for Payer: Aetna of AZ Medicare |
$47.32
|
| Rate for Payer: Allwell Medicare |
$27.04
|
| Rate for Payer: Amerigroup Medicare |
$27.04
|
| Rate for Payer: APIPA Medicare/Medicaid |
$63.12
|
| Rate for Payer: AZCH Complete Medicare |
$27.04
|
| Rate for Payer: Banner UC Health Medicare |
$27.04
|
| Rate for Payer: Bisbee Police All Plans |
$43.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$114.92
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cigna of AZ Commercial |
$109.85
|
| Rate for Payer: Copperpoint Commercial |
$41.83
|
| Rate for Payer: Health Net of AZ Commercial |
$101.40
|
| Rate for Payer: Health Net of AZ Medicare |
$47.32
|
| Rate for Payer: Humana of AZ Medicare |
$27.04
|
| Rate for Payer: Self Pay Self Pay |
$135.20
|
| Rate for Payer: TriWest Medicare |
$27.04
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$98.53
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.42
|
|
|
.CHROMOSOM IN SITU HYB <300 CELLS
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
22481444
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna of AZ Commercial |
$152.10
|
| Rate for Payer: Bisbee Police All Plans |
$43.94
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Self Pay Self Pay |
$135.20
|
|
|
Chromotubation
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 58350
|
| Hospital Charge Code |
23390089
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Aetna of AZ Commercial |
$238.50
|
| Rate for Payer: Aetna of AZ Medicare |
$74.20
|
| Rate for Payer: Allwell Medicare |
$42.40
|
| Rate for Payer: Amerigroup Medicare |
$42.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$98.98
|
| Rate for Payer: AZCH Complete Medicare |
$42.40
|
| Rate for Payer: Banner UC Health Medicare |
$42.40
|
| Rate for Payer: Bisbee Police All Plans |
$68.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$180.20
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna of AZ Commercial |
$185.50
|
| Rate for Payer: Copperpoint Commercial |
$65.59
|
| Rate for Payer: Health Net of AZ Commercial |
$159.00
|
| Rate for Payer: Health Net of AZ Medicare |
$74.20
|
| Rate for Payer: Humana of AZ Medicare |
$42.40
|
| Rate for Payer: Self Pay Self Pay |
$212.00
|
| Rate for Payer: TriWest Medicare |
$42.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$154.50
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$47.70
|
|
|
Chromotubation
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 58350
|
| Hospital Charge Code |
23390089
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Aetna of AZ Commercial |
$238.50
|
| Rate for Payer: Bisbee Police All Plans |
$68.90
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Self Pay Self Pay |
$212.00
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$11,939.93
|
|
|
Service Code
|
APR-DRG 4704
|
| Hospital Charge Code |
APRDRG4703
|
| Min. Negotiated Rate |
$11,939.93 |
| Max. Negotiated Rate |
$11,939.93 |
| Rate for Payer: AHCCCS Medicaid |
$11,939.93
|
| Rate for Payer: Allwell Medicaid |
$11,939.93
|
| Rate for Payer: AZCH Complete Medicaid |
$11,939.93
|
| Rate for Payer: Banner UC Health Medicaid |
$11,939.93
|
| Rate for Payer: Mercy Care Medicaid |
$11,939.93
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$11,939.93
|
|
|
Service Code
|
APR-DRG 4704
|
| Hospital Charge Code |
APRDRG4702
|
| Min. Negotiated Rate |
$11,939.93 |
| Max. Negotiated Rate |
$11,939.93 |
| Rate for Payer: AHCCCS Medicaid |
$11,939.93
|
| Rate for Payer: Allwell Medicaid |
$11,939.93
|
| Rate for Payer: AZCH Complete Medicaid |
$11,939.93
|
| Rate for Payer: Banner UC Health Medicaid |
$11,939.93
|
| Rate for Payer: Mercy Care Medicaid |
$11,939.93
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$6,330.84
|
|
|
Service Code
|
APR-DRG 4703
|
| Hospital Charge Code |
APRDRG4704
|
| Min. Negotiated Rate |
$6,330.84 |
| Max. Negotiated Rate |
$6,330.84 |
| Rate for Payer: AHCCCS Medicaid |
$6,330.84
|
| Rate for Payer: Allwell Medicaid |
$6,330.84
|
| Rate for Payer: AZCH Complete Medicaid |
$6,330.84
|
| Rate for Payer: Banner UC Health Medicaid |
$6,330.84
|
| Rate for Payer: Mercy Care Medicaid |
$6,330.84
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$4,275.73
|
|
|
Service Code
|
APR-DRG 4702
|
| Hospital Charge Code |
APRDRG4704
|
| Min. Negotiated Rate |
$4,275.73 |
| Max. Negotiated Rate |
$4,275.73 |
| Rate for Payer: AHCCCS Medicaid |
$4,275.73
|
| Rate for Payer: Allwell Medicaid |
$4,275.73
|
| Rate for Payer: AZCH Complete Medicaid |
$4,275.73
|
| Rate for Payer: Banner UC Health Medicaid |
$4,275.73
|
| Rate for Payer: Mercy Care Medicaid |
$4,275.73
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$6,330.84
|
|
|
Service Code
|
APR-DRG 4703
|
| Hospital Charge Code |
APRDRG4703
|
| Min. Negotiated Rate |
$6,330.84 |
| Max. Negotiated Rate |
$6,330.84 |
| Rate for Payer: AHCCCS Medicaid |
$6,330.84
|
| Rate for Payer: Allwell Medicaid |
$6,330.84
|
| Rate for Payer: AZCH Complete Medicaid |
$6,330.84
|
| Rate for Payer: Banner UC Health Medicaid |
$6,330.84
|
| Rate for Payer: Mercy Care Medicaid |
$6,330.84
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$11,939.93
|
|
|
Service Code
|
APR-DRG 4704
|
| Hospital Charge Code |
APRDRG4701
|
| Min. Negotiated Rate |
$11,939.93 |
| Max. Negotiated Rate |
$11,939.93 |
| Rate for Payer: AHCCCS Medicaid |
$11,939.93
|
| Rate for Payer: Allwell Medicaid |
$11,939.93
|
| Rate for Payer: AZCH Complete Medicaid |
$11,939.93
|
| Rate for Payer: Banner UC Health Medicaid |
$11,939.93
|
| Rate for Payer: Mercy Care Medicaid |
$11,939.93
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$4,275.73
|
|
|
Service Code
|
APR-DRG 4702
|
| Hospital Charge Code |
APRDRG4702
|
| Min. Negotiated Rate |
$4,275.73 |
| Max. Negotiated Rate |
$4,275.73 |
| Rate for Payer: AHCCCS Medicaid |
$4,275.73
|
| Rate for Payer: Allwell Medicaid |
$4,275.73
|
| Rate for Payer: AZCH Complete Medicaid |
$4,275.73
|
| Rate for Payer: Banner UC Health Medicaid |
$4,275.73
|
| Rate for Payer: Mercy Care Medicaid |
$4,275.73
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$6,330.84
|
|
|
Service Code
|
APR-DRG 4703
|
| Hospital Charge Code |
APRDRG4702
|
| Min. Negotiated Rate |
$6,330.84 |
| Max. Negotiated Rate |
$6,330.84 |
| Rate for Payer: AHCCCS Medicaid |
$6,330.84
|
| Rate for Payer: Allwell Medicaid |
$6,330.84
|
| Rate for Payer: AZCH Complete Medicaid |
$6,330.84
|
| Rate for Payer: Banner UC Health Medicaid |
$6,330.84
|
| Rate for Payer: Mercy Care Medicaid |
$6,330.84
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$3,170.33
|
|
|
Service Code
|
APR-DRG 4701
|
| Hospital Charge Code |
APRDRG4702
|
| Min. Negotiated Rate |
$3,170.33 |
| Max. Negotiated Rate |
$3,170.33 |
| Rate for Payer: AHCCCS Medicaid |
$3,170.33
|
| Rate for Payer: Allwell Medicaid |
$3,170.33
|
| Rate for Payer: AZCH Complete Medicaid |
$3,170.33
|
| Rate for Payer: Banner UC Health Medicaid |
$3,170.33
|
| Rate for Payer: Mercy Care Medicaid |
$3,170.33
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$4,275.73
|
|
|
Service Code
|
APR-DRG 4702
|
| Hospital Charge Code |
APRDRG4703
|
| Min. Negotiated Rate |
$4,275.73 |
| Max. Negotiated Rate |
$4,275.73 |
| Rate for Payer: AHCCCS Medicaid |
$4,275.73
|
| Rate for Payer: Allwell Medicaid |
$4,275.73
|
| Rate for Payer: AZCH Complete Medicaid |
$4,275.73
|
| Rate for Payer: Banner UC Health Medicaid |
$4,275.73
|
| Rate for Payer: Mercy Care Medicaid |
$4,275.73
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$6,330.84
|
|
|
Service Code
|
APR-DRG 4703
|
| Hospital Charge Code |
APRDRG4701
|
| Min. Negotiated Rate |
$6,330.84 |
| Max. Negotiated Rate |
$6,330.84 |
| Rate for Payer: AHCCCS Medicaid |
$6,330.84
|
| Rate for Payer: Allwell Medicaid |
$6,330.84
|
| Rate for Payer: AZCH Complete Medicaid |
$6,330.84
|
| Rate for Payer: Banner UC Health Medicaid |
$6,330.84
|
| Rate for Payer: Mercy Care Medicaid |
$6,330.84
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$3,170.33
|
|
|
Service Code
|
APR-DRG 4701
|
| Hospital Charge Code |
APRDRG4703
|
| Min. Negotiated Rate |
$3,170.33 |
| Max. Negotiated Rate |
$3,170.33 |
| Rate for Payer: AHCCCS Medicaid |
$3,170.33
|
| Rate for Payer: Allwell Medicaid |
$3,170.33
|
| Rate for Payer: AZCH Complete Medicaid |
$3,170.33
|
| Rate for Payer: Banner UC Health Medicaid |
$3,170.33
|
| Rate for Payer: Mercy Care Medicaid |
$3,170.33
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$11,939.93
|
|
|
Service Code
|
APR-DRG 4704
|
| Hospital Charge Code |
APRDRG4704
|
| Min. Negotiated Rate |
$11,939.93 |
| Max. Negotiated Rate |
$11,939.93 |
| Rate for Payer: AHCCCS Medicaid |
$11,939.93
|
| Rate for Payer: Allwell Medicaid |
$11,939.93
|
| Rate for Payer: AZCH Complete Medicaid |
$11,939.93
|
| Rate for Payer: Banner UC Health Medicaid |
$11,939.93
|
| Rate for Payer: Mercy Care Medicaid |
$11,939.93
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$3,170.33
|
|
|
Service Code
|
APR-DRG 4701
|
| Hospital Charge Code |
APRDRG4701
|
| Min. Negotiated Rate |
$3,170.33 |
| Max. Negotiated Rate |
$3,170.33 |
| Rate for Payer: AHCCCS Medicaid |
$3,170.33
|
| Rate for Payer: Allwell Medicaid |
$3,170.33
|
| Rate for Payer: AZCH Complete Medicaid |
$3,170.33
|
| Rate for Payer: Banner UC Health Medicaid |
$3,170.33
|
| Rate for Payer: Mercy Care Medicaid |
$3,170.33
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$4,275.73
|
|
|
Service Code
|
APR-DRG 4702
|
| Hospital Charge Code |
APRDRG4701
|
| Min. Negotiated Rate |
$4,275.73 |
| Max. Negotiated Rate |
$4,275.73 |
| Rate for Payer: AHCCCS Medicaid |
$4,275.73
|
| Rate for Payer: Allwell Medicaid |
$4,275.73
|
| Rate for Payer: AZCH Complete Medicaid |
$4,275.73
|
| Rate for Payer: Banner UC Health Medicaid |
$4,275.73
|
| Rate for Payer: Mercy Care Medicaid |
$4,275.73
|
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$3,170.33
|
|
|
Service Code
|
APR-DRG 4701
|
| Hospital Charge Code |
APRDRG4704
|
| Min. Negotiated Rate |
$3,170.33 |
| Max. Negotiated Rate |
$3,170.33 |
| Rate for Payer: AHCCCS Medicaid |
$3,170.33
|
| Rate for Payer: Allwell Medicaid |
$3,170.33
|
| Rate for Payer: AZCH Complete Medicaid |
$3,170.33
|
| Rate for Payer: Banner UC Health Medicaid |
$3,170.33
|
| Rate for Payer: Mercy Care Medicaid |
$3,170.33
|
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$5,325.73
|
|
|
Service Code
|
APR-DRG 1403
|
| Hospital Charge Code |
APRDRG1402
|
| Min. Negotiated Rate |
$5,325.73 |
| Max. Negotiated Rate |
$5,325.73 |
| Rate for Payer: AHCCCS Medicaid |
$5,325.73
|
| Rate for Payer: Allwell Medicaid |
$5,325.73
|
| Rate for Payer: AZCH Complete Medicaid |
$5,325.73
|
| Rate for Payer: Banner UC Health Medicaid |
$5,325.73
|
| Rate for Payer: Mercy Care Medicaid |
$5,325.73
|
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$8,423.11
|
|
|
Service Code
|
APR-DRG 1404
|
| Hospital Charge Code |
APRDRG1401
|
| Min. Negotiated Rate |
$8,423.11 |
| Max. Negotiated Rate |
$8,423.11 |
| Rate for Payer: AHCCCS Medicaid |
$8,423.11
|
| Rate for Payer: Allwell Medicaid |
$8,423.11
|
| Rate for Payer: AZCH Complete Medicaid |
$8,423.11
|
| Rate for Payer: Banner UC Health Medicaid |
$8,423.11
|
| Rate for Payer: Mercy Care Medicaid |
$8,423.11
|
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$8,423.11
|
|
|
Service Code
|
APR-DRG 1404
|
| Hospital Charge Code |
APRDRG1403
|
| Min. Negotiated Rate |
$8,423.11 |
| Max. Negotiated Rate |
$8,423.11 |
| Rate for Payer: AHCCCS Medicaid |
$8,423.11
|
| Rate for Payer: Allwell Medicaid |
$8,423.11
|
| Rate for Payer: AZCH Complete Medicaid |
$8,423.11
|
| Rate for Payer: Banner UC Health Medicaid |
$8,423.11
|
| Rate for Payer: Mercy Care Medicaid |
$8,423.11
|
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$5,325.73
|
|
|
Service Code
|
APR-DRG 1403
|
| Hospital Charge Code |
APRDRG1401
|
| Min. Negotiated Rate |
$5,325.73 |
| Max. Negotiated Rate |
$5,325.73 |
| Rate for Payer: AHCCCS Medicaid |
$5,325.73
|
| Rate for Payer: Allwell Medicaid |
$5,325.73
|
| Rate for Payer: AZCH Complete Medicaid |
$5,325.73
|
| Rate for Payer: Banner UC Health Medicaid |
$5,325.73
|
| Rate for Payer: Mercy Care Medicaid |
$5,325.73
|
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$3,418.62
|
|
|
Service Code
|
APR-DRG 1401
|
| Hospital Charge Code |
APRDRG1404
|
| Min. Negotiated Rate |
$3,418.62 |
| Max. Negotiated Rate |
$3,418.62 |
| Rate for Payer: AHCCCS Medicaid |
$3,418.62
|
| Rate for Payer: Allwell Medicaid |
$3,418.62
|
| Rate for Payer: AZCH Complete Medicaid |
$3,418.62
|
| Rate for Payer: Banner UC Health Medicaid |
$3,418.62
|
| Rate for Payer: Mercy Care Medicaid |
$3,418.62
|
|
