|
CYGNUS DUAL 4X6
|
Facility
|
IP
|
$7,433.33
|
|
|
Service Code
|
HCPCS Q4282
|
| Hospital Charge Code |
27694677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,690.00 |
| Max. Negotiated Rate |
$6,690.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,690.00
|
| Rate for Payer: Cash Price |
$5,946.66
|
|
|
CYGNUS DUAL 4X6
|
Facility
|
OP
|
$7,433.33
|
|
|
Service Code
|
HCPCS Q4282
|
| Hospital Charge Code |
27694677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.55 |
| Max. Negotiated Rate |
$6,690.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,690.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$1,189.33
|
| Rate for Payer: Banner UC Health Medicare |
$1,189.33
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$5,054.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$1,189.33
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$1,189.33
|
| Rate for Payer: Cash Price |
$5,946.66
|
| Rate for Payer: Cash Price |
$5,946.66
|
| Rate for Payer: Cigna of AZ Commercial |
$5,203.33
|
| Rate for Payer: Devoted Health Medicare |
$1,338.00
|
| Rate for Payer: Humana of AZ Medicare |
$1,189.33
|
| Rate for Payer: Seven Corners Travel Insurance |
$192.55
|
| Rate for Payer: Southwest Service Administrators UFCW |
$5,054.66
|
| Rate for Payer: TriWest Medicare |
$1,189.33
|
| Rate for Payer: United Healthcare Commercial |
$4,251.86
|
| Rate for Payer: United Healthcare Medicare |
$1,189.33
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$1,412.33
|
| Rate for Payer: Veterans Affairs TRICARE |
$1,177.44
|
|
|
CYSTATIN C
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
28010045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of AZ Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$73.60
|
|
|
CYSTATIN C
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
28010045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of AZ Commercial |
$82.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$14.72
|
| Rate for Payer: Banner UC Health Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$14.72
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$14.72
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cigna of AZ Commercial |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$16.56
|
| Rate for Payer: Humana of AZ Medicare |
$14.72
|
| Rate for Payer: Seven Corners Travel Insurance |
$26.85
|
| Rate for Payer: Southwest Service Administrators UFCW |
$62.56
|
| Rate for Payer: TriWest Medicare |
$14.72
|
| Rate for Payer: United Healthcare Commercial |
$52.62
|
| Rate for Payer: United Healthcare Medicare |
$14.72
|
| Rate for Payer: Veterans Affairs TRICARE |
$14.57
|
|
|
Cystatin C LC
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
22623884
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of AZ Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$73.60
|
|
|
Cystatin C LC
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
22623884
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of AZ Commercial |
$82.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$14.72
|
| Rate for Payer: Banner UC Health Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$14.72
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$14.72
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cigna of AZ Commercial |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$16.56
|
| Rate for Payer: Humana of AZ Medicare |
$14.72
|
| Rate for Payer: Seven Corners Travel Insurance |
$26.85
|
| Rate for Payer: Southwest Service Administrators UFCW |
$62.56
|
| Rate for Payer: TriWest Medicare |
$14.72
|
| Rate for Payer: United Healthcare Commercial |
$52.62
|
| Rate for Payer: United Healthcare Medicare |
$14.72
|
| Rate for Payer: Veterans Affairs TRICARE |
$14.57
|
|
|
Cystatin C w/eGFR LC
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
27662843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of AZ Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$73.60
|
|
|
Cystatin C w/eGFR LC
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
27662843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of AZ Commercial |
$82.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$14.72
|
| Rate for Payer: Banner UC Health Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$14.72
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$14.72
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cigna of AZ Commercial |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$16.56
|
| Rate for Payer: Humana of AZ Medicare |
$14.72
|
| Rate for Payer: Seven Corners Travel Insurance |
$26.85
|
| Rate for Payer: Southwest Service Administrators UFCW |
$62.56
|
| Rate for Payer: TriWest Medicare |
$14.72
|
| Rate for Payer: United Healthcare Commercial |
$52.62
|
| Rate for Payer: United Healthcare Medicare |
$14.72
|
| Rate for Payer: Veterans Affairs TRICARE |
$14.57
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$10,269.90
|
|
|
Service Code
|
APR-DRG 1312
|
| Hospital Charge Code |
APRDRG1313
|
| Min. Negotiated Rate |
$10,269.90 |
| Max. Negotiated Rate |
$10,269.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,269.90
|
| Rate for Payer: Mercy Care Medicaid |
$10,269.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,269.90
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$8,339.65
|
|
|
Service Code
|
APR-DRG 1311
|
| Hospital Charge Code |
APRDRG1311
|
| Min. Negotiated Rate |
$8,339.65 |
| Max. Negotiated Rate |
$8,339.65 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,339.65
|
| Rate for Payer: Mercy Care Medicaid |
$8,339.65
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,339.65
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$13,952.95
|
|
|
Service Code
|
APR-DRG 1313
|
| Hospital Charge Code |
APRDRG1312
|
| Min. Negotiated Rate |
$13,952.95 |
| Max. Negotiated Rate |
$13,952.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,952.95
|
| Rate for Payer: Mercy Care Medicaid |
$13,952.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,952.95
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$13,952.95
|
|
|
Service Code
|
APR-DRG 1313
|
| Hospital Charge Code |
APRDRG1311
|
| Min. Negotiated Rate |
$13,952.95 |
| Max. Negotiated Rate |
$13,952.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,952.95
|
| Rate for Payer: Mercy Care Medicaid |
$13,952.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,952.95
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$13,952.95
|
|
|
Service Code
|
APR-DRG 1313
|
| Hospital Charge Code |
APRDRG1313
|
| Min. Negotiated Rate |
$13,952.95 |
| Max. Negotiated Rate |
$13,952.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,952.95
|
| Rate for Payer: Mercy Care Medicaid |
$13,952.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,952.95
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$10,269.90
|
|
|
Service Code
|
APR-DRG 1312
|
| Hospital Charge Code |
APRDRG1314
|
| Min. Negotiated Rate |
$10,269.90 |
| Max. Negotiated Rate |
$10,269.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,269.90
|
| Rate for Payer: Mercy Care Medicaid |
$10,269.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,269.90
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$18,516.96
|
|
|
Service Code
|
APR-DRG 1314
|
| Hospital Charge Code |
APRDRG1312
|
| Min. Negotiated Rate |
$18,516.96 |
| Max. Negotiated Rate |
$18,516.96 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$18,516.96
|
| Rate for Payer: Mercy Care Medicaid |
$18,516.96
|
| Rate for Payer: NaphCare Correctional Healthcare |
$18,516.96
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$10,269.90
|
|
|
Service Code
|
APR-DRG 1312
|
| Hospital Charge Code |
APRDRG1311
|
| Min. Negotiated Rate |
$10,269.90 |
| Max. Negotiated Rate |
$10,269.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,269.90
|
| Rate for Payer: Mercy Care Medicaid |
$10,269.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,269.90
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$10,269.90
|
|
|
Service Code
|
APR-DRG 1312
|
| Hospital Charge Code |
APRDRG1312
|
| Min. Negotiated Rate |
$10,269.90 |
| Max. Negotiated Rate |
$10,269.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,269.90
|
| Rate for Payer: Mercy Care Medicaid |
$10,269.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,269.90
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$8,339.65
|
|
|
Service Code
|
APR-DRG 1311
|
| Hospital Charge Code |
APRDRG1313
|
| Min. Negotiated Rate |
$8,339.65 |
| Max. Negotiated Rate |
$8,339.65 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,339.65
|
| Rate for Payer: Mercy Care Medicaid |
$8,339.65
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,339.65
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$8,339.65
|
|
|
Service Code
|
APR-DRG 1311
|
| Hospital Charge Code |
APRDRG1312
|
| Min. Negotiated Rate |
$8,339.65 |
| Max. Negotiated Rate |
$8,339.65 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,339.65
|
| Rate for Payer: Mercy Care Medicaid |
$8,339.65
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,339.65
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$13,952.95
|
|
|
Service Code
|
APR-DRG 1313
|
| Hospital Charge Code |
APRDRG1314
|
| Min. Negotiated Rate |
$13,952.95 |
| Max. Negotiated Rate |
$13,952.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,952.95
|
| Rate for Payer: Mercy Care Medicaid |
$13,952.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,952.95
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$18,516.96
|
|
|
Service Code
|
APR-DRG 1314
|
| Hospital Charge Code |
APRDRG1314
|
| Min. Negotiated Rate |
$18,516.96 |
| Max. Negotiated Rate |
$18,516.96 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$18,516.96
|
| Rate for Payer: Mercy Care Medicaid |
$18,516.96
|
| Rate for Payer: NaphCare Correctional Healthcare |
$18,516.96
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$8,339.65
|
|
|
Service Code
|
APR-DRG 1311
|
| Hospital Charge Code |
APRDRG1314
|
| Min. Negotiated Rate |
$8,339.65 |
| Max. Negotiated Rate |
$8,339.65 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,339.65
|
| Rate for Payer: Mercy Care Medicaid |
$8,339.65
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,339.65
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$18,516.96
|
|
|
Service Code
|
APR-DRG 1314
|
| Hospital Charge Code |
APRDRG1313
|
| Min. Negotiated Rate |
$18,516.96 |
| Max. Negotiated Rate |
$18,516.96 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$18,516.96
|
| Rate for Payer: Mercy Care Medicaid |
$18,516.96
|
| Rate for Payer: NaphCare Correctional Healthcare |
$18,516.96
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$18,516.96
|
|
|
Service Code
|
APR-DRG 1314
|
| Hospital Charge Code |
APRDRG1311
|
| Min. Negotiated Rate |
$18,516.96 |
| Max. Negotiated Rate |
$18,516.96 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$18,516.96
|
| Rate for Payer: Mercy Care Medicaid |
$18,516.96
|
| Rate for Payer: NaphCare Correctional Healthcare |
$18,516.96
|
|
|
CYSTINE 24HR
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 82131
|
| Hospital Charge Code |
22481472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$254.70 |
| Max. Negotiated Rate |
$254.70 |
| Rate for Payer: Aetna of AZ Commercial |
$254.70
|
| Rate for Payer: Cash Price |
$226.40
|
|
