|
Drug Analysis Profile, Comprehensive, Urine LC
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
28073685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.51 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna of AZ Commercial |
$252.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$44.96
|
| Rate for Payer: Banner UC Health Medicare |
$44.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$191.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$44.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$44.96
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cigna of AZ Commercial |
$182.65
|
| Rate for Payer: Devoted Health Medicare |
$50.58
|
| Rate for Payer: Humana of AZ Medicare |
$44.96
|
| Rate for Payer: Seven Corners Travel Insurance |
$90.10
|
| Rate for Payer: Southwest Service Administrators UFCW |
$191.08
|
| Rate for Payer: TriWest Medicare |
$44.96
|
| Rate for Payer: United Healthcare Commercial |
$160.73
|
| Rate for Payer: United Healthcare Medicare |
$44.96
|
| Rate for Payer: Veterans Affairs TRICARE |
$44.51
|
|
|
Drug Analysis Profile, Comprehensive, Urine LC
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
28073685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$252.90 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna of AZ Commercial |
$252.90
|
| Rate for Payer: Cash Price |
$224.80
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$4,497.38
|
|
|
Service Code
|
APR-DRG 7703
|
| Hospital Charge Code |
APRDRG7703
|
| Min. Negotiated Rate |
$4,497.38 |
| Max. Negotiated Rate |
$4,497.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,497.38
|
| Rate for Payer: Mercy Care Medicaid |
$4,497.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,497.38
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$2,506.80
|
|
|
Service Code
|
APR-DRG 7702
|
| Hospital Charge Code |
APRDRG7703
|
| Min. Negotiated Rate |
$2,506.80 |
| Max. Negotiated Rate |
$2,506.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,506.80
|
| Rate for Payer: Mercy Care Medicaid |
$2,506.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,506.80
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$4,497.38
|
|
|
Service Code
|
APR-DRG 7703
|
| Hospital Charge Code |
APRDRG7701
|
| Min. Negotiated Rate |
$4,497.38 |
| Max. Negotiated Rate |
$4,497.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,497.38
|
| Rate for Payer: Mercy Care Medicaid |
$4,497.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,497.38
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$2,506.80
|
|
|
Service Code
|
APR-DRG 7702
|
| Hospital Charge Code |
APRDRG7702
|
| Min. Negotiated Rate |
$2,506.80 |
| Max. Negotiated Rate |
$2,506.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,506.80
|
| Rate for Payer: Mercy Care Medicaid |
$2,506.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,506.80
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$1,604.10
|
|
|
Service Code
|
APR-DRG 7701
|
| Hospital Charge Code |
APRDRG7701
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$1,604.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,604.10
|
| Rate for Payer: Mercy Care Medicaid |
$1,604.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,604.10
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$2,506.80
|
|
|
Service Code
|
APR-DRG 7702
|
| Hospital Charge Code |
APRDRG7704
|
| Min. Negotiated Rate |
$2,506.80 |
| Max. Negotiated Rate |
$2,506.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,506.80
|
| Rate for Payer: Mercy Care Medicaid |
$2,506.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,506.80
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$9,774.71
|
|
|
Service Code
|
APR-DRG 7704
|
| Hospital Charge Code |
APRDRG7702
|
| Min. Negotiated Rate |
$9,774.71 |
| Max. Negotiated Rate |
$9,774.71 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,774.71
|
| Rate for Payer: Mercy Care Medicaid |
$9,774.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,774.71
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$1,604.10
|
|
|
Service Code
|
APR-DRG 7701
|
| Hospital Charge Code |
APRDRG7703
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$1,604.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,604.10
|
| Rate for Payer: Mercy Care Medicaid |
$1,604.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,604.10
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$1,604.10
|
|
|
Service Code
|
APR-DRG 7701
|
| Hospital Charge Code |
APRDRG7702
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$1,604.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,604.10
|
| Rate for Payer: Mercy Care Medicaid |
$1,604.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,604.10
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$4,497.38
|
|
|
Service Code
|
APR-DRG 7703
|
| Hospital Charge Code |
APRDRG7702
|
| Min. Negotiated Rate |
$4,497.38 |
| Max. Negotiated Rate |
$4,497.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,497.38
|
| Rate for Payer: Mercy Care Medicaid |
$4,497.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,497.38
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$9,774.71
|
|
|
Service Code
|
APR-DRG 7704
|
| Hospital Charge Code |
APRDRG7703
|
| Min. Negotiated Rate |
$9,774.71 |
| Max. Negotiated Rate |
$9,774.71 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,774.71
|
| Rate for Payer: Mercy Care Medicaid |
$9,774.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,774.71
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$2,506.80
|
|
|
Service Code
|
APR-DRG 7702
|
| Hospital Charge Code |
APRDRG7701
|
| Min. Negotiated Rate |
$2,506.80 |
| Max. Negotiated Rate |
$2,506.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,506.80
|
| Rate for Payer: Mercy Care Medicaid |
$2,506.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,506.80
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$1,604.10
|
|
|
Service Code
|
APR-DRG 7701
|
| Hospital Charge Code |
APRDRG7704
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$1,604.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,604.10
|
| Rate for Payer: Mercy Care Medicaid |
$1,604.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,604.10
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$9,774.71
|
|
|
Service Code
|
APR-DRG 7704
|
| Hospital Charge Code |
APRDRG7704
|
| Min. Negotiated Rate |
$9,774.71 |
| Max. Negotiated Rate |
$9,774.71 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,774.71
|
| Rate for Payer: Mercy Care Medicaid |
$9,774.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,774.71
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$9,774.71
|
|
|
Service Code
|
APR-DRG 7704
|
| Hospital Charge Code |
APRDRG7701
|
| Min. Negotiated Rate |
$9,774.71 |
| Max. Negotiated Rate |
$9,774.71 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,774.71
|
| Rate for Payer: Mercy Care Medicaid |
$9,774.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,774.71
|
|
|
Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice
|
Facility
|
IP
|
$4,497.38
|
|
|
Service Code
|
APR-DRG 7703
|
| Hospital Charge Code |
APRDRG7704
|
| Min. Negotiated Rate |
$4,497.38 |
| Max. Negotiated Rate |
$4,497.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,497.38
|
| Rate for Payer: Mercy Care Medicaid |
$4,497.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,497.38
|
|
|
Drug Screen POC
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 80102
|
| Hospital Charge Code |
2673149
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna of AZ Commercial |
$83.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$14.88
|
| Rate for Payer: Banner UC Health Medicare |
$14.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$63.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$14.88
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$14.88
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna of AZ Commercial |
$65.10
|
| Rate for Payer: Devoted Health Medicare |
$16.74
|
| Rate for Payer: Humana of AZ Medicare |
$14.88
|
| Rate for Payer: Southwest Service Administrators UFCW |
$63.24
|
| Rate for Payer: TriWest Medicare |
$14.88
|
| Rate for Payer: United Healthcare Commercial |
$53.20
|
| Rate for Payer: United Healthcare Medicare |
$14.88
|
| Rate for Payer: Veterans Affairs TRICARE |
$14.73
|
|
|
Drug Screen POC
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 80102
|
| Hospital Charge Code |
2673149
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna of AZ Commercial |
$83.70
|
| Rate for Payer: Cash Price |
$74.40
|
|
|
Drugs of Abuse Screen Only, Whole Blood LC
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
22510235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$42.88
|
| Rate for Payer: Banner UC Health Medicare |
$42.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$182.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$42.88
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$42.88
|
| 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: Devoted Health Medicare |
$48.24
|
| Rate for Payer: Humana of AZ Medicare |
$42.88
|
| Rate for Payer: Seven Corners Travel Insurance |
$90.10
|
| Rate for Payer: Southwest Service Administrators UFCW |
$182.24
|
| Rate for Payer: TriWest Medicare |
$42.88
|
| Rate for Payer: United Healthcare Commercial |
$153.30
|
| Rate for Payer: United Healthcare Medicare |
$42.88
|
| Rate for Payer: Veterans Affairs TRICARE |
$42.45
|
|
|
Drugs of Abuse Screen Only, Whole Blood LC
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
22510235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Cash Price |
$214.40
|
|
|
DRY BUBBLE HUMIDIFIER
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
24153386
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna of AZ Commercial |
$20.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$3.68
|
| Rate for Payer: Banner UC Health Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$3.68
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$3.68
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cigna of AZ Commercial |
$16.10
|
| Rate for Payer: Devoted Health Medicare |
$4.14
|
| Rate for Payer: Humana of AZ Medicare |
$3.68
|
| Rate for Payer: Southwest Service Administrators UFCW |
$15.64
|
| Rate for Payer: TriWest Medicare |
$3.68
|
| Rate for Payer: United Healthcare Commercial |
$13.16
|
| Rate for Payer: United Healthcare Medicare |
$3.68
|
| Rate for Payer: Veterans Affairs TRICARE |
$3.64
|
|
|
DRY BUBBLE HUMIDIFIER
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
24153386
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna of AZ Commercial |
$20.70
|
| Rate for Payer: Cash Price |
$18.40
|
|
|
DRYLINE WATER TRAP ADULT/PEDIATRIC
|
Facility
|
OP
|
$156.00
|
|
| Hospital Charge Code |
24157851
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$24.96
|
| Rate for Payer: Banner UC Health Medicare |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$106.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$24.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$24.96
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna of AZ Commercial |
$109.20
|
| Rate for Payer: Devoted Health Medicare |
$28.08
|
| Rate for Payer: Humana of AZ Medicare |
$24.96
|
| Rate for Payer: Southwest Service Administrators UFCW |
$106.08
|
| Rate for Payer: TriWest Medicare |
$24.96
|
| Rate for Payer: United Healthcare Commercial |
$89.23
|
| Rate for Payer: United Healthcare Medicare |
$24.96
|
| Rate for Payer: Veterans Affairs TRICARE |
$24.71
|
|
