Inborn Errors Of Metabolism
|
Facility
|
IP
|
$8,634.23
|
|
Service Code
|
APR-DRG 4233
|
Hospital Charge Code |
APRDRG4232
|
Min. Negotiated Rate |
$8,634.23 |
Max. Negotiated Rate |
$8,634.23 |
Rate for Payer: AHCCCS Medicaid |
$8,634.23
|
Rate for Payer: Allwell Medicaid |
$8,634.23
|
Rate for Payer: AZCH Complete Medicaid |
$8,634.23
|
Rate for Payer: Banner UC Health Medicaid |
$8,634.23
|
Rate for Payer: Mercy Care Medicaid |
$8,634.23
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$20,239.60
|
|
Service Code
|
APR-DRG 4234
|
Hospital Charge Code |
APRDRG4233
|
Min. Negotiated Rate |
$20,239.60 |
Max. Negotiated Rate |
$20,239.60 |
Rate for Payer: AHCCCS Medicaid |
$20,239.60
|
Rate for Payer: Allwell Medicaid |
$20,239.60
|
Rate for Payer: AZCH Complete Medicaid |
$20,239.60
|
Rate for Payer: Banner UC Health Medicaid |
$20,239.60
|
Rate for Payer: Mercy Care Medicaid |
$20,239.60
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$20,239.60
|
|
Service Code
|
APR-DRG 4234
|
Hospital Charge Code |
APRDRG4232
|
Min. Negotiated Rate |
$20,239.60 |
Max. Negotiated Rate |
$20,239.60 |
Rate for Payer: AHCCCS Medicaid |
$20,239.60
|
Rate for Payer: Allwell Medicaid |
$20,239.60
|
Rate for Payer: AZCH Complete Medicaid |
$20,239.60
|
Rate for Payer: Banner UC Health Medicaid |
$20,239.60
|
Rate for Payer: Mercy Care Medicaid |
$20,239.60
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$5,705.19
|
|
Service Code
|
APR-DRG 4232
|
Hospital Charge Code |
APRDRG4233
|
Min. Negotiated Rate |
$5,705.19 |
Max. Negotiated Rate |
$5,705.19 |
Rate for Payer: AHCCCS Medicaid |
$5,705.19
|
Rate for Payer: Allwell Medicaid |
$5,705.19
|
Rate for Payer: AZCH Complete Medicaid |
$5,705.19
|
Rate for Payer: Banner UC Health Medicaid |
$5,705.19
|
Rate for Payer: Mercy Care Medicaid |
$5,705.19
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$3,920.83
|
|
Service Code
|
APR-DRG 4231
|
Hospital Charge Code |
APRDRG4231
|
Min. Negotiated Rate |
$3,920.83 |
Max. Negotiated Rate |
$3,920.83 |
Rate for Payer: AHCCCS Medicaid |
$3,920.83
|
Rate for Payer: Allwell Medicaid |
$3,920.83
|
Rate for Payer: AZCH Complete Medicaid |
$3,920.83
|
Rate for Payer: Banner UC Health Medicaid |
$3,920.83
|
Rate for Payer: Mercy Care Medicaid |
$3,920.83
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$3,920.83
|
|
Service Code
|
APR-DRG 4231
|
Hospital Charge Code |
APRDRG4232
|
Min. Negotiated Rate |
$3,920.83 |
Max. Negotiated Rate |
$3,920.83 |
Rate for Payer: AHCCCS Medicaid |
$3,920.83
|
Rate for Payer: Allwell Medicaid |
$3,920.83
|
Rate for Payer: AZCH Complete Medicaid |
$3,920.83
|
Rate for Payer: Banner UC Health Medicaid |
$3,920.83
|
Rate for Payer: Mercy Care Medicaid |
$3,920.83
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$5,705.19
|
|
Service Code
|
APR-DRG 4232
|
Hospital Charge Code |
APRDRG4234
|
Min. Negotiated Rate |
$5,705.19 |
Max. Negotiated Rate |
$5,705.19 |
Rate for Payer: AHCCCS Medicaid |
$5,705.19
|
Rate for Payer: Allwell Medicaid |
$5,705.19
|
Rate for Payer: AZCH Complete Medicaid |
$5,705.19
|
Rate for Payer: Banner UC Health Medicaid |
$5,705.19
|
Rate for Payer: Mercy Care Medicaid |
$5,705.19
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$8,634.23
|
|
Service Code
|
APR-DRG 4233
|
Hospital Charge Code |
APRDRG4233
|
Min. Negotiated Rate |
$8,634.23 |
Max. Negotiated Rate |
$8,634.23 |
Rate for Payer: AHCCCS Medicaid |
$8,634.23
|
Rate for Payer: Allwell Medicaid |
$8,634.23
|
Rate for Payer: AZCH Complete Medicaid |
$8,634.23
|
Rate for Payer: Banner UC Health Medicaid |
$8,634.23
|
Rate for Payer: Mercy Care Medicaid |
$8,634.23
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$20,239.60
|
|
Service Code
|
APR-DRG 4234
|
Hospital Charge Code |
APRDRG4231
|
Min. Negotiated Rate |
$20,239.60 |
Max. Negotiated Rate |
$20,239.60 |
Rate for Payer: AHCCCS Medicaid |
$20,239.60
|
Rate for Payer: Allwell Medicaid |
$20,239.60
|
Rate for Payer: AZCH Complete Medicaid |
$20,239.60
|
Rate for Payer: Banner UC Health Medicaid |
$20,239.60
|
Rate for Payer: Mercy Care Medicaid |
$20,239.60
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$20,239.60
|
|
Service Code
|
APR-DRG 4234
|
Hospital Charge Code |
APRDRG4234
|
Min. Negotiated Rate |
$20,239.60 |
Max. Negotiated Rate |
$20,239.60 |
Rate for Payer: AHCCCS Medicaid |
$20,239.60
|
Rate for Payer: Allwell Medicaid |
$20,239.60
|
Rate for Payer: AZCH Complete Medicaid |
$20,239.60
|
Rate for Payer: Banner UC Health Medicaid |
$20,239.60
|
Rate for Payer: Mercy Care Medicaid |
$20,239.60
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$3,920.83
|
|
Service Code
|
APR-DRG 4231
|
Hospital Charge Code |
APRDRG4234
|
Min. Negotiated Rate |
$3,920.83 |
Max. Negotiated Rate |
$3,920.83 |
Rate for Payer: AHCCCS Medicaid |
$3,920.83
|
Rate for Payer: Allwell Medicaid |
$3,920.83
|
Rate for Payer: AZCH Complete Medicaid |
$3,920.83
|
Rate for Payer: Banner UC Health Medicaid |
$3,920.83
|
Rate for Payer: Mercy Care Medicaid |
$3,920.83
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$8,634.23
|
|
Service Code
|
APR-DRG 4233
|
Hospital Charge Code |
APRDRG4234
|
Min. Negotiated Rate |
$8,634.23 |
Max. Negotiated Rate |
$8,634.23 |
Rate for Payer: AHCCCS Medicaid |
$8,634.23
|
Rate for Payer: Allwell Medicaid |
$8,634.23
|
Rate for Payer: AZCH Complete Medicaid |
$8,634.23
|
Rate for Payer: Banner UC Health Medicaid |
$8,634.23
|
Rate for Payer: Mercy Care Medicaid |
$8,634.23
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$5,705.19
|
|
Service Code
|
APR-DRG 4232
|
Hospital Charge Code |
APRDRG4232
|
Min. Negotiated Rate |
$5,705.19 |
Max. Negotiated Rate |
$5,705.19 |
Rate for Payer: AHCCCS Medicaid |
$5,705.19
|
Rate for Payer: Allwell Medicaid |
$5,705.19
|
Rate for Payer: AZCH Complete Medicaid |
$5,705.19
|
Rate for Payer: Banner UC Health Medicaid |
$5,705.19
|
Rate for Payer: Mercy Care Medicaid |
$5,705.19
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$3,920.83
|
|
Service Code
|
APR-DRG 4231
|
Hospital Charge Code |
APRDRG4233
|
Min. Negotiated Rate |
$3,920.83 |
Max. Negotiated Rate |
$3,920.83 |
Rate for Payer: AHCCCS Medicaid |
$3,920.83
|
Rate for Payer: Allwell Medicaid |
$3,920.83
|
Rate for Payer: AZCH Complete Medicaid |
$3,920.83
|
Rate for Payer: Banner UC Health Medicaid |
$3,920.83
|
Rate for Payer: Mercy Care Medicaid |
$3,920.83
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$5,705.19
|
|
Service Code
|
APR-DRG 4232
|
Hospital Charge Code |
APRDRG4231
|
Min. Negotiated Rate |
$5,705.19 |
Max. Negotiated Rate |
$5,705.19 |
Rate for Payer: AHCCCS Medicaid |
$5,705.19
|
Rate for Payer: Allwell Medicaid |
$5,705.19
|
Rate for Payer: AZCH Complete Medicaid |
$5,705.19
|
Rate for Payer: Banner UC Health Medicaid |
$5,705.19
|
Rate for Payer: Mercy Care Medicaid |
$5,705.19
|
|
Inborn Errors Of Metabolism
|
Facility
|
IP
|
$8,634.23
|
|
Service Code
|
APR-DRG 4233
|
Hospital Charge Code |
APRDRG4231
|
Min. Negotiated Rate |
$8,634.23 |
Max. Negotiated Rate |
$8,634.23 |
Rate for Payer: AHCCCS Medicaid |
$8,634.23
|
Rate for Payer: Allwell Medicaid |
$8,634.23
|
Rate for Payer: AZCH Complete Medicaid |
$8,634.23
|
Rate for Payer: Banner UC Health Medicaid |
$8,634.23
|
Rate for Payer: Mercy Care Medicaid |
$8,634.23
|
|
INCENTIVE SPIROMTRY
|
Facility
|
IP
|
$83.00
|
|
Service Code
|
CPT 94010
|
Hospital Charge Code |
1886937
|
Hospital Revenue Code
|
412
|
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
|
|
INCENTIVE SPIROMTRY
|
Facility
|
OP
|
$83.00
|
|
Service Code
|
CPT 94010
|
Hospital Charge Code |
1886937
|
Hospital Revenue Code
|
412
|
Min. Negotiated Rate |
$12.45 |
Max. Negotiated Rate |
$202.34 |
Rate for Payer: Aetna of AZ Commercial |
$74.70
|
Rate for Payer: Aetna of AZ Medicare |
$23.24
|
Rate for Payer: AHCCCS Medicaid |
$202.34
|
Rate for Payer: Allwell Medicaid |
$202.34
|
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 |
$202.34
|
Rate for Payer: AZCH Complete Medicare |
$12.45
|
Rate for Payer: Banner UC Health Medicaid |
$202.34
|
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 |
$58.10
|
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 |
$202.34
|
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
|
|
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE
|
Facility
|
OP
|
$874.00
|
|
Service Code
|
CPT 10061
|
Hospital Charge Code |
24049283
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$131.10 |
Max. Negotiated Rate |
$2,161.00 |
Rate for Payer: Aetna of AZ Commercial |
$786.60
|
Rate for Payer: Aetna of AZ Medicare |
$244.72
|
Rate for Payer: AHCCCS Medicaid |
$501.46
|
Rate for Payer: Allwell Medicaid |
$501.46
|
Rate for Payer: Allwell Medicare |
$131.10
|
Rate for Payer: Amerigroup Medicare |
$131.10
|
Rate for Payer: APIPA Medicare/Medicaid |
$326.44
|
Rate for Payer: AZCH Complete Medicaid |
$501.46
|
Rate for Payer: AZCH Complete Medicare |
$131.10
|
Rate for Payer: Banner UC Health Medicaid |
$501.46
|
Rate for Payer: Banner UC Health Medicare |
$131.10
|
Rate for Payer: Bisbee Police All Plans |
$227.24
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$594.32
|
Rate for Payer: Cash Price |
$699.20
|
Rate for Payer: Cash Price |
$699.20
|
Rate for Payer: Cigna of AZ Commercial |
$437.00
|
Rate for Payer: Copperpoint Commercial |
$216.32
|
Rate for Payer: Health Net of AZ Commercial |
$524.40
|
Rate for Payer: Health Net of AZ Medicare |
$244.72
|
Rate for Payer: Humana of AZ Medicare |
$131.10
|
Rate for Payer: Mercy Care Medicaid |
$501.46
|
Rate for Payer: Self Pay Self Pay |
$699.20
|
Rate for Payer: TriWest Medicare |
$131.10
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$157.32
|
|
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE
|
Facility
|
IP
|
$874.00
|
|
Service Code
|
CPT 10061
|
Hospital Charge Code |
24049283
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$227.24 |
Max. Negotiated Rate |
$786.60 |
Rate for Payer: Aetna of AZ Commercial |
$786.60
|
Rate for Payer: Bisbee Police All Plans |
$227.24
|
Rate for Payer: Cash Price |
$699.20
|
Rate for Payer: Self Pay Self Pay |
$699.20
|
|
INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSCESS
|
Facility
|
OP
|
$694.00
|
|
Service Code
|
CPT 56420
|
Hospital Charge Code |
23008149
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$104.10 |
Max. Negotiated Rate |
$2,161.00 |
Rate for Payer: Aetna of AZ Commercial |
$624.60
|
Rate for Payer: Aetna of AZ Medicare |
$194.32
|
Rate for Payer: AHCCCS Medicaid |
$246.96
|
Rate for Payer: Allwell Medicaid |
$246.96
|
Rate for Payer: Allwell Medicare |
$104.10
|
Rate for Payer: Amerigroup Medicare |
$104.10
|
Rate for Payer: APIPA Medicare/Medicaid |
$259.21
|
Rate for Payer: AZCH Complete Medicaid |
$246.96
|
Rate for Payer: AZCH Complete Medicare |
$104.10
|
Rate for Payer: Banner UC Health Medicaid |
$246.96
|
Rate for Payer: Banner UC Health Medicare |
$104.10
|
Rate for Payer: Bisbee Police All Plans |
$180.44
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$471.92
|
Rate for Payer: Cash Price |
$555.20
|
Rate for Payer: Cash Price |
$555.20
|
Rate for Payer: Cigna of AZ Commercial |
$347.00
|
Rate for Payer: Copperpoint Commercial |
$171.76
|
Rate for Payer: Health Net of AZ Commercial |
$416.40
|
Rate for Payer: Health Net of AZ Medicare |
$194.32
|
Rate for Payer: Humana of AZ Medicare |
$104.10
|
Rate for Payer: Mercy Care Medicaid |
$246.96
|
Rate for Payer: Self Pay Self Pay |
$555.20
|
Rate for Payer: TriWest Medicare |
$104.10
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$124.92
|
|
INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSCESS
|
Facility
|
IP
|
$694.00
|
|
Service Code
|
CPT 56420
|
Hospital Charge Code |
23008149
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$180.44 |
Max. Negotiated Rate |
$624.60 |
Rate for Payer: Aetna of AZ Commercial |
$624.60
|
Rate for Payer: Bisbee Police All Plans |
$180.44
|
Rate for Payer: Cash Price |
$555.20
|
Rate for Payer: Self Pay Self Pay |
$555.20
|
|
INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES;
|
Facility
|
IP
|
$901.00
|
|
Service Code
|
CPT 10121
|
Hospital Charge Code |
24049284
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$234.26 |
Max. Negotiated Rate |
$810.90 |
Rate for Payer: Aetna of AZ Commercial |
$810.90
|
Rate for Payer: Bisbee Police All Plans |
$234.26
|
Rate for Payer: Cash Price |
$720.80
|
Rate for Payer: Self Pay Self Pay |
$720.80
|
|
INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES;
|
Facility
|
OP
|
$901.00
|
|
Service Code
|
CPT 10121
|
Hospital Charge Code |
24049284
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$135.15 |
Max. Negotiated Rate |
$2,909.00 |
Rate for Payer: Aetna of AZ Commercial |
$810.90
|
Rate for Payer: Aetna of AZ Medicare |
$252.28
|
Rate for Payer: AHCCCS Medicaid |
$2,040.16
|
Rate for Payer: Allwell Medicaid |
$2,040.16
|
Rate for Payer: Allwell Medicare |
$135.15
|
Rate for Payer: Amerigroup Medicare |
$135.15
|
Rate for Payer: APIPA Medicare/Medicaid |
$336.52
|
Rate for Payer: AZCH Complete Medicaid |
$2,040.16
|
Rate for Payer: AZCH Complete Medicare |
$135.15
|
Rate for Payer: Banner UC Health Medicaid |
$2,040.16
|
Rate for Payer: Banner UC Health Medicare |
$135.15
|
Rate for Payer: Bisbee Police All Plans |
$234.26
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$612.68
|
Rate for Payer: Cash Price |
$720.80
|
Rate for Payer: Cash Price |
$720.80
|
Rate for Payer: Cigna of AZ Commercial |
$450.50
|
Rate for Payer: Copperpoint Commercial |
$223.00
|
Rate for Payer: Health Net of AZ Commercial |
$540.60
|
Rate for Payer: Health Net of AZ Medicare |
$252.28
|
Rate for Payer: Humana of AZ Medicare |
$135.15
|
Rate for Payer: Mercy Care Medicaid |
$2,040.16
|
Rate for Payer: Self Pay Self Pay |
$720.80
|
Rate for Payer: TriWest Medicare |
$135.15
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$162.18
|
|
inclisiran 284 mg/1.5 mL Sol[CQCH]
|
Facility
|
IP
|
$2,254.28
|
|
Service Code
|
HCPCS J1306
|
Hospital Charge Code |
242946825
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$586.11 |
Max. Negotiated Rate |
$2,028.85 |
Rate for Payer: Aetna of AZ Commercial |
$2,028.85
|
Rate for Payer: Bisbee Police All Plans |
$586.11
|
Rate for Payer: Cash Price |
$1,803.42
|
Rate for Payer: Self Pay Self Pay |
$1,803.42
|
|