|
Infections Of Upper Respiratory Tract
|
Facility
|
IP
|
$2,419.13
|
|
|
Service Code
|
APR-DRG 1131
|
| Hospital Charge Code |
APRDRG1134
|
| Min. Negotiated Rate |
$2,419.13 |
| Max. Negotiated Rate |
$2,419.13 |
| Rate for Payer: AHCCCS Medicaid |
$2,419.13
|
| Rate for Payer: Allwell Medicaid |
$2,419.13
|
| Rate for Payer: AZCH Complete Medicaid |
$2,419.13
|
| Rate for Payer: Banner UC Health Medicaid |
$2,419.13
|
| Rate for Payer: Mercy Care Medicaid |
$2,419.13
|
|
|
Infections Of Upper Respiratory Tract
|
Facility
|
IP
|
$3,359.71
|
|
|
Service Code
|
APR-DRG 1132
|
| Hospital Charge Code |
APRDRG1131
|
| Min. Negotiated Rate |
$3,359.71 |
| Max. Negotiated Rate |
$3,359.71 |
| Rate for Payer: AHCCCS Medicaid |
$3,359.71
|
| Rate for Payer: Allwell Medicaid |
$3,359.71
|
| Rate for Payer: AZCH Complete Medicaid |
$3,359.71
|
| Rate for Payer: Banner UC Health Medicaid |
$3,359.71
|
| Rate for Payer: Mercy Care Medicaid |
$3,359.71
|
|
|
Infections Of Upper Respiratory Tract
|
Facility
|
IP
|
$3,359.71
|
|
|
Service Code
|
APR-DRG 1132
|
| Hospital Charge Code |
APRDRG1134
|
| Min. Negotiated Rate |
$3,359.71 |
| Max. Negotiated Rate |
$3,359.71 |
| Rate for Payer: AHCCCS Medicaid |
$3,359.71
|
| Rate for Payer: Allwell Medicaid |
$3,359.71
|
| Rate for Payer: AZCH Complete Medicaid |
$3,359.71
|
| Rate for Payer: Banner UC Health Medicaid |
$3,359.71
|
| Rate for Payer: Mercy Care Medicaid |
$3,359.71
|
|
|
Infections Of Upper Respiratory Tract
|
Facility
|
IP
|
$2,419.13
|
|
|
Service Code
|
APR-DRG 1131
|
| Hospital Charge Code |
APRDRG1131
|
| Min. Negotiated Rate |
$2,419.13 |
| Max. Negotiated Rate |
$2,419.13 |
| Rate for Payer: AHCCCS Medicaid |
$2,419.13
|
| Rate for Payer: Allwell Medicaid |
$2,419.13
|
| Rate for Payer: AZCH Complete Medicaid |
$2,419.13
|
| Rate for Payer: Banner UC Health Medicaid |
$2,419.13
|
| Rate for Payer: Mercy Care Medicaid |
$2,419.13
|
|
|
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA)
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
23934513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.54 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of AZ Commercial |
$251.10
|
| Rate for Payer: Bisbee Police All Plans |
$72.54
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Self Pay Self Pay |
$223.20
|
|
|
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA)
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
23934513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna of AZ Commercial |
$251.10
|
| Rate for Payer: Aetna of AZ Medicare |
$78.12
|
| Rate for Payer: AHCCCS Medicaid |
$51.31
|
| Rate for Payer: Allwell Medicaid |
$51.31
|
| Rate for Payer: Allwell Medicare |
$41.85
|
| Rate for Payer: Amerigroup Medicare |
$41.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$104.21
|
| Rate for Payer: AZCH Complete Medicaid |
$51.31
|
| Rate for Payer: AZCH Complete Medicare |
$41.85
|
| Rate for Payer: Banner UC Health Medicaid |
$51.31
|
| Rate for Payer: Banner UC Health Medicare |
$41.85
|
| Rate for Payer: Bisbee Police All Plans |
$72.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$189.72
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cigna of AZ Commercial |
$181.35
|
| Rate for Payer: Copperpoint Commercial |
$69.05
|
| Rate for Payer: Health Net of AZ Commercial |
$167.40
|
| Rate for Payer: Health Net of AZ Medicare |
$78.12
|
| Rate for Payer: Humana of AZ Medicare |
$41.85
|
| Rate for Payer: Mercy Care Medicaid |
$51.31
|
| Rate for Payer: Self Pay Self Pay |
$223.20
|
| Rate for Payer: TriWest Medicare |
$41.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$162.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$50.22
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$17,367.37
|
|
|
Service Code
|
APR-DRG 7103
|
| Hospital Charge Code |
APRDRG7102
|
| Min. Negotiated Rate |
$17,367.37 |
| Max. Negotiated Rate |
$17,367.37 |
| Rate for Payer: AHCCCS Medicaid |
$17,367.37
|
| Rate for Payer: Allwell Medicaid |
$17,367.37
|
| Rate for Payer: AZCH Complete Medicaid |
$17,367.37
|
| Rate for Payer: Banner UC Health Medicaid |
$17,367.37
|
| Rate for Payer: Mercy Care Medicaid |
$17,367.37
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$7,378.73
|
|
|
Service Code
|
APR-DRG 7101
|
| Hospital Charge Code |
APRDRG7104
|
| Min. Negotiated Rate |
$7,378.73 |
| Max. Negotiated Rate |
$7,378.73 |
| Rate for Payer: AHCCCS Medicaid |
$7,378.73
|
| Rate for Payer: Allwell Medicaid |
$7,378.73
|
| Rate for Payer: AZCH Complete Medicaid |
$7,378.73
|
| Rate for Payer: Banner UC Health Medicaid |
$7,378.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,378.73
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$10,647.95
|
|
|
Service Code
|
APR-DRG 7102
|
| Hospital Charge Code |
APRDRG7104
|
| Min. Negotiated Rate |
$10,647.95 |
| Max. Negotiated Rate |
$10,647.95 |
| Rate for Payer: AHCCCS Medicaid |
$10,647.95
|
| Rate for Payer: Allwell Medicaid |
$10,647.95
|
| Rate for Payer: AZCH Complete Medicaid |
$10,647.95
|
| Rate for Payer: Banner UC Health Medicaid |
$10,647.95
|
| Rate for Payer: Mercy Care Medicaid |
$10,647.95
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$10,647.95
|
|
|
Service Code
|
APR-DRG 7102
|
| Hospital Charge Code |
APRDRG7102
|
| Min. Negotiated Rate |
$10,647.95 |
| Max. Negotiated Rate |
$10,647.95 |
| Rate for Payer: AHCCCS Medicaid |
$10,647.95
|
| Rate for Payer: Allwell Medicaid |
$10,647.95
|
| Rate for Payer: AZCH Complete Medicaid |
$10,647.95
|
| Rate for Payer: Banner UC Health Medicaid |
$10,647.95
|
| Rate for Payer: Mercy Care Medicaid |
$10,647.95
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$10,647.95
|
|
|
Service Code
|
APR-DRG 7102
|
| Hospital Charge Code |
APRDRG7101
|
| Min. Negotiated Rate |
$10,647.95 |
| Max. Negotiated Rate |
$10,647.95 |
| Rate for Payer: AHCCCS Medicaid |
$10,647.95
|
| Rate for Payer: Allwell Medicaid |
$10,647.95
|
| Rate for Payer: AZCH Complete Medicaid |
$10,647.95
|
| Rate for Payer: Banner UC Health Medicaid |
$10,647.95
|
| Rate for Payer: Mercy Care Medicaid |
$10,647.95
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$17,367.37
|
|
|
Service Code
|
APR-DRG 7103
|
| Hospital Charge Code |
APRDRG7101
|
| Min. Negotiated Rate |
$17,367.37 |
| Max. Negotiated Rate |
$17,367.37 |
| Rate for Payer: AHCCCS Medicaid |
$17,367.37
|
| Rate for Payer: Allwell Medicaid |
$17,367.37
|
| Rate for Payer: AZCH Complete Medicaid |
$17,367.37
|
| Rate for Payer: Banner UC Health Medicaid |
$17,367.37
|
| Rate for Payer: Mercy Care Medicaid |
$17,367.37
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$33,463.79
|
|
|
Service Code
|
APR-DRG 7104
|
| Hospital Charge Code |
APRDRG7104
|
| Min. Negotiated Rate |
$33,463.79 |
| Max. Negotiated Rate |
$33,463.79 |
| Rate for Payer: AHCCCS Medicaid |
$33,463.79
|
| Rate for Payer: Allwell Medicaid |
$33,463.79
|
| Rate for Payer: AZCH Complete Medicaid |
$33,463.79
|
| Rate for Payer: Banner UC Health Medicaid |
$33,463.79
|
| Rate for Payer: Mercy Care Medicaid |
$33,463.79
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$17,367.37
|
|
|
Service Code
|
APR-DRG 7103
|
| Hospital Charge Code |
APRDRG7104
|
| Min. Negotiated Rate |
$17,367.37 |
| Max. Negotiated Rate |
$17,367.37 |
| Rate for Payer: AHCCCS Medicaid |
$17,367.37
|
| Rate for Payer: Allwell Medicaid |
$17,367.37
|
| Rate for Payer: AZCH Complete Medicaid |
$17,367.37
|
| Rate for Payer: Banner UC Health Medicaid |
$17,367.37
|
| Rate for Payer: Mercy Care Medicaid |
$17,367.37
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$33,463.79
|
|
|
Service Code
|
APR-DRG 7104
|
| Hospital Charge Code |
APRDRG7101
|
| Min. Negotiated Rate |
$33,463.79 |
| Max. Negotiated Rate |
$33,463.79 |
| Rate for Payer: AHCCCS Medicaid |
$33,463.79
|
| Rate for Payer: Allwell Medicaid |
$33,463.79
|
| Rate for Payer: AZCH Complete Medicaid |
$33,463.79
|
| Rate for Payer: Banner UC Health Medicaid |
$33,463.79
|
| Rate for Payer: Mercy Care Medicaid |
$33,463.79
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$33,463.79
|
|
|
Service Code
|
APR-DRG 7104
|
| Hospital Charge Code |
APRDRG7102
|
| Min. Negotiated Rate |
$33,463.79 |
| Max. Negotiated Rate |
$33,463.79 |
| Rate for Payer: AHCCCS Medicaid |
$33,463.79
|
| Rate for Payer: Allwell Medicaid |
$33,463.79
|
| Rate for Payer: AZCH Complete Medicaid |
$33,463.79
|
| Rate for Payer: Banner UC Health Medicaid |
$33,463.79
|
| Rate for Payer: Mercy Care Medicaid |
$33,463.79
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$17,367.37
|
|
|
Service Code
|
APR-DRG 7103
|
| Hospital Charge Code |
APRDRG7103
|
| Min. Negotiated Rate |
$17,367.37 |
| Max. Negotiated Rate |
$17,367.37 |
| Rate for Payer: AHCCCS Medicaid |
$17,367.37
|
| Rate for Payer: Allwell Medicaid |
$17,367.37
|
| Rate for Payer: AZCH Complete Medicaid |
$17,367.37
|
| Rate for Payer: Banner UC Health Medicaid |
$17,367.37
|
| Rate for Payer: Mercy Care Medicaid |
$17,367.37
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$7,378.73
|
|
|
Service Code
|
APR-DRG 7101
|
| Hospital Charge Code |
APRDRG7103
|
| Min. Negotiated Rate |
$7,378.73 |
| Max. Negotiated Rate |
$7,378.73 |
| Rate for Payer: AHCCCS Medicaid |
$7,378.73
|
| Rate for Payer: Allwell Medicaid |
$7,378.73
|
| Rate for Payer: AZCH Complete Medicaid |
$7,378.73
|
| Rate for Payer: Banner UC Health Medicaid |
$7,378.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,378.73
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$33,463.79
|
|
|
Service Code
|
APR-DRG 7104
|
| Hospital Charge Code |
APRDRG7103
|
| Min. Negotiated Rate |
$33,463.79 |
| Max. Negotiated Rate |
$33,463.79 |
| Rate for Payer: AHCCCS Medicaid |
$33,463.79
|
| Rate for Payer: Allwell Medicaid |
$33,463.79
|
| Rate for Payer: AZCH Complete Medicaid |
$33,463.79
|
| Rate for Payer: Banner UC Health Medicaid |
$33,463.79
|
| Rate for Payer: Mercy Care Medicaid |
$33,463.79
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$7,378.73
|
|
|
Service Code
|
APR-DRG 7101
|
| Hospital Charge Code |
APRDRG7102
|
| Min. Negotiated Rate |
$7,378.73 |
| Max. Negotiated Rate |
$7,378.73 |
| Rate for Payer: AHCCCS Medicaid |
$7,378.73
|
| Rate for Payer: Allwell Medicaid |
$7,378.73
|
| Rate for Payer: AZCH Complete Medicaid |
$7,378.73
|
| Rate for Payer: Banner UC Health Medicaid |
$7,378.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,378.73
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$10,647.95
|
|
|
Service Code
|
APR-DRG 7102
|
| Hospital Charge Code |
APRDRG7103
|
| Min. Negotiated Rate |
$10,647.95 |
| Max. Negotiated Rate |
$10,647.95 |
| Rate for Payer: AHCCCS Medicaid |
$10,647.95
|
| Rate for Payer: Allwell Medicaid |
$10,647.95
|
| Rate for Payer: AZCH Complete Medicaid |
$10,647.95
|
| Rate for Payer: Banner UC Health Medicaid |
$10,647.95
|
| Rate for Payer: Mercy Care Medicaid |
$10,647.95
|
|
|
Infectious And Parasitic Diseases Including Hiv With O.R. Procedure
|
Facility
|
IP
|
$7,378.73
|
|
|
Service Code
|
APR-DRG 7101
|
| Hospital Charge Code |
APRDRG7101
|
| Min. Negotiated Rate |
$7,378.73 |
| Max. Negotiated Rate |
$7,378.73 |
| Rate for Payer: AHCCCS Medicaid |
$7,378.73
|
| Rate for Payer: Allwell Medicaid |
$7,378.73
|
| Rate for Payer: AZCH Complete Medicaid |
$7,378.73
|
| Rate for Payer: Banner UC Health Medicaid |
$7,378.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,378.73
|
|
|
Infectious disease, chronic hepatitis C virus (HCV) infectio
|
Facility
|
IP
|
$1,736.00
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
23599256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$451.36 |
| Max. Negotiated Rate |
$1,562.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,562.40
|
| Rate for Payer: Bisbee Police All Plans |
$451.36
|
| Rate for Payer: Cash Price |
$1,388.80
|
| Rate for Payer: Self Pay Self Pay |
$1,388.80
|
|
|
Infectious disease, chronic hepatitis C virus (HCV) infectio
|
Facility
|
OP
|
$1,736.00
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
23599256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$1,562.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,562.40
|
| Rate for Payer: Aetna of AZ Medicare |
$486.08
|
| Rate for Payer: AHCCCS Medicaid |
$72.19
|
| Rate for Payer: Allwell Medicaid |
$72.19
|
| Rate for Payer: Allwell Medicare |
$260.40
|
| Rate for Payer: Amerigroup Medicare |
$260.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$648.40
|
| Rate for Payer: AZCH Complete Medicaid |
$72.19
|
| Rate for Payer: AZCH Complete Medicare |
$260.40
|
| Rate for Payer: Banner UC Health Medicaid |
$72.19
|
| Rate for Payer: Banner UC Health Medicare |
$260.40
|
| Rate for Payer: Bisbee Police All Plans |
$451.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,180.48
|
| Rate for Payer: Cash Price |
$1,388.80
|
| Rate for Payer: Cash Price |
$1,388.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,128.40
|
| Rate for Payer: Copperpoint Commercial |
$429.66
|
| Rate for Payer: Health Net of AZ Commercial |
$1,041.60
|
| Rate for Payer: Health Net of AZ Medicare |
$486.08
|
| Rate for Payer: Humana of AZ Medicare |
$260.40
|
| Rate for Payer: Mercy Care Medicaid |
$72.19
|
| Rate for Payer: Self Pay Self Pay |
$1,388.80
|
| Rate for Payer: TriWest Medicare |
$260.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,012.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$312.48
|
|
|
Inflammatory Bowel Disease
|
Facility
|
IP
|
$3,807.20
|
|
|
Service Code
|
APR-DRG 2451
|
| Hospital Charge Code |
APRDRG2453
|
| Min. Negotiated Rate |
$3,807.20 |
| Max. Negotiated Rate |
$3,807.20 |
| Rate for Payer: AHCCCS Medicaid |
$3,807.20
|
| Rate for Payer: Allwell Medicaid |
$3,807.20
|
| Rate for Payer: AZCH Complete Medicaid |
$3,807.20
|
| Rate for Payer: Banner UC Health Medicaid |
$3,807.20
|
| Rate for Payer: Mercy Care Medicaid |
$3,807.20
|
|
