|
Pneumococcal IM (14 Serotype) LC
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
22311203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of AZ Commercial |
$65.70
|
| Rate for Payer: Bisbee Police All Plans |
$18.98
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Self Pay Self Pay |
$58.40
|
|
|
Pneumococcal IM (14 Serotype) LC
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
22311203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of AZ Commercial |
$65.70
|
| Rate for Payer: Aetna of AZ Medicare |
$20.44
|
| Rate for Payer: AHCCCS Medicaid |
$14.99
|
| Rate for Payer: Allwell Medicaid |
$14.99
|
| Rate for Payer: Allwell Medicare |
$10.95
|
| Rate for Payer: Amerigroup Medicare |
$10.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$27.27
|
| Rate for Payer: AZCH Complete Medicaid |
$14.99
|
| Rate for Payer: AZCH Complete Medicare |
$10.95
|
| Rate for Payer: Banner UC Health Medicaid |
$14.99
|
| Rate for Payer: Banner UC Health Medicare |
$10.95
|
| Rate for Payer: Bisbee Police All Plans |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$49.64
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cigna of AZ Commercial |
$47.45
|
| Rate for Payer: Copperpoint Commercial |
$18.07
|
| Rate for Payer: Health Net of AZ Commercial |
$43.80
|
| Rate for Payer: Health Net of AZ Medicare |
$20.44
|
| Rate for Payer: Humana of AZ Medicare |
$10.95
|
| Rate for Payer: Mercy Care Medicaid |
$14.99
|
| Rate for Payer: Self Pay Self Pay |
$58.40
|
| Rate for Payer: TriWest Medicare |
$10.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$42.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.14
|
|
|
PNT 1002836 Drug Screen 10 w/ confirmation
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
23090932
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna of AZ Commercial |
$253.80
|
| Rate for Payer: Aetna of AZ Medicare |
$78.96
|
| Rate for Payer: AHCCCS Medicaid |
$62.14
|
| Rate for Payer: Allwell Medicaid |
$62.14
|
| Rate for Payer: Allwell Medicare |
$42.30
|
| Rate for Payer: Amerigroup Medicare |
$42.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$105.33
|
| Rate for Payer: AZCH Complete Medicaid |
$62.14
|
| Rate for Payer: AZCH Complete Medicare |
$42.30
|
| Rate for Payer: Banner UC Health Medicaid |
$62.14
|
| Rate for Payer: Banner UC Health Medicare |
$42.30
|
| Rate for Payer: Bisbee Police All Plans |
$73.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$191.76
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna of AZ Commercial |
$183.30
|
| Rate for Payer: Copperpoint Commercial |
$69.80
|
| Rate for Payer: Health Net of AZ Commercial |
$169.20
|
| Rate for Payer: Health Net of AZ Medicare |
$78.96
|
| Rate for Payer: Humana of AZ Medicare |
$42.30
|
| Rate for Payer: Mercy Care Medicaid |
$62.14
|
| Rate for Payer: Self Pay Self Pay |
$225.60
|
| Rate for Payer: TriWest Medicare |
$42.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$164.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$50.76
|
|
|
PNT 1002836 Drug Screen 10 w/ confirmation
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
23090932
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna of AZ Commercial |
$253.80
|
| Rate for Payer: Bisbee Police All Plans |
$73.32
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Self Pay Self Pay |
$225.60
|
|
|
PNT 1007757 C Diff Toxin Gene NAA DPT
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
23090942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of AZ Commercial |
$243.00
|
| Rate for Payer: Aetna of AZ Medicare |
$75.60
|
| Rate for Payer: AHCCCS Medicaid |
$37.27
|
| Rate for Payer: Allwell Medicaid |
$37.27
|
| Rate for Payer: Allwell Medicare |
$40.50
|
| Rate for Payer: Amerigroup Medicare |
$40.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$100.84
|
| Rate for Payer: AZCH Complete Medicaid |
$37.27
|
| Rate for Payer: AZCH Complete Medicare |
$40.50
|
| Rate for Payer: Banner UC Health Medicaid |
$37.27
|
| Rate for Payer: Banner UC Health Medicare |
$40.50
|
| Rate for Payer: Bisbee Police All Plans |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$183.60
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of AZ Commercial |
$175.50
|
| Rate for Payer: Copperpoint Commercial |
$66.82
|
| Rate for Payer: Health Net of AZ Commercial |
$162.00
|
| Rate for Payer: Health Net of AZ Medicare |
$75.60
|
| Rate for Payer: Humana of AZ Medicare |
$40.50
|
| Rate for Payer: Mercy Care Medicaid |
$37.27
|
| Rate for Payer: Self Pay Self Pay |
$216.00
|
| Rate for Payer: TriWest Medicare |
$40.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$157.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.60
|
|
|
PNT 1007757 C Diff Toxin Gene NAA DPT
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
23090942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of AZ Commercial |
$243.00
|
| Rate for Payer: Bisbee Police All Plans |
$70.20
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Self Pay Self Pay |
$216.00
|
|
|
PNT 1011215 Chromium, Unirine
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
23090945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna of AZ Commercial |
$269.10
|
| Rate for Payer: Aetna of AZ Medicare |
$83.72
|
| Rate for Payer: AHCCCS Medicaid |
$20.28
|
| Rate for Payer: Allwell Medicaid |
$20.28
|
| Rate for Payer: Allwell Medicare |
$44.85
|
| Rate for Payer: Amerigroup Medicare |
$44.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$111.68
|
| Rate for Payer: AZCH Complete Medicaid |
$20.28
|
| Rate for Payer: AZCH Complete Medicare |
$44.85
|
| Rate for Payer: Banner UC Health Medicaid |
$20.28
|
| Rate for Payer: Banner UC Health Medicare |
$44.85
|
| Rate for Payer: Bisbee Police All Plans |
$77.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$203.32
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cigna of AZ Commercial |
$194.35
|
| Rate for Payer: Copperpoint Commercial |
$74.00
|
| Rate for Payer: Health Net of AZ Commercial |
$179.40
|
| Rate for Payer: Health Net of AZ Medicare |
$83.72
|
| Rate for Payer: Humana of AZ Medicare |
$44.85
|
| Rate for Payer: Mercy Care Medicaid |
$20.28
|
| Rate for Payer: Self Pay Self Pay |
$239.20
|
| Rate for Payer: TriWest Medicare |
$44.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$174.32
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$53.82
|
|
|
PNT 1011215 Chromium, Unirine
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
23090945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.74 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna of AZ Commercial |
$269.10
|
| Rate for Payer: Bisbee Police All Plans |
$77.74
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Self Pay Self Pay |
$239.20
|
|
|
PNT 1209072 Aspergillus AB
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
23090944
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Aetna of AZ Commercial |
$363.60
|
| Rate for Payer: Aetna of AZ Medicare |
$113.12
|
| Rate for Payer: AHCCCS Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicaid |
$15.05
|
| Rate for Payer: Allwell Medicare |
$60.60
|
| Rate for Payer: Amerigroup Medicare |
$60.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$150.89
|
| Rate for Payer: AZCH Complete Medicaid |
$15.05
|
| Rate for Payer: AZCH Complete Medicare |
$60.60
|
| Rate for Payer: Banner UC Health Medicaid |
$15.05
|
| Rate for Payer: Banner UC Health Medicare |
$60.60
|
| Rate for Payer: Bisbee Police All Plans |
$105.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$274.72
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cigna of AZ Commercial |
$262.60
|
| Rate for Payer: Copperpoint Commercial |
$99.99
|
| Rate for Payer: Health Net of AZ Commercial |
$242.40
|
| Rate for Payer: Health Net of AZ Medicare |
$113.12
|
| Rate for Payer: Humana of AZ Medicare |
$60.60
|
| Rate for Payer: Mercy Care Medicaid |
$15.05
|
| Rate for Payer: Self Pay Self Pay |
$323.20
|
| Rate for Payer: TriWest Medicare |
$60.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$235.53
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$72.72
|
|
|
PNT 1209072 Aspergillus AB
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
23090944
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Aetna of AZ Commercial |
$363.60
|
| Rate for Payer: Bisbee Police All Plans |
$105.04
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Self Pay Self Pay |
$323.20
|
|
|
PNT Coccidiodies Abs IGG/IGM
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
23090943
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of AZ Commercial |
$79.20
|
| Rate for Payer: Aetna of AZ Medicare |
$24.64
|
| Rate for Payer: AHCCCS Medicaid |
$11.47
|
| Rate for Payer: Allwell Medicaid |
$11.47
|
| Rate for Payer: Allwell Medicare |
$13.20
|
| Rate for Payer: Amerigroup Medicare |
$13.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$32.87
|
| Rate for Payer: AZCH Complete Medicaid |
$11.47
|
| Rate for Payer: AZCH Complete Medicare |
$13.20
|
| Rate for Payer: Banner UC Health Medicaid |
$11.47
|
| Rate for Payer: Banner UC Health Medicare |
$13.20
|
| Rate for Payer: Bisbee Police All Plans |
$22.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$59.84
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cigna of AZ Commercial |
$57.20
|
| Rate for Payer: Copperpoint Commercial |
$21.78
|
| Rate for Payer: Health Net of AZ Commercial |
$52.80
|
| Rate for Payer: Health Net of AZ Medicare |
$24.64
|
| Rate for Payer: Humana of AZ Medicare |
$13.20
|
| Rate for Payer: Mercy Care Medicaid |
$11.47
|
| Rate for Payer: Self Pay Self Pay |
$70.40
|
| Rate for Payer: TriWest Medicare |
$13.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$51.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.84
|
|
|
PNT Coccidiodies Abs IGG/IGM
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
23090943
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of AZ Commercial |
$79.20
|
| Rate for Payer: Bisbee Police All Plans |
$22.88
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Self Pay Self Pay |
$70.40
|
|
|
PNT Non-Severe Hemophilia
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 80500
|
| Hospital Charge Code |
23090939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Aetna of AZ Commercial |
$212.40
|
| Rate for Payer: Aetna of AZ Medicare |
$66.08
|
| Rate for Payer: Allwell Medicare |
$35.40
|
| Rate for Payer: Amerigroup Medicare |
$35.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$88.15
|
| Rate for Payer: AZCH Complete Medicare |
$35.40
|
| Rate for Payer: Banner UC Health Medicare |
$35.40
|
| Rate for Payer: Bisbee Police All Plans |
$61.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$160.48
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cigna of AZ Commercial |
$153.40
|
| Rate for Payer: Copperpoint Commercial |
$58.41
|
| Rate for Payer: Health Net of AZ Commercial |
$141.60
|
| Rate for Payer: Health Net of AZ Medicare |
$66.08
|
| Rate for Payer: Humana of AZ Medicare |
$35.40
|
| Rate for Payer: Self Pay Self Pay |
$188.80
|
| Rate for Payer: TriWest Medicare |
$35.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$137.59
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$42.48
|
|
|
PNT Non-Severe Hemophilia
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 80500
|
| Hospital Charge Code |
23090939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.36 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Aetna of AZ Commercial |
$212.40
|
| Rate for Payer: Bisbee Police All Plans |
$61.36
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Self Pay Self Pay |
$188.80
|
|
|
PODIATRY SURGICAL TRAY II STEIRLE
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
24083758
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of AZ Commercial |
$136.80
|
| Rate for Payer: Bisbee Police All Plans |
$39.52
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Self Pay Self Pay |
$121.60
|
|
|
PODIATRY SURGICAL TRAY II STEIRLE
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
24083758
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of AZ Commercial |
$136.80
|
| Rate for Payer: Aetna of AZ Medicare |
$42.56
|
| Rate for Payer: Allwell Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicare |
$22.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$56.77
|
| Rate for Payer: AZCH Complete Medicare |
$22.80
|
| Rate for Payer: Banner UC Health Medicare |
$22.80
|
| Rate for Payer: Bisbee Police All Plans |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$103.36
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cigna of AZ Commercial |
$106.40
|
| Rate for Payer: Copperpoint Commercial |
$37.62
|
| Rate for Payer: Health Net of AZ Commercial |
$91.20
|
| Rate for Payer: Health Net of AZ Medicare |
$42.56
|
| Rate for Payer: Humana of AZ Medicare |
$22.80
|
| Rate for Payer: Self Pay Self Pay |
$121.60
|
| Rate for Payer: TriWest Medicare |
$22.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$88.62
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$27.36
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$3,462.81
|
|
|
Service Code
|
APR-DRG 8122
|
| Hospital Charge Code |
APRDRG8123
|
| Min. Negotiated Rate |
$3,462.81 |
| Max. Negotiated Rate |
$3,462.81 |
| Rate for Payer: AHCCCS Medicaid |
$3,462.81
|
| Rate for Payer: Allwell Medicaid |
$3,462.81
|
| Rate for Payer: AZCH Complete Medicaid |
$3,462.81
|
| Rate for Payer: Banner UC Health Medicaid |
$3,462.81
|
| Rate for Payer: Mercy Care Medicaid |
$3,462.81
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$9,939.54
|
|
|
Service Code
|
APR-DRG 8124
|
| Hospital Charge Code |
APRDRG8124
|
| Min. Negotiated Rate |
$9,939.54 |
| Max. Negotiated Rate |
$9,939.54 |
| Rate for Payer: AHCCCS Medicaid |
$9,939.54
|
| Rate for Payer: Allwell Medicaid |
$9,939.54
|
| Rate for Payer: AZCH Complete Medicaid |
$9,939.54
|
| Rate for Payer: Banner UC Health Medicaid |
$9,939.54
|
| Rate for Payer: Mercy Care Medicaid |
$9,939.54
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$3,462.81
|
|
|
Service Code
|
APR-DRG 8122
|
| Hospital Charge Code |
APRDRG8121
|
| Min. Negotiated Rate |
$3,462.81 |
| Max. Negotiated Rate |
$3,462.81 |
| Rate for Payer: AHCCCS Medicaid |
$3,462.81
|
| Rate for Payer: Allwell Medicaid |
$3,462.81
|
| Rate for Payer: AZCH Complete Medicaid |
$3,462.81
|
| Rate for Payer: Banner UC Health Medicaid |
$3,462.81
|
| Rate for Payer: Mercy Care Medicaid |
$3,462.81
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$9,939.54
|
|
|
Service Code
|
APR-DRG 8124
|
| Hospital Charge Code |
APRDRG8123
|
| Min. Negotiated Rate |
$9,939.54 |
| Max. Negotiated Rate |
$9,939.54 |
| Rate for Payer: AHCCCS Medicaid |
$9,939.54
|
| Rate for Payer: Allwell Medicaid |
$9,939.54
|
| Rate for Payer: AZCH Complete Medicaid |
$9,939.54
|
| Rate for Payer: Banner UC Health Medicaid |
$9,939.54
|
| Rate for Payer: Mercy Care Medicaid |
$9,939.54
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$2,564.32
|
|
|
Service Code
|
APR-DRG 8121
|
| Hospital Charge Code |
APRDRG8121
|
| Min. Negotiated Rate |
$2,564.32 |
| Max. Negotiated Rate |
$2,564.32 |
| Rate for Payer: AHCCCS Medicaid |
$2,564.32
|
| Rate for Payer: Allwell Medicaid |
$2,564.32
|
| Rate for Payer: AZCH Complete Medicaid |
$2,564.32
|
| Rate for Payer: Banner UC Health Medicaid |
$2,564.32
|
| Rate for Payer: Mercy Care Medicaid |
$2,564.32
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$5,178.44
|
|
|
Service Code
|
APR-DRG 8123
|
| Hospital Charge Code |
APRDRG8124
|
| Min. Negotiated Rate |
$5,178.44 |
| Max. Negotiated Rate |
$5,178.44 |
| Rate for Payer: AHCCCS Medicaid |
$5,178.44
|
| Rate for Payer: Allwell Medicaid |
$5,178.44
|
| Rate for Payer: AZCH Complete Medicaid |
$5,178.44
|
| Rate for Payer: Banner UC Health Medicaid |
$5,178.44
|
| Rate for Payer: Mercy Care Medicaid |
$5,178.44
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$2,564.32
|
|
|
Service Code
|
APR-DRG 8121
|
| Hospital Charge Code |
APRDRG8123
|
| Min. Negotiated Rate |
$2,564.32 |
| Max. Negotiated Rate |
$2,564.32 |
| Rate for Payer: AHCCCS Medicaid |
$2,564.32
|
| Rate for Payer: Allwell Medicaid |
$2,564.32
|
| Rate for Payer: AZCH Complete Medicaid |
$2,564.32
|
| Rate for Payer: Banner UC Health Medicaid |
$2,564.32
|
| Rate for Payer: Mercy Care Medicaid |
$2,564.32
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$5,178.44
|
|
|
Service Code
|
APR-DRG 8123
|
| Hospital Charge Code |
APRDRG8122
|
| Min. Negotiated Rate |
$5,178.44 |
| Max. Negotiated Rate |
$5,178.44 |
| Rate for Payer: AHCCCS Medicaid |
$5,178.44
|
| Rate for Payer: Allwell Medicaid |
$5,178.44
|
| Rate for Payer: AZCH Complete Medicaid |
$5,178.44
|
| Rate for Payer: Banner UC Health Medicaid |
$5,178.44
|
| Rate for Payer: Mercy Care Medicaid |
$5,178.44
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$9,939.54
|
|
|
Service Code
|
APR-DRG 8124
|
| Hospital Charge Code |
APRDRG8121
|
| Min. Negotiated Rate |
$9,939.54 |
| Max. Negotiated Rate |
$9,939.54 |
| Rate for Payer: AHCCCS Medicaid |
$9,939.54
|
| Rate for Payer: Allwell Medicaid |
$9,939.54
|
| Rate for Payer: AZCH Complete Medicaid |
$9,939.54
|
| Rate for Payer: Banner UC Health Medicaid |
$9,939.54
|
| Rate for Payer: Mercy Care Medicaid |
$9,939.54
|
|
