|
Respiratory Malignancy
|
Facility
|
IP
|
$4,724.63
|
|
|
Service Code
|
APR-DRG 1361
|
| Hospital Charge Code |
APRDRG1364
|
| Min. Negotiated Rate |
$4,724.63 |
| Max. Negotiated Rate |
$4,724.63 |
| Rate for Payer: AHCCCS Medicaid |
$4,724.63
|
| Rate for Payer: Allwell Medicaid |
$4,724.63
|
| Rate for Payer: AZCH Complete Medicaid |
$4,724.63
|
| Rate for Payer: Banner UC Health Medicaid |
$4,724.63
|
| Rate for Payer: Mercy Care Medicaid |
$4,724.63
|
|
|
Respiratory Malignancy
|
Facility
|
IP
|
$8,765.40
|
|
|
Service Code
|
APR-DRG 1363
|
| Hospital Charge Code |
APRDRG1362
|
| Min. Negotiated Rate |
$8,765.40 |
| Max. Negotiated Rate |
$8,765.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,765.40
|
| Rate for Payer: Allwell Medicaid |
$8,765.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,765.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,765.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,765.40
|
|
|
Respiratory Malignancy
|
Facility
|
IP
|
$4,724.63
|
|
|
Service Code
|
APR-DRG 1361
|
| Hospital Charge Code |
APRDRG1361
|
| Min. Negotiated Rate |
$4,724.63 |
| Max. Negotiated Rate |
$4,724.63 |
| Rate for Payer: AHCCCS Medicaid |
$4,724.63
|
| Rate for Payer: Allwell Medicaid |
$4,724.63
|
| Rate for Payer: AZCH Complete Medicaid |
$4,724.63
|
| Rate for Payer: Banner UC Health Medicaid |
$4,724.63
|
| Rate for Payer: Mercy Care Medicaid |
$4,724.63
|
|
|
Respiratory Malignancy
|
Facility
|
IP
|
$6,182.14
|
|
|
Service Code
|
APR-DRG 1362
|
| Hospital Charge Code |
APRDRG1364
|
| Min. Negotiated Rate |
$6,182.14 |
| Max. Negotiated Rate |
$6,182.14 |
| Rate for Payer: AHCCCS Medicaid |
$6,182.14
|
| Rate for Payer: Allwell Medicaid |
$6,182.14
|
| Rate for Payer: AZCH Complete Medicaid |
$6,182.14
|
| Rate for Payer: Banner UC Health Medicaid |
$6,182.14
|
| Rate for Payer: Mercy Care Medicaid |
$6,182.14
|
|
|
Respiratory Malignancy
|
Facility
|
IP
|
$12,962.57
|
|
|
Service Code
|
APR-DRG 1364
|
| Hospital Charge Code |
APRDRG1364
|
| Min. Negotiated Rate |
$12,962.57 |
| Max. Negotiated Rate |
$12,962.57 |
| Rate for Payer: AHCCCS Medicaid |
$12,962.57
|
| Rate for Payer: Allwell Medicaid |
$12,962.57
|
| Rate for Payer: AZCH Complete Medicaid |
$12,962.57
|
| Rate for Payer: Banner UC Health Medicaid |
$12,962.57
|
| Rate for Payer: Mercy Care Medicaid |
$12,962.57
|
|
|
Respiratory Malignancy
|
Facility
|
IP
|
$12,962.57
|
|
|
Service Code
|
APR-DRG 1364
|
| Hospital Charge Code |
APRDRG1362
|
| Min. Negotiated Rate |
$12,962.57 |
| Max. Negotiated Rate |
$12,962.57 |
| Rate for Payer: AHCCCS Medicaid |
$12,962.57
|
| Rate for Payer: Allwell Medicaid |
$12,962.57
|
| Rate for Payer: AZCH Complete Medicaid |
$12,962.57
|
| Rate for Payer: Banner UC Health Medicaid |
$12,962.57
|
| Rate for Payer: Mercy Care Medicaid |
$12,962.57
|
|
|
Respiratory Malignancy
|
Facility
|
IP
|
$8,765.40
|
|
|
Service Code
|
APR-DRG 1363
|
| Hospital Charge Code |
APRDRG1363
|
| Min. Negotiated Rate |
$8,765.40 |
| Max. Negotiated Rate |
$8,765.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,765.40
|
| Rate for Payer: Allwell Medicaid |
$8,765.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,765.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,765.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,765.40
|
|
|
Respiratory Malignancy
|
Facility
|
IP
|
$8,765.40
|
|
|
Service Code
|
APR-DRG 1363
|
| Hospital Charge Code |
APRDRG1364
|
| Min. Negotiated Rate |
$8,765.40 |
| Max. Negotiated Rate |
$8,765.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,765.40
|
| Rate for Payer: Allwell Medicaid |
$8,765.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,765.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,765.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,765.40
|
|
|
Respiratory Malignancy
|
Facility
|
IP
|
$8,765.40
|
|
|
Service Code
|
APR-DRG 1363
|
| Hospital Charge Code |
APRDRG1361
|
| Min. Negotiated Rate |
$8,765.40 |
| Max. Negotiated Rate |
$8,765.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,765.40
|
| Rate for Payer: Allwell Medicaid |
$8,765.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,765.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,765.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,765.40
|
|
|
Respiratory Panel 2.1 (BioFire)
|
Facility
|
IP
|
$2,083.00
|
|
|
Service Code
|
CPT 0202U
|
| Hospital Charge Code |
23979884
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$541.58 |
| Max. Negotiated Rate |
$1,874.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,874.70
|
| Rate for Payer: Bisbee Police All Plans |
$541.58
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Self Pay Self Pay |
$1,666.40
|
|
|
Respiratory Panel 2.1 (BioFire)
|
Facility
|
OP
|
$2,083.00
|
|
|
Service Code
|
CPT 0202U
|
| Hospital Charge Code |
23979884
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$312.45 |
| Max. Negotiated Rate |
$1,874.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,874.70
|
| Rate for Payer: Aetna of AZ Medicare |
$583.24
|
| Rate for Payer: AHCCCS Medicaid |
$833.56
|
| Rate for Payer: Allwell Medicaid |
$833.56
|
| Rate for Payer: Allwell Medicare |
$312.45
|
| Rate for Payer: Amerigroup Medicare |
$312.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$778.00
|
| Rate for Payer: AZCH Complete Medicaid |
$833.56
|
| Rate for Payer: AZCH Complete Medicare |
$312.45
|
| Rate for Payer: Banner UC Health Medicaid |
$833.56
|
| Rate for Payer: Banner UC Health Medicare |
$312.45
|
| Rate for Payer: Bisbee Police All Plans |
$541.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,416.44
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,353.95
|
| Rate for Payer: Copperpoint Commercial |
$515.54
|
| Rate for Payer: Health Net of AZ Commercial |
$1,249.80
|
| Rate for Payer: Health Net of AZ Medicare |
$583.24
|
| Rate for Payer: Humana of AZ Medicare |
$312.45
|
| Rate for Payer: Mercy Care Medicaid |
$833.56
|
| Rate for Payer: Self Pay Self Pay |
$1,666.40
|
| Rate for Payer: TriWest Medicare |
$312.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,214.39
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$374.94
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$10,920.10
|
|
|
Service Code
|
APR-DRG 1444
|
| Hospital Charge Code |
APRDRG1443
|
| Min. Negotiated Rate |
$10,920.10 |
| Max. Negotiated Rate |
$10,920.10 |
| Rate for Payer: AHCCCS Medicaid |
$10,920.10
|
| Rate for Payer: Allwell Medicaid |
$10,920.10
|
| Rate for Payer: AZCH Complete Medicaid |
$10,920.10
|
| Rate for Payer: Banner UC Health Medicaid |
$10,920.10
|
| Rate for Payer: Mercy Care Medicaid |
$10,920.10
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$10,920.10
|
|
|
Service Code
|
APR-DRG 1444
|
| Hospital Charge Code |
APRDRG1441
|
| Min. Negotiated Rate |
$10,920.10 |
| Max. Negotiated Rate |
$10,920.10 |
| Rate for Payer: AHCCCS Medicaid |
$10,920.10
|
| Rate for Payer: Allwell Medicaid |
$10,920.10
|
| Rate for Payer: AZCH Complete Medicaid |
$10,920.10
|
| Rate for Payer: Banner UC Health Medicaid |
$10,920.10
|
| Rate for Payer: Mercy Care Medicaid |
$10,920.10
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$4,564.01
|
|
|
Service Code
|
APR-DRG 1442
|
| Hospital Charge Code |
APRDRG1441
|
| Min. Negotiated Rate |
$4,564.01 |
| Max. Negotiated Rate |
$4,564.01 |
| Rate for Payer: AHCCCS Medicaid |
$4,564.01
|
| Rate for Payer: Allwell Medicaid |
$4,564.01
|
| Rate for Payer: AZCH Complete Medicaid |
$4,564.01
|
| Rate for Payer: Banner UC Health Medicaid |
$4,564.01
|
| Rate for Payer: Mercy Care Medicaid |
$4,564.01
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$4,564.01
|
|
|
Service Code
|
APR-DRG 1442
|
| Hospital Charge Code |
APRDRG1442
|
| Min. Negotiated Rate |
$4,564.01 |
| Max. Negotiated Rate |
$4,564.01 |
| Rate for Payer: AHCCCS Medicaid |
$4,564.01
|
| Rate for Payer: Allwell Medicaid |
$4,564.01
|
| Rate for Payer: AZCH Complete Medicaid |
$4,564.01
|
| Rate for Payer: Banner UC Health Medicaid |
$4,564.01
|
| Rate for Payer: Mercy Care Medicaid |
$4,564.01
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$6,396.07
|
|
|
Service Code
|
APR-DRG 1443
|
| Hospital Charge Code |
APRDRG1442
|
| Min. Negotiated Rate |
$6,396.07 |
| Max. Negotiated Rate |
$6,396.07 |
| Rate for Payer: AHCCCS Medicaid |
$6,396.07
|
| Rate for Payer: Allwell Medicaid |
$6,396.07
|
| Rate for Payer: AZCH Complete Medicaid |
$6,396.07
|
| Rate for Payer: Banner UC Health Medicaid |
$6,396.07
|
| Rate for Payer: Mercy Care Medicaid |
$6,396.07
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$6,396.07
|
|
|
Service Code
|
APR-DRG 1443
|
| Hospital Charge Code |
APRDRG1441
|
| Min. Negotiated Rate |
$6,396.07 |
| Max. Negotiated Rate |
$6,396.07 |
| Rate for Payer: AHCCCS Medicaid |
$6,396.07
|
| Rate for Payer: Allwell Medicaid |
$6,396.07
|
| Rate for Payer: AZCH Complete Medicaid |
$6,396.07
|
| Rate for Payer: Banner UC Health Medicaid |
$6,396.07
|
| Rate for Payer: Mercy Care Medicaid |
$6,396.07
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$6,396.07
|
|
|
Service Code
|
APR-DRG 1443
|
| Hospital Charge Code |
APRDRG1443
|
| Min. Negotiated Rate |
$6,396.07 |
| Max. Negotiated Rate |
$6,396.07 |
| Rate for Payer: AHCCCS Medicaid |
$6,396.07
|
| Rate for Payer: Allwell Medicaid |
$6,396.07
|
| Rate for Payer: AZCH Complete Medicaid |
$6,396.07
|
| Rate for Payer: Banner UC Health Medicaid |
$6,396.07
|
| Rate for Payer: Mercy Care Medicaid |
$6,396.07
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$3,584.15
|
|
|
Service Code
|
APR-DRG 1441
|
| Hospital Charge Code |
APRDRG1441
|
| Min. Negotiated Rate |
$3,584.15 |
| Max. Negotiated Rate |
$3,584.15 |
| Rate for Payer: AHCCCS Medicaid |
$3,584.15
|
| Rate for Payer: Allwell Medicaid |
$3,584.15
|
| Rate for Payer: AZCH Complete Medicaid |
$3,584.15
|
| Rate for Payer: Banner UC Health Medicaid |
$3,584.15
|
| Rate for Payer: Mercy Care Medicaid |
$3,584.15
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$4,564.01
|
|
|
Service Code
|
APR-DRG 1442
|
| Hospital Charge Code |
APRDRG1444
|
| Min. Negotiated Rate |
$4,564.01 |
| Max. Negotiated Rate |
$4,564.01 |
| Rate for Payer: AHCCCS Medicaid |
$4,564.01
|
| Rate for Payer: Allwell Medicaid |
$4,564.01
|
| Rate for Payer: AZCH Complete Medicaid |
$4,564.01
|
| Rate for Payer: Banner UC Health Medicaid |
$4,564.01
|
| Rate for Payer: Mercy Care Medicaid |
$4,564.01
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$10,920.10
|
|
|
Service Code
|
APR-DRG 1444
|
| Hospital Charge Code |
APRDRG1444
|
| Min. Negotiated Rate |
$10,920.10 |
| Max. Negotiated Rate |
$10,920.10 |
| Rate for Payer: AHCCCS Medicaid |
$10,920.10
|
| Rate for Payer: Allwell Medicaid |
$10,920.10
|
| Rate for Payer: AZCH Complete Medicaid |
$10,920.10
|
| Rate for Payer: Banner UC Health Medicaid |
$10,920.10
|
| Rate for Payer: Mercy Care Medicaid |
$10,920.10
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$3,584.15
|
|
|
Service Code
|
APR-DRG 1441
|
| Hospital Charge Code |
APRDRG1443
|
| Min. Negotiated Rate |
$3,584.15 |
| Max. Negotiated Rate |
$3,584.15 |
| Rate for Payer: AHCCCS Medicaid |
$3,584.15
|
| Rate for Payer: Allwell Medicaid |
$3,584.15
|
| Rate for Payer: AZCH Complete Medicaid |
$3,584.15
|
| Rate for Payer: Banner UC Health Medicaid |
$3,584.15
|
| Rate for Payer: Mercy Care Medicaid |
$3,584.15
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$6,396.07
|
|
|
Service Code
|
APR-DRG 1443
|
| Hospital Charge Code |
APRDRG1444
|
| Min. Negotiated Rate |
$6,396.07 |
| Max. Negotiated Rate |
$6,396.07 |
| Rate for Payer: AHCCCS Medicaid |
$6,396.07
|
| Rate for Payer: Allwell Medicaid |
$6,396.07
|
| Rate for Payer: AZCH Complete Medicaid |
$6,396.07
|
| Rate for Payer: Banner UC Health Medicaid |
$6,396.07
|
| Rate for Payer: Mercy Care Medicaid |
$6,396.07
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$3,584.15
|
|
|
Service Code
|
APR-DRG 1441
|
| Hospital Charge Code |
APRDRG1442
|
| Min. Negotiated Rate |
$3,584.15 |
| Max. Negotiated Rate |
$3,584.15 |
| Rate for Payer: AHCCCS Medicaid |
$3,584.15
|
| Rate for Payer: Allwell Medicaid |
$3,584.15
|
| Rate for Payer: AZCH Complete Medicaid |
$3,584.15
|
| Rate for Payer: Banner UC Health Medicaid |
$3,584.15
|
| Rate for Payer: Mercy Care Medicaid |
$3,584.15
|
|
|
Respiratory Signs, Symptoms And Miscellaneous Diagnoses
|
Facility
|
IP
|
$3,584.15
|
|
|
Service Code
|
APR-DRG 1441
|
| Hospital Charge Code |
APRDRG1444
|
| Min. Negotiated Rate |
$3,584.15 |
| Max. Negotiated Rate |
$3,584.15 |
| Rate for Payer: AHCCCS Medicaid |
$3,584.15
|
| Rate for Payer: Allwell Medicaid |
$3,584.15
|
| Rate for Payer: AZCH Complete Medicaid |
$3,584.15
|
| Rate for Payer: Banner UC Health Medicaid |
$3,584.15
|
| Rate for Payer: Mercy Care Medicaid |
$3,584.15
|
|
