TPMT Genetic Test LC
|
Facility
|
IP
|
$1,788.00
|
|
Service Code
|
CPT 81401
|
Hospital Charge Code |
22348727
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$464.88 |
Max. Negotiated Rate |
$1,609.20 |
Rate for Payer: Aetna of AZ Commercial |
$1,609.20
|
Rate for Payer: Bisbee Police All Plans |
$464.88
|
Rate for Payer: Cash Price |
$1,430.40
|
Rate for Payer: Self Pay Self Pay |
$1,430.40
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$74,757.32
|
|
Service Code
|
APR-DRG 0043
|
Hospital Charge Code |
APRDRG0042
|
Min. Negotiated Rate |
$74,757.32 |
Max. Negotiated Rate |
$74,757.32 |
Rate for Payer: AHCCCS Medicaid |
$74,757.32
|
Rate for Payer: Allwell Medicaid |
$74,757.32
|
Rate for Payer: AZCH Complete Medicaid |
$74,757.32
|
Rate for Payer: Banner UC Health Medicaid |
$74,757.32
|
Rate for Payer: Mercy Care Medicaid |
$74,757.32
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$74,757.32
|
|
Service Code
|
APR-DRG 0043
|
Hospital Charge Code |
APRDRG0041
|
Min. Negotiated Rate |
$74,757.32 |
Max. Negotiated Rate |
$74,757.32 |
Rate for Payer: AHCCCS Medicaid |
$74,757.32
|
Rate for Payer: Allwell Medicaid |
$74,757.32
|
Rate for Payer: AZCH Complete Medicaid |
$74,757.32
|
Rate for Payer: Banner UC Health Medicaid |
$74,757.32
|
Rate for Payer: Mercy Care Medicaid |
$74,757.32
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$44,109.64
|
|
Service Code
|
APR-DRG 0041
|
Hospital Charge Code |
APRDRG0044
|
Min. Negotiated Rate |
$44,109.64 |
Max. Negotiated Rate |
$44,109.64 |
Rate for Payer: AHCCCS Medicaid |
$44,109.64
|
Rate for Payer: Allwell Medicaid |
$44,109.64
|
Rate for Payer: AZCH Complete Medicaid |
$44,109.64
|
Rate for Payer: Banner UC Health Medicaid |
$44,109.64
|
Rate for Payer: Mercy Care Medicaid |
$44,109.64
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$52,364.42
|
|
Service Code
|
APR-DRG 0042
|
Hospital Charge Code |
APRDRG0042
|
Min. Negotiated Rate |
$52,364.42 |
Max. Negotiated Rate |
$52,364.42 |
Rate for Payer: AHCCCS Medicaid |
$52,364.42
|
Rate for Payer: Allwell Medicaid |
$52,364.42
|
Rate for Payer: AZCH Complete Medicaid |
$52,364.42
|
Rate for Payer: Banner UC Health Medicaid |
$52,364.42
|
Rate for Payer: Mercy Care Medicaid |
$52,364.42
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$109,327.92
|
|
Service Code
|
APR-DRG 0044
|
Hospital Charge Code |
APRDRG0044
|
Min. Negotiated Rate |
$109,327.92 |
Max. Negotiated Rate |
$109,327.92 |
Rate for Payer: AHCCCS Medicaid |
$109,327.92
|
Rate for Payer: Allwell Medicaid |
$109,327.92
|
Rate for Payer: AZCH Complete Medicaid |
$109,327.92
|
Rate for Payer: Banner UC Health Medicaid |
$109,327.92
|
Rate for Payer: Mercy Care Medicaid |
$109,327.92
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$109,327.92
|
|
Service Code
|
APR-DRG 0044
|
Hospital Charge Code |
APRDRG0042
|
Min. Negotiated Rate |
$109,327.92 |
Max. Negotiated Rate |
$109,327.92 |
Rate for Payer: AHCCCS Medicaid |
$109,327.92
|
Rate for Payer: Allwell Medicaid |
$109,327.92
|
Rate for Payer: AZCH Complete Medicaid |
$109,327.92
|
Rate for Payer: Banner UC Health Medicaid |
$109,327.92
|
Rate for Payer: Mercy Care Medicaid |
$109,327.92
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$74,757.32
|
|
Service Code
|
APR-DRG 0043
|
Hospital Charge Code |
APRDRG0043
|
Min. Negotiated Rate |
$74,757.32 |
Max. Negotiated Rate |
$74,757.32 |
Rate for Payer: AHCCCS Medicaid |
$74,757.32
|
Rate for Payer: Allwell Medicaid |
$74,757.32
|
Rate for Payer: AZCH Complete Medicaid |
$74,757.32
|
Rate for Payer: Banner UC Health Medicaid |
$74,757.32
|
Rate for Payer: Mercy Care Medicaid |
$74,757.32
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$44,109.64
|
|
Service Code
|
APR-DRG 0041
|
Hospital Charge Code |
APRDRG0041
|
Min. Negotiated Rate |
$44,109.64 |
Max. Negotiated Rate |
$44,109.64 |
Rate for Payer: AHCCCS Medicaid |
$44,109.64
|
Rate for Payer: Allwell Medicaid |
$44,109.64
|
Rate for Payer: AZCH Complete Medicaid |
$44,109.64
|
Rate for Payer: Banner UC Health Medicaid |
$44,109.64
|
Rate for Payer: Mercy Care Medicaid |
$44,109.64
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$109,327.92
|
|
Service Code
|
APR-DRG 0044
|
Hospital Charge Code |
APRDRG0041
|
Min. Negotiated Rate |
$109,327.92 |
Max. Negotiated Rate |
$109,327.92 |
Rate for Payer: AHCCCS Medicaid |
$109,327.92
|
Rate for Payer: Allwell Medicaid |
$109,327.92
|
Rate for Payer: AZCH Complete Medicaid |
$109,327.92
|
Rate for Payer: Banner UC Health Medicaid |
$109,327.92
|
Rate for Payer: Mercy Care Medicaid |
$109,327.92
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$44,109.64
|
|
Service Code
|
APR-DRG 0041
|
Hospital Charge Code |
APRDRG0042
|
Min. Negotiated Rate |
$44,109.64 |
Max. Negotiated Rate |
$44,109.64 |
Rate for Payer: AHCCCS Medicaid |
$44,109.64
|
Rate for Payer: Allwell Medicaid |
$44,109.64
|
Rate for Payer: AZCH Complete Medicaid |
$44,109.64
|
Rate for Payer: Banner UC Health Medicaid |
$44,109.64
|
Rate for Payer: Mercy Care Medicaid |
$44,109.64
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$52,364.42
|
|
Service Code
|
APR-DRG 0042
|
Hospital Charge Code |
APRDRG0041
|
Min. Negotiated Rate |
$52,364.42 |
Max. Negotiated Rate |
$52,364.42 |
Rate for Payer: AHCCCS Medicaid |
$52,364.42
|
Rate for Payer: Allwell Medicaid |
$52,364.42
|
Rate for Payer: AZCH Complete Medicaid |
$52,364.42
|
Rate for Payer: Banner UC Health Medicaid |
$52,364.42
|
Rate for Payer: Mercy Care Medicaid |
$52,364.42
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$44,109.64
|
|
Service Code
|
APR-DRG 0041
|
Hospital Charge Code |
APRDRG0043
|
Min. Negotiated Rate |
$44,109.64 |
Max. Negotiated Rate |
$44,109.64 |
Rate for Payer: AHCCCS Medicaid |
$44,109.64
|
Rate for Payer: Allwell Medicaid |
$44,109.64
|
Rate for Payer: AZCH Complete Medicaid |
$44,109.64
|
Rate for Payer: Banner UC Health Medicaid |
$44,109.64
|
Rate for Payer: Mercy Care Medicaid |
$44,109.64
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$109,327.92
|
|
Service Code
|
APR-DRG 0044
|
Hospital Charge Code |
APRDRG0043
|
Min. Negotiated Rate |
$109,327.92 |
Max. Negotiated Rate |
$109,327.92 |
Rate for Payer: AHCCCS Medicaid |
$109,327.92
|
Rate for Payer: Allwell Medicaid |
$109,327.92
|
Rate for Payer: AZCH Complete Medicaid |
$109,327.92
|
Rate for Payer: Banner UC Health Medicaid |
$109,327.92
|
Rate for Payer: Mercy Care Medicaid |
$109,327.92
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$52,364.42
|
|
Service Code
|
APR-DRG 0042
|
Hospital Charge Code |
APRDRG0044
|
Min. Negotiated Rate |
$52,364.42 |
Max. Negotiated Rate |
$52,364.42 |
Rate for Payer: AHCCCS Medicaid |
$52,364.42
|
Rate for Payer: Allwell Medicaid |
$52,364.42
|
Rate for Payer: AZCH Complete Medicaid |
$52,364.42
|
Rate for Payer: Banner UC Health Medicaid |
$52,364.42
|
Rate for Payer: Mercy Care Medicaid |
$52,364.42
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$74,757.32
|
|
Service Code
|
APR-DRG 0043
|
Hospital Charge Code |
APRDRG0044
|
Min. Negotiated Rate |
$74,757.32 |
Max. Negotiated Rate |
$74,757.32 |
Rate for Payer: AHCCCS Medicaid |
$74,757.32
|
Rate for Payer: Allwell Medicaid |
$74,757.32
|
Rate for Payer: AZCH Complete Medicaid |
$74,757.32
|
Rate for Payer: Banner UC Health Medicaid |
$74,757.32
|
Rate for Payer: Mercy Care Medicaid |
$74,757.32
|
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
Facility
|
IP
|
$52,364.42
|
|
Service Code
|
APR-DRG 0042
|
Hospital Charge Code |
APRDRG0043
|
Min. Negotiated Rate |
$52,364.42 |
Max. Negotiated Rate |
$52,364.42 |
Rate for Payer: AHCCCS Medicaid |
$52,364.42
|
Rate for Payer: Allwell Medicaid |
$52,364.42
|
Rate for Payer: AZCH Complete Medicaid |
$52,364.42
|
Rate for Payer: Banner UC Health Medicaid |
$52,364.42
|
Rate for Payer: Mercy Care Medicaid |
$52,364.42
|
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
Facility
|
IP
|
$71,753.92
|
|
Service Code
|
APR-DRG 0054
|
Hospital Charge Code |
APRDRG0053
|
Min. Negotiated Rate |
$71,753.92 |
Max. Negotiated Rate |
$71,753.92 |
Rate for Payer: AHCCCS Medicaid |
$71,753.92
|
Rate for Payer: Allwell Medicaid |
$71,753.92
|
Rate for Payer: AZCH Complete Medicaid |
$71,753.92
|
Rate for Payer: Banner UC Health Medicaid |
$71,753.92
|
Rate for Payer: Mercy Care Medicaid |
$71,753.92
|
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
Facility
|
IP
|
$50,436.27
|
|
Service Code
|
APR-DRG 0053
|
Hospital Charge Code |
APRDRG0053
|
Min. Negotiated Rate |
$50,436.27 |
Max. Negotiated Rate |
$50,436.27 |
Rate for Payer: AHCCCS Medicaid |
$50,436.27
|
Rate for Payer: Allwell Medicaid |
$50,436.27
|
Rate for Payer: AZCH Complete Medicaid |
$50,436.27
|
Rate for Payer: Banner UC Health Medicaid |
$50,436.27
|
Rate for Payer: Mercy Care Medicaid |
$50,436.27
|
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
Facility
|
IP
|
$50,436.27
|
|
Service Code
|
APR-DRG 0053
|
Hospital Charge Code |
APRDRG0052
|
Min. Negotiated Rate |
$50,436.27 |
Max. Negotiated Rate |
$50,436.27 |
Rate for Payer: AHCCCS Medicaid |
$50,436.27
|
Rate for Payer: Allwell Medicaid |
$50,436.27
|
Rate for Payer: AZCH Complete Medicaid |
$50,436.27
|
Rate for Payer: Banner UC Health Medicaid |
$50,436.27
|
Rate for Payer: Mercy Care Medicaid |
$50,436.27
|
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
Facility
|
IP
|
$29,144.57
|
|
Service Code
|
APR-DRG 0051
|
Hospital Charge Code |
APRDRG0053
|
Min. Negotiated Rate |
$29,144.57 |
Max. Negotiated Rate |
$29,144.57 |
Rate for Payer: AHCCCS Medicaid |
$29,144.57
|
Rate for Payer: Allwell Medicaid |
$29,144.57
|
Rate for Payer: AZCH Complete Medicaid |
$29,144.57
|
Rate for Payer: Banner UC Health Medicaid |
$29,144.57
|
Rate for Payer: Mercy Care Medicaid |
$29,144.57
|
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
Facility
|
IP
|
$71,753.92
|
|
Service Code
|
APR-DRG 0054
|
Hospital Charge Code |
APRDRG0054
|
Min. Negotiated Rate |
$71,753.92 |
Max. Negotiated Rate |
$71,753.92 |
Rate for Payer: AHCCCS Medicaid |
$71,753.92
|
Rate for Payer: Allwell Medicaid |
$71,753.92
|
Rate for Payer: AZCH Complete Medicaid |
$71,753.92
|
Rate for Payer: Banner UC Health Medicaid |
$71,753.92
|
Rate for Payer: Mercy Care Medicaid |
$71,753.92
|
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
Facility
|
IP
|
$39,671.18
|
|
Service Code
|
APR-DRG 0052
|
Hospital Charge Code |
APRDRG0051
|
Min. Negotiated Rate |
$39,671.18 |
Max. Negotiated Rate |
$39,671.18 |
Rate for Payer: AHCCCS Medicaid |
$39,671.18
|
Rate for Payer: Allwell Medicaid |
$39,671.18
|
Rate for Payer: AZCH Complete Medicaid |
$39,671.18
|
Rate for Payer: Banner UC Health Medicaid |
$39,671.18
|
Rate for Payer: Mercy Care Medicaid |
$39,671.18
|
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
Facility
|
IP
|
$50,436.27
|
|
Service Code
|
APR-DRG 0053
|
Hospital Charge Code |
APRDRG0054
|
Min. Negotiated Rate |
$50,436.27 |
Max. Negotiated Rate |
$50,436.27 |
Rate for Payer: AHCCCS Medicaid |
$50,436.27
|
Rate for Payer: Allwell Medicaid |
$50,436.27
|
Rate for Payer: AZCH Complete Medicaid |
$50,436.27
|
Rate for Payer: Banner UC Health Medicaid |
$50,436.27
|
Rate for Payer: Mercy Care Medicaid |
$50,436.27
|
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
Facility
|
IP
|
$39,671.18
|
|
Service Code
|
APR-DRG 0052
|
Hospital Charge Code |
APRDRG0053
|
Min. Negotiated Rate |
$39,671.18 |
Max. Negotiated Rate |
$39,671.18 |
Rate for Payer: AHCCCS Medicaid |
$39,671.18
|
Rate for Payer: Allwell Medicaid |
$39,671.18
|
Rate for Payer: AZCH Complete Medicaid |
$39,671.18
|
Rate for Payer: Banner UC Health Medicaid |
$39,671.18
|
Rate for Payer: Mercy Care Medicaid |
$39,671.18
|
|