|
Toxic Effects Of Non-Medicinal Substances
|
Facility
|
IP
|
$3,952.39
|
|
|
Service Code
|
APR-DRG 8161
|
| Hospital Charge Code |
APRDRG8163
|
| Min. Negotiated Rate |
$3,952.39 |
| Max. Negotiated Rate |
$3,952.39 |
| Rate for Payer: AHCCCS Medicaid |
$3,952.39
|
| Rate for Payer: Allwell Medicaid |
$3,952.39
|
| Rate for Payer: AZCH Complete Medicaid |
$3,952.39
|
| Rate for Payer: Banner UC Health Medicaid |
$3,952.39
|
| Rate for Payer: Mercy Care Medicaid |
$3,952.39
|
|
|
Toxic Effects Of Non-Medicinal Substances
|
Facility
|
IP
|
$5,035.35
|
|
|
Service Code
|
APR-DRG 8163
|
| Hospital Charge Code |
APRDRG8163
|
| Min. Negotiated Rate |
$5,035.35 |
| Max. Negotiated Rate |
$5,035.35 |
| Rate for Payer: AHCCCS Medicaid |
$5,035.35
|
| Rate for Payer: Allwell Medicaid |
$5,035.35
|
| Rate for Payer: AZCH Complete Medicaid |
$5,035.35
|
| Rate for Payer: Banner UC Health Medicaid |
$5,035.35
|
| Rate for Payer: Mercy Care Medicaid |
$5,035.35
|
|
|
Toxic Effects Of Non-Medicinal Substances
|
Facility
|
IP
|
$5,035.35
|
|
|
Service Code
|
APR-DRG 8163
|
| Hospital Charge Code |
APRDRG8161
|
| Min. Negotiated Rate |
$5,035.35 |
| Max. Negotiated Rate |
$5,035.35 |
| Rate for Payer: AHCCCS Medicaid |
$5,035.35
|
| Rate for Payer: Allwell Medicaid |
$5,035.35
|
| Rate for Payer: AZCH Complete Medicaid |
$5,035.35
|
| Rate for Payer: Banner UC Health Medicaid |
$5,035.35
|
| Rate for Payer: Mercy Care Medicaid |
$5,035.35
|
|
|
Toxic Effects Of Non-Medicinal Substances
|
Facility
|
IP
|
$3,952.39
|
|
|
Service Code
|
APR-DRG 8162
|
| Hospital Charge Code |
APRDRG8162
|
| Min. Negotiated Rate |
$3,952.39 |
| Max. Negotiated Rate |
$3,952.39 |
| Rate for Payer: AHCCCS Medicaid |
$3,952.39
|
| Rate for Payer: Allwell Medicaid |
$3,952.39
|
| Rate for Payer: AZCH Complete Medicaid |
$3,952.39
|
| Rate for Payer: Banner UC Health Medicaid |
$3,952.39
|
| Rate for Payer: Mercy Care Medicaid |
$3,952.39
|
|
|
Toxic Effects Of Non-Medicinal Substances
|
Facility
|
IP
|
$10,319.70
|
|
|
Service Code
|
APR-DRG 8164
|
| Hospital Charge Code |
APRDRG8161
|
| Min. Negotiated Rate |
$10,319.70 |
| Max. Negotiated Rate |
$10,319.70 |
| Rate for Payer: AHCCCS Medicaid |
$10,319.70
|
| Rate for Payer: Allwell Medicaid |
$10,319.70
|
| Rate for Payer: AZCH Complete Medicaid |
$10,319.70
|
| Rate for Payer: Banner UC Health Medicaid |
$10,319.70
|
| Rate for Payer: Mercy Care Medicaid |
$10,319.70
|
|
|
Toxic Effects Of Non-Medicinal Substances
|
Facility
|
IP
|
$3,952.39
|
|
|
Service Code
|
APR-DRG 8161
|
| Hospital Charge Code |
APRDRG8161
|
| Min. Negotiated Rate |
$3,952.39 |
| Max. Negotiated Rate |
$3,952.39 |
| Rate for Payer: AHCCCS Medicaid |
$3,952.39
|
| Rate for Payer: Allwell Medicaid |
$3,952.39
|
| Rate for Payer: AZCH Complete Medicaid |
$3,952.39
|
| Rate for Payer: Banner UC Health Medicaid |
$3,952.39
|
| Rate for Payer: Mercy Care Medicaid |
$3,952.39
|
|
|
Toxoplasma gondii Ab, IgG, Qn LC
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
7328613
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna of AZ Commercial |
$154.80
|
| Rate for Payer: Aetna of AZ Medicare |
$48.16
|
| Rate for Payer: Allwell Medicare |
$27.52
|
| Rate for Payer: Amerigroup Medicare |
$27.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$64.24
|
| Rate for Payer: AZCH Complete Medicare |
$27.52
|
| Rate for Payer: Banner UC Health Medicare |
$27.52
|
| Rate for Payer: Bisbee Police All Plans |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$116.96
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cigna of AZ Commercial |
$111.80
|
| Rate for Payer: Copperpoint Commercial |
$42.57
|
| Rate for Payer: Health Net of AZ Commercial |
$103.20
|
| Rate for Payer: Health Net of AZ Medicare |
$48.16
|
| Rate for Payer: Humana of AZ Medicare |
$27.52
|
| Rate for Payer: Self Pay Self Pay |
$137.60
|
| Rate for Payer: TriWest Medicare |
$27.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$100.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$30.96
|
|
|
Toxoplasma gondii Ab, IgG, Qn LC
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
7328613
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna of AZ Commercial |
$154.80
|
| Rate for Payer: Bisbee Police All Plans |
$44.72
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Self Pay Self Pay |
$137.60
|
|
|
.Toxoplasma gondii Ab, IgM, Comment LC
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
22311169
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Aetna of AZ Medicare |
$50.68
|
| Rate for Payer: Allwell Medicare |
$28.96
|
| Rate for Payer: Amerigroup Medicare |
$28.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$28.96
|
| Rate for Payer: Banner UC Health Medicare |
$28.96
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$123.08
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna of AZ Commercial |
$117.65
|
| Rate for Payer: Copperpoint Commercial |
$44.80
|
| Rate for Payer: Health Net of AZ Commercial |
$108.60
|
| Rate for Payer: Health Net of AZ Medicare |
$50.68
|
| Rate for Payer: Humana of AZ Medicare |
$28.96
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$28.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
.Toxoplasma gondii Ab, IgM, Comment LC
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
22311169
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
|
|
Toxoplasma gondii IgM Ab LC
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
6782185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Aetna of AZ Medicare |
$50.68
|
| Rate for Payer: Allwell Medicare |
$28.96
|
| Rate for Payer: Amerigroup Medicare |
$28.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$67.60
|
| Rate for Payer: AZCH Complete Medicare |
$28.96
|
| Rate for Payer: Banner UC Health Medicare |
$28.96
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$123.08
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna of AZ Commercial |
$117.65
|
| Rate for Payer: Copperpoint Commercial |
$44.80
|
| Rate for Payer: Health Net of AZ Commercial |
$108.60
|
| Rate for Payer: Health Net of AZ Medicare |
$50.68
|
| Rate for Payer: Humana of AZ Medicare |
$28.96
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
| Rate for Payer: TriWest Medicare |
$28.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$105.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$32.58
|
|
|
Toxoplasma gondii IgM Ab LC
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
6782185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Bisbee Police All Plans |
$47.06
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Self Pay Self Pay |
$144.80
|
|
|
T pallidum Ab (FTA-Ab) LC
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
2270018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna of AZ Commercial |
$175.50
|
| Rate for Payer: Aetna of AZ Medicare |
$54.60
|
| Rate for Payer: Allwell Medicare |
$31.20
|
| Rate for Payer: Amerigroup Medicare |
$31.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$72.83
|
| Rate for Payer: AZCH Complete Medicare |
$31.20
|
| Rate for Payer: Banner UC Health Medicare |
$31.20
|
| Rate for Payer: Bisbee Police All Plans |
$50.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$132.60
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna of AZ Commercial |
$126.75
|
| Rate for Payer: Copperpoint Commercial |
$48.26
|
| Rate for Payer: Health Net of AZ Commercial |
$117.00
|
| Rate for Payer: Health Net of AZ Medicare |
$54.60
|
| Rate for Payer: Humana of AZ Medicare |
$31.20
|
| Rate for Payer: Self Pay Self Pay |
$156.00
|
| Rate for Payer: TriWest Medicare |
$31.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$113.69
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$35.10
|
|
|
T pallidum Ab (FTA-Ab) LC
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
2270018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna of AZ Commercial |
$175.50
|
| Rate for Payer: Bisbee Police All Plans |
$50.70
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Self Pay Self Pay |
$156.00
|
|
|
TPMT Genetic Test LC
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
22348727
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$286.08 |
| Max. Negotiated Rate |
$1,609.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,609.20
|
| Rate for Payer: Aetna of AZ Medicare |
$500.64
|
| Rate for Payer: Allwell Medicare |
$286.08
|
| Rate for Payer: Amerigroup Medicare |
$286.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$667.82
|
| Rate for Payer: AZCH Complete Medicare |
$286.08
|
| Rate for Payer: Banner UC Health Medicare |
$286.08
|
| Rate for Payer: Bisbee Police All Plans |
$464.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,215.84
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,162.20
|
| Rate for Payer: Copperpoint Commercial |
$442.53
|
| Rate for Payer: Health Net of AZ Commercial |
$1,072.80
|
| Rate for Payer: Health Net of AZ Medicare |
$500.64
|
| Rate for Payer: Humana of AZ Medicare |
$286.08
|
| Rate for Payer: Self Pay Self Pay |
$1,430.40
|
| Rate for Payer: TriWest Medicare |
$286.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,042.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$321.84
|
|
|
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
|
$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 |
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
|
$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
|
$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 |
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
|
$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
|
$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
|
$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
|
$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
|
|
