|
Acid Fast Smear+Culture LC
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
22201719
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna of AZ Commercial |
$48.60
|
| Rate for Payer: Cash Price |
$43.20
|
|
|
Acid Fast Smear+Culture W/Rflx LC
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
22380620
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna of AZ Commercial |
$48.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$8.64
|
| Rate for Payer: Banner UC Health Medicare |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$36.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$8.64
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$8.64
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of AZ Commercial |
$35.10
|
| Rate for Payer: Devoted Health Medicare |
$9.72
|
| Rate for Payer: Humana of AZ Medicare |
$8.64
|
| Rate for Payer: Seven Corners Travel Insurance |
$15.66
|
| Rate for Payer: Southwest Service Administrators UFCW |
$36.72
|
| Rate for Payer: TriWest Medicare |
$8.64
|
| Rate for Payer: United Healthcare Commercial |
$30.89
|
| Rate for Payer: United Healthcare Medicare |
$8.64
|
| Rate for Payer: Veterans Affairs TRICARE |
$8.55
|
|
|
Acid Fast Smear+Culture W/Rflx LC
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
22380620
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna of AZ Commercial |
$48.60
|
| Rate for Payer: Cash Price |
$43.20
|
|
|
ACTH, Plasma LC
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
1905879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Aetna of AZ Commercial |
$412.20
|
| Rate for Payer: Cash Price |
$366.40
|
|
|
ACTH, Plasma LC
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
1905879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Aetna of AZ Commercial |
$412.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$73.28
|
| Rate for Payer: Banner UC Health Medicare |
$73.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$311.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$73.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$73.28
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cigna of AZ Commercial |
$297.70
|
| Rate for Payer: Devoted Health Medicare |
$82.44
|
| Rate for Payer: Humana of AZ Medicare |
$73.28
|
| Rate for Payer: Seven Corners Travel Insurance |
$56.00
|
| Rate for Payer: Southwest Service Administrators UFCW |
$311.44
|
| Rate for Payer: TriWest Medicare |
$73.28
|
| Rate for Payer: United Healthcare Commercial |
$261.98
|
| Rate for Payer: United Healthcare Medicare |
$73.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$72.55
|
|
|
Actin (Smooth Muscle) Antibody LC
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2029263
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1,278.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
|
|
Actin (Smooth Muscle) Antibody LC
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2029263
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,278.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$227.20
|
| Rate for Payer: Banner UC Health Medicare |
$227.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$965.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$227.20
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$227.20
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cigna of AZ Commercial |
$923.00
|
| Rate for Payer: Devoted Health Medicare |
$255.60
|
| Rate for Payer: Humana of AZ Medicare |
$227.20
|
| Rate for Payer: Seven Corners Travel Insurance |
$16.72
|
| Rate for Payer: Southwest Service Administrators UFCW |
$965.60
|
| Rate for Payer: TriWest Medicare |
$227.20
|
| Rate for Payer: United Healthcare Commercial |
$812.24
|
| Rate for Payer: United Healthcare Medicare |
$227.20
|
| Rate for Payer: Veterans Affairs TRICARE |
$224.93
|
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$12,522.29
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$12,522.29 |
| Max. Negotiated Rate |
$12,522.29 |
| Rate for Payer: Seven Corners Travel Insurance |
$12,522.29
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$16,508.85
|
|
|
Service Code
|
APR-DRG 1934
|
| Hospital Charge Code |
APRDRG1932
|
| Min. Negotiated Rate |
$16,508.85 |
| Max. Negotiated Rate |
$16,508.85 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,508.85
|
| Rate for Payer: Mercy Care Medicaid |
$16,508.85
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,508.85
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$16,508.85
|
|
|
Service Code
|
APR-DRG 1934
|
| Hospital Charge Code |
APRDRG1933
|
| Min. Negotiated Rate |
$16,508.85 |
| Max. Negotiated Rate |
$16,508.85 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,508.85
|
| Rate for Payer: Mercy Care Medicaid |
$16,508.85
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,508.85
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$7,461.49
|
|
|
Service Code
|
APR-DRG 1932
|
| Hospital Charge Code |
APRDRG1931
|
| Min. Negotiated Rate |
$7,461.49 |
| Max. Negotiated Rate |
$7,461.49 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,461.49
|
| Rate for Payer: Mercy Care Medicaid |
$7,461.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,461.49
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$11,496.65
|
|
|
Service Code
|
APR-DRG 1933
|
| Hospital Charge Code |
APRDRG1931
|
| Min. Negotiated Rate |
$11,496.65 |
| Max. Negotiated Rate |
$11,496.65 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,496.65
|
| Rate for Payer: Mercy Care Medicaid |
$11,496.65
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,496.65
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$11,496.65
|
|
|
Service Code
|
APR-DRG 1933
|
| Hospital Charge Code |
APRDRG1933
|
| Min. Negotiated Rate |
$11,496.65 |
| Max. Negotiated Rate |
$11,496.65 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,496.65
|
| Rate for Payer: Mercy Care Medicaid |
$11,496.65
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,496.65
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$5,556.49
|
|
|
Service Code
|
APR-DRG 1931
|
| Hospital Charge Code |
APRDRG1934
|
| Min. Negotiated Rate |
$5,556.49 |
| Max. Negotiated Rate |
$5,556.49 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,556.49
|
| Rate for Payer: Mercy Care Medicaid |
$5,556.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,556.49
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$16,508.85
|
|
|
Service Code
|
APR-DRG 1934
|
| Hospital Charge Code |
APRDRG1931
|
| Min. Negotiated Rate |
$16,508.85 |
| Max. Negotiated Rate |
$16,508.85 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,508.85
|
| Rate for Payer: Mercy Care Medicaid |
$16,508.85
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,508.85
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$16,508.85
|
|
|
Service Code
|
APR-DRG 1934
|
| Hospital Charge Code |
APRDRG1934
|
| Min. Negotiated Rate |
$16,508.85 |
| Max. Negotiated Rate |
$16,508.85 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,508.85
|
| Rate for Payer: Mercy Care Medicaid |
$16,508.85
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,508.85
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$5,556.49
|
|
|
Service Code
|
APR-DRG 1931
|
| Hospital Charge Code |
APRDRG1932
|
| Min. Negotiated Rate |
$5,556.49 |
| Max. Negotiated Rate |
$5,556.49 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,556.49
|
| Rate for Payer: Mercy Care Medicaid |
$5,556.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,556.49
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$5,556.49
|
|
|
Service Code
|
APR-DRG 1931
|
| Hospital Charge Code |
APRDRG1931
|
| Min. Negotiated Rate |
$5,556.49 |
| Max. Negotiated Rate |
$5,556.49 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,556.49
|
| Rate for Payer: Mercy Care Medicaid |
$5,556.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,556.49
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$11,496.65
|
|
|
Service Code
|
APR-DRG 1933
|
| Hospital Charge Code |
APRDRG1932
|
| Min. Negotiated Rate |
$11,496.65 |
| Max. Negotiated Rate |
$11,496.65 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,496.65
|
| Rate for Payer: Mercy Care Medicaid |
$11,496.65
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,496.65
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$7,461.49
|
|
|
Service Code
|
APR-DRG 1932
|
| Hospital Charge Code |
APRDRG1932
|
| Min. Negotiated Rate |
$7,461.49 |
| Max. Negotiated Rate |
$7,461.49 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,461.49
|
| Rate for Payer: Mercy Care Medicaid |
$7,461.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,461.49
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$11,496.65
|
|
|
Service Code
|
APR-DRG 1933
|
| Hospital Charge Code |
APRDRG1934
|
| Min. Negotiated Rate |
$11,496.65 |
| Max. Negotiated Rate |
$11,496.65 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,496.65
|
| Rate for Payer: Mercy Care Medicaid |
$11,496.65
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,496.65
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$5,556.49
|
|
|
Service Code
|
APR-DRG 1931
|
| Hospital Charge Code |
APRDRG1933
|
| Min. Negotiated Rate |
$5,556.49 |
| Max. Negotiated Rate |
$5,556.49 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,556.49
|
| Rate for Payer: Mercy Care Medicaid |
$5,556.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,556.49
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$7,461.49
|
|
|
Service Code
|
APR-DRG 1932
|
| Hospital Charge Code |
APRDRG1933
|
| Min. Negotiated Rate |
$7,461.49 |
| Max. Negotiated Rate |
$7,461.49 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,461.49
|
| Rate for Payer: Mercy Care Medicaid |
$7,461.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,461.49
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
IP
|
$7,461.49
|
|
|
Service Code
|
APR-DRG 1932
|
| Hospital Charge Code |
APRDRG1934
|
| Min. Negotiated Rate |
$7,461.49 |
| Max. Negotiated Rate |
$7,461.49 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,461.49
|
| Rate for Payer: Mercy Care Medicaid |
$7,461.49
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,461.49
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$22,060.21
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$22,060.21 |
| Max. Negotiated Rate |
$22,060.21 |
| Rate for Payer: Seven Corners Travel Insurance |
$22,060.21
|
|
