|
Toxoplasma gondii IgM Ab LC
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
6782185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of AZ Commercial |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
|
|
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 |
$175.50 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna of AZ Commercial |
$175.50
|
| Rate for Payer: Cash Price |
$156.00
|
|
|
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 |
$19.20 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna of AZ Commercial |
$175.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$31.20
|
| Rate for Payer: Banner UC Health Medicare |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$31.20
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$31.20
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna of AZ Commercial |
$126.75
|
| Rate for Payer: Devoted Health Medicare |
$35.10
|
| Rate for Payer: Humana of AZ Medicare |
$31.20
|
| Rate for Payer: Seven Corners Travel Insurance |
$19.20
|
| Rate for Payer: Southwest Service Administrators UFCW |
$132.60
|
| Rate for Payer: TriWest Medicare |
$31.20
|
| Rate for Payer: United Healthcare Commercial |
$111.54
|
| Rate for Payer: United Healthcare Medicare |
$31.20
|
| Rate for Payer: Veterans Affairs TRICARE |
$30.89
|
|
|
TPMT Genetic Test LC
|
Facility
|
IP
|
$1,788.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
22348727
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1,609.20 |
| Max. Negotiated Rate |
$1,609.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,609.20
|
| Rate for Payer: Cash Price |
$1,430.40
|
|
|
TPMT Genetic Test LC
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
22348727
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$198.65 |
| Max. Negotiated Rate |
$1,609.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,609.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$286.08
|
| Rate for Payer: Banner UC Health Medicare |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,215.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$286.08
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$286.08
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,162.20
|
| Rate for Payer: Devoted Health Medicare |
$321.84
|
| Rate for Payer: Humana of AZ Medicare |
$286.08
|
| Rate for Payer: Seven Corners Travel Insurance |
$198.65
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,215.84
|
| Rate for Payer: TriWest Medicare |
$286.08
|
| Rate for Payer: United Healthcare Commercial |
$1,022.74
|
| Rate for Payer: United Healthcare Medicare |
$286.08
|
| Rate for Payer: Veterans Affairs TRICARE |
$283.22
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
|
IP
|
$54,488.19
|
|
|
Service Code
|
MSDRG 012
|
| Min. Negotiated Rate |
$54,488.19 |
| Max. Negotiated Rate |
$54,488.19 |
| Rate for Payer: Seven Corners Travel Insurance |
$54,488.19
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
|
IP
|
$70,489.56
|
|
|
Service Code
|
MSDRG 011
|
| Min. Negotiated Rate |
$70,489.56 |
| Max. Negotiated Rate |
$70,489.56 |
| Rate for Payer: Seven Corners Travel Insurance |
$70,489.56
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$37,244.82
|
|
|
Service Code
|
MSDRG 013
|
| Min. Negotiated Rate |
$37,244.82 |
| Max. Negotiated Rate |
$37,244.82 |
| Rate for Payer: Seven Corners Travel Insurance |
$37,244.82
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$179,017.43
|
|
|
Service Code
|
MSDRG 004
|
| Min. Negotiated Rate |
$179,017.43 |
| Max. Negotiated Rate |
$179,017.43 |
| Rate for Payer: Seven Corners Travel Insurance |
$179,017.43
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$44,109.64
|
| Rate for Payer: Mercy Care Medicaid |
$44,109.64
|
| Rate for Payer: NaphCare Correctional Healthcare |
$44,109.64
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$109,327.92
|
| Rate for Payer: Mercy Care Medicaid |
$109,327.92
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$74,757.32
|
| Rate for Payer: Mercy Care Medicaid |
$74,757.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$74,757.32
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$109,327.92
|
| Rate for Payer: Mercy Care Medicaid |
$109,327.92
|
| Rate for Payer: NaphCare Correctional Healthcare |
$109,327.92
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$52,364.42
|
| Rate for Payer: Mercy Care Medicaid |
$52,364.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$74,757.32
|
| Rate for Payer: Mercy Care Medicaid |
$74,757.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$74,757.32
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$52,364.42
|
| Rate for Payer: Mercy Care Medicaid |
$52,364.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$52,364.42
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$44,109.64
|
| Rate for Payer: Mercy Care Medicaid |
$44,109.64
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$109,327.92
|
| Rate for Payer: Mercy Care Medicaid |
$109,327.92
|
| Rate for Payer: NaphCare Correctional Healthcare |
$109,327.92
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$109,327.92
|
| Rate for Payer: Mercy Care Medicaid |
$109,327.92
|
| Rate for Payer: NaphCare Correctional Healthcare |
$109,327.92
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$52,364.42
|
| Rate for Payer: Mercy Care Medicaid |
$52,364.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$74,757.32
|
| Rate for Payer: Mercy Care Medicaid |
$74,757.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$44,109.64
|
| Rate for Payer: Mercy Care Medicaid |
$44,109.64
|
| Rate for Payer: NaphCare Correctional Healthcare |
$44,109.64
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$52,364.42
|
| Rate for Payer: Mercy Care Medicaid |
$52,364.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$74,757.32
|
| Rate for Payer: Mercy Care Medicaid |
$74,757.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$74,757.32
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$44,109.64
|
| Rate for Payer: Mercy Care Medicaid |
$44,109.64
|
| Rate for Payer: NaphCare Correctional Healthcare |
$44,109.64
|
|
