|
Alcohol Abuse And Dependence
|
Facility
|
IP
|
$6,181.44
|
|
|
Service Code
|
APR-DRG 7753
|
| Hospital Charge Code |
APRDRG7752
|
| Min. Negotiated Rate |
$6,181.44 |
| Max. Negotiated Rate |
$6,181.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,181.44
|
| Rate for Payer: Mercy Care Medicaid |
$6,181.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,181.44
|
|
|
Alcohol Abuse And Dependence
|
Facility
|
IP
|
$15,554.25
|
|
|
Service Code
|
APR-DRG 7754
|
| Hospital Charge Code |
APRDRG7753
|
| Min. Negotiated Rate |
$15,554.25 |
| Max. Negotiated Rate |
$15,554.25 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,554.25
|
| Rate for Payer: Mercy Care Medicaid |
$15,554.25
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,554.25
|
|
|
Alcohol Abuse And Dependence
|
Facility
|
IP
|
$2,454.20
|
|
|
Service Code
|
APR-DRG 7751
|
| Hospital Charge Code |
APRDRG7753
|
| Min. Negotiated Rate |
$2,454.20 |
| Max. Negotiated Rate |
$2,454.20 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,454.20
|
| Rate for Payer: Mercy Care Medicaid |
$2,454.20
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,454.20
|
|
|
Alcohol Abuse And Dependence
|
Facility
|
IP
|
$3,457.90
|
|
|
Service Code
|
APR-DRG 7752
|
| Hospital Charge Code |
APRDRG7752
|
| Min. Negotiated Rate |
$3,457.90 |
| Max. Negotiated Rate |
$3,457.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,457.90
|
| Rate for Payer: Mercy Care Medicaid |
$3,457.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,457.90
|
|
|
Alcohol Abuse And Dependence
|
Facility
|
IP
|
$2,454.20
|
|
|
Service Code
|
APR-DRG 7751
|
| Hospital Charge Code |
APRDRG7752
|
| Min. Negotiated Rate |
$2,454.20 |
| Max. Negotiated Rate |
$2,454.20 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,454.20
|
| Rate for Payer: Mercy Care Medicaid |
$2,454.20
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,454.20
|
|
|
Alcohol Abuse And Dependence
|
Facility
|
IP
|
$3,457.90
|
|
|
Service Code
|
APR-DRG 7752
|
| Hospital Charge Code |
APRDRG7751
|
| Min. Negotiated Rate |
$3,457.90 |
| Max. Negotiated Rate |
$3,457.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,457.90
|
| Rate for Payer: Mercy Care Medicaid |
$3,457.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,457.90
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$4,314.31
|
|
|
Service Code
|
APR-DRG 7722
|
| Hospital Charge Code |
APRDRG7723
|
| Min. Negotiated Rate |
$4,314.31 |
| Max. Negotiated Rate |
$4,314.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,314.31
|
| Rate for Payer: Mercy Care Medicaid |
$4,314.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,314.31
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$5,360.10
|
|
|
Service Code
|
APR-DRG 7723
|
| Hospital Charge Code |
APRDRG7724
|
| Min. Negotiated Rate |
$5,360.10 |
| Max. Negotiated Rate |
$5,360.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,360.10
|
| Rate for Payer: Mercy Care Medicaid |
$5,360.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,360.10
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$5,360.10
|
|
|
Service Code
|
APR-DRG 7723
|
| Hospital Charge Code |
APRDRG7723
|
| Min. Negotiated Rate |
$5,360.10 |
| Max. Negotiated Rate |
$5,360.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,360.10
|
| Rate for Payer: Mercy Care Medicaid |
$5,360.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,360.10
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$3,490.87
|
|
|
Service Code
|
APR-DRG 7721
|
| Hospital Charge Code |
APRDRG7723
|
| Min. Negotiated Rate |
$3,490.87 |
| Max. Negotiated Rate |
$3,490.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,490.87
|
| Rate for Payer: Mercy Care Medicaid |
$3,490.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,490.87
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$16,819.57
|
|
|
Service Code
|
APR-DRG 7724
|
| Hospital Charge Code |
APRDRG7722
|
| Min. Negotiated Rate |
$16,819.57 |
| Max. Negotiated Rate |
$16,819.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,819.57
|
| Rate for Payer: Mercy Care Medicaid |
$16,819.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,819.57
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$3,490.87
|
|
|
Service Code
|
APR-DRG 7721
|
| Hospital Charge Code |
APRDRG7724
|
| Min. Negotiated Rate |
$3,490.87 |
| Max. Negotiated Rate |
$3,490.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,490.87
|
| Rate for Payer: Mercy Care Medicaid |
$3,490.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,490.87
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$16,819.57
|
|
|
Service Code
|
APR-DRG 7724
|
| Hospital Charge Code |
APRDRG7721
|
| Min. Negotiated Rate |
$16,819.57 |
| Max. Negotiated Rate |
$16,819.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,819.57
|
| Rate for Payer: Mercy Care Medicaid |
$16,819.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,819.57
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$5,360.10
|
|
|
Service Code
|
APR-DRG 7723
|
| Hospital Charge Code |
APRDRG7721
|
| Min. Negotiated Rate |
$5,360.10 |
| Max. Negotiated Rate |
$5,360.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,360.10
|
| Rate for Payer: Mercy Care Medicaid |
$5,360.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,360.10
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$3,490.87
|
|
|
Service Code
|
APR-DRG 7721
|
| Hospital Charge Code |
APRDRG7722
|
| Min. Negotiated Rate |
$3,490.87 |
| Max. Negotiated Rate |
$3,490.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,490.87
|
| Rate for Payer: Mercy Care Medicaid |
$3,490.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,490.87
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$4,314.31
|
|
|
Service Code
|
APR-DRG 7722
|
| Hospital Charge Code |
APRDRG7721
|
| Min. Negotiated Rate |
$4,314.31 |
| Max. Negotiated Rate |
$4,314.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,314.31
|
| Rate for Payer: Mercy Care Medicaid |
$4,314.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,314.31
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$4,314.31
|
|
|
Service Code
|
APR-DRG 7722
|
| Hospital Charge Code |
APRDRG7724
|
| Min. Negotiated Rate |
$4,314.31 |
| Max. Negotiated Rate |
$4,314.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,314.31
|
| Rate for Payer: Mercy Care Medicaid |
$4,314.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,314.31
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$16,819.57
|
|
|
Service Code
|
APR-DRG 7724
|
| Hospital Charge Code |
APRDRG7724
|
| Min. Negotiated Rate |
$16,819.57 |
| Max. Negotiated Rate |
$16,819.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,819.57
|
| Rate for Payer: Mercy Care Medicaid |
$16,819.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,819.57
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$4,314.31
|
|
|
Service Code
|
APR-DRG 7722
|
| Hospital Charge Code |
APRDRG7722
|
| Min. Negotiated Rate |
$4,314.31 |
| Max. Negotiated Rate |
$4,314.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,314.31
|
| Rate for Payer: Mercy Care Medicaid |
$4,314.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,314.31
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$3,490.87
|
|
|
Service Code
|
APR-DRG 7721
|
| Hospital Charge Code |
APRDRG7721
|
| Min. Negotiated Rate |
$3,490.87 |
| Max. Negotiated Rate |
$3,490.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,490.87
|
| Rate for Payer: Mercy Care Medicaid |
$3,490.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,490.87
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$16,819.57
|
|
|
Service Code
|
APR-DRG 7724
|
| Hospital Charge Code |
APRDRG7723
|
| Min. Negotiated Rate |
$16,819.57 |
| Max. Negotiated Rate |
$16,819.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,819.57
|
| Rate for Payer: Mercy Care Medicaid |
$16,819.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,819.57
|
|
|
Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy
|
Facility
|
IP
|
$5,360.10
|
|
|
Service Code
|
APR-DRG 7723
|
| Hospital Charge Code |
APRDRG7722
|
| Min. Negotiated Rate |
$5,360.10 |
| Max. Negotiated Rate |
$5,360.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,360.10
|
| Rate for Payer: Mercy Care Medicaid |
$5,360.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,360.10
|
|
|
Alcohol Breath
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 82075
|
| Hospital Charge Code |
22600606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of AZ Commercial |
$42.30
|
| Rate for Payer: Cash Price |
$37.60
|
|
|
Alcohol Breath
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82075
|
| Hospital Charge Code |
22600606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Aetna of AZ Commercial |
$42.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$7.52
|
| Rate for Payer: Banner UC Health Medicare |
$7.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$31.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$7.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$7.52
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cigna of AZ Commercial |
$30.55
|
| Rate for Payer: Devoted Health Medicare |
$8.46
|
| Rate for Payer: Humana of AZ Medicare |
$7.52
|
| Rate for Payer: Seven Corners Travel Insurance |
$43.50
|
| Rate for Payer: Southwest Service Administrators UFCW |
$31.96
|
| Rate for Payer: TriWest Medicare |
$7.52
|
| Rate for Payer: United Healthcare Commercial |
$26.88
|
| Rate for Payer: United Healthcare Medicare |
$7.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$7.44
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
|
IP
|
$8,172.29
|
|
|
Service Code
|
MSDRG 894
|
| Min. Negotiated Rate |
$8,172.29 |
| Max. Negotiated Rate |
$8,172.29 |
| Rate for Payer: Seven Corners Travel Insurance |
$8,172.29
|
|
