Cesarean Section Without Sterilization
|
Facility
|
IP
|
$3,586.96
|
|
Service Code
|
APR-DRG 5401
|
Hospital Charge Code |
APRDRG5401
|
Min. Negotiated Rate |
$3,586.96 |
Max. Negotiated Rate |
$3,586.96 |
Rate for Payer: AHCCCS Medicaid |
$3,586.96
|
Rate for Payer: Allwell Medicaid |
$3,586.96
|
Rate for Payer: AZCH Complete Medicaid |
$3,586.96
|
Rate for Payer: Banner UC Health Medicaid |
$3,586.96
|
Rate for Payer: Mercy Care Medicaid |
$3,586.96
|
|
Cesarean Section Without Sterilization
|
Facility
|
IP
|
$4,371.83
|
|
Service Code
|
APR-DRG 5402
|
Hospital Charge Code |
APRDRG5402
|
Min. Negotiated Rate |
$4,371.83 |
Max. Negotiated Rate |
$4,371.83 |
Rate for Payer: AHCCCS Medicaid |
$4,371.83
|
Rate for Payer: Allwell Medicaid |
$4,371.83
|
Rate for Payer: AZCH Complete Medicaid |
$4,371.83
|
Rate for Payer: Banner UC Health Medicaid |
$4,371.83
|
Rate for Payer: Mercy Care Medicaid |
$4,371.83
|
|
Cesarean Section Without Sterilization
|
Facility
|
IP
|
$4,371.83
|
|
Service Code
|
APR-DRG 5402
|
Hospital Charge Code |
APRDRG5401
|
Min. Negotiated Rate |
$4,371.83 |
Max. Negotiated Rate |
$4,371.83 |
Rate for Payer: AHCCCS Medicaid |
$4,371.83
|
Rate for Payer: Allwell Medicaid |
$4,371.83
|
Rate for Payer: AZCH Complete Medicaid |
$4,371.83
|
Rate for Payer: Banner UC Health Medicaid |
$4,371.83
|
Rate for Payer: Mercy Care Medicaid |
$4,371.83
|
|
Cesarean Section Without Sterilization
|
Facility
|
IP
|
$4,371.83
|
|
Service Code
|
APR-DRG 5402
|
Hospital Charge Code |
APRDRG5404
|
Min. Negotiated Rate |
$4,371.83 |
Max. Negotiated Rate |
$4,371.83 |
Rate for Payer: AHCCCS Medicaid |
$4,371.83
|
Rate for Payer: Allwell Medicaid |
$4,371.83
|
Rate for Payer: AZCH Complete Medicaid |
$4,371.83
|
Rate for Payer: Banner UC Health Medicaid |
$4,371.83
|
Rate for Payer: Mercy Care Medicaid |
$4,371.83
|
|
Cesarean Section Without Sterilization
|
Facility
|
IP
|
$3,586.96
|
|
Service Code
|
APR-DRG 5401
|
Hospital Charge Code |
APRDRG5403
|
Min. Negotiated Rate |
$3,586.96 |
Max. Negotiated Rate |
$3,586.96 |
Rate for Payer: AHCCCS Medicaid |
$3,586.96
|
Rate for Payer: Allwell Medicaid |
$3,586.96
|
Rate for Payer: AZCH Complete Medicaid |
$3,586.96
|
Rate for Payer: Banner UC Health Medicaid |
$3,586.96
|
Rate for Payer: Mercy Care Medicaid |
$3,586.96
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$16,231.80
|
|
Service Code
|
APR-DRG 5394
|
Hospital Charge Code |
APRDRG5394
|
Min. Negotiated Rate |
$16,231.80 |
Max. Negotiated Rate |
$16,231.80 |
Rate for Payer: AHCCCS Medicaid |
$16,231.80
|
Rate for Payer: Allwell Medicaid |
$16,231.80
|
Rate for Payer: AZCH Complete Medicaid |
$16,231.80
|
Rate for Payer: Banner UC Health Medicaid |
$16,231.80
|
Rate for Payer: Mercy Care Medicaid |
$16,231.80
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$3,573.63
|
|
Service Code
|
APR-DRG 5391
|
Hospital Charge Code |
APRDRG5391
|
Min. Negotiated Rate |
$3,573.63 |
Max. Negotiated Rate |
$3,573.63 |
Rate for Payer: AHCCCS Medicaid |
$3,573.63
|
Rate for Payer: Allwell Medicaid |
$3,573.63
|
Rate for Payer: AZCH Complete Medicaid |
$3,573.63
|
Rate for Payer: Banner UC Health Medicaid |
$3,573.63
|
Rate for Payer: Mercy Care Medicaid |
$3,573.63
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$3,573.63
|
|
Service Code
|
APR-DRG 5391
|
Hospital Charge Code |
APRDRG5394
|
Min. Negotiated Rate |
$3,573.63 |
Max. Negotiated Rate |
$3,573.63 |
Rate for Payer: AHCCCS Medicaid |
$3,573.63
|
Rate for Payer: Allwell Medicaid |
$3,573.63
|
Rate for Payer: AZCH Complete Medicaid |
$3,573.63
|
Rate for Payer: Banner UC Health Medicaid |
$3,573.63
|
Rate for Payer: Mercy Care Medicaid |
$3,573.63
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$4,119.32
|
|
Service Code
|
APR-DRG 5392
|
Hospital Charge Code |
APRDRG5392
|
Min. Negotiated Rate |
$4,119.32 |
Max. Negotiated Rate |
$4,119.32 |
Rate for Payer: AHCCCS Medicaid |
$4,119.32
|
Rate for Payer: Allwell Medicaid |
$4,119.32
|
Rate for Payer: AZCH Complete Medicaid |
$4,119.32
|
Rate for Payer: Banner UC Health Medicaid |
$4,119.32
|
Rate for Payer: Mercy Care Medicaid |
$4,119.32
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$16,231.80
|
|
Service Code
|
APR-DRG 5394
|
Hospital Charge Code |
APRDRG5393
|
Min. Negotiated Rate |
$16,231.80 |
Max. Negotiated Rate |
$16,231.80 |
Rate for Payer: AHCCCS Medicaid |
$16,231.80
|
Rate for Payer: Allwell Medicaid |
$16,231.80
|
Rate for Payer: AZCH Complete Medicaid |
$16,231.80
|
Rate for Payer: Banner UC Health Medicaid |
$16,231.80
|
Rate for Payer: Mercy Care Medicaid |
$16,231.80
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$6,450.07
|
|
Service Code
|
APR-DRG 5393
|
Hospital Charge Code |
APRDRG5393
|
Min. Negotiated Rate |
$6,450.07 |
Max. Negotiated Rate |
$6,450.07 |
Rate for Payer: AHCCCS Medicaid |
$6,450.07
|
Rate for Payer: Allwell Medicaid |
$6,450.07
|
Rate for Payer: AZCH Complete Medicaid |
$6,450.07
|
Rate for Payer: Banner UC Health Medicaid |
$6,450.07
|
Rate for Payer: Mercy Care Medicaid |
$6,450.07
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$4,119.32
|
|
Service Code
|
APR-DRG 5392
|
Hospital Charge Code |
APRDRG5393
|
Min. Negotiated Rate |
$4,119.32 |
Max. Negotiated Rate |
$4,119.32 |
Rate for Payer: AHCCCS Medicaid |
$4,119.32
|
Rate for Payer: Allwell Medicaid |
$4,119.32
|
Rate for Payer: AZCH Complete Medicaid |
$4,119.32
|
Rate for Payer: Banner UC Health Medicaid |
$4,119.32
|
Rate for Payer: Mercy Care Medicaid |
$4,119.32
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$4,119.32
|
|
Service Code
|
APR-DRG 5392
|
Hospital Charge Code |
APRDRG5394
|
Min. Negotiated Rate |
$4,119.32 |
Max. Negotiated Rate |
$4,119.32 |
Rate for Payer: AHCCCS Medicaid |
$4,119.32
|
Rate for Payer: Allwell Medicaid |
$4,119.32
|
Rate for Payer: AZCH Complete Medicaid |
$4,119.32
|
Rate for Payer: Banner UC Health Medicaid |
$4,119.32
|
Rate for Payer: Mercy Care Medicaid |
$4,119.32
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$3,573.63
|
|
Service Code
|
APR-DRG 5391
|
Hospital Charge Code |
APRDRG5393
|
Min. Negotiated Rate |
$3,573.63 |
Max. Negotiated Rate |
$3,573.63 |
Rate for Payer: AHCCCS Medicaid |
$3,573.63
|
Rate for Payer: Allwell Medicaid |
$3,573.63
|
Rate for Payer: AZCH Complete Medicaid |
$3,573.63
|
Rate for Payer: Banner UC Health Medicaid |
$3,573.63
|
Rate for Payer: Mercy Care Medicaid |
$3,573.63
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$6,450.07
|
|
Service Code
|
APR-DRG 5393
|
Hospital Charge Code |
APRDRG5392
|
Min. Negotiated Rate |
$6,450.07 |
Max. Negotiated Rate |
$6,450.07 |
Rate for Payer: AHCCCS Medicaid |
$6,450.07
|
Rate for Payer: Allwell Medicaid |
$6,450.07
|
Rate for Payer: AZCH Complete Medicaid |
$6,450.07
|
Rate for Payer: Banner UC Health Medicaid |
$6,450.07
|
Rate for Payer: Mercy Care Medicaid |
$6,450.07
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$6,450.07
|
|
Service Code
|
APR-DRG 5393
|
Hospital Charge Code |
APRDRG5391
|
Min. Negotiated Rate |
$6,450.07 |
Max. Negotiated Rate |
$6,450.07 |
Rate for Payer: AHCCCS Medicaid |
$6,450.07
|
Rate for Payer: Allwell Medicaid |
$6,450.07
|
Rate for Payer: AZCH Complete Medicaid |
$6,450.07
|
Rate for Payer: Banner UC Health Medicaid |
$6,450.07
|
Rate for Payer: Mercy Care Medicaid |
$6,450.07
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$16,231.80
|
|
Service Code
|
APR-DRG 5394
|
Hospital Charge Code |
APRDRG5391
|
Min. Negotiated Rate |
$16,231.80 |
Max. Negotiated Rate |
$16,231.80 |
Rate for Payer: AHCCCS Medicaid |
$16,231.80
|
Rate for Payer: Allwell Medicaid |
$16,231.80
|
Rate for Payer: AZCH Complete Medicaid |
$16,231.80
|
Rate for Payer: Banner UC Health Medicaid |
$16,231.80
|
Rate for Payer: Mercy Care Medicaid |
$16,231.80
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$3,573.63
|
|
Service Code
|
APR-DRG 5391
|
Hospital Charge Code |
APRDRG5392
|
Min. Negotiated Rate |
$3,573.63 |
Max. Negotiated Rate |
$3,573.63 |
Rate for Payer: AHCCCS Medicaid |
$3,573.63
|
Rate for Payer: Allwell Medicaid |
$3,573.63
|
Rate for Payer: AZCH Complete Medicaid |
$3,573.63
|
Rate for Payer: Banner UC Health Medicaid |
$3,573.63
|
Rate for Payer: Mercy Care Medicaid |
$3,573.63
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$4,119.32
|
|
Service Code
|
APR-DRG 5392
|
Hospital Charge Code |
APRDRG5391
|
Min. Negotiated Rate |
$4,119.32 |
Max. Negotiated Rate |
$4,119.32 |
Rate for Payer: AHCCCS Medicaid |
$4,119.32
|
Rate for Payer: Allwell Medicaid |
$4,119.32
|
Rate for Payer: AZCH Complete Medicaid |
$4,119.32
|
Rate for Payer: Banner UC Health Medicaid |
$4,119.32
|
Rate for Payer: Mercy Care Medicaid |
$4,119.32
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$16,231.80
|
|
Service Code
|
APR-DRG 5394
|
Hospital Charge Code |
APRDRG5392
|
Min. Negotiated Rate |
$16,231.80 |
Max. Negotiated Rate |
$16,231.80 |
Rate for Payer: AHCCCS Medicaid |
$16,231.80
|
Rate for Payer: Allwell Medicaid |
$16,231.80
|
Rate for Payer: AZCH Complete Medicaid |
$16,231.80
|
Rate for Payer: Banner UC Health Medicaid |
$16,231.80
|
Rate for Payer: Mercy Care Medicaid |
$16,231.80
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$6,450.07
|
|
Service Code
|
APR-DRG 5393
|
Hospital Charge Code |
APRDRG5394
|
Min. Negotiated Rate |
$6,450.07 |
Max. Negotiated Rate |
$6,450.07 |
Rate for Payer: AHCCCS Medicaid |
$6,450.07
|
Rate for Payer: Allwell Medicaid |
$6,450.07
|
Rate for Payer: AZCH Complete Medicaid |
$6,450.07
|
Rate for Payer: Banner UC Health Medicaid |
$6,450.07
|
Rate for Payer: Mercy Care Medicaid |
$6,450.07
|
|
CHAIN OF CUST URINE
|
Facility
|
OP
|
$49.00
|
|
Service Code
|
CPT 99001
|
Hospital Charge Code |
22587919
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$44.10 |
Rate for Payer: Aetna of AZ Commercial |
$44.10
|
Rate for Payer: Aetna of AZ Medicare |
$13.72
|
Rate for Payer: AHCCCS Medicaid |
$0.13
|
Rate for Payer: Allwell Medicaid |
$0.13
|
Rate for Payer: Allwell Medicare |
$7.35
|
Rate for Payer: Amerigroup Medicare |
$7.35
|
Rate for Payer: APIPA Medicare/Medicaid |
$18.30
|
Rate for Payer: AZCH Complete Medicaid |
$0.13
|
Rate for Payer: AZCH Complete Medicare |
$7.35
|
Rate for Payer: Banner UC Health Medicaid |
$0.13
|
Rate for Payer: Banner UC Health Medicare |
$7.35
|
Rate for Payer: Bisbee Police All Plans |
$12.74
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$33.32
|
Rate for Payer: Cash Price |
$39.20
|
Rate for Payer: Cash Price |
$39.20
|
Rate for Payer: Cigna of AZ Commercial |
$31.85
|
Rate for Payer: Copperpoint Commercial |
$12.13
|
Rate for Payer: Health Net of AZ Commercial |
$29.40
|
Rate for Payer: Health Net of AZ Medicare |
$13.72
|
Rate for Payer: Humana of AZ Medicare |
$7.35
|
Rate for Payer: Mercy Care Medicaid |
$0.13
|
Rate for Payer: Self Pay Self Pay |
$39.20
|
Rate for Payer: TriWest Medicare |
$7.35
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$28.57
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.82
|
|
CHAIN OF CUST URINE
|
Facility
|
IP
|
$49.00
|
|
Service Code
|
CPT 99001
|
Hospital Charge Code |
22587919
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$12.74 |
Max. Negotiated Rate |
$44.10 |
Rate for Payer: Aetna of AZ Commercial |
$44.10
|
Rate for Payer: Bisbee Police All Plans |
$12.74
|
Rate for Payer: Cash Price |
$39.20
|
Rate for Payer: Self Pay Self Pay |
$39.20
|
|
charcoal 25 g Oral Susp 120 mL [CQCH]
|
Facility
|
IP
|
$0.11
|
|
Service Code
|
NDC 574012174
|
Hospital Charge Code |
105915987
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.10 |
Rate for Payer: Aetna of AZ Commercial |
$0.10
|
Rate for Payer: Bisbee Police All Plans |
$0.03
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Self Pay Self Pay |
$0.09
|
|
charcoal 25 g Oral Susp 120 mL [CQCH]
|
Facility
|
OP
|
$0.11
|
|
Service Code
|
NDC 574012174
|
Hospital Charge Code |
105915987
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.10 |
Rate for Payer: Aetna of AZ Commercial |
$0.10
|
Rate for Payer: Aetna of AZ Medicare |
$0.03
|
Rate for Payer: Allwell Medicare |
$0.02
|
Rate for Payer: Amerigroup Medicare |
$0.02
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.04
|
Rate for Payer: AZCH Complete Medicare |
$0.02
|
Rate for Payer: Banner UC Health Medicare |
$0.02
|
Rate for Payer: Bisbee Police All Plans |
$0.03
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.07
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cigna of AZ Commercial |
$0.07
|
Rate for Payer: Copperpoint Commercial |
$0.03
|
Rate for Payer: Health Net of AZ Commercial |
$0.07
|
Rate for Payer: Health Net of AZ Medicare |
$0.03
|
Rate for Payer: Humana of AZ Medicare |
$0.02
|
Rate for Payer: Self Pay Self Pay |
$0.09
|
Rate for Payer: TriWest Medicare |
$0.02
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.06
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|