Chronic Kidney Disease
|
Facility
|
IP
|
$4,275.73
|
|
Service Code
|
APR-DRG 4702
|
Hospital Charge Code |
APRDRG4704
|
Min. Negotiated Rate |
$4,275.73 |
Max. Negotiated Rate |
$4,275.73 |
Rate for Payer: AHCCCS Medicaid |
$4,275.73
|
Rate for Payer: Allwell Medicaid |
$4,275.73
|
Rate for Payer: AZCH Complete Medicaid |
$4,275.73
|
Rate for Payer: Banner UC Health Medicaid |
$4,275.73
|
Rate for Payer: Mercy Care Medicaid |
$4,275.73
|
|
Chronic Kidney Disease
|
Facility
|
IP
|
$3,170.33
|
|
Service Code
|
APR-DRG 4701
|
Hospital Charge Code |
APRDRG4703
|
Min. Negotiated Rate |
$3,170.33 |
Max. Negotiated Rate |
$3,170.33 |
Rate for Payer: AHCCCS Medicaid |
$3,170.33
|
Rate for Payer: Allwell Medicaid |
$3,170.33
|
Rate for Payer: AZCH Complete Medicaid |
$3,170.33
|
Rate for Payer: Banner UC Health Medicaid |
$3,170.33
|
Rate for Payer: Mercy Care Medicaid |
$3,170.33
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$4,269.42
|
|
Service Code
|
APR-DRG 1402
|
Hospital Charge Code |
APRDRG1403
|
Min. Negotiated Rate |
$4,269.42 |
Max. Negotiated Rate |
$4,269.42 |
Rate for Payer: AHCCCS Medicaid |
$4,269.42
|
Rate for Payer: Allwell Medicaid |
$4,269.42
|
Rate for Payer: AZCH Complete Medicaid |
$4,269.42
|
Rate for Payer: Banner UC Health Medicaid |
$4,269.42
|
Rate for Payer: Mercy Care Medicaid |
$4,269.42
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$4,269.42
|
|
Service Code
|
APR-DRG 1402
|
Hospital Charge Code |
APRDRG1404
|
Min. Negotiated Rate |
$4,269.42 |
Max. Negotiated Rate |
$4,269.42 |
Rate for Payer: AHCCCS Medicaid |
$4,269.42
|
Rate for Payer: Allwell Medicaid |
$4,269.42
|
Rate for Payer: AZCH Complete Medicaid |
$4,269.42
|
Rate for Payer: Banner UC Health Medicaid |
$4,269.42
|
Rate for Payer: Mercy Care Medicaid |
$4,269.42
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$5,325.73
|
|
Service Code
|
APR-DRG 1403
|
Hospital Charge Code |
APRDRG1404
|
Min. Negotiated Rate |
$5,325.73 |
Max. Negotiated Rate |
$5,325.73 |
Rate for Payer: AHCCCS Medicaid |
$5,325.73
|
Rate for Payer: Allwell Medicaid |
$5,325.73
|
Rate for Payer: AZCH Complete Medicaid |
$5,325.73
|
Rate for Payer: Banner UC Health Medicaid |
$5,325.73
|
Rate for Payer: Mercy Care Medicaid |
$5,325.73
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$4,269.42
|
|
Service Code
|
APR-DRG 1402
|
Hospital Charge Code |
APRDRG1402
|
Min. Negotiated Rate |
$4,269.42 |
Max. Negotiated Rate |
$4,269.42 |
Rate for Payer: AHCCCS Medicaid |
$4,269.42
|
Rate for Payer: Allwell Medicaid |
$4,269.42
|
Rate for Payer: AZCH Complete Medicaid |
$4,269.42
|
Rate for Payer: Banner UC Health Medicaid |
$4,269.42
|
Rate for Payer: Mercy Care Medicaid |
$4,269.42
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$5,325.73
|
|
Service Code
|
APR-DRG 1403
|
Hospital Charge Code |
APRDRG1401
|
Min. Negotiated Rate |
$5,325.73 |
Max. Negotiated Rate |
$5,325.73 |
Rate for Payer: AHCCCS Medicaid |
$5,325.73
|
Rate for Payer: Allwell Medicaid |
$5,325.73
|
Rate for Payer: AZCH Complete Medicaid |
$5,325.73
|
Rate for Payer: Banner UC Health Medicaid |
$5,325.73
|
Rate for Payer: Mercy Care Medicaid |
$5,325.73
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$5,325.73
|
|
Service Code
|
APR-DRG 1403
|
Hospital Charge Code |
APRDRG1403
|
Min. Negotiated Rate |
$5,325.73 |
Max. Negotiated Rate |
$5,325.73 |
Rate for Payer: AHCCCS Medicaid |
$5,325.73
|
Rate for Payer: Allwell Medicaid |
$5,325.73
|
Rate for Payer: AZCH Complete Medicaid |
$5,325.73
|
Rate for Payer: Banner UC Health Medicaid |
$5,325.73
|
Rate for Payer: Mercy Care Medicaid |
$5,325.73
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$8,423.11
|
|
Service Code
|
APR-DRG 1404
|
Hospital Charge Code |
APRDRG1403
|
Min. Negotiated Rate |
$8,423.11 |
Max. Negotiated Rate |
$8,423.11 |
Rate for Payer: AHCCCS Medicaid |
$8,423.11
|
Rate for Payer: Allwell Medicaid |
$8,423.11
|
Rate for Payer: AZCH Complete Medicaid |
$8,423.11
|
Rate for Payer: Banner UC Health Medicaid |
$8,423.11
|
Rate for Payer: Mercy Care Medicaid |
$8,423.11
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$8,423.11
|
|
Service Code
|
APR-DRG 1404
|
Hospital Charge Code |
APRDRG1404
|
Min. Negotiated Rate |
$8,423.11 |
Max. Negotiated Rate |
$8,423.11 |
Rate for Payer: AHCCCS Medicaid |
$8,423.11
|
Rate for Payer: Allwell Medicaid |
$8,423.11
|
Rate for Payer: AZCH Complete Medicaid |
$8,423.11
|
Rate for Payer: Banner UC Health Medicaid |
$8,423.11
|
Rate for Payer: Mercy Care Medicaid |
$8,423.11
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$4,269.42
|
|
Service Code
|
APR-DRG 1402
|
Hospital Charge Code |
APRDRG1401
|
Min. Negotiated Rate |
$4,269.42 |
Max. Negotiated Rate |
$4,269.42 |
Rate for Payer: AHCCCS Medicaid |
$4,269.42
|
Rate for Payer: Allwell Medicaid |
$4,269.42
|
Rate for Payer: AZCH Complete Medicaid |
$4,269.42
|
Rate for Payer: Banner UC Health Medicaid |
$4,269.42
|
Rate for Payer: Mercy Care Medicaid |
$4,269.42
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$8,423.11
|
|
Service Code
|
APR-DRG 1404
|
Hospital Charge Code |
APRDRG1401
|
Min. Negotiated Rate |
$8,423.11 |
Max. Negotiated Rate |
$8,423.11 |
Rate for Payer: AHCCCS Medicaid |
$8,423.11
|
Rate for Payer: Allwell Medicaid |
$8,423.11
|
Rate for Payer: AZCH Complete Medicaid |
$8,423.11
|
Rate for Payer: Banner UC Health Medicaid |
$8,423.11
|
Rate for Payer: Mercy Care Medicaid |
$8,423.11
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$5,325.73
|
|
Service Code
|
APR-DRG 1403
|
Hospital Charge Code |
APRDRG1402
|
Min. Negotiated Rate |
$5,325.73 |
Max. Negotiated Rate |
$5,325.73 |
Rate for Payer: AHCCCS Medicaid |
$5,325.73
|
Rate for Payer: Allwell Medicaid |
$5,325.73
|
Rate for Payer: AZCH Complete Medicaid |
$5,325.73
|
Rate for Payer: Banner UC Health Medicaid |
$5,325.73
|
Rate for Payer: Mercy Care Medicaid |
$5,325.73
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$8,423.11
|
|
Service Code
|
APR-DRG 1404
|
Hospital Charge Code |
APRDRG1402
|
Min. Negotiated Rate |
$8,423.11 |
Max. Negotiated Rate |
$8,423.11 |
Rate for Payer: AHCCCS Medicaid |
$8,423.11
|
Rate for Payer: Allwell Medicaid |
$8,423.11
|
Rate for Payer: AZCH Complete Medicaid |
$8,423.11
|
Rate for Payer: Banner UC Health Medicaid |
$8,423.11
|
Rate for Payer: Mercy Care Medicaid |
$8,423.11
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$3,418.62
|
|
Service Code
|
APR-DRG 1401
|
Hospital Charge Code |
APRDRG1403
|
Min. Negotiated Rate |
$3,418.62 |
Max. Negotiated Rate |
$3,418.62 |
Rate for Payer: AHCCCS Medicaid |
$3,418.62
|
Rate for Payer: Allwell Medicaid |
$3,418.62
|
Rate for Payer: AZCH Complete Medicaid |
$3,418.62
|
Rate for Payer: Banner UC Health Medicaid |
$3,418.62
|
Rate for Payer: Mercy Care Medicaid |
$3,418.62
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$3,418.62
|
|
Service Code
|
APR-DRG 1401
|
Hospital Charge Code |
APRDRG1404
|
Min. Negotiated Rate |
$3,418.62 |
Max. Negotiated Rate |
$3,418.62 |
Rate for Payer: AHCCCS Medicaid |
$3,418.62
|
Rate for Payer: Allwell Medicaid |
$3,418.62
|
Rate for Payer: AZCH Complete Medicaid |
$3,418.62
|
Rate for Payer: Banner UC Health Medicaid |
$3,418.62
|
Rate for Payer: Mercy Care Medicaid |
$3,418.62
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$3,418.62
|
|
Service Code
|
APR-DRG 1401
|
Hospital Charge Code |
APRDRG1402
|
Min. Negotiated Rate |
$3,418.62 |
Max. Negotiated Rate |
$3,418.62 |
Rate for Payer: AHCCCS Medicaid |
$3,418.62
|
Rate for Payer: Allwell Medicaid |
$3,418.62
|
Rate for Payer: AZCH Complete Medicaid |
$3,418.62
|
Rate for Payer: Banner UC Health Medicaid |
$3,418.62
|
Rate for Payer: Mercy Care Medicaid |
$3,418.62
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
IP
|
$3,418.62
|
|
Service Code
|
APR-DRG 1401
|
Hospital Charge Code |
APRDRG1401
|
Min. Negotiated Rate |
$3,418.62 |
Max. Negotiated Rate |
$3,418.62 |
Rate for Payer: AHCCCS Medicaid |
$3,418.62
|
Rate for Payer: Allwell Medicaid |
$3,418.62
|
Rate for Payer: AZCH Complete Medicaid |
$3,418.62
|
Rate for Payer: Banner UC Health Medicaid |
$3,418.62
|
Rate for Payer: Mercy Care Medicaid |
$3,418.62
|
|
ciprofloxacin 400 mg Premix IVPB [CQCH]
|
Facility
|
OP
|
$0.01
|
|
Service Code
|
HCPCS J0706
|
Hospital Charge Code |
105916460
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Aetna of AZ Commercial |
$0.01
|
Rate for Payer: Aetna of AZ Medicare |
$0.00
|
Rate for Payer: Allwell Medicare |
$0.00
|
Rate for Payer: Amerigroup Medicare |
$0.00
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.00
|
Rate for Payer: AZCH Complete Medicare |
$0.00
|
Rate for Payer: Banner UC Health Medicare |
$0.00
|
Rate for Payer: Bisbee Police All Plans |
$0.00
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.01
|
Rate for Payer: Cash Price |
$0.01
|
Rate for Payer: Cigna of AZ Commercial |
$0.01
|
Rate for Payer: Copperpoint Commercial |
$0.00
|
Rate for Payer: Health Net of AZ Commercial |
$0.01
|
Rate for Payer: Health Net of AZ Medicare |
$0.00
|
Rate for Payer: Humana of AZ Medicare |
$0.00
|
Rate for Payer: Self Pay Self Pay |
$0.01
|
Rate for Payer: TriWest Medicare |
$0.00
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.01
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.00
|
|
ciprofloxacin 400 mg Premix IVPB [CQCH]
|
Facility
|
IP
|
$0.01
|
|
Service Code
|
HCPCS J0706
|
Hospital Charge Code |
105916460
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Aetna of AZ Commercial |
$0.01
|
Rate for Payer: Bisbee Police All Plans |
$0.00
|
Rate for Payer: Cash Price |
$0.01
|
Rate for Payer: Self Pay Self Pay |
$0.01
|
|
ciprofloxacin 500 mg Tab [CQCH]
|
Facility
|
OP
|
$0.16
|
|
Service Code
|
NDC 63739055910
|
Hospital Charge Code |
105916393
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of AZ Commercial |
$0.14
|
Rate for Payer: Aetna of AZ Medicare |
$0.04
|
Rate for Payer: Allwell Medicare |
$0.02
|
Rate for Payer: Amerigroup Medicare |
$0.02
|
Rate for Payer: APIPA Medicare/Medicaid |
$0.06
|
Rate for Payer: AZCH Complete Medicare |
$0.02
|
Rate for Payer: Banner UC Health Medicare |
$0.02
|
Rate for Payer: Bisbee Police All Plans |
$0.04
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.11
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of AZ Commercial |
$0.10
|
Rate for Payer: Copperpoint Commercial |
$0.04
|
Rate for Payer: Health Net of AZ Commercial |
$0.10
|
Rate for Payer: Health Net of AZ Medicare |
$0.04
|
Rate for Payer: Humana of AZ Medicare |
$0.02
|
Rate for Payer: Self Pay Self Pay |
$0.13
|
Rate for Payer: TriWest Medicare |
$0.02
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.09
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
ciprofloxacin 500 mg Tab [CQCH]
|
Facility
|
IP
|
$0.16
|
|
Service Code
|
NDC 63739055910
|
Hospital Charge Code |
105916393
|
Hospital Revenue Code
|
251
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of AZ Commercial |
$0.14
|
Rate for Payer: Bisbee Police All Plans |
$0.04
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Self Pay Self Pay |
$0.13
|
|
ciprofloxacin-dexamethasone otic Sus 7.5 mL [CQCH]
|
Facility
|
OP
|
$231.68
|
|
Service Code
|
NDC 65853302
|
Hospital Charge Code |
107994705
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$34.75 |
Max. Negotiated Rate |
$208.51 |
Rate for Payer: Aetna of AZ Commercial |
$208.51
|
Rate for Payer: Aetna of AZ Medicare |
$64.87
|
Rate for Payer: Allwell Medicare |
$34.75
|
Rate for Payer: Amerigroup Medicare |
$34.75
|
Rate for Payer: APIPA Medicare/Medicaid |
$86.53
|
Rate for Payer: AZCH Complete Medicare |
$34.75
|
Rate for Payer: Banner UC Health Medicare |
$34.75
|
Rate for Payer: Bisbee Police All Plans |
$60.24
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$157.54
|
Rate for Payer: Cash Price |
$185.34
|
Rate for Payer: Cigna of AZ Commercial |
$150.59
|
Rate for Payer: Copperpoint Commercial |
$57.34
|
Rate for Payer: Health Net of AZ Commercial |
$139.01
|
Rate for Payer: Health Net of AZ Medicare |
$64.87
|
Rate for Payer: Humana of AZ Medicare |
$34.75
|
Rate for Payer: Self Pay Self Pay |
$185.34
|
Rate for Payer: TriWest Medicare |
$34.75
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$135.07
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.70
|
|
ciprofloxacin-dexamethasone otic Sus 7.5 mL [CQCH]
|
Facility
|
IP
|
$231.68
|
|
Service Code
|
NDC 65853302
|
Hospital Charge Code |
107994705
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$60.24 |
Max. Negotiated Rate |
$208.51 |
Rate for Payer: Aetna of AZ Commercial |
$208.51
|
Rate for Payer: Bisbee Police All Plans |
$60.24
|
Rate for Payer: Cash Price |
$185.34
|
Rate for Payer: Self Pay Self Pay |
$185.34
|
|
CIT AC 24HR
|
Facility
|
OP
|
$344.00
|
|
Service Code
|
CPT 82507
|
Hospital Charge Code |
22481467
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$27.80 |
Max. Negotiated Rate |
$309.60 |
Rate for Payer: Aetna of AZ Commercial |
$309.60
|
Rate for Payer: Aetna of AZ Medicare |
$96.32
|
Rate for Payer: AHCCCS Medicaid |
$27.80
|
Rate for Payer: Allwell Medicaid |
$27.80
|
Rate for Payer: Allwell Medicare |
$51.60
|
Rate for Payer: Amerigroup Medicare |
$51.60
|
Rate for Payer: APIPA Medicare/Medicaid |
$128.48
|
Rate for Payer: AZCH Complete Medicaid |
$27.80
|
Rate for Payer: AZCH Complete Medicare |
$51.60
|
Rate for Payer: Banner UC Health Medicaid |
$27.80
|
Rate for Payer: Banner UC Health Medicare |
$51.60
|
Rate for Payer: Bisbee Police All Plans |
$89.44
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$233.92
|
Rate for Payer: Cash Price |
$275.20
|
Rate for Payer: Cash Price |
$275.20
|
Rate for Payer: Cigna of AZ Commercial |
$223.60
|
Rate for Payer: Copperpoint Commercial |
$85.14
|
Rate for Payer: Health Net of AZ Commercial |
$206.40
|
Rate for Payer: Health Net of AZ Medicare |
$96.32
|
Rate for Payer: Humana of AZ Medicare |
$51.60
|
Rate for Payer: Mercy Care Medicaid |
$27.80
|
Rate for Payer: Self Pay Self Pay |
$275.20
|
Rate for Payer: TriWest Medicare |
$51.60
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$200.55
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$61.92
|
|