|
Complement C4, Serum LC
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
1285559
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna of AZ Commercial |
$244.80
|
| Rate for Payer: Bisbee Police All Plans |
$70.72
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Self Pay Self Pay |
$217.60
|
|
|
Complement, Total (CH50) LC
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
1906808
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna of AZ Commercial |
$292.50
|
| Rate for Payer: Bisbee Police All Plans |
$84.50
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Self Pay Self Pay |
$260.00
|
|
|
Complement, Total (CH50) LC
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
1906808
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna of AZ Commercial |
$292.50
|
| Rate for Payer: Aetna of AZ Medicare |
$91.00
|
| Rate for Payer: AHCCCS Medicaid |
$20.32
|
| Rate for Payer: Allwell Medicaid |
$20.32
|
| Rate for Payer: Allwell Medicare |
$48.75
|
| Rate for Payer: Amerigroup Medicare |
$48.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$121.39
|
| Rate for Payer: AZCH Complete Medicaid |
$20.32
|
| Rate for Payer: AZCH Complete Medicare |
$48.75
|
| Rate for Payer: Banner UC Health Medicaid |
$20.32
|
| Rate for Payer: Banner UC Health Medicare |
$48.75
|
| Rate for Payer: Bisbee Police All Plans |
$84.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$221.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna of AZ Commercial |
$211.25
|
| Rate for Payer: Copperpoint Commercial |
$80.44
|
| Rate for Payer: Health Net of AZ Commercial |
$195.00
|
| Rate for Payer: Health Net of AZ Medicare |
$91.00
|
| Rate for Payer: Humana of AZ Medicare |
$48.75
|
| Rate for Payer: Mercy Care Medicaid |
$20.32
|
| Rate for Payer: Self Pay Self Pay |
$260.00
|
| Rate for Payer: TriWest Medicare |
$48.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$189.48
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$58.50
|
|
|
Complete Blood Count/Hemogram Standard
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
22141055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Complete Blood Count/Hemogram Standard
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
22141055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Aetna of AZ Medicare |
$49.56
|
| Rate for Payer: AHCCCS Medicaid |
$7.77
|
| Rate for Payer: Allwell Medicaid |
$7.77
|
| Rate for Payer: Allwell Medicare |
$26.55
|
| Rate for Payer: Amerigroup Medicare |
$26.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$66.11
|
| Rate for Payer: AZCH Complete Medicaid |
$7.77
|
| Rate for Payer: AZCH Complete Medicare |
$26.55
|
| Rate for Payer: Banner UC Health Medicaid |
$7.77
|
| Rate for Payer: Banner UC Health Medicare |
$26.55
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$120.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$115.05
|
| Rate for Payer: Copperpoint Commercial |
$43.81
|
| Rate for Payer: Health Net of AZ Commercial |
$106.20
|
| Rate for Payer: Health Net of AZ Medicare |
$49.56
|
| Rate for Payer: Humana of AZ Medicare |
$26.55
|
| Rate for Payer: Mercy Care Medicaid |
$7.77
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
| Rate for Payer: TriWest Medicare |
$26.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$103.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.86
|
|
|
COMPLETE REMOVAL OF REMAINING OR REGROWN PROSTATE TISSUE WIT
|
Facility
|
IP
|
$2,113.00
|
|
|
Service Code
|
CPT 52630
|
| Hospital Charge Code |
27797699
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$549.38 |
| Max. Negotiated Rate |
$1,901.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,901.70
|
| Rate for Payer: Bisbee Police All Plans |
$549.38
|
| Rate for Payer: Cash Price |
$1,690.40
|
| Rate for Payer: Self Pay Self Pay |
$1,690.40
|
|
|
COMPLETE REMOVAL OF REMAINING OR REGROWN PROSTATE TISSUE WIT
|
Facility
|
OP
|
$2,113.00
|
|
|
Service Code
|
CPT 52630
|
| Hospital Charge Code |
27797699
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$316.95 |
| Max. Negotiated Rate |
$6,400.16 |
| Rate for Payer: Aetna of AZ Commercial |
$1,901.70
|
| Rate for Payer: Aetna of AZ Medicare |
$591.64
|
| Rate for Payer: AHCCCS Medicaid |
$6,400.16
|
| Rate for Payer: Allwell Medicaid |
$6,400.16
|
| Rate for Payer: Allwell Medicare |
$316.95
|
| Rate for Payer: Amerigroup Medicare |
$316.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$789.21
|
| Rate for Payer: AZCH Complete Medicaid |
$6,400.16
|
| Rate for Payer: AZCH Complete Medicare |
$316.95
|
| Rate for Payer: Banner UC Health Medicaid |
$6,400.16
|
| Rate for Payer: Banner UC Health Medicare |
$316.95
|
| Rate for Payer: Bisbee Police All Plans |
$549.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,436.84
|
| Rate for Payer: Cash Price |
$1,690.40
|
| Rate for Payer: Cash Price |
$1,690.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,056.50
|
| Rate for Payer: Copperpoint Commercial |
$522.97
|
| Rate for Payer: Health Net of AZ Commercial |
$1,267.80
|
| Rate for Payer: Health Net of AZ Medicare |
$591.64
|
| Rate for Payer: Humana of AZ Medicare |
$316.95
|
| Rate for Payer: Mercy Care Medicaid |
$6,400.16
|
| Rate for Payer: Self Pay Self Pay |
$1,690.40
|
| Rate for Payer: TriWest Medicare |
$316.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4,540.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$380.34
|
|
|
COMPLEX MEASUREMENT OF PRESSURE OF URINE FLOW IN BLADDER WITH URETHRA PRESSURE��COMPLEX MEASUREMENT O
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
27802895
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$541.06 |
| Max. Negotiated Rate |
$1,872.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,872.90
|
| Rate for Payer: Bisbee Police All Plans |
$541.06
|
| Rate for Payer: Cash Price |
$1,664.80
|
| Rate for Payer: Self Pay Self Pay |
$1,664.80
|
|
|
COMPLEX MEASUREMENT OF PRESSURE OF URINE FLOW IN BLADDER WITH URETHRA PRESSURE��COMPLEX MEASUREMENT O
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
27802895
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$312.15 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,872.90
|
| Rate for Payer: Aetna of AZ Medicare |
$582.68
|
| Rate for Payer: AHCCCS Medicaid |
$833.42
|
| Rate for Payer: Allwell Medicaid |
$833.42
|
| Rate for Payer: Allwell Medicare |
$312.15
|
| Rate for Payer: Amerigroup Medicare |
$312.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$777.25
|
| Rate for Payer: AZCH Complete Medicaid |
$833.42
|
| Rate for Payer: AZCH Complete Medicare |
$312.15
|
| Rate for Payer: Banner UC Health Medicaid |
$833.42
|
| Rate for Payer: Banner UC Health Medicare |
$312.15
|
| Rate for Payer: Bisbee Police All Plans |
$541.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,415.08
|
| Rate for Payer: Cash Price |
$1,664.80
|
| Rate for Payer: Cash Price |
$1,664.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,040.50
|
| Rate for Payer: Copperpoint Commercial |
$515.05
|
| Rate for Payer: Health Net of AZ Commercial |
$1,248.60
|
| Rate for Payer: Health Net of AZ Medicare |
$582.68
|
| Rate for Payer: Humana of AZ Medicare |
$312.15
|
| Rate for Payer: Mercy Care Medicaid |
$833.42
|
| Rate for Payer: Self Pay Self Pay |
$1,664.80
|
| Rate for Payer: TriWest Medicare |
$312.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$374.58
|
|
|
Comprehensive Metabolic Panel Standard
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
22141044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Aetna of AZ Commercial |
$369.90
|
| Rate for Payer: Aetna of AZ Medicare |
$115.08
|
| Rate for Payer: AHCCCS Medicaid |
$10.56
|
| Rate for Payer: Allwell Medicaid |
$10.56
|
| Rate for Payer: Allwell Medicare |
$61.65
|
| Rate for Payer: Amerigroup Medicare |
$61.65
|
| Rate for Payer: APIPA Medicare/Medicaid |
$153.51
|
| Rate for Payer: AZCH Complete Medicaid |
$10.56
|
| Rate for Payer: AZCH Complete Medicare |
$61.65
|
| Rate for Payer: Banner UC Health Medicaid |
$10.56
|
| Rate for Payer: Banner UC Health Medicare |
$61.65
|
| Rate for Payer: Bisbee Police All Plans |
$106.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$279.48
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna of AZ Commercial |
$267.15
|
| Rate for Payer: Copperpoint Commercial |
$101.72
|
| Rate for Payer: Health Net of AZ Commercial |
$246.60
|
| Rate for Payer: Health Net of AZ Medicare |
$115.08
|
| Rate for Payer: Humana of AZ Medicare |
$61.65
|
| Rate for Payer: Mercy Care Medicaid |
$10.56
|
| Rate for Payer: Self Pay Self Pay |
$328.80
|
| Rate for Payer: TriWest Medicare |
$61.65
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$239.61
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$73.98
|
|
|
Comprehensive Metabolic Panel Standard
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
22141044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.86 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Aetna of AZ Commercial |
$369.90
|
| Rate for Payer: Bisbee Police All Plans |
$106.86
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Self Pay Self Pay |
$328.80
|
|
|
Computer Crossmatch
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
1779651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Computer Crossmatch
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
1681859
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Computer Crossmatch
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
1681859
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Aetna of AZ Medicare |
$49.56
|
| Rate for Payer: AHCCCS Medicaid |
$108.14
|
| Rate for Payer: Allwell Medicaid |
$108.14
|
| Rate for Payer: Allwell Medicare |
$26.55
|
| Rate for Payer: Amerigroup Medicare |
$26.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$66.11
|
| Rate for Payer: AZCH Complete Medicaid |
$108.14
|
| Rate for Payer: AZCH Complete Medicare |
$26.55
|
| Rate for Payer: Banner UC Health Medicaid |
$108.14
|
| Rate for Payer: Banner UC Health Medicare |
$26.55
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$120.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$115.05
|
| Rate for Payer: Copperpoint Commercial |
$43.81
|
| Rate for Payer: Health Net of AZ Commercial |
$106.20
|
| Rate for Payer: Health Net of AZ Medicare |
$49.56
|
| Rate for Payer: Humana of AZ Medicare |
$26.55
|
| Rate for Payer: Mercy Care Medicaid |
$108.14
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
| Rate for Payer: TriWest Medicare |
$26.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$103.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.86
|
|
|
Computer Crossmatch
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
1779651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Aetna of AZ Medicare |
$49.56
|
| Rate for Payer: AHCCCS Medicaid |
$108.14
|
| Rate for Payer: Allwell Medicaid |
$108.14
|
| Rate for Payer: Allwell Medicare |
$26.55
|
| Rate for Payer: Amerigroup Medicare |
$26.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$66.11
|
| Rate for Payer: AZCH Complete Medicaid |
$108.14
|
| Rate for Payer: AZCH Complete Medicare |
$26.55
|
| Rate for Payer: Banner UC Health Medicaid |
$108.14
|
| Rate for Payer: Banner UC Health Medicare |
$26.55
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$120.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$115.05
|
| Rate for Payer: Copperpoint Commercial |
$43.81
|
| Rate for Payer: Health Net of AZ Commercial |
$106.20
|
| Rate for Payer: Health Net of AZ Medicare |
$49.56
|
| Rate for Payer: Humana of AZ Medicare |
$26.55
|
| Rate for Payer: Mercy Care Medicaid |
$108.14
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
| Rate for Payer: TriWest Medicare |
$26.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$103.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.86
|
|
|
CONCENTRATION INFECT AGENT
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
22422557
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of AZ Commercial |
$77.40
|
| Rate for Payer: Bisbee Police All Plans |
$22.36
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Self Pay Self Pay |
$68.80
|
|
|
CONCENTRATION INFECT AGENT
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
22422557
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of AZ Commercial |
$77.40
|
| Rate for Payer: Aetna of AZ Medicare |
$24.08
|
| Rate for Payer: AHCCCS Medicaid |
$6.68
|
| Rate for Payer: Allwell Medicaid |
$6.68
|
| Rate for Payer: Allwell Medicare |
$12.90
|
| Rate for Payer: Amerigroup Medicare |
$12.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$32.12
|
| Rate for Payer: AZCH Complete Medicaid |
$6.68
|
| Rate for Payer: AZCH Complete Medicare |
$12.90
|
| Rate for Payer: Banner UC Health Medicaid |
$6.68
|
| Rate for Payer: Banner UC Health Medicare |
$12.90
|
| Rate for Payer: Bisbee Police All Plans |
$22.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$58.48
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cigna of AZ Commercial |
$55.90
|
| Rate for Payer: Copperpoint Commercial |
$21.28
|
| Rate for Payer: Health Net of AZ Commercial |
$51.60
|
| Rate for Payer: Health Net of AZ Medicare |
$24.08
|
| Rate for Payer: Humana of AZ Medicare |
$12.90
|
| Rate for Payer: Mercy Care Medicaid |
$6.68
|
| Rate for Payer: Self Pay Self Pay |
$68.80
|
| Rate for Payer: TriWest Medicare |
$12.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$50.14
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.48
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,350.78
|
|
|
Service Code
|
APR-DRG 0571
|
| Hospital Charge Code |
APRDRG0574
|
| Min. Negotiated Rate |
$4,350.78 |
| Max. Negotiated Rate |
$4,350.78 |
| Rate for Payer: AHCCCS Medicaid |
$4,350.78
|
| Rate for Payer: Allwell Medicaid |
$4,350.78
|
| Rate for Payer: AZCH Complete Medicaid |
$4,350.78
|
| Rate for Payer: Banner UC Health Medicaid |
$4,350.78
|
| Rate for Payer: Mercy Care Medicaid |
$4,350.78
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$6,008.19
|
|
|
Service Code
|
APR-DRG 0572
|
| Hospital Charge Code |
APRDRG0573
|
| Min. Negotiated Rate |
$6,008.19 |
| Max. Negotiated Rate |
$6,008.19 |
| Rate for Payer: AHCCCS Medicaid |
$6,008.19
|
| Rate for Payer: Allwell Medicaid |
$6,008.19
|
| Rate for Payer: AZCH Complete Medicaid |
$6,008.19
|
| Rate for Payer: Banner UC Health Medicaid |
$6,008.19
|
| Rate for Payer: Mercy Care Medicaid |
$6,008.19
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$6,008.19
|
|
|
Service Code
|
APR-DRG 0572
|
| Hospital Charge Code |
APRDRG0572
|
| Min. Negotiated Rate |
$6,008.19 |
| Max. Negotiated Rate |
$6,008.19 |
| Rate for Payer: AHCCCS Medicaid |
$6,008.19
|
| Rate for Payer: Allwell Medicaid |
$6,008.19
|
| Rate for Payer: AZCH Complete Medicaid |
$6,008.19
|
| Rate for Payer: Banner UC Health Medicaid |
$6,008.19
|
| Rate for Payer: Mercy Care Medicaid |
$6,008.19
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$6,008.19
|
|
|
Service Code
|
APR-DRG 0572
|
| Hospital Charge Code |
APRDRG0574
|
| Min. Negotiated Rate |
$6,008.19 |
| Max. Negotiated Rate |
$6,008.19 |
| Rate for Payer: AHCCCS Medicaid |
$6,008.19
|
| Rate for Payer: Allwell Medicaid |
$6,008.19
|
| Rate for Payer: AZCH Complete Medicaid |
$6,008.19
|
| Rate for Payer: Banner UC Health Medicaid |
$6,008.19
|
| Rate for Payer: Mercy Care Medicaid |
$6,008.19
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$8,392.25
|
|
|
Service Code
|
APR-DRG 0573
|
| Hospital Charge Code |
APRDRG0573
|
| Min. Negotiated Rate |
$8,392.25 |
| Max. Negotiated Rate |
$8,392.25 |
| Rate for Payer: AHCCCS Medicaid |
$8,392.25
|
| Rate for Payer: Allwell Medicaid |
$8,392.25
|
| Rate for Payer: AZCH Complete Medicaid |
$8,392.25
|
| Rate for Payer: Banner UC Health Medicaid |
$8,392.25
|
| Rate for Payer: Mercy Care Medicaid |
$8,392.25
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$8,392.25
|
|
|
Service Code
|
APR-DRG 0573
|
| Hospital Charge Code |
APRDRG0574
|
| Min. Negotiated Rate |
$8,392.25 |
| Max. Negotiated Rate |
$8,392.25 |
| Rate for Payer: AHCCCS Medicaid |
$8,392.25
|
| Rate for Payer: Allwell Medicaid |
$8,392.25
|
| Rate for Payer: AZCH Complete Medicaid |
$8,392.25
|
| Rate for Payer: Banner UC Health Medicaid |
$8,392.25
|
| Rate for Payer: Mercy Care Medicaid |
$8,392.25
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$8,392.25
|
|
|
Service Code
|
APR-DRG 0573
|
| Hospital Charge Code |
APRDRG0571
|
| Min. Negotiated Rate |
$8,392.25 |
| Max. Negotiated Rate |
$8,392.25 |
| Rate for Payer: AHCCCS Medicaid |
$8,392.25
|
| Rate for Payer: Allwell Medicaid |
$8,392.25
|
| Rate for Payer: AZCH Complete Medicaid |
$8,392.25
|
| Rate for Payer: Banner UC Health Medicaid |
$8,392.25
|
| Rate for Payer: Mercy Care Medicaid |
$8,392.25
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,350.78
|
|
|
Service Code
|
APR-DRG 0571
|
| Hospital Charge Code |
APRDRG0573
|
| Min. Negotiated Rate |
$4,350.78 |
| Max. Negotiated Rate |
$4,350.78 |
| Rate for Payer: AHCCCS Medicaid |
$4,350.78
|
| Rate for Payer: Allwell Medicaid |
$4,350.78
|
| Rate for Payer: AZCH Complete Medicaid |
$4,350.78
|
| Rate for Payer: Banner UC Health Medicaid |
$4,350.78
|
| Rate for Payer: Mercy Care Medicaid |
$4,350.78
|
|
