|
CONNECTING TUBING FOR CUFF PRESSURE GAUGE
|
Facility
|
IP
|
$57.57
|
|
| Hospital Charge Code |
28000331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna of AZ Commercial |
$51.81
|
| Rate for Payer: Bisbee Police All Plans |
$14.97
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Self Pay Self Pay |
$46.06
|
|
|
CONNECTING TUBING FOR CUFF PRESSURE GAUGE
|
Facility
|
OP
|
$57.57
|
|
| Hospital Charge Code |
28000331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna of AZ Commercial |
$51.81
|
| Rate for Payer: Aetna of AZ Medicare |
$16.12
|
| Rate for Payer: Allwell Medicare |
$9.21
|
| Rate for Payer: Amerigroup Medicare |
$9.21
|
| Rate for Payer: APIPA Medicare/Medicaid |
$21.50
|
| Rate for Payer: AZCH Complete Medicare |
$9.21
|
| Rate for Payer: Banner UC Health Medicare |
$9.21
|
| Rate for Payer: Bisbee Police All Plans |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$39.15
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cigna of AZ Commercial |
$40.30
|
| Rate for Payer: Copperpoint Commercial |
$14.25
|
| Rate for Payer: Health Net of AZ Commercial |
$34.54
|
| Rate for Payer: Health Net of AZ Medicare |
$16.12
|
| Rate for Payer: Humana of AZ Medicare |
$9.21
|
| Rate for Payer: Self Pay Self Pay |
$46.06
|
| Rate for Payer: TriWest Medicare |
$9.21
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$33.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$10.36
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$5,984.34
|
|
|
Service Code
|
APR-DRG 3462
|
| Hospital Charge Code |
APRDRG3462
|
| Min. Negotiated Rate |
$5,984.34 |
| Max. Negotiated Rate |
$5,984.34 |
| Rate for Payer: AHCCCS Medicaid |
$5,984.34
|
| Rate for Payer: Allwell Medicaid |
$5,984.34
|
| Rate for Payer: AZCH Complete Medicaid |
$5,984.34
|
| Rate for Payer: Banner UC Health Medicaid |
$5,984.34
|
| Rate for Payer: Mercy Care Medicaid |
$5,984.34
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$9,961.98
|
|
|
Service Code
|
APR-DRG 3463
|
| Hospital Charge Code |
APRDRG3462
|
| Min. Negotiated Rate |
$9,961.98 |
| Max. Negotiated Rate |
$9,961.98 |
| Rate for Payer: AHCCCS Medicaid |
$9,961.98
|
| Rate for Payer: Allwell Medicaid |
$9,961.98
|
| Rate for Payer: AZCH Complete Medicaid |
$9,961.98
|
| Rate for Payer: Banner UC Health Medicaid |
$9,961.98
|
| Rate for Payer: Mercy Care Medicaid |
$9,961.98
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$9,961.98
|
|
|
Service Code
|
APR-DRG 3463
|
| Hospital Charge Code |
APRDRG3464
|
| Min. Negotiated Rate |
$9,961.98 |
| Max. Negotiated Rate |
$9,961.98 |
| Rate for Payer: AHCCCS Medicaid |
$9,961.98
|
| Rate for Payer: Allwell Medicaid |
$9,961.98
|
| Rate for Payer: AZCH Complete Medicaid |
$9,961.98
|
| Rate for Payer: Banner UC Health Medicaid |
$9,961.98
|
| Rate for Payer: Mercy Care Medicaid |
$9,961.98
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$5,984.34
|
|
|
Service Code
|
APR-DRG 3462
|
| Hospital Charge Code |
APRDRG3461
|
| Min. Negotiated Rate |
$5,984.34 |
| Max. Negotiated Rate |
$5,984.34 |
| Rate for Payer: AHCCCS Medicaid |
$5,984.34
|
| Rate for Payer: Allwell Medicaid |
$5,984.34
|
| Rate for Payer: AZCH Complete Medicaid |
$5,984.34
|
| Rate for Payer: Banner UC Health Medicaid |
$5,984.34
|
| Rate for Payer: Mercy Care Medicaid |
$5,984.34
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$9,961.98
|
|
|
Service Code
|
APR-DRG 3463
|
| Hospital Charge Code |
APRDRG3463
|
| Min. Negotiated Rate |
$9,961.98 |
| Max. Negotiated Rate |
$9,961.98 |
| Rate for Payer: AHCCCS Medicaid |
$9,961.98
|
| Rate for Payer: Allwell Medicaid |
$9,961.98
|
| Rate for Payer: AZCH Complete Medicaid |
$9,961.98
|
| Rate for Payer: Banner UC Health Medicaid |
$9,961.98
|
| Rate for Payer: Mercy Care Medicaid |
$9,961.98
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$4,388.66
|
|
|
Service Code
|
APR-DRG 3461
|
| Hospital Charge Code |
APRDRG3461
|
| Min. Negotiated Rate |
$4,388.66 |
| Max. Negotiated Rate |
$4,388.66 |
| Rate for Payer: AHCCCS Medicaid |
$4,388.66
|
| Rate for Payer: Allwell Medicaid |
$4,388.66
|
| Rate for Payer: AZCH Complete Medicaid |
$4,388.66
|
| Rate for Payer: Banner UC Health Medicaid |
$4,388.66
|
| Rate for Payer: Mercy Care Medicaid |
$4,388.66
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$4,388.66
|
|
|
Service Code
|
APR-DRG 3461
|
| Hospital Charge Code |
APRDRG3462
|
| Min. Negotiated Rate |
$4,388.66 |
| Max. Negotiated Rate |
$4,388.66 |
| Rate for Payer: AHCCCS Medicaid |
$4,388.66
|
| Rate for Payer: Allwell Medicaid |
$4,388.66
|
| Rate for Payer: AZCH Complete Medicaid |
$4,388.66
|
| Rate for Payer: Banner UC Health Medicaid |
$4,388.66
|
| Rate for Payer: Mercy Care Medicaid |
$4,388.66
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$22,866.34
|
|
|
Service Code
|
APR-DRG 3464
|
| Hospital Charge Code |
APRDRG3462
|
| Min. Negotiated Rate |
$22,866.34 |
| Max. Negotiated Rate |
$22,866.34 |
| Rate for Payer: AHCCCS Medicaid |
$22,866.34
|
| Rate for Payer: Allwell Medicaid |
$22,866.34
|
| Rate for Payer: AZCH Complete Medicaid |
$22,866.34
|
| Rate for Payer: Banner UC Health Medicaid |
$22,866.34
|
| Rate for Payer: Mercy Care Medicaid |
$22,866.34
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$5,984.34
|
|
|
Service Code
|
APR-DRG 3462
|
| Hospital Charge Code |
APRDRG3463
|
| Min. Negotiated Rate |
$5,984.34 |
| Max. Negotiated Rate |
$5,984.34 |
| Rate for Payer: AHCCCS Medicaid |
$5,984.34
|
| Rate for Payer: Allwell Medicaid |
$5,984.34
|
| Rate for Payer: AZCH Complete Medicaid |
$5,984.34
|
| Rate for Payer: Banner UC Health Medicaid |
$5,984.34
|
| Rate for Payer: Mercy Care Medicaid |
$5,984.34
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$4,388.66
|
|
|
Service Code
|
APR-DRG 3461
|
| Hospital Charge Code |
APRDRG3463
|
| Min. Negotiated Rate |
$4,388.66 |
| Max. Negotiated Rate |
$4,388.66 |
| Rate for Payer: AHCCCS Medicaid |
$4,388.66
|
| Rate for Payer: Allwell Medicaid |
$4,388.66
|
| Rate for Payer: AZCH Complete Medicaid |
$4,388.66
|
| Rate for Payer: Banner UC Health Medicaid |
$4,388.66
|
| Rate for Payer: Mercy Care Medicaid |
$4,388.66
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$4,388.66
|
|
|
Service Code
|
APR-DRG 3461
|
| Hospital Charge Code |
APRDRG3464
|
| Min. Negotiated Rate |
$4,388.66 |
| Max. Negotiated Rate |
$4,388.66 |
| Rate for Payer: AHCCCS Medicaid |
$4,388.66
|
| Rate for Payer: Allwell Medicaid |
$4,388.66
|
| Rate for Payer: AZCH Complete Medicaid |
$4,388.66
|
| Rate for Payer: Banner UC Health Medicaid |
$4,388.66
|
| Rate for Payer: Mercy Care Medicaid |
$4,388.66
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$22,866.34
|
|
|
Service Code
|
APR-DRG 3464
|
| Hospital Charge Code |
APRDRG3464
|
| Min. Negotiated Rate |
$22,866.34 |
| Max. Negotiated Rate |
$22,866.34 |
| Rate for Payer: AHCCCS Medicaid |
$22,866.34
|
| Rate for Payer: Allwell Medicaid |
$22,866.34
|
| Rate for Payer: AZCH Complete Medicaid |
$22,866.34
|
| Rate for Payer: Banner UC Health Medicaid |
$22,866.34
|
| Rate for Payer: Mercy Care Medicaid |
$22,866.34
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$22,866.34
|
|
|
Service Code
|
APR-DRG 3464
|
| Hospital Charge Code |
APRDRG3463
|
| Min. Negotiated Rate |
$22,866.34 |
| Max. Negotiated Rate |
$22,866.34 |
| Rate for Payer: AHCCCS Medicaid |
$22,866.34
|
| Rate for Payer: Allwell Medicaid |
$22,866.34
|
| Rate for Payer: AZCH Complete Medicaid |
$22,866.34
|
| Rate for Payer: Banner UC Health Medicaid |
$22,866.34
|
| Rate for Payer: Mercy Care Medicaid |
$22,866.34
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$5,984.34
|
|
|
Service Code
|
APR-DRG 3462
|
| Hospital Charge Code |
APRDRG3464
|
| Min. Negotiated Rate |
$5,984.34 |
| Max. Negotiated Rate |
$5,984.34 |
| Rate for Payer: AHCCCS Medicaid |
$5,984.34
|
| Rate for Payer: Allwell Medicaid |
$5,984.34
|
| Rate for Payer: AZCH Complete Medicaid |
$5,984.34
|
| Rate for Payer: Banner UC Health Medicaid |
$5,984.34
|
| Rate for Payer: Mercy Care Medicaid |
$5,984.34
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$22,866.34
|
|
|
Service Code
|
APR-DRG 3464
|
| Hospital Charge Code |
APRDRG3461
|
| Min. Negotiated Rate |
$22,866.34 |
| Max. Negotiated Rate |
$22,866.34 |
| Rate for Payer: AHCCCS Medicaid |
$22,866.34
|
| Rate for Payer: Allwell Medicaid |
$22,866.34
|
| Rate for Payer: AZCH Complete Medicaid |
$22,866.34
|
| Rate for Payer: Banner UC Health Medicaid |
$22,866.34
|
| Rate for Payer: Mercy Care Medicaid |
$22,866.34
|
|
|
Connective Tissue Disorders
|
Facility
|
IP
|
$9,961.98
|
|
|
Service Code
|
APR-DRG 3463
|
| Hospital Charge Code |
APRDRG3461
|
| Min. Negotiated Rate |
$9,961.98 |
| Max. Negotiated Rate |
$9,961.98 |
| Rate for Payer: AHCCCS Medicaid |
$9,961.98
|
| Rate for Payer: Allwell Medicaid |
$9,961.98
|
| Rate for Payer: AZCH Complete Medicaid |
$9,961.98
|
| Rate for Payer: Banner UC Health Medicaid |
$9,961.98
|
| Rate for Payer: Mercy Care Medicaid |
$9,961.98
|
|
|
Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue
|
Facility
|
IP
|
$3,958.00
|
|
|
Service Code
|
APR-DRG 3841
|
| Hospital Charge Code |
APRDRG3844
|
| Min. Negotiated Rate |
$3,958.00 |
| Max. Negotiated Rate |
$3,958.00 |
| Rate for Payer: AHCCCS Medicaid |
$3,958.00
|
| Rate for Payer: Allwell Medicaid |
$3,958.00
|
| Rate for Payer: AZCH Complete Medicaid |
$3,958.00
|
| Rate for Payer: Banner UC Health Medicaid |
$3,958.00
|
| Rate for Payer: Mercy Care Medicaid |
$3,958.00
|
|
|
Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue
|
Facility
|
IP
|
$7,002.78
|
|
|
Service Code
|
APR-DRG 3843
|
| Hospital Charge Code |
APRDRG3844
|
| Min. Negotiated Rate |
$7,002.78 |
| Max. Negotiated Rate |
$7,002.78 |
| Rate for Payer: AHCCCS Medicaid |
$7,002.78
|
| Rate for Payer: Allwell Medicaid |
$7,002.78
|
| Rate for Payer: AZCH Complete Medicaid |
$7,002.78
|
| Rate for Payer: Banner UC Health Medicaid |
$7,002.78
|
| Rate for Payer: Mercy Care Medicaid |
$7,002.78
|
|
|
Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue
|
Facility
|
IP
|
$7,002.78
|
|
|
Service Code
|
APR-DRG 3843
|
| Hospital Charge Code |
APRDRG3841
|
| Min. Negotiated Rate |
$7,002.78 |
| Max. Negotiated Rate |
$7,002.78 |
| Rate for Payer: AHCCCS Medicaid |
$7,002.78
|
| Rate for Payer: Allwell Medicaid |
$7,002.78
|
| Rate for Payer: AZCH Complete Medicaid |
$7,002.78
|
| Rate for Payer: Banner UC Health Medicaid |
$7,002.78
|
| Rate for Payer: Mercy Care Medicaid |
$7,002.78
|
|
|
Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue
|
Facility
|
IP
|
$13,242.43
|
|
|
Service Code
|
APR-DRG 3844
|
| Hospital Charge Code |
APRDRG3842
|
| Min. Negotiated Rate |
$13,242.43 |
| Max. Negotiated Rate |
$13,242.43 |
| Rate for Payer: AHCCCS Medicaid |
$13,242.43
|
| Rate for Payer: Allwell Medicaid |
$13,242.43
|
| Rate for Payer: AZCH Complete Medicaid |
$13,242.43
|
| Rate for Payer: Banner UC Health Medicaid |
$13,242.43
|
| Rate for Payer: Mercy Care Medicaid |
$13,242.43
|
|
|
Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue
|
Facility
|
IP
|
$4,782.85
|
|
|
Service Code
|
APR-DRG 3842
|
| Hospital Charge Code |
APRDRG3841
|
| Min. Negotiated Rate |
$4,782.85 |
| Max. Negotiated Rate |
$4,782.85 |
| Rate for Payer: AHCCCS Medicaid |
$4,782.85
|
| Rate for Payer: Allwell Medicaid |
$4,782.85
|
| Rate for Payer: AZCH Complete Medicaid |
$4,782.85
|
| Rate for Payer: Banner UC Health Medicaid |
$4,782.85
|
| Rate for Payer: Mercy Care Medicaid |
$4,782.85
|
|
|
Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue
|
Facility
|
IP
|
$3,958.00
|
|
|
Service Code
|
APR-DRG 3841
|
| Hospital Charge Code |
APRDRG3841
|
| Min. Negotiated Rate |
$3,958.00 |
| Max. Negotiated Rate |
$3,958.00 |
| Rate for Payer: AHCCCS Medicaid |
$3,958.00
|
| Rate for Payer: Allwell Medicaid |
$3,958.00
|
| Rate for Payer: AZCH Complete Medicaid |
$3,958.00
|
| Rate for Payer: Banner UC Health Medicaid |
$3,958.00
|
| Rate for Payer: Mercy Care Medicaid |
$3,958.00
|
|
|
Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue
|
Facility
|
IP
|
$7,002.78
|
|
|
Service Code
|
APR-DRG 3843
|
| Hospital Charge Code |
APRDRG3843
|
| Min. Negotiated Rate |
$7,002.78 |
| Max. Negotiated Rate |
$7,002.78 |
| Rate for Payer: AHCCCS Medicaid |
$7,002.78
|
| Rate for Payer: Allwell Medicaid |
$7,002.78
|
| Rate for Payer: AZCH Complete Medicaid |
$7,002.78
|
| Rate for Payer: Banner UC Health Medicaid |
$7,002.78
|
| Rate for Payer: Mercy Care Medicaid |
$7,002.78
|
|
