|
COOK G53566
|
Facility
|
IP
|
$142.00
|
|
| Hospital Charge Code |
22619314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna of AZ Commercial |
$127.80
|
| Rate for Payer: Bisbee Police All Plans |
$36.92
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Self Pay Self Pay |
$113.60
|
|
|
COOK G53566
|
Facility
|
OP
|
$142.00
|
|
| Hospital Charge Code |
22619314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna of AZ Commercial |
$127.80
|
| Rate for Payer: Aetna of AZ Medicare |
$39.76
|
| Rate for Payer: Allwell Medicare |
$22.72
|
| Rate for Payer: Amerigroup Medicare |
$22.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$53.04
|
| Rate for Payer: AZCH Complete Medicare |
$22.72
|
| Rate for Payer: Banner UC Health Medicare |
$22.72
|
| Rate for Payer: Bisbee Police All Plans |
$36.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$96.56
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cigna of AZ Commercial |
$99.40
|
| Rate for Payer: Copperpoint Commercial |
$35.15
|
| Rate for Payer: Health Net of AZ Commercial |
$85.20
|
| Rate for Payer: Health Net of AZ Medicare |
$39.76
|
| Rate for Payer: Humana of AZ Medicare |
$22.72
|
| Rate for Payer: Self Pay Self Pay |
$113.60
|
| Rate for Payer: TriWest Medicare |
$22.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$82.79
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.56
|
|
|
COOK ULTRAXX NEPHROSTOMY BALLOON SET 10M
|
Facility
|
IP
|
$948.00
|
|
| Hospital Charge Code |
22354223
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$853.20 |
| Rate for Payer: Aetna of AZ Commercial |
$853.20
|
| Rate for Payer: Bisbee Police All Plans |
$246.48
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Self Pay Self Pay |
$758.40
|
|
|
COOK ULTRAXX NEPHROSTOMY BALLOON SET 10M
|
Facility
|
OP
|
$948.00
|
|
| Hospital Charge Code |
22354223
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.68 |
| Max. Negotiated Rate |
$853.20 |
| Rate for Payer: Aetna of AZ Commercial |
$853.20
|
| Rate for Payer: Aetna of AZ Medicare |
$265.44
|
| Rate for Payer: Allwell Medicare |
$151.68
|
| Rate for Payer: Amerigroup Medicare |
$151.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$354.08
|
| Rate for Payer: AZCH Complete Medicare |
$151.68
|
| Rate for Payer: Banner UC Health Medicare |
$151.68
|
| Rate for Payer: Bisbee Police All Plans |
$246.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$644.64
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cigna of AZ Commercial |
$663.60
|
| Rate for Payer: Copperpoint Commercial |
$234.63
|
| Rate for Payer: Health Net of AZ Commercial |
$568.80
|
| Rate for Payer: Health Net of AZ Medicare |
$265.44
|
| Rate for Payer: Humana of AZ Medicare |
$151.68
|
| Rate for Payer: Self Pay Self Pay |
$758.40
|
| Rate for Payer: TriWest Medicare |
$151.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$552.68
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$170.64
|
|
|
Copper Serum LC
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
1285554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Aetna of AZ Medicare |
$41.44
|
| Rate for Payer: Allwell Medicare |
$23.68
|
| Rate for Payer: Amerigroup Medicare |
$23.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.28
|
| Rate for Payer: AZCH Complete Medicare |
$23.68
|
| Rate for Payer: Banner UC Health Medicare |
$23.68
|
| Rate for Payer: Bisbee Police All Plans |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$100.64
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cigna of AZ Commercial |
$96.20
|
| Rate for Payer: Copperpoint Commercial |
$36.63
|
| Rate for Payer: Health Net of AZ Commercial |
$88.80
|
| Rate for Payer: Health Net of AZ Medicare |
$41.44
|
| Rate for Payer: Humana of AZ Medicare |
$23.68
|
| Rate for Payer: Self Pay Self Pay |
$118.40
|
| Rate for Payer: TriWest Medicare |
$23.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$86.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.64
|
|
|
Copper Serum LC
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
1285554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Bisbee Police All Plans |
$38.48
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Self Pay Self Pay |
$118.40
|
|
|
Copper, Urine LC
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
2029250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Aetna of AZ Medicare |
$43.68
|
| Rate for Payer: Allwell Medicare |
$24.96
|
| Rate for Payer: Amerigroup Medicare |
$24.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$58.27
|
| Rate for Payer: AZCH Complete Medicare |
$24.96
|
| Rate for Payer: Banner UC Health Medicare |
$24.96
|
| Rate for Payer: Bisbee Police All Plans |
$40.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$106.08
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna of AZ Commercial |
$101.40
|
| Rate for Payer: Copperpoint Commercial |
$38.61
|
| Rate for Payer: Health Net of AZ Commercial |
$93.60
|
| Rate for Payer: Health Net of AZ Medicare |
$43.68
|
| Rate for Payer: Humana of AZ Medicare |
$24.96
|
| Rate for Payer: Self Pay Self Pay |
$124.80
|
| Rate for Payer: TriWest Medicare |
$24.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$90.95
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.08
|
|
|
Copper, Urine LC
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
2029250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Bisbee Police All Plans |
$40.56
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Self Pay Self Pay |
$124.80
|
|
|
Cord Gas Venous 1
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
5144987
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.36 |
| Max. Negotiated Rate |
$288.90 |
| Rate for Payer: Aetna of AZ Commercial |
$288.90
|
| Rate for Payer: Aetna of AZ Medicare |
$89.88
|
| Rate for Payer: Allwell Medicare |
$51.36
|
| Rate for Payer: Amerigroup Medicare |
$51.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$119.89
|
| Rate for Payer: AZCH Complete Medicare |
$51.36
|
| Rate for Payer: Banner UC Health Medicare |
$51.36
|
| Rate for Payer: Bisbee Police All Plans |
$83.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$218.28
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cigna of AZ Commercial |
$208.65
|
| Rate for Payer: Copperpoint Commercial |
$79.45
|
| Rate for Payer: Health Net of AZ Commercial |
$192.60
|
| Rate for Payer: Health Net of AZ Medicare |
$89.88
|
| Rate for Payer: Humana of AZ Medicare |
$51.36
|
| Rate for Payer: Self Pay Self Pay |
$256.80
|
| Rate for Payer: TriWest Medicare |
$51.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$187.14
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$57.78
|
|
|
Cord Gas Venous 1
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
5144987
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.46 |
| Max. Negotiated Rate |
$288.90 |
| Rate for Payer: Aetna of AZ Commercial |
$288.90
|
| Rate for Payer: Bisbee Police All Plans |
$83.46
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Self Pay Self Pay |
$256.80
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,605.67
|
|
|
Service Code
|
APR-DRG 1653
|
| Hospital Charge Code |
APRDRG1651
|
| Min. Negotiated Rate |
$34,605.67 |
| Max. Negotiated Rate |
$34,605.67 |
| Rate for Payer: AHCCCS Medicaid |
$34,605.67
|
| Rate for Payer: Allwell Medicaid |
$34,605.67
|
| Rate for Payer: AZCH Complete Medicaid |
$34,605.67
|
| Rate for Payer: Banner UC Health Medicaid |
$34,605.67
|
| Rate for Payer: Mercy Care Medicaid |
$34,605.67
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$50,697.89
|
|
|
Service Code
|
APR-DRG 1654
|
| Hospital Charge Code |
APRDRG1651
|
| Min. Negotiated Rate |
$50,697.89 |
| Max. Negotiated Rate |
$50,697.89 |
| Rate for Payer: AHCCCS Medicaid |
$50,697.89
|
| Rate for Payer: Allwell Medicaid |
$50,697.89
|
| Rate for Payer: AZCH Complete Medicaid |
$50,697.89
|
| Rate for Payer: Banner UC Health Medicaid |
$50,697.89
|
| Rate for Payer: Mercy Care Medicaid |
$50,697.89
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$27,271.13
|
|
|
Service Code
|
APR-DRG 1652
|
| Hospital Charge Code |
APRDRG1654
|
| Min. Negotiated Rate |
$27,271.13 |
| Max. Negotiated Rate |
$27,271.13 |
| Rate for Payer: AHCCCS Medicaid |
$27,271.13
|
| Rate for Payer: Allwell Medicaid |
$27,271.13
|
| Rate for Payer: AZCH Complete Medicaid |
$27,271.13
|
| Rate for Payer: Banner UC Health Medicaid |
$27,271.13
|
| Rate for Payer: Mercy Care Medicaid |
$27,271.13
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,605.67
|
|
|
Service Code
|
APR-DRG 1653
|
| Hospital Charge Code |
APRDRG1653
|
| Min. Negotiated Rate |
$34,605.67 |
| Max. Negotiated Rate |
$34,605.67 |
| Rate for Payer: AHCCCS Medicaid |
$34,605.67
|
| Rate for Payer: Allwell Medicaid |
$34,605.67
|
| Rate for Payer: AZCH Complete Medicaid |
$34,605.67
|
| Rate for Payer: Banner UC Health Medicaid |
$34,605.67
|
| Rate for Payer: Mercy Care Medicaid |
$34,605.67
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$23,090.79
|
|
|
Service Code
|
APR-DRG 1651
|
| Hospital Charge Code |
APRDRG1654
|
| Min. Negotiated Rate |
$23,090.79 |
| Max. Negotiated Rate |
$23,090.79 |
| Rate for Payer: AHCCCS Medicaid |
$23,090.79
|
| Rate for Payer: Allwell Medicaid |
$23,090.79
|
| Rate for Payer: AZCH Complete Medicaid |
$23,090.79
|
| Rate for Payer: Banner UC Health Medicaid |
$23,090.79
|
| Rate for Payer: Mercy Care Medicaid |
$23,090.79
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$23,090.79
|
|
|
Service Code
|
APR-DRG 1651
|
| Hospital Charge Code |
APRDRG1652
|
| Min. Negotiated Rate |
$23,090.79 |
| Max. Negotiated Rate |
$23,090.79 |
| Rate for Payer: AHCCCS Medicaid |
$23,090.79
|
| Rate for Payer: Allwell Medicaid |
$23,090.79
|
| Rate for Payer: AZCH Complete Medicaid |
$23,090.79
|
| Rate for Payer: Banner UC Health Medicaid |
$23,090.79
|
| Rate for Payer: Mercy Care Medicaid |
$23,090.79
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$23,090.79
|
|
|
Service Code
|
APR-DRG 1651
|
| Hospital Charge Code |
APRDRG1653
|
| Min. Negotiated Rate |
$23,090.79 |
| Max. Negotiated Rate |
$23,090.79 |
| Rate for Payer: AHCCCS Medicaid |
$23,090.79
|
| Rate for Payer: Allwell Medicaid |
$23,090.79
|
| Rate for Payer: AZCH Complete Medicaid |
$23,090.79
|
| Rate for Payer: Banner UC Health Medicaid |
$23,090.79
|
| Rate for Payer: Mercy Care Medicaid |
$23,090.79
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$23,090.79
|
|
|
Service Code
|
APR-DRG 1651
|
| Hospital Charge Code |
APRDRG1651
|
| Min. Negotiated Rate |
$23,090.79 |
| Max. Negotiated Rate |
$23,090.79 |
| Rate for Payer: AHCCCS Medicaid |
$23,090.79
|
| Rate for Payer: Allwell Medicaid |
$23,090.79
|
| Rate for Payer: AZCH Complete Medicaid |
$23,090.79
|
| Rate for Payer: Banner UC Health Medicaid |
$23,090.79
|
| Rate for Payer: Mercy Care Medicaid |
$23,090.79
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$50,697.89
|
|
|
Service Code
|
APR-DRG 1654
|
| Hospital Charge Code |
APRDRG1653
|
| Min. Negotiated Rate |
$50,697.89 |
| Max. Negotiated Rate |
$50,697.89 |
| Rate for Payer: AHCCCS Medicaid |
$50,697.89
|
| Rate for Payer: Allwell Medicaid |
$50,697.89
|
| Rate for Payer: AZCH Complete Medicaid |
$50,697.89
|
| Rate for Payer: Banner UC Health Medicaid |
$50,697.89
|
| Rate for Payer: Mercy Care Medicaid |
$50,697.89
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$27,271.13
|
|
|
Service Code
|
APR-DRG 1652
|
| Hospital Charge Code |
APRDRG1651
|
| Min. Negotiated Rate |
$27,271.13 |
| Max. Negotiated Rate |
$27,271.13 |
| Rate for Payer: AHCCCS Medicaid |
$27,271.13
|
| Rate for Payer: Allwell Medicaid |
$27,271.13
|
| Rate for Payer: AZCH Complete Medicaid |
$27,271.13
|
| Rate for Payer: Banner UC Health Medicaid |
$27,271.13
|
| Rate for Payer: Mercy Care Medicaid |
$27,271.13
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,605.67
|
|
|
Service Code
|
APR-DRG 1653
|
| Hospital Charge Code |
APRDRG1652
|
| Min. Negotiated Rate |
$34,605.67 |
| Max. Negotiated Rate |
$34,605.67 |
| Rate for Payer: AHCCCS Medicaid |
$34,605.67
|
| Rate for Payer: Allwell Medicaid |
$34,605.67
|
| Rate for Payer: AZCH Complete Medicaid |
$34,605.67
|
| Rate for Payer: Banner UC Health Medicaid |
$34,605.67
|
| Rate for Payer: Mercy Care Medicaid |
$34,605.67
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,605.67
|
|
|
Service Code
|
APR-DRG 1653
|
| Hospital Charge Code |
APRDRG1654
|
| Min. Negotiated Rate |
$34,605.67 |
| Max. Negotiated Rate |
$34,605.67 |
| Rate for Payer: AHCCCS Medicaid |
$34,605.67
|
| Rate for Payer: Allwell Medicaid |
$34,605.67
|
| Rate for Payer: AZCH Complete Medicaid |
$34,605.67
|
| Rate for Payer: Banner UC Health Medicaid |
$34,605.67
|
| Rate for Payer: Mercy Care Medicaid |
$34,605.67
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$27,271.13
|
|
|
Service Code
|
APR-DRG 1652
|
| Hospital Charge Code |
APRDRG1653
|
| Min. Negotiated Rate |
$27,271.13 |
| Max. Negotiated Rate |
$27,271.13 |
| Rate for Payer: AHCCCS Medicaid |
$27,271.13
|
| Rate for Payer: Allwell Medicaid |
$27,271.13
|
| Rate for Payer: AZCH Complete Medicaid |
$27,271.13
|
| Rate for Payer: Banner UC Health Medicaid |
$27,271.13
|
| Rate for Payer: Mercy Care Medicaid |
$27,271.13
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$50,697.89
|
|
|
Service Code
|
APR-DRG 1654
|
| Hospital Charge Code |
APRDRG1652
|
| Min. Negotiated Rate |
$50,697.89 |
| Max. Negotiated Rate |
$50,697.89 |
| Rate for Payer: AHCCCS Medicaid |
$50,697.89
|
| Rate for Payer: Allwell Medicaid |
$50,697.89
|
| Rate for Payer: AZCH Complete Medicaid |
$50,697.89
|
| Rate for Payer: Banner UC Health Medicaid |
$50,697.89
|
| Rate for Payer: Mercy Care Medicaid |
$50,697.89
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$27,271.13
|
|
|
Service Code
|
APR-DRG 1652
|
| Hospital Charge Code |
APRDRG1652
|
| Min. Negotiated Rate |
$27,271.13 |
| Max. Negotiated Rate |
$27,271.13 |
| Rate for Payer: AHCCCS Medicaid |
$27,271.13
|
| Rate for Payer: Allwell Medicaid |
$27,271.13
|
| Rate for Payer: AZCH Complete Medicaid |
$27,271.13
|
| Rate for Payer: Banner UC Health Medicaid |
$27,271.13
|
| Rate for Payer: Mercy Care Medicaid |
$27,271.13
|
|
