|
cortrosyn injection[CQCH]
|
Facility
|
IP
|
$18.52
|
|
|
Service Code
|
NDC 3.05486E+11
|
| Hospital Charge Code |
124449918
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$16.67 |
| Rate for Payer: Aetna of AZ Commercial |
$16.67
|
| Rate for Payer: Bisbee Police All Plans |
$4.82
|
| Rate for Payer: Cash Price |
$14.82
|
| Rate for Payer: Self Pay Self Pay |
$14.82
|
|
|
COVER LIGHT HANDLE
|
Facility
|
OP
|
$47.00
|
|
| Hospital Charge Code |
22355305
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of AZ Commercial |
$42.30
|
| Rate for Payer: Aetna of AZ Medicare |
$13.16
|
| Rate for Payer: Allwell Medicare |
$7.05
|
| Rate for Payer: Amerigroup Medicare |
$7.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$17.55
|
| Rate for Payer: AZCH Complete Medicare |
$7.05
|
| Rate for Payer: Banner UC Health Medicare |
$7.05
|
| Rate for Payer: Bisbee Police All Plans |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$31.96
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cigna of AZ Commercial |
$32.90
|
| Rate for Payer: Copperpoint Commercial |
$11.63
|
| Rate for Payer: Health Net of AZ Commercial |
$28.20
|
| Rate for Payer: Health Net of AZ Medicare |
$13.16
|
| Rate for Payer: Humana of AZ Medicare |
$7.05
|
| Rate for Payer: Self Pay Self Pay |
$37.60
|
| Rate for Payer: TriWest Medicare |
$7.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$27.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.46
|
|
|
COVER LIGHT HANDLE
|
Facility
|
IP
|
$47.00
|
|
| Hospital Charge Code |
22355305
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of AZ Commercial |
$42.30
|
| Rate for Payer: Bisbee Police All Plans |
$12.22
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Self Pay Self Pay |
$37.60
|
|
|
Covidien Multifire Versa Tack Stapler reload
|
Facility
|
IP
|
$203.00
|
|
| Hospital Charge Code |
22926412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.78 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna of AZ Commercial |
$182.70
|
| Rate for Payer: Bisbee Police All Plans |
$52.78
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Self Pay Self Pay |
$162.40
|
|
|
Covidien Multifire Versa Tack Stapler reload
|
Facility
|
OP
|
$203.00
|
|
| Hospital Charge Code |
22926412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna of AZ Commercial |
$182.70
|
| Rate for Payer: Aetna of AZ Medicare |
$56.84
|
| Rate for Payer: Allwell Medicare |
$30.45
|
| Rate for Payer: Amerigroup Medicare |
$30.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$75.82
|
| Rate for Payer: AZCH Complete Medicare |
$30.45
|
| Rate for Payer: Banner UC Health Medicare |
$30.45
|
| Rate for Payer: Bisbee Police All Plans |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$138.04
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cigna of AZ Commercial |
$142.10
|
| Rate for Payer: Copperpoint Commercial |
$50.24
|
| Rate for Payer: Health Net of AZ Commercial |
$121.80
|
| Rate for Payer: Health Net of AZ Medicare |
$56.84
|
| Rate for Payer: Humana of AZ Medicare |
$30.45
|
| Rate for Payer: Self Pay Self Pay |
$162.40
|
| Rate for Payer: TriWest Medicare |
$30.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$118.35
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$36.54
|
|
|
C-Peptide, Serum LC
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
1285617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Aetna of AZ Commercial |
$548.10
|
| Rate for Payer: Aetna of AZ Medicare |
$170.52
|
| Rate for Payer: AHCCCS Medicaid |
$20.81
|
| Rate for Payer: Allwell Medicaid |
$20.81
|
| Rate for Payer: Allwell Medicare |
$91.35
|
| Rate for Payer: Amerigroup Medicare |
$91.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$227.46
|
| Rate for Payer: AZCH Complete Medicaid |
$20.81
|
| Rate for Payer: AZCH Complete Medicare |
$91.35
|
| Rate for Payer: Banner UC Health Medicaid |
$20.81
|
| Rate for Payer: Banner UC Health Medicare |
$91.35
|
| Rate for Payer: Bisbee Police All Plans |
$158.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$414.12
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna of AZ Commercial |
$395.85
|
| Rate for Payer: Copperpoint Commercial |
$150.73
|
| Rate for Payer: Health Net of AZ Commercial |
$365.40
|
| Rate for Payer: Health Net of AZ Medicare |
$170.52
|
| Rate for Payer: Humana of AZ Medicare |
$91.35
|
| Rate for Payer: Mercy Care Medicaid |
$20.81
|
| Rate for Payer: Self Pay Self Pay |
$487.20
|
| Rate for Payer: TriWest Medicare |
$91.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$355.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$109.62
|
|
|
C-Peptide, Serum LC
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
1285617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Aetna of AZ Commercial |
$548.10
|
| Rate for Payer: Bisbee Police All Plans |
$158.34
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Self Pay Self Pay |
$487.20
|
|
|
CPT ACAPELLA INITIAL
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
1886933
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Aetna of AZ Commercial |
$293.40
|
| Rate for Payer: Aetna of AZ Medicare |
$91.28
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$48.90
|
| Rate for Payer: Amerigroup Medicare |
$48.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$121.76
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$48.90
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$48.90
|
| Rate for Payer: Bisbee Police All Plans |
$84.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$221.68
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cigna of AZ Commercial |
$228.20
|
| Rate for Payer: Copperpoint Commercial |
$80.68
|
| Rate for Payer: Health Net of AZ Commercial |
$195.60
|
| Rate for Payer: Health Net of AZ Medicare |
$91.28
|
| Rate for Payer: Humana of AZ Medicare |
$48.90
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$260.80
|
| Rate for Payer: TriWest Medicare |
$48.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$190.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$58.68
|
|
|
CPT ACAPELLA INITIAL
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
1886933
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$84.76 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Aetna of AZ Commercial |
$293.40
|
| Rate for Payer: Bisbee Police All Plans |
$84.76
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Self Pay Self Pay |
$260.80
|
|
|
CQCH Echo Doppler
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
22427827
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna of AZ Commercial |
$788.40
|
| Rate for Payer: Aetna of AZ Medicare |
$245.28
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$131.40
|
| Rate for Payer: Amerigroup Medicare |
$131.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$327.19
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$131.40
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$131.40
|
| Rate for Payer: Bisbee Police All Plans |
$227.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$595.68
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cigna of AZ Commercial |
$613.20
|
| Rate for Payer: Copperpoint Commercial |
$216.81
|
| Rate for Payer: Health Net of AZ Commercial |
$525.60
|
| Rate for Payer: Health Net of AZ Medicare |
$245.28
|
| Rate for Payer: Humana of AZ Medicare |
$131.40
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$700.80
|
| Rate for Payer: TriWest Medicare |
$131.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$510.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$157.68
|
|
|
CQCH Echo Doppler
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
22427827
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$227.76 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna of AZ Commercial |
$788.40
|
| Rate for Payer: Bisbee Police All Plans |
$227.76
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Self Pay Self Pay |
$700.80
|
|
|
CQCH Isovue 300
|
Facility
|
IP
|
$139.00
|
|
| Hospital Charge Code |
22427819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Bisbee Police All Plans |
$36.14
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Self Pay Self Pay |
$111.20
|
|
|
CQCH Isovue 300
|
Facility
|
OP
|
$139.00
|
|
| Hospital Charge Code |
22427819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Aetna of AZ Medicare |
$38.92
|
| Rate for Payer: Allwell Medicare |
$20.85
|
| Rate for Payer: Amerigroup Medicare |
$20.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$51.92
|
| Rate for Payer: AZCH Complete Medicare |
$20.85
|
| Rate for Payer: Banner UC Health Medicare |
$20.85
|
| Rate for Payer: Bisbee Police All Plans |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$94.52
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cigna of AZ Commercial |
$97.30
|
| Rate for Payer: Copperpoint Commercial |
$34.40
|
| Rate for Payer: Health Net of AZ Commercial |
$83.40
|
| Rate for Payer: Health Net of AZ Medicare |
$38.92
|
| Rate for Payer: Humana of AZ Medicare |
$20.85
|
| Rate for Payer: Self Pay Self Pay |
$111.20
|
| Rate for Payer: TriWest Medicare |
$20.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$81.04
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.02
|
|
|
CQCH Isovue 370
|
Facility
|
OP
|
$139.00
|
|
| Hospital Charge Code |
22427821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Aetna of AZ Medicare |
$38.92
|
| Rate for Payer: Allwell Medicare |
$20.85
|
| Rate for Payer: Amerigroup Medicare |
$20.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$51.92
|
| Rate for Payer: AZCH Complete Medicare |
$20.85
|
| Rate for Payer: Banner UC Health Medicare |
$20.85
|
| Rate for Payer: Bisbee Police All Plans |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$94.52
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cigna of AZ Commercial |
$97.30
|
| Rate for Payer: Copperpoint Commercial |
$34.40
|
| Rate for Payer: Health Net of AZ Commercial |
$83.40
|
| Rate for Payer: Health Net of AZ Medicare |
$38.92
|
| Rate for Payer: Humana of AZ Medicare |
$20.85
|
| Rate for Payer: Self Pay Self Pay |
$111.20
|
| Rate for Payer: TriWest Medicare |
$20.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$81.04
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.02
|
|
|
CQCH Isovue 370
|
Facility
|
IP
|
$139.00
|
|
| Hospital Charge Code |
22427821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Bisbee Police All Plans |
$36.14
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Self Pay Self Pay |
$111.20
|
|
|
CQCH Magnevist
|
Facility
|
IP
|
$249.00
|
|
| Hospital Charge Code |
22427823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Aetna of AZ Commercial |
$224.10
|
| Rate for Payer: Bisbee Police All Plans |
$64.74
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Self Pay Self Pay |
$199.20
|
|
|
CQCH Magnevist
|
Facility
|
OP
|
$249.00
|
|
| Hospital Charge Code |
22427823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Aetna of AZ Commercial |
$224.10
|
| Rate for Payer: Aetna of AZ Medicare |
$69.72
|
| Rate for Payer: Allwell Medicare |
$37.35
|
| Rate for Payer: Amerigroup Medicare |
$37.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$93.00
|
| Rate for Payer: AZCH Complete Medicare |
$37.35
|
| Rate for Payer: Banner UC Health Medicare |
$37.35
|
| Rate for Payer: Bisbee Police All Plans |
$64.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$169.32
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna of AZ Commercial |
$174.30
|
| Rate for Payer: Copperpoint Commercial |
$61.63
|
| Rate for Payer: Health Net of AZ Commercial |
$149.40
|
| Rate for Payer: Health Net of AZ Medicare |
$69.72
|
| Rate for Payer: Humana of AZ Medicare |
$37.35
|
| Rate for Payer: Self Pay Self Pay |
$199.20
|
| Rate for Payer: TriWest Medicare |
$37.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$145.17
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$44.82
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$22,777.26
|
|
|
Service Code
|
APR-DRG 9101
|
| Hospital Charge Code |
APRDRG9102
|
| Min. Negotiated Rate |
$22,777.26 |
| Max. Negotiated Rate |
$22,777.26 |
| Rate for Payer: AHCCCS Medicaid |
$22,777.26
|
| Rate for Payer: Allwell Medicaid |
$22,777.26
|
| Rate for Payer: AZCH Complete Medicaid |
$22,777.26
|
| Rate for Payer: Banner UC Health Medicaid |
$22,777.26
|
| Rate for Payer: Mercy Care Medicaid |
$22,777.26
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$22,777.26
|
|
|
Service Code
|
APR-DRG 9102
|
| Hospital Charge Code |
APRDRG9102
|
| Min. Negotiated Rate |
$22,777.26 |
| Max. Negotiated Rate |
$22,777.26 |
| Rate for Payer: AHCCCS Medicaid |
$22,777.26
|
| Rate for Payer: Allwell Medicaid |
$22,777.26
|
| Rate for Payer: AZCH Complete Medicaid |
$22,777.26
|
| Rate for Payer: Banner UC Health Medicaid |
$22,777.26
|
| Rate for Payer: Mercy Care Medicaid |
$22,777.26
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$50,111.52
|
|
|
Service Code
|
APR-DRG 9104
|
| Hospital Charge Code |
APRDRG9104
|
| Min. Negotiated Rate |
$50,111.52 |
| Max. Negotiated Rate |
$50,111.52 |
| Rate for Payer: AHCCCS Medicaid |
$50,111.52
|
| Rate for Payer: Allwell Medicaid |
$50,111.52
|
| Rate for Payer: AZCH Complete Medicaid |
$50,111.52
|
| Rate for Payer: Banner UC Health Medicaid |
$50,111.52
|
| Rate for Payer: Mercy Care Medicaid |
$50,111.52
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$22,777.26
|
|
|
Service Code
|
APR-DRG 9102
|
| Hospital Charge Code |
APRDRG9101
|
| Min. Negotiated Rate |
$22,777.26 |
| Max. Negotiated Rate |
$22,777.26 |
| Rate for Payer: AHCCCS Medicaid |
$22,777.26
|
| Rate for Payer: Allwell Medicaid |
$22,777.26
|
| Rate for Payer: AZCH Complete Medicaid |
$22,777.26
|
| Rate for Payer: Banner UC Health Medicaid |
$22,777.26
|
| Rate for Payer: Mercy Care Medicaid |
$22,777.26
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$22,777.26
|
|
|
Service Code
|
APR-DRG 9101
|
| Hospital Charge Code |
APRDRG9103
|
| Min. Negotiated Rate |
$22,777.26 |
| Max. Negotiated Rate |
$22,777.26 |
| Rate for Payer: AHCCCS Medicaid |
$22,777.26
|
| Rate for Payer: Allwell Medicaid |
$22,777.26
|
| Rate for Payer: AZCH Complete Medicaid |
$22,777.26
|
| Rate for Payer: Banner UC Health Medicaid |
$22,777.26
|
| Rate for Payer: Mercy Care Medicaid |
$22,777.26
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$22,777.26
|
|
|
Service Code
|
APR-DRG 9101
|
| Hospital Charge Code |
APRDRG9101
|
| Min. Negotiated Rate |
$22,777.26 |
| Max. Negotiated Rate |
$22,777.26 |
| Rate for Payer: AHCCCS Medicaid |
$22,777.26
|
| Rate for Payer: Allwell Medicaid |
$22,777.26
|
| Rate for Payer: AZCH Complete Medicaid |
$22,777.26
|
| Rate for Payer: Banner UC Health Medicaid |
$22,777.26
|
| Rate for Payer: Mercy Care Medicaid |
$22,777.26
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$50,111.52
|
|
|
Service Code
|
APR-DRG 9104
|
| Hospital Charge Code |
APRDRG9101
|
| Min. Negotiated Rate |
$50,111.52 |
| Max. Negotiated Rate |
$50,111.52 |
| Rate for Payer: AHCCCS Medicaid |
$50,111.52
|
| Rate for Payer: Allwell Medicaid |
$50,111.52
|
| Rate for Payer: AZCH Complete Medicaid |
$50,111.52
|
| Rate for Payer: Banner UC Health Medicaid |
$50,111.52
|
| Rate for Payer: Mercy Care Medicaid |
$50,111.52
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$50,111.52
|
|
|
Service Code
|
APR-DRG 9104
|
| Hospital Charge Code |
APRDRG9103
|
| Min. Negotiated Rate |
$50,111.52 |
| Max. Negotiated Rate |
$50,111.52 |
| Rate for Payer: AHCCCS Medicaid |
$50,111.52
|
| Rate for Payer: Allwell Medicaid |
$50,111.52
|
| Rate for Payer: AZCH Complete Medicaid |
$50,111.52
|
| Rate for Payer: Banner UC Health Medicaid |
$50,111.52
|
| Rate for Payer: Mercy Care Medicaid |
$50,111.52
|
|
