|
cortrosyn injection[CQCH]
|
Facility
|
OP
|
$18.52
|
|
|
Service Code
|
NDC 3.05486E+11
|
| Hospital Charge Code |
124449918
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$16.67 |
| Rate for Payer: Aetna of AZ Commercial |
$16.67
|
| Rate for Payer: Aetna of AZ Medicare |
$5.19
|
| Rate for Payer: Allwell Medicare |
$2.96
|
| Rate for Payer: Amerigroup Medicare |
$2.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$6.92
|
| Rate for Payer: AZCH Complete Medicare |
$2.96
|
| Rate for Payer: Banner UC Health Medicare |
$2.96
|
| Rate for Payer: Bisbee Police All Plans |
$4.82
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$12.59
|
| Rate for Payer: Cash Price |
$14.82
|
| Rate for Payer: Cigna of AZ Commercial |
$12.04
|
| Rate for Payer: Copperpoint Commercial |
$4.58
|
| Rate for Payer: Health Net of AZ Commercial |
$11.11
|
| Rate for Payer: Health Net of AZ Medicare |
$5.19
|
| Rate for Payer: Humana of AZ Medicare |
$2.96
|
| Rate for Payer: Self Pay Self Pay |
$14.82
|
| Rate for Payer: TriWest Medicare |
$2.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$10.80
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.33
|
|
|
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
|
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
|
|
|
COVER LIGHT HANDLE
|
Facility
|
OP
|
$47.00
|
|
| Hospital Charge Code |
22355305
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.52 |
| 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 |
$7.52
|
| Rate for Payer: Amerigroup Medicare |
$7.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$17.55
|
| Rate for Payer: AZCH Complete Medicare |
$7.52
|
| Rate for Payer: Banner UC Health Medicare |
$7.52
|
| 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 |
$7.52
|
| Rate for Payer: Self Pay Self Pay |
$37.60
|
| Rate for Payer: TriWest Medicare |
$7.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$27.40
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$8.46
|
|
|
Covidien Multifire Versa Tack Stapler reload
|
Facility
|
OP
|
$203.00
|
|
| Hospital Charge Code |
22926412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.48 |
| 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 |
$32.48
|
| Rate for Payer: Amerigroup Medicare |
$32.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$75.82
|
| Rate for Payer: AZCH Complete Medicare |
$32.48
|
| Rate for Payer: Banner UC Health Medicare |
$32.48
|
| 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 |
$32.48
|
| Rate for Payer: Self Pay Self Pay |
$162.40
|
| Rate for Payer: TriWest Medicare |
$32.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$118.35
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$36.54
|
|
|
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
|
|
|
C-Peptide, Serum LC
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
1285617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$150.54 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of AZ Commercial |
$521.10
|
| Rate for Payer: Bisbee Police All Plans |
$150.54
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Self Pay Self Pay |
$463.20
|
|
|
C-Peptide, Serum LC
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
1285617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.64 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of AZ Commercial |
$521.10
|
| Rate for Payer: Aetna of AZ Medicare |
$162.12
|
| Rate for Payer: Allwell Medicare |
$92.64
|
| Rate for Payer: Amerigroup Medicare |
$92.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$216.26
|
| Rate for Payer: AZCH Complete Medicare |
$92.64
|
| Rate for Payer: Banner UC Health Medicare |
$92.64
|
| Rate for Payer: Bisbee Police All Plans |
$150.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$393.72
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna of AZ Commercial |
$376.35
|
| Rate for Payer: Copperpoint Commercial |
$143.30
|
| Rate for Payer: Health Net of AZ Commercial |
$347.40
|
| Rate for Payer: Health Net of AZ Medicare |
$162.12
|
| Rate for Payer: Humana of AZ Medicare |
$92.64
|
| Rate for Payer: Self Pay Self Pay |
$463.20
|
| Rate for Payer: TriWest Medicare |
$92.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$337.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$104.22
|
|
|
CPT ACAPELLA INITIAL
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
1886933
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of AZ Commercial |
$279.00
|
| Rate for Payer: Bisbee Police All Plans |
$80.60
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Self Pay Self Pay |
$248.00
|
|
|
CPT ACAPELLA INITIAL
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
1886933
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of AZ Commercial |
$279.00
|
| Rate for Payer: Aetna of AZ Medicare |
$86.80
|
| Rate for Payer: Allwell Medicare |
$49.60
|
| Rate for Payer: Amerigroup Medicare |
$49.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$115.78
|
| Rate for Payer: AZCH Complete Medicare |
$49.60
|
| Rate for Payer: Banner UC Health Medicare |
$49.60
|
| Rate for Payer: Bisbee Police All Plans |
$80.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$210.80
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna of AZ Commercial |
$217.00
|
| Rate for Payer: Copperpoint Commercial |
$76.72
|
| Rate for Payer: Health Net of AZ Commercial |
$186.00
|
| Rate for Payer: Health Net of AZ Medicare |
$86.80
|
| Rate for Payer: Humana of AZ Medicare |
$49.60
|
| Rate for Payer: Self Pay Self Pay |
$248.00
|
| Rate for Payer: TriWest Medicare |
$49.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$180.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.80
|
|
|
CQCH CT Angiography Neck w/ Contrast
|
Facility
|
OP
|
$4,323.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
22543582
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$691.68 |
| Max. Negotiated Rate |
$3,890.70 |
| Rate for Payer: Aetna of AZ Commercial |
$3,890.70
|
| Rate for Payer: Aetna of AZ Medicare |
$1,210.44
|
| Rate for Payer: Allwell Medicare |
$691.68
|
| Rate for Payer: Amerigroup Medicare |
$691.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,614.64
|
| Rate for Payer: AZCH Complete Medicare |
$691.68
|
| Rate for Payer: Banner UC Health Medicare |
$691.68
|
| Rate for Payer: Bisbee Police All Plans |
$1,123.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,939.64
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Cigna of AZ Commercial |
$2,809.95
|
| Rate for Payer: Copperpoint Commercial |
$1,069.94
|
| Rate for Payer: Health Net of AZ Commercial |
$2,593.80
|
| Rate for Payer: Health Net of AZ Medicare |
$1,210.44
|
| Rate for Payer: Humana of AZ Medicare |
$691.68
|
| Rate for Payer: Self Pay Self Pay |
$3,458.40
|
| Rate for Payer: TriWest Medicare |
$691.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,520.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$778.14
|
|
|
CQCH CT Angiography Neck w/ Contrast
|
Facility
|
IP
|
$4,323.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
22543582
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,123.98 |
| Max. Negotiated Rate |
$3,890.70 |
| Rate for Payer: Aetna of AZ Commercial |
$3,890.70
|
| Rate for Payer: Bisbee Police All Plans |
$1,123.98
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Self Pay Self Pay |
$3,458.40
|
|
|
CQCH Echo Doppler
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
22427827
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$140.16 |
| 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: Allwell Medicare |
$140.16
|
| Rate for Payer: Amerigroup Medicare |
$140.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$327.19
|
| Rate for Payer: AZCH Complete Medicare |
$140.16
|
| Rate for Payer: Banner UC Health Medicare |
$140.16
|
| 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: 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 |
$140.16
|
| Rate for Payer: Self Pay Self Pay |
$700.80
|
| Rate for Payer: TriWest Medicare |
$140.16
|
| 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 |
$22.24 |
| 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 |
$22.24
|
| Rate for Payer: Amerigroup Medicare |
$22.24
|
| Rate for Payer: APIPA Medicare/Medicaid |
$51.92
|
| Rate for Payer: AZCH Complete Medicare |
$22.24
|
| Rate for Payer: Banner UC Health Medicare |
$22.24
|
| 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 |
$22.24
|
| Rate for Payer: Self Pay Self Pay |
$111.20
|
| Rate for Payer: TriWest Medicare |
$22.24
|
| 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 |
$22.24 |
| 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 |
$22.24
|
| Rate for Payer: Amerigroup Medicare |
$22.24
|
| Rate for Payer: APIPA Medicare/Medicaid |
$51.92
|
| Rate for Payer: AZCH Complete Medicare |
$22.24
|
| Rate for Payer: Banner UC Health Medicare |
$22.24
|
| 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 |
$22.24
|
| Rate for Payer: Self Pay Self Pay |
$111.20
|
| Rate for Payer: TriWest Medicare |
$22.24
|
| 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 |
$39.84 |
| 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 |
$39.84
|
| Rate for Payer: Amerigroup Medicare |
$39.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$93.00
|
| Rate for Payer: AZCH Complete Medicare |
$39.84
|
| Rate for Payer: Banner UC Health Medicare |
$39.84
|
| 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 |
$39.84
|
| Rate for Payer: Self Pay Self Pay |
$199.20
|
| Rate for Payer: TriWest Medicare |
$39.84
|
| 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
|
$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 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
|
$28,854.89
|
|
|
Service Code
|
APR-DRG 9103
|
| Hospital Charge Code |
APRDRG9101
|
| Min. Negotiated Rate |
$28,854.89 |
| Max. Negotiated Rate |
$28,854.89 |
| Rate for Payer: AHCCCS Medicaid |
$28,854.89
|
| Rate for Payer: Allwell Medicaid |
$28,854.89
|
| Rate for Payer: AZCH Complete Medicaid |
$28,854.89
|
| Rate for Payer: Banner UC Health Medicaid |
$28,854.89
|
| Rate for Payer: Mercy Care Medicaid |
$28,854.89
|
|
|
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
|
|
