|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$6,159.69
|
|
|
Service Code
|
APR-DRG 0452
|
| Hospital Charge Code |
APRDRG0452
|
| Min. Negotiated Rate |
$6,159.69 |
| Max. Negotiated Rate |
$6,159.69 |
| Rate for Payer: AHCCCS Medicaid |
$6,159.69
|
| Rate for Payer: Allwell Medicaid |
$6,159.69
|
| Rate for Payer: AZCH Complete Medicaid |
$6,159.69
|
| Rate for Payer: Banner UC Health Medicaid |
$6,159.69
|
| Rate for Payer: Mercy Care Medicaid |
$6,159.69
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$8,899.36
|
|
|
Service Code
|
APR-DRG 0453
|
| Hospital Charge Code |
APRDRG0454
|
| Min. Negotiated Rate |
$8,899.36 |
| Max. Negotiated Rate |
$8,899.36 |
| Rate for Payer: AHCCCS Medicaid |
$8,899.36
|
| Rate for Payer: Allwell Medicaid |
$8,899.36
|
| Rate for Payer: AZCH Complete Medicaid |
$8,899.36
|
| Rate for Payer: Banner UC Health Medicaid |
$8,899.36
|
| Rate for Payer: Mercy Care Medicaid |
$8,899.36
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$16,038.21
|
|
|
Service Code
|
APR-DRG 0454
|
| Hospital Charge Code |
APRDRG0454
|
| Min. Negotiated Rate |
$16,038.21 |
| Max. Negotiated Rate |
$16,038.21 |
| Rate for Payer: AHCCCS Medicaid |
$16,038.21
|
| Rate for Payer: Allwell Medicaid |
$16,038.21
|
| Rate for Payer: AZCH Complete Medicaid |
$16,038.21
|
| Rate for Payer: Banner UC Health Medicaid |
$16,038.21
|
| Rate for Payer: Mercy Care Medicaid |
$16,038.21
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$6,159.69
|
|
|
Service Code
|
APR-DRG 0452
|
| Hospital Charge Code |
APRDRG0454
|
| Min. Negotiated Rate |
$6,159.69 |
| Max. Negotiated Rate |
$6,159.69 |
| Rate for Payer: AHCCCS Medicaid |
$6,159.69
|
| Rate for Payer: Allwell Medicaid |
$6,159.69
|
| Rate for Payer: AZCH Complete Medicaid |
$6,159.69
|
| Rate for Payer: Banner UC Health Medicaid |
$6,159.69
|
| Rate for Payer: Mercy Care Medicaid |
$6,159.69
|
|
|
cyanocobalamin 1000 mcg/mL Inj Sol [CQCH]
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
105917587
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1.92
|
| Rate for Payer: Aetna of AZ Medicare |
$0.60
|
| Rate for Payer: AHCCCS Medicaid |
$3.90
|
| Rate for Payer: Allwell Medicaid |
$3.90
|
| Rate for Payer: Allwell Medicare |
$0.32
|
| Rate for Payer: Amerigroup Medicare |
$0.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.80
|
| Rate for Payer: AZCH Complete Medicaid |
$3.90
|
| Rate for Payer: AZCH Complete Medicare |
$0.32
|
| Rate for Payer: Banner UC Health Medicaid |
$3.90
|
| Rate for Payer: Banner UC Health Medicare |
$0.32
|
| Rate for Payer: Bisbee Police All Plans |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of AZ Commercial |
$1.38
|
| Rate for Payer: Copperpoint Commercial |
$0.53
|
| Rate for Payer: Health Net of AZ Commercial |
$1.28
|
| Rate for Payer: Health Net of AZ Medicare |
$0.60
|
| Rate for Payer: Humana of AZ Medicare |
$0.32
|
| Rate for Payer: Mercy Care Medicaid |
$3.90
|
| Rate for Payer: Self Pay Self Pay |
$1.70
|
| Rate for Payer: TriWest Medicare |
$0.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.38
|
|
|
cyanocobalamin 1000 mcg/mL Inj Sol [CQCH]
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
105917587
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna of AZ Commercial |
$1.92
|
| Rate for Payer: Bisbee Police All Plans |
$0.55
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Self Pay Self Pay |
$1.70
|
|
|
cyclopentolate Ophth 1% Sol [CQCH]
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
105917736
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna of AZ Commercial |
$23.41
|
| Rate for Payer: Bisbee Police All Plans |
$6.76
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Self Pay Self Pay |
$20.81
|
|
|
cyclopentolate Ophth 1% Sol [CQCH]
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
105917736
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna of AZ Commercial |
$23.41
|
| Rate for Payer: Aetna of AZ Medicare |
$7.28
|
| Rate for Payer: Allwell Medicare |
$3.90
|
| Rate for Payer: Amerigroup Medicare |
$3.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$9.71
|
| Rate for Payer: AZCH Complete Medicare |
$3.90
|
| Rate for Payer: Banner UC Health Medicare |
$3.90
|
| Rate for Payer: Bisbee Police All Plans |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$17.69
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cigna of AZ Commercial |
$16.91
|
| Rate for Payer: Copperpoint Commercial |
$6.44
|
| Rate for Payer: Health Net of AZ Commercial |
$15.61
|
| Rate for Payer: Health Net of AZ Medicare |
$7.28
|
| Rate for Payer: Humana of AZ Medicare |
$3.90
|
| Rate for Payer: Self Pay Self Pay |
$20.81
|
| Rate for Payer: TriWest Medicare |
$3.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$15.16
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.68
|
|
|
Cyclosporine, Blood LC
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
1285593
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.05 |
| 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: AHCCCS Medicaid |
$18.05
|
| Rate for Payer: Allwell Medicaid |
$18.05
|
| Rate for Payer: Allwell Medicare |
$46.50
|
| Rate for Payer: Amerigroup Medicare |
$46.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$115.78
|
| Rate for Payer: AZCH Complete Medicaid |
$18.05
|
| Rate for Payer: AZCH Complete Medicare |
$46.50
|
| Rate for Payer: Banner UC Health Medicaid |
$18.05
|
| Rate for Payer: Banner UC Health Medicare |
$46.50
|
| 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: Cash Price |
$248.00
|
| Rate for Payer: Cigna of AZ Commercial |
$201.50
|
| 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 |
$46.50
|
| Rate for Payer: Mercy Care Medicaid |
$18.05
|
| Rate for Payer: Self Pay Self Pay |
$248.00
|
| Rate for Payer: TriWest Medicare |
$46.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$180.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.80
|
|
|
Cyclosporine, Blood LC
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
1285593
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
CYGNUS DUAL 2X3
|
Facility
|
IP
|
$7,666.67
|
|
| Hospital Charge Code |
27694663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,993.33 |
| Max. Negotiated Rate |
$6,900.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,900.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,993.33
|
| Rate for Payer: Cash Price |
$6,133.34
|
| Rate for Payer: Self Pay Self Pay |
$6,133.34
|
|
|
CYGNUS DUAL 2X3
|
Facility
|
OP
|
$7,666.67
|
|
| Hospital Charge Code |
27694663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,150.00 |
| Max. Negotiated Rate |
$6,900.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,900.00
|
| Rate for Payer: Aetna of AZ Medicare |
$2,146.67
|
| Rate for Payer: Allwell Medicare |
$1,150.00
|
| Rate for Payer: Amerigroup Medicare |
$1,150.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,863.50
|
| Rate for Payer: AZCH Complete Medicare |
$1,150.00
|
| Rate for Payer: Banner UC Health Medicare |
$1,150.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,993.33
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5,213.34
|
| Rate for Payer: Cash Price |
$6,133.34
|
| Rate for Payer: Cigna of AZ Commercial |
$5,366.67
|
| Rate for Payer: Copperpoint Commercial |
$1,897.50
|
| Rate for Payer: Health Net of AZ Commercial |
$4,600.00
|
| Rate for Payer: Health Net of AZ Medicare |
$2,146.67
|
| Rate for Payer: Humana of AZ Medicare |
$1,150.00
|
| Rate for Payer: Self Pay Self Pay |
$6,133.34
|
| Rate for Payer: TriWest Medicare |
$1,150.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4,469.67
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,380.00
|
|
|
CYGNUS DUAL 4X4
|
Facility
|
OP
|
$7,450.00
|
|
| Hospital Charge Code |
27702637
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,117.50 |
| Max. Negotiated Rate |
$6,705.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,705.00
|
| Rate for Payer: Aetna of AZ Medicare |
$2,086.00
|
| Rate for Payer: Allwell Medicare |
$1,117.50
|
| Rate for Payer: Amerigroup Medicare |
$1,117.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,782.58
|
| Rate for Payer: AZCH Complete Medicare |
$1,117.50
|
| Rate for Payer: Banner UC Health Medicare |
$1,117.50
|
| Rate for Payer: Bisbee Police All Plans |
$1,937.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5,066.00
|
| Rate for Payer: Cash Price |
$5,960.00
|
| Rate for Payer: Cigna of AZ Commercial |
$5,215.00
|
| Rate for Payer: Copperpoint Commercial |
$1,843.88
|
| Rate for Payer: Health Net of AZ Commercial |
$4,470.00
|
| Rate for Payer: Health Net of AZ Medicare |
$2,086.00
|
| Rate for Payer: Humana of AZ Medicare |
$1,117.50
|
| Rate for Payer: Self Pay Self Pay |
$5,960.00
|
| Rate for Payer: TriWest Medicare |
$1,117.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4,343.35
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,341.00
|
|
|
CYGNUS DUAL 4X4
|
Facility
|
IP
|
$7,450.00
|
|
| Hospital Charge Code |
27702637
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,937.00 |
| Max. Negotiated Rate |
$6,705.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,705.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,937.00
|
| Rate for Payer: Cash Price |
$5,960.00
|
| Rate for Payer: Self Pay Self Pay |
$5,960.00
|
|
|
CYGNUS DUAL 4X6
|
Facility
|
IP
|
$7,433.33
|
|
| Hospital Charge Code |
27694677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,932.67 |
| Max. Negotiated Rate |
$6,690.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,690.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,932.67
|
| Rate for Payer: Cash Price |
$5,946.66
|
| Rate for Payer: Self Pay Self Pay |
$5,946.66
|
|
|
CYGNUS DUAL 4X6
|
Facility
|
OP
|
$7,433.33
|
|
| Hospital Charge Code |
27694677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,115.00 |
| Max. Negotiated Rate |
$6,690.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,690.00
|
| Rate for Payer: Aetna of AZ Medicare |
$2,081.33
|
| Rate for Payer: Allwell Medicare |
$1,115.00
|
| Rate for Payer: Amerigroup Medicare |
$1,115.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,776.35
|
| Rate for Payer: AZCH Complete Medicare |
$1,115.00
|
| Rate for Payer: Banner UC Health Medicare |
$1,115.00
|
| Rate for Payer: Bisbee Police All Plans |
$1,932.67
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5,054.66
|
| Rate for Payer: Cash Price |
$5,946.66
|
| Rate for Payer: Cigna of AZ Commercial |
$5,203.33
|
| Rate for Payer: Copperpoint Commercial |
$1,839.75
|
| Rate for Payer: Health Net of AZ Commercial |
$4,460.00
|
| Rate for Payer: Health Net of AZ Medicare |
$2,081.33
|
| Rate for Payer: Humana of AZ Medicare |
$1,115.00
|
| Rate for Payer: Self Pay Self Pay |
$5,946.66
|
| Rate for Payer: TriWest Medicare |
$1,115.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4,333.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,338.00
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$18,516.96
|
|
|
Service Code
|
APR-DRG 1314
|
| Hospital Charge Code |
APRDRG1312
|
| Min. Negotiated Rate |
$18,516.96 |
| Max. Negotiated Rate |
$18,516.96 |
| Rate for Payer: AHCCCS Medicaid |
$18,516.96
|
| Rate for Payer: Allwell Medicaid |
$18,516.96
|
| Rate for Payer: AZCH Complete Medicaid |
$18,516.96
|
| Rate for Payer: Banner UC Health Medicaid |
$18,516.96
|
| Rate for Payer: Mercy Care Medicaid |
$18,516.96
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$10,269.90
|
|
|
Service Code
|
APR-DRG 1312
|
| Hospital Charge Code |
APRDRG1311
|
| Min. Negotiated Rate |
$10,269.90 |
| Max. Negotiated Rate |
$10,269.90 |
| Rate for Payer: AHCCCS Medicaid |
$10,269.90
|
| Rate for Payer: Allwell Medicaid |
$10,269.90
|
| Rate for Payer: AZCH Complete Medicaid |
$10,269.90
|
| Rate for Payer: Banner UC Health Medicaid |
$10,269.90
|
| Rate for Payer: Mercy Care Medicaid |
$10,269.90
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$18,516.96
|
|
|
Service Code
|
APR-DRG 1314
|
| Hospital Charge Code |
APRDRG1313
|
| Min. Negotiated Rate |
$18,516.96 |
| Max. Negotiated Rate |
$18,516.96 |
| Rate for Payer: AHCCCS Medicaid |
$18,516.96
|
| Rate for Payer: Allwell Medicaid |
$18,516.96
|
| Rate for Payer: AZCH Complete Medicaid |
$18,516.96
|
| Rate for Payer: Banner UC Health Medicaid |
$18,516.96
|
| Rate for Payer: Mercy Care Medicaid |
$18,516.96
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$18,516.96
|
|
|
Service Code
|
APR-DRG 1314
|
| Hospital Charge Code |
APRDRG1311
|
| Min. Negotiated Rate |
$18,516.96 |
| Max. Negotiated Rate |
$18,516.96 |
| Rate for Payer: AHCCCS Medicaid |
$18,516.96
|
| Rate for Payer: Allwell Medicaid |
$18,516.96
|
| Rate for Payer: AZCH Complete Medicaid |
$18,516.96
|
| Rate for Payer: Banner UC Health Medicaid |
$18,516.96
|
| Rate for Payer: Mercy Care Medicaid |
$18,516.96
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$10,269.90
|
|
|
Service Code
|
APR-DRG 1312
|
| Hospital Charge Code |
APRDRG1313
|
| Min. Negotiated Rate |
$10,269.90 |
| Max. Negotiated Rate |
$10,269.90 |
| Rate for Payer: AHCCCS Medicaid |
$10,269.90
|
| Rate for Payer: Allwell Medicaid |
$10,269.90
|
| Rate for Payer: AZCH Complete Medicaid |
$10,269.90
|
| Rate for Payer: Banner UC Health Medicaid |
$10,269.90
|
| Rate for Payer: Mercy Care Medicaid |
$10,269.90
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$10,269.90
|
|
|
Service Code
|
APR-DRG 1312
|
| Hospital Charge Code |
APRDRG1314
|
| Min. Negotiated Rate |
$10,269.90 |
| Max. Negotiated Rate |
$10,269.90 |
| Rate for Payer: AHCCCS Medicaid |
$10,269.90
|
| Rate for Payer: Allwell Medicaid |
$10,269.90
|
| Rate for Payer: AZCH Complete Medicaid |
$10,269.90
|
| Rate for Payer: Banner UC Health Medicaid |
$10,269.90
|
| Rate for Payer: Mercy Care Medicaid |
$10,269.90
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$13,952.95
|
|
|
Service Code
|
APR-DRG 1313
|
| Hospital Charge Code |
APRDRG1314
|
| Min. Negotiated Rate |
$13,952.95 |
| Max. Negotiated Rate |
$13,952.95 |
| Rate for Payer: AHCCCS Medicaid |
$13,952.95
|
| Rate for Payer: Allwell Medicaid |
$13,952.95
|
| Rate for Payer: AZCH Complete Medicaid |
$13,952.95
|
| Rate for Payer: Banner UC Health Medicaid |
$13,952.95
|
| Rate for Payer: Mercy Care Medicaid |
$13,952.95
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$18,516.96
|
|
|
Service Code
|
APR-DRG 1314
|
| Hospital Charge Code |
APRDRG1314
|
| Min. Negotiated Rate |
$18,516.96 |
| Max. Negotiated Rate |
$18,516.96 |
| Rate for Payer: AHCCCS Medicaid |
$18,516.96
|
| Rate for Payer: Allwell Medicaid |
$18,516.96
|
| Rate for Payer: AZCH Complete Medicaid |
$18,516.96
|
| Rate for Payer: Banner UC Health Medicaid |
$18,516.96
|
| Rate for Payer: Mercy Care Medicaid |
$18,516.96
|
|
|
Cystic Fibrosis - Pulmonary Disease
|
Facility
|
IP
|
$10,269.90
|
|
|
Service Code
|
APR-DRG 1312
|
| Hospital Charge Code |
APRDRG1312
|
| Min. Negotiated Rate |
$10,269.90 |
| Max. Negotiated Rate |
$10,269.90 |
| Rate for Payer: AHCCCS Medicaid |
$10,269.90
|
| Rate for Payer: Allwell Medicaid |
$10,269.90
|
| Rate for Payer: AZCH Complete Medicaid |
$10,269.90
|
| Rate for Payer: Banner UC Health Medicaid |
$10,269.90
|
| Rate for Payer: Mercy Care Medicaid |
$10,269.90
|
|
