|
dilTIAZem 25 mg IV Sol [CQCH]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 17478093705
|
| Hospital Charge Code |
105966082
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna of AZ Commercial |
$0.47
|
| Rate for Payer: Aetna of AZ Medicare |
$0.15
|
| Rate for Payer: Allwell Medicare |
$0.08
|
| Rate for Payer: Amerigroup Medicare |
$0.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.19
|
| Rate for Payer: AZCH Complete Medicare |
$0.08
|
| Rate for Payer: Banner UC Health Medicare |
$0.08
|
| Rate for Payer: Bisbee Police All Plans |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.35
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of AZ Commercial |
$0.34
|
| Rate for Payer: Copperpoint Commercial |
$0.13
|
| Rate for Payer: Health Net of AZ Commercial |
$0.31
|
| Rate for Payer: Health Net of AZ Medicare |
$0.15
|
| Rate for Payer: Humana of AZ Medicare |
$0.08
|
| Rate for Payer: Self Pay Self Pay |
$0.42
|
| Rate for Payer: TriWest Medicare |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.09
|
|
|
dilTIAZem 25 mg IV Sol [CQCH]
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
NDC 17478093705
|
| Hospital Charge Code |
105966082
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna of AZ Commercial |
$0.47
|
| Rate for Payer: Bisbee Police All Plans |
$0.14
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Self Pay Self Pay |
$0.42
|
|
|
dilTIAZem 30 mg Tab [CQCH]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
105919041
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of AZ Commercial |
$0.39
|
| Rate for Payer: Aetna of AZ Medicare |
$0.12
|
| Rate for Payer: Allwell Medicare |
$0.06
|
| Rate for Payer: Amerigroup Medicare |
$0.06
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.16
|
| Rate for Payer: AZCH Complete Medicare |
$0.06
|
| Rate for Payer: Banner UC Health Medicare |
$0.06
|
| Rate for Payer: Bisbee Police All Plans |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of AZ Commercial |
$0.28
|
| Rate for Payer: Copperpoint Commercial |
$0.11
|
| Rate for Payer: Health Net of AZ Commercial |
$0.26
|
| Rate for Payer: Health Net of AZ Medicare |
$0.12
|
| Rate for Payer: Humana of AZ Medicare |
$0.06
|
| Rate for Payer: Self Pay Self Pay |
$0.34
|
| Rate for Payer: TriWest Medicare |
$0.06
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.25
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.08
|
|
|
dilTIAZem 30 mg Tab [CQCH]
|
Facility
|
IP
|
$0.43
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
105919041
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of AZ Commercial |
$0.39
|
| Rate for Payer: Bisbee Police All Plans |
$0.11
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Self Pay Self Pay |
$0.34
|
|
|
diphenhydrAMINE 12.5 mg/5 mL Liq UD[CQCH]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
HCPCS Q0163
|
| Hospital Charge Code |
127935116
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of AZ Commercial |
$0.29
|
| Rate for Payer: Aetna of AZ Medicare |
$0.09
|
| Rate for Payer: AHCCCS Medicaid |
$1.52
|
| Rate for Payer: Allwell Medicaid |
$1.52
|
| Rate for Payer: Allwell Medicare |
$0.05
|
| Rate for Payer: Amerigroup Medicare |
$0.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.12
|
| Rate for Payer: AZCH Complete Medicaid |
$1.52
|
| Rate for Payer: AZCH Complete Medicare |
$0.05
|
| Rate for Payer: Banner UC Health Medicaid |
$1.52
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of AZ Commercial |
$0.21
|
| Rate for Payer: Copperpoint Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Commercial |
$0.19
|
| Rate for Payer: Health Net of AZ Medicare |
$0.09
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Mercy Care Medicaid |
$1.52
|
| Rate for Payer: Self Pay Self Pay |
$0.26
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.06
|
|
|
diphenhydrAMINE 12.5 mg/5 mL Liq UD[CQCH]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
HCPCS Q0163
|
| Hospital Charge Code |
127935116
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of AZ Commercial |
$0.29
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Self Pay Self Pay |
$0.26
|
|
|
diphenhydrAMINE 25 mg/10 mL Oral Liq [CQCH]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
HCPCS Q0163
|
| Hospital Charge Code |
105919435
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of AZ Commercial |
$0.13
|
| Rate for Payer: Bisbee Police All Plans |
$0.04
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Self Pay Self Pay |
$0.11
|
|
|
diphenhydrAMINE 25 mg/10 mL Oral Liq [CQCH]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
HCPCS Q0163
|
| Hospital Charge Code |
105919435
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of AZ Commercial |
$0.13
|
| Rate for Payer: Aetna of AZ Medicare |
$0.04
|
| Rate for Payer: AHCCCS Medicaid |
$1.52
|
| Rate for Payer: Allwell Medicaid |
$1.52
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.05
|
| Rate for Payer: AZCH Complete Medicaid |
$1.52
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicaid |
$1.52
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of AZ Commercial |
$0.09
|
| Rate for Payer: Copperpoint Commercial |
$0.03
|
| Rate for Payer: Health Net of AZ Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Medicare |
$0.04
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Mercy Care Medicaid |
$1.52
|
| Rate for Payer: Self Pay Self Pay |
$0.11
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.08
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
|
diphenhydrAMINE 25 mg Cap [CQCH]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
HCPCS Q0163
|
| Hospital Charge Code |
105919293
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of AZ Commercial |
$0.03
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
|
|
diphenhydrAMINE 25 mg Cap [CQCH]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
HCPCS Q0163
|
| Hospital Charge Code |
105919293
|
|
Hospital Revenue Code
|
251
|
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of AZ Commercial |
$0.03
|
| Rate for Payer: Aetna of AZ Medicare |
$0.01
|
| Rate for Payer: AHCCCS Medicaid |
$1.52
|
| Rate for Payer: Allwell Medicaid |
$1.52
|
| Rate for Payer: Allwell Medicare |
$0.00
|
| Rate for Payer: Amerigroup Medicare |
$0.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.01
|
| Rate for Payer: AZCH Complete Medicaid |
$1.52
|
| Rate for Payer: AZCH Complete Medicare |
$0.00
|
| Rate for Payer: Banner UC Health Medicaid |
$1.52
|
| Rate for Payer: Banner UC Health Medicare |
$0.00
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of AZ Commercial |
$0.02
|
| Rate for Payer: Copperpoint Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Medicare |
$0.01
|
| Rate for Payer: Humana of AZ Medicare |
$0.00
|
| Rate for Payer: Mercy Care Medicaid |
$1.52
|
| Rate for Payer: Self Pay Self Pay |
$0.02
|
| Rate for Payer: TriWest Medicare |
$0.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
diphenhydrAMINE 50 mg/mL Inj Sol [CQCH]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
105919362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Aetna of AZ Commercial |
$0.73
|
| Rate for Payer: Bisbee Police All Plans |
$0.21
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Self Pay Self Pay |
$0.65
|
|
|
diphenhydrAMINE 50 mg/mL Inj Sol [CQCH]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
105919362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna of AZ Commercial |
$0.73
|
| Rate for Payer: Aetna of AZ Medicare |
$0.23
|
| Rate for Payer: AHCCCS Medicaid |
$2.22
|
| Rate for Payer: Allwell Medicaid |
$2.22
|
| Rate for Payer: Allwell Medicare |
$0.12
|
| Rate for Payer: Amerigroup Medicare |
$0.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.30
|
| Rate for Payer: AZCH Complete Medicaid |
$2.22
|
| Rate for Payer: AZCH Complete Medicare |
$0.12
|
| Rate for Payer: Banner UC Health Medicaid |
$2.22
|
| Rate for Payer: Banner UC Health Medicare |
$0.12
|
| Rate for Payer: Bisbee Police All Plans |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of AZ Commercial |
$0.53
|
| Rate for Payer: Copperpoint Commercial |
$0.20
|
| Rate for Payer: Health Net of AZ Commercial |
$0.49
|
| Rate for Payer: Health Net of AZ Medicare |
$0.23
|
| Rate for Payer: Humana of AZ Medicare |
$0.12
|
| Rate for Payer: Mercy Care Medicaid |
$2.22
|
| Rate for Payer: Self Pay Self Pay |
$0.65
|
| Rate for Payer: TriWest Medicare |
$0.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.15
|
|
|
Direct LDL
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
1735730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna of AZ Commercial |
$149.40
|
| Rate for Payer: Bisbee Police All Plans |
$43.16
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Self Pay Self Pay |
$132.80
|
|
|
Direct LDL
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
1735730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna of AZ Commercial |
$149.40
|
| Rate for Payer: Aetna of AZ Medicare |
$46.48
|
| Rate for Payer: AHCCCS Medicaid |
$10.50
|
| Rate for Payer: Allwell Medicaid |
$10.50
|
| Rate for Payer: Allwell Medicare |
$24.90
|
| Rate for Payer: Amerigroup Medicare |
$24.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$62.00
|
| Rate for Payer: AZCH Complete Medicaid |
$10.50
|
| Rate for Payer: AZCH Complete Medicare |
$24.90
|
| Rate for Payer: Banner UC Health Medicaid |
$10.50
|
| Rate for Payer: Banner UC Health Medicare |
$24.90
|
| Rate for Payer: Bisbee Police All Plans |
$43.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$112.88
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cigna of AZ Commercial |
$107.90
|
| Rate for Payer: Copperpoint Commercial |
$41.08
|
| Rate for Payer: Health Net of AZ Commercial |
$99.60
|
| Rate for Payer: Health Net of AZ Medicare |
$46.48
|
| Rate for Payer: Humana of AZ Medicare |
$24.90
|
| Rate for Payer: Mercy Care Medicaid |
$10.50
|
| Rate for Payer: Self Pay Self Pay |
$132.80
|
| Rate for Payer: TriWest Medicare |
$24.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$96.78
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$29.88
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$4,418.12
|
|
|
Service Code
|
APR-DRG 2841
|
| Hospital Charge Code |
APRDRG2844
|
| Min. Negotiated Rate |
$4,418.12 |
| Max. Negotiated Rate |
$4,418.12 |
| Rate for Payer: AHCCCS Medicaid |
$4,418.12
|
| Rate for Payer: Allwell Medicaid |
$4,418.12
|
| Rate for Payer: AZCH Complete Medicaid |
$4,418.12
|
| Rate for Payer: Banner UC Health Medicaid |
$4,418.12
|
| Rate for Payer: Mercy Care Medicaid |
$4,418.12
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$5,649.08
|
|
|
Service Code
|
APR-DRG 2842
|
| Hospital Charge Code |
APRDRG2844
|
| Min. Negotiated Rate |
$5,649.08 |
| Max. Negotiated Rate |
$5,649.08 |
| Rate for Payer: AHCCCS Medicaid |
$5,649.08
|
| Rate for Payer: Allwell Medicaid |
$5,649.08
|
| Rate for Payer: AZCH Complete Medicaid |
$5,649.08
|
| Rate for Payer: Banner UC Health Medicaid |
$5,649.08
|
| Rate for Payer: Mercy Care Medicaid |
$5,649.08
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$15,486.91
|
|
|
Service Code
|
APR-DRG 2844
|
| Hospital Charge Code |
APRDRG2841
|
| Min. Negotiated Rate |
$15,486.91 |
| Max. Negotiated Rate |
$15,486.91 |
| Rate for Payer: AHCCCS Medicaid |
$15,486.91
|
| Rate for Payer: Allwell Medicaid |
$15,486.91
|
| Rate for Payer: AZCH Complete Medicaid |
$15,486.91
|
| Rate for Payer: Banner UC Health Medicaid |
$15,486.91
|
| Rate for Payer: Mercy Care Medicaid |
$15,486.91
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$4,418.12
|
|
|
Service Code
|
APR-DRG 2841
|
| Hospital Charge Code |
APRDRG2843
|
| Min. Negotiated Rate |
$4,418.12 |
| Max. Negotiated Rate |
$4,418.12 |
| Rate for Payer: AHCCCS Medicaid |
$4,418.12
|
| Rate for Payer: Allwell Medicaid |
$4,418.12
|
| Rate for Payer: AZCH Complete Medicaid |
$4,418.12
|
| Rate for Payer: Banner UC Health Medicaid |
$4,418.12
|
| Rate for Payer: Mercy Care Medicaid |
$4,418.12
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$15,486.91
|
|
|
Service Code
|
APR-DRG 2844
|
| Hospital Charge Code |
APRDRG2844
|
| Min. Negotiated Rate |
$15,486.91 |
| Max. Negotiated Rate |
$15,486.91 |
| Rate for Payer: AHCCCS Medicaid |
$15,486.91
|
| Rate for Payer: Allwell Medicaid |
$15,486.91
|
| Rate for Payer: AZCH Complete Medicaid |
$15,486.91
|
| Rate for Payer: Banner UC Health Medicaid |
$15,486.91
|
| Rate for Payer: Mercy Care Medicaid |
$15,486.91
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$8,132.03
|
|
|
Service Code
|
APR-DRG 2843
|
| Hospital Charge Code |
APRDRG2842
|
| Min. Negotiated Rate |
$8,132.03 |
| Max. Negotiated Rate |
$8,132.03 |
| Rate for Payer: AHCCCS Medicaid |
$8,132.03
|
| Rate for Payer: Allwell Medicaid |
$8,132.03
|
| Rate for Payer: AZCH Complete Medicaid |
$8,132.03
|
| Rate for Payer: Banner UC Health Medicaid |
$8,132.03
|
| Rate for Payer: Mercy Care Medicaid |
$8,132.03
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$5,649.08
|
|
|
Service Code
|
APR-DRG 2842
|
| Hospital Charge Code |
APRDRG2841
|
| Min. Negotiated Rate |
$5,649.08 |
| Max. Negotiated Rate |
$5,649.08 |
| Rate for Payer: AHCCCS Medicaid |
$5,649.08
|
| Rate for Payer: Allwell Medicaid |
$5,649.08
|
| Rate for Payer: AZCH Complete Medicaid |
$5,649.08
|
| Rate for Payer: Banner UC Health Medicaid |
$5,649.08
|
| Rate for Payer: Mercy Care Medicaid |
$5,649.08
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$8,132.03
|
|
|
Service Code
|
APR-DRG 2843
|
| Hospital Charge Code |
APRDRG2841
|
| Min. Negotiated Rate |
$8,132.03 |
| Max. Negotiated Rate |
$8,132.03 |
| Rate for Payer: AHCCCS Medicaid |
$8,132.03
|
| Rate for Payer: Allwell Medicaid |
$8,132.03
|
| Rate for Payer: AZCH Complete Medicaid |
$8,132.03
|
| Rate for Payer: Banner UC Health Medicaid |
$8,132.03
|
| Rate for Payer: Mercy Care Medicaid |
$8,132.03
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$5,649.08
|
|
|
Service Code
|
APR-DRG 2842
|
| Hospital Charge Code |
APRDRG2842
|
| Min. Negotiated Rate |
$5,649.08 |
| Max. Negotiated Rate |
$5,649.08 |
| Rate for Payer: AHCCCS Medicaid |
$5,649.08
|
| Rate for Payer: Allwell Medicaid |
$5,649.08
|
| Rate for Payer: AZCH Complete Medicaid |
$5,649.08
|
| Rate for Payer: Banner UC Health Medicaid |
$5,649.08
|
| Rate for Payer: Mercy Care Medicaid |
$5,649.08
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$4,418.12
|
|
|
Service Code
|
APR-DRG 2841
|
| Hospital Charge Code |
APRDRG2842
|
| Min. Negotiated Rate |
$4,418.12 |
| Max. Negotiated Rate |
$4,418.12 |
| Rate for Payer: AHCCCS Medicaid |
$4,418.12
|
| Rate for Payer: Allwell Medicaid |
$4,418.12
|
| Rate for Payer: AZCH Complete Medicaid |
$4,418.12
|
| Rate for Payer: Banner UC Health Medicaid |
$4,418.12
|
| Rate for Payer: Mercy Care Medicaid |
$4,418.12
|
|
|
Disorders Of Gallbladder And Biliary Tract
|
Facility
|
IP
|
$8,132.03
|
|
|
Service Code
|
APR-DRG 2843
|
| Hospital Charge Code |
APRDRG2844
|
| Min. Negotiated Rate |
$8,132.03 |
| Max. Negotiated Rate |
$8,132.03 |
| Rate for Payer: AHCCCS Medicaid |
$8,132.03
|
| Rate for Payer: Allwell Medicaid |
$8,132.03
|
| Rate for Payer: AZCH Complete Medicaid |
$8,132.03
|
| Rate for Payer: Banner UC Health Medicaid |
$8,132.03
|
| Rate for Payer: Mercy Care Medicaid |
$8,132.03
|
|
