|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
Facility
|
IP
|
$47,588.59
|
|
|
Service Code
|
APR-DRG 3044
|
| Hospital Charge Code |
APRDRG3042
|
| Min. Negotiated Rate |
$47,588.59 |
| Max. Negotiated Rate |
$47,588.59 |
| Rate for Payer: AHCCCS Medicaid |
$47,588.59
|
| Rate for Payer: Allwell Medicaid |
$47,588.59
|
| Rate for Payer: AZCH Complete Medicaid |
$47,588.59
|
| Rate for Payer: Banner UC Health Medicaid |
$47,588.59
|
| Rate for Payer: Mercy Care Medicaid |
$47,588.59
|
|
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
Facility
|
IP
|
$32,927.92
|
|
|
Service Code
|
APR-DRG 3043
|
| Hospital Charge Code |
APRDRG3042
|
| Min. Negotiated Rate |
$32,927.92 |
| Max. Negotiated Rate |
$32,927.92 |
| Rate for Payer: AHCCCS Medicaid |
$32,927.92
|
| Rate for Payer: Allwell Medicaid |
$32,927.92
|
| Rate for Payer: AZCH Complete Medicaid |
$32,927.92
|
| Rate for Payer: Banner UC Health Medicaid |
$32,927.92
|
| Rate for Payer: Mercy Care Medicaid |
$32,927.92
|
|
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
Facility
|
IP
|
$17,155.54
|
|
|
Service Code
|
APR-DRG 3041
|
| Hospital Charge Code |
APRDRG3043
|
| Min. Negotiated Rate |
$17,155.54 |
| Max. Negotiated Rate |
$17,155.54 |
| Rate for Payer: AHCCCS Medicaid |
$17,155.54
|
| Rate for Payer: Allwell Medicaid |
$17,155.54
|
| Rate for Payer: AZCH Complete Medicaid |
$17,155.54
|
| Rate for Payer: Banner UC Health Medicaid |
$17,155.54
|
| Rate for Payer: Mercy Care Medicaid |
$17,155.54
|
|
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
Facility
|
IP
|
$21,589.09
|
|
|
Service Code
|
APR-DRG 3042
|
| Hospital Charge Code |
APRDRG3043
|
| Min. Negotiated Rate |
$21,589.09 |
| Max. Negotiated Rate |
$21,589.09 |
| Rate for Payer: AHCCCS Medicaid |
$21,589.09
|
| Rate for Payer: Allwell Medicaid |
$21,589.09
|
| Rate for Payer: AZCH Complete Medicaid |
$21,589.09
|
| Rate for Payer: Banner UC Health Medicaid |
$21,589.09
|
| Rate for Payer: Mercy Care Medicaid |
$21,589.09
|
|
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
Facility
|
IP
|
$32,927.92
|
|
|
Service Code
|
APR-DRG 3043
|
| Hospital Charge Code |
APRDRG3044
|
| Min. Negotiated Rate |
$32,927.92 |
| Max. Negotiated Rate |
$32,927.92 |
| Rate for Payer: AHCCCS Medicaid |
$32,927.92
|
| Rate for Payer: Allwell Medicaid |
$32,927.92
|
| Rate for Payer: AZCH Complete Medicaid |
$32,927.92
|
| Rate for Payer: Banner UC Health Medicaid |
$32,927.92
|
| Rate for Payer: Mercy Care Medicaid |
$32,927.92
|
|
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
Facility
|
IP
|
$32,927.92
|
|
|
Service Code
|
APR-DRG 3043
|
| Hospital Charge Code |
APRDRG3041
|
| Min. Negotiated Rate |
$32,927.92 |
| Max. Negotiated Rate |
$32,927.92 |
| Rate for Payer: AHCCCS Medicaid |
$32,927.92
|
| Rate for Payer: Allwell Medicaid |
$32,927.92
|
| Rate for Payer: AZCH Complete Medicaid |
$32,927.92
|
| Rate for Payer: Banner UC Health Medicaid |
$32,927.92
|
| Rate for Payer: Mercy Care Medicaid |
$32,927.92
|
|
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
Facility
|
IP
|
$17,155.54
|
|
|
Service Code
|
APR-DRG 3041
|
| Hospital Charge Code |
APRDRG3042
|
| Min. Negotiated Rate |
$17,155.54 |
| Max. Negotiated Rate |
$17,155.54 |
| Rate for Payer: AHCCCS Medicaid |
$17,155.54
|
| Rate for Payer: Allwell Medicaid |
$17,155.54
|
| Rate for Payer: AZCH Complete Medicaid |
$17,155.54
|
| Rate for Payer: Banner UC Health Medicaid |
$17,155.54
|
| Rate for Payer: Mercy Care Medicaid |
$17,155.54
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$51,028.95
|
|
|
Service Code
|
APR-DRG 3033
|
| Hospital Charge Code |
APRDRG3032
|
| Min. Negotiated Rate |
$51,028.95 |
| Max. Negotiated Rate |
$51,028.95 |
| Rate for Payer: AHCCCS Medicaid |
$51,028.95
|
| Rate for Payer: Allwell Medicaid |
$51,028.95
|
| Rate for Payer: AZCH Complete Medicaid |
$51,028.95
|
| Rate for Payer: Banner UC Health Medicaid |
$51,028.95
|
| Rate for Payer: Mercy Care Medicaid |
$51,028.95
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$35,683.73
|
|
|
Service Code
|
APR-DRG 3032
|
| Hospital Charge Code |
APRDRG3034
|
| Min. Negotiated Rate |
$35,683.73 |
| Max. Negotiated Rate |
$35,683.73 |
| Rate for Payer: AHCCCS Medicaid |
$35,683.73
|
| Rate for Payer: Allwell Medicaid |
$35,683.73
|
| Rate for Payer: AZCH Complete Medicaid |
$35,683.73
|
| Rate for Payer: Banner UC Health Medicaid |
$35,683.73
|
| Rate for Payer: Mercy Care Medicaid |
$35,683.73
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$66,449.23
|
|
|
Service Code
|
APR-DRG 3034
|
| Hospital Charge Code |
APRDRG3031
|
| Min. Negotiated Rate |
$66,449.23 |
| Max. Negotiated Rate |
$66,449.23 |
| Rate for Payer: AHCCCS Medicaid |
$66,449.23
|
| Rate for Payer: Allwell Medicaid |
$66,449.23
|
| Rate for Payer: AZCH Complete Medicaid |
$66,449.23
|
| Rate for Payer: Banner UC Health Medicaid |
$66,449.23
|
| Rate for Payer: Mercy Care Medicaid |
$66,449.23
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$66,449.23
|
|
|
Service Code
|
APR-DRG 3034
|
| Hospital Charge Code |
APRDRG3033
|
| Min. Negotiated Rate |
$66,449.23 |
| Max. Negotiated Rate |
$66,449.23 |
| Rate for Payer: AHCCCS Medicaid |
$66,449.23
|
| Rate for Payer: Allwell Medicaid |
$66,449.23
|
| Rate for Payer: AZCH Complete Medicaid |
$66,449.23
|
| Rate for Payer: Banner UC Health Medicaid |
$66,449.23
|
| Rate for Payer: Mercy Care Medicaid |
$66,449.23
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$27,633.76
|
|
|
Service Code
|
APR-DRG 3031
|
| Hospital Charge Code |
APRDRG3032
|
| Min. Negotiated Rate |
$27,633.76 |
| Max. Negotiated Rate |
$27,633.76 |
| Rate for Payer: AHCCCS Medicaid |
$27,633.76
|
| Rate for Payer: Allwell Medicaid |
$27,633.76
|
| Rate for Payer: AZCH Complete Medicaid |
$27,633.76
|
| Rate for Payer: Banner UC Health Medicaid |
$27,633.76
|
| Rate for Payer: Mercy Care Medicaid |
$27,633.76
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$66,449.23
|
|
|
Service Code
|
APR-DRG 3034
|
| Hospital Charge Code |
APRDRG3034
|
| Min. Negotiated Rate |
$66,449.23 |
| Max. Negotiated Rate |
$66,449.23 |
| Rate for Payer: AHCCCS Medicaid |
$66,449.23
|
| Rate for Payer: Allwell Medicaid |
$66,449.23
|
| Rate for Payer: AZCH Complete Medicaid |
$66,449.23
|
| Rate for Payer: Banner UC Health Medicaid |
$66,449.23
|
| Rate for Payer: Mercy Care Medicaid |
$66,449.23
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$27,633.76
|
|
|
Service Code
|
APR-DRG 3031
|
| Hospital Charge Code |
APRDRG3034
|
| Min. Negotiated Rate |
$27,633.76 |
| Max. Negotiated Rate |
$27,633.76 |
| Rate for Payer: AHCCCS Medicaid |
$27,633.76
|
| Rate for Payer: Allwell Medicaid |
$27,633.76
|
| Rate for Payer: AZCH Complete Medicaid |
$27,633.76
|
| Rate for Payer: Banner UC Health Medicaid |
$27,633.76
|
| Rate for Payer: Mercy Care Medicaid |
$27,633.76
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$51,028.95
|
|
|
Service Code
|
APR-DRG 3033
|
| Hospital Charge Code |
APRDRG3034
|
| Min. Negotiated Rate |
$51,028.95 |
| Max. Negotiated Rate |
$51,028.95 |
| Rate for Payer: AHCCCS Medicaid |
$51,028.95
|
| Rate for Payer: Allwell Medicaid |
$51,028.95
|
| Rate for Payer: AZCH Complete Medicaid |
$51,028.95
|
| Rate for Payer: Banner UC Health Medicaid |
$51,028.95
|
| Rate for Payer: Mercy Care Medicaid |
$51,028.95
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$35,683.73
|
|
|
Service Code
|
APR-DRG 3032
|
| Hospital Charge Code |
APRDRG3031
|
| Min. Negotiated Rate |
$35,683.73 |
| Max. Negotiated Rate |
$35,683.73 |
| Rate for Payer: AHCCCS Medicaid |
$35,683.73
|
| Rate for Payer: Allwell Medicaid |
$35,683.73
|
| Rate for Payer: AZCH Complete Medicaid |
$35,683.73
|
| Rate for Payer: Banner UC Health Medicaid |
$35,683.73
|
| Rate for Payer: Mercy Care Medicaid |
$35,683.73
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$35,683.73
|
|
|
Service Code
|
APR-DRG 3032
|
| Hospital Charge Code |
APRDRG3033
|
| Min. Negotiated Rate |
$35,683.73 |
| Max. Negotiated Rate |
$35,683.73 |
| Rate for Payer: AHCCCS Medicaid |
$35,683.73
|
| Rate for Payer: Allwell Medicaid |
$35,683.73
|
| Rate for Payer: AZCH Complete Medicaid |
$35,683.73
|
| Rate for Payer: Banner UC Health Medicaid |
$35,683.73
|
| Rate for Payer: Mercy Care Medicaid |
$35,683.73
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$27,633.76
|
|
|
Service Code
|
APR-DRG 3031
|
| Hospital Charge Code |
APRDRG3033
|
| Min. Negotiated Rate |
$27,633.76 |
| Max. Negotiated Rate |
$27,633.76 |
| Rate for Payer: AHCCCS Medicaid |
$27,633.76
|
| Rate for Payer: Allwell Medicaid |
$27,633.76
|
| Rate for Payer: AZCH Complete Medicaid |
$27,633.76
|
| Rate for Payer: Banner UC Health Medicaid |
$27,633.76
|
| Rate for Payer: Mercy Care Medicaid |
$27,633.76
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$51,028.95
|
|
|
Service Code
|
APR-DRG 3033
|
| Hospital Charge Code |
APRDRG3031
|
| Min. Negotiated Rate |
$51,028.95 |
| Max. Negotiated Rate |
$51,028.95 |
| Rate for Payer: AHCCCS Medicaid |
$51,028.95
|
| Rate for Payer: Allwell Medicaid |
$51,028.95
|
| Rate for Payer: AZCH Complete Medicaid |
$51,028.95
|
| Rate for Payer: Banner UC Health Medicaid |
$51,028.95
|
| Rate for Payer: Mercy Care Medicaid |
$51,028.95
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$51,028.95
|
|
|
Service Code
|
APR-DRG 3033
|
| Hospital Charge Code |
APRDRG3033
|
| Min. Negotiated Rate |
$51,028.95 |
| Max. Negotiated Rate |
$51,028.95 |
| Rate for Payer: AHCCCS Medicaid |
$51,028.95
|
| Rate for Payer: Allwell Medicaid |
$51,028.95
|
| Rate for Payer: AZCH Complete Medicaid |
$51,028.95
|
| Rate for Payer: Banner UC Health Medicaid |
$51,028.95
|
| Rate for Payer: Mercy Care Medicaid |
$51,028.95
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$66,449.23
|
|
|
Service Code
|
APR-DRG 3034
|
| Hospital Charge Code |
APRDRG3032
|
| Min. Negotiated Rate |
$66,449.23 |
| Max. Negotiated Rate |
$66,449.23 |
| Rate for Payer: AHCCCS Medicaid |
$66,449.23
|
| Rate for Payer: Allwell Medicaid |
$66,449.23
|
| Rate for Payer: AZCH Complete Medicaid |
$66,449.23
|
| Rate for Payer: Banner UC Health Medicaid |
$66,449.23
|
| Rate for Payer: Mercy Care Medicaid |
$66,449.23
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$27,633.76
|
|
|
Service Code
|
APR-DRG 3031
|
| Hospital Charge Code |
APRDRG3031
|
| Min. Negotiated Rate |
$27,633.76 |
| Max. Negotiated Rate |
$27,633.76 |
| Rate for Payer: AHCCCS Medicaid |
$27,633.76
|
| Rate for Payer: Allwell Medicaid |
$27,633.76
|
| Rate for Payer: AZCH Complete Medicaid |
$27,633.76
|
| Rate for Payer: Banner UC Health Medicaid |
$27,633.76
|
| Rate for Payer: Mercy Care Medicaid |
$27,633.76
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$35,683.73
|
|
|
Service Code
|
APR-DRG 3032
|
| Hospital Charge Code |
APRDRG3032
|
| Min. Negotiated Rate |
$35,683.73 |
| Max. Negotiated Rate |
$35,683.73 |
| Rate for Payer: AHCCCS Medicaid |
$35,683.73
|
| Rate for Payer: Allwell Medicaid |
$35,683.73
|
| Rate for Payer: AZCH Complete Medicaid |
$35,683.73
|
| Rate for Payer: Banner UC Health Medicaid |
$35,683.73
|
| Rate for Payer: Mercy Care Medicaid |
$35,683.73
|
|
|
doxazosin 2 mg Tab [CQCH]
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 51079095820
|
| Hospital Charge Code |
105919979
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna of AZ Commercial |
$2.92
|
| Rate for Payer: Bisbee Police All Plans |
$0.84
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Self Pay Self Pay |
$2.59
|
|
|
doxazosin 2 mg Tab [CQCH]
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 51079095820
|
| Hospital Charge Code |
105919979
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna of AZ Commercial |
$2.92
|
| Rate for Payer: Aetna of AZ Medicare |
$0.91
|
| Rate for Payer: Allwell Medicare |
$0.52
|
| Rate for Payer: Amerigroup Medicare |
$0.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.21
|
| Rate for Payer: AZCH Complete Medicare |
$0.52
|
| Rate for Payer: Banner UC Health Medicare |
$0.52
|
| Rate for Payer: Bisbee Police All Plans |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cigna of AZ Commercial |
$2.11
|
| Rate for Payer: Copperpoint Commercial |
$0.80
|
| Rate for Payer: Health Net of AZ Commercial |
$1.94
|
| Rate for Payer: Health Net of AZ Medicare |
$0.91
|
| Rate for Payer: Humana of AZ Medicare |
$0.52
|
| Rate for Payer: Self Pay Self Pay |
$2.59
|
| Rate for Payer: TriWest Medicare |
$0.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.89
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.58
|
|
