EACH ADDITIONAL HOUR
|
Facility
|
OP
|
$97.00
|
|
Service Code
|
CPT 96361
|
Hospital Charge Code |
22247980
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$14.55 |
Max. Negotiated Rate |
$87.30 |
Rate for Payer: Aetna of AZ Commercial |
$87.30
|
Rate for Payer: Aetna of AZ Medicare |
$27.16
|
Rate for Payer: AHCCCS Medicaid |
$58.00
|
Rate for Payer: Allwell Medicaid |
$58.00
|
Rate for Payer: Allwell Medicare |
$14.55
|
Rate for Payer: Amerigroup Medicare |
$14.55
|
Rate for Payer: APIPA Medicare/Medicaid |
$36.23
|
Rate for Payer: AZCH Complete Medicaid |
$58.00
|
Rate for Payer: AZCH Complete Medicare |
$14.55
|
Rate for Payer: Banner UC Health Medicaid |
$58.00
|
Rate for Payer: Banner UC Health Medicare |
$14.55
|
Rate for Payer: Bisbee Police All Plans |
$25.22
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$65.96
|
Rate for Payer: Cash Price |
$77.60
|
Rate for Payer: Cash Price |
$77.60
|
Rate for Payer: Cigna of AZ Commercial |
$67.90
|
Rate for Payer: Copperpoint Commercial |
$24.01
|
Rate for Payer: Health Net of AZ Commercial |
$58.20
|
Rate for Payer: Health Net of AZ Medicare |
$27.16
|
Rate for Payer: Humana of AZ Medicare |
$14.55
|
Rate for Payer: Mercy Care Medicaid |
$58.00
|
Rate for Payer: Self Pay Self Pay |
$77.60
|
Rate for Payer: TriWest Medicare |
$14.55
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$56.55
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$17.46
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$5,968.21
|
|
Service Code
|
APR-DRG 1102
|
Hospital Charge Code |
APRDRG1103
|
Min. Negotiated Rate |
$5,968.21 |
Max. Negotiated Rate |
$5,968.21 |
Rate for Payer: AHCCCS Medicaid |
$5,968.21
|
Rate for Payer: Allwell Medicaid |
$5,968.21
|
Rate for Payer: AZCH Complete Medicaid |
$5,968.21
|
Rate for Payer: Banner UC Health Medicaid |
$5,968.21
|
Rate for Payer: Mercy Care Medicaid |
$5,968.21
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$4,909.80
|
|
Service Code
|
APR-DRG 1101
|
Hospital Charge Code |
APRDRG1102
|
Min. Negotiated Rate |
$4,909.80 |
Max. Negotiated Rate |
$4,909.80 |
Rate for Payer: AHCCCS Medicaid |
$4,909.80
|
Rate for Payer: Allwell Medicaid |
$4,909.80
|
Rate for Payer: AZCH Complete Medicaid |
$4,909.80
|
Rate for Payer: Banner UC Health Medicaid |
$4,909.80
|
Rate for Payer: Mercy Care Medicaid |
$4,909.80
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$9,130.12
|
|
Service Code
|
APR-DRG 1103
|
Hospital Charge Code |
APRDRG1104
|
Min. Negotiated Rate |
$9,130.12 |
Max. Negotiated Rate |
$9,130.12 |
Rate for Payer: AHCCCS Medicaid |
$9,130.12
|
Rate for Payer: Allwell Medicaid |
$9,130.12
|
Rate for Payer: AZCH Complete Medicaid |
$9,130.12
|
Rate for Payer: Banner UC Health Medicaid |
$9,130.12
|
Rate for Payer: Mercy Care Medicaid |
$9,130.12
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$5,968.21
|
|
Service Code
|
APR-DRG 1102
|
Hospital Charge Code |
APRDRG1101
|
Min. Negotiated Rate |
$5,968.21 |
Max. Negotiated Rate |
$5,968.21 |
Rate for Payer: AHCCCS Medicaid |
$5,968.21
|
Rate for Payer: Allwell Medicaid |
$5,968.21
|
Rate for Payer: AZCH Complete Medicaid |
$5,968.21
|
Rate for Payer: Banner UC Health Medicaid |
$5,968.21
|
Rate for Payer: Mercy Care Medicaid |
$5,968.21
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$15,546.53
|
|
Service Code
|
APR-DRG 1104
|
Hospital Charge Code |
APRDRG1101
|
Min. Negotiated Rate |
$15,546.53 |
Max. Negotiated Rate |
$15,546.53 |
Rate for Payer: AHCCCS Medicaid |
$15,546.53
|
Rate for Payer: Allwell Medicaid |
$15,546.53
|
Rate for Payer: AZCH Complete Medicaid |
$15,546.53
|
Rate for Payer: Banner UC Health Medicaid |
$15,546.53
|
Rate for Payer: Mercy Care Medicaid |
$15,546.53
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$15,546.53
|
|
Service Code
|
APR-DRG 1104
|
Hospital Charge Code |
APRDRG1104
|
Min. Negotiated Rate |
$15,546.53 |
Max. Negotiated Rate |
$15,546.53 |
Rate for Payer: AHCCCS Medicaid |
$15,546.53
|
Rate for Payer: Allwell Medicaid |
$15,546.53
|
Rate for Payer: AZCH Complete Medicaid |
$15,546.53
|
Rate for Payer: Banner UC Health Medicaid |
$15,546.53
|
Rate for Payer: Mercy Care Medicaid |
$15,546.53
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$9,130.12
|
|
Service Code
|
APR-DRG 1103
|
Hospital Charge Code |
APRDRG1102
|
Min. Negotiated Rate |
$9,130.12 |
Max. Negotiated Rate |
$9,130.12 |
Rate for Payer: AHCCCS Medicaid |
$9,130.12
|
Rate for Payer: Allwell Medicaid |
$9,130.12
|
Rate for Payer: AZCH Complete Medicaid |
$9,130.12
|
Rate for Payer: Banner UC Health Medicaid |
$9,130.12
|
Rate for Payer: Mercy Care Medicaid |
$9,130.12
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$15,546.53
|
|
Service Code
|
APR-DRG 1104
|
Hospital Charge Code |
APRDRG1102
|
Min. Negotiated Rate |
$15,546.53 |
Max. Negotiated Rate |
$15,546.53 |
Rate for Payer: AHCCCS Medicaid |
$15,546.53
|
Rate for Payer: Allwell Medicaid |
$15,546.53
|
Rate for Payer: AZCH Complete Medicaid |
$15,546.53
|
Rate for Payer: Banner UC Health Medicaid |
$15,546.53
|
Rate for Payer: Mercy Care Medicaid |
$15,546.53
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$4,909.80
|
|
Service Code
|
APR-DRG 1101
|
Hospital Charge Code |
APRDRG1103
|
Min. Negotiated Rate |
$4,909.80 |
Max. Negotiated Rate |
$4,909.80 |
Rate for Payer: AHCCCS Medicaid |
$4,909.80
|
Rate for Payer: Allwell Medicaid |
$4,909.80
|
Rate for Payer: AZCH Complete Medicaid |
$4,909.80
|
Rate for Payer: Banner UC Health Medicaid |
$4,909.80
|
Rate for Payer: Mercy Care Medicaid |
$4,909.80
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$9,130.12
|
|
Service Code
|
APR-DRG 1103
|
Hospital Charge Code |
APRDRG1101
|
Min. Negotiated Rate |
$9,130.12 |
Max. Negotiated Rate |
$9,130.12 |
Rate for Payer: AHCCCS Medicaid |
$9,130.12
|
Rate for Payer: Allwell Medicaid |
$9,130.12
|
Rate for Payer: AZCH Complete Medicaid |
$9,130.12
|
Rate for Payer: Banner UC Health Medicaid |
$9,130.12
|
Rate for Payer: Mercy Care Medicaid |
$9,130.12
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$15,546.53
|
|
Service Code
|
APR-DRG 1104
|
Hospital Charge Code |
APRDRG1103
|
Min. Negotiated Rate |
$15,546.53 |
Max. Negotiated Rate |
$15,546.53 |
Rate for Payer: AHCCCS Medicaid |
$15,546.53
|
Rate for Payer: Allwell Medicaid |
$15,546.53
|
Rate for Payer: AZCH Complete Medicaid |
$15,546.53
|
Rate for Payer: Banner UC Health Medicaid |
$15,546.53
|
Rate for Payer: Mercy Care Medicaid |
$15,546.53
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$4,909.80
|
|
Service Code
|
APR-DRG 1101
|
Hospital Charge Code |
APRDRG1104
|
Min. Negotiated Rate |
$4,909.80 |
Max. Negotiated Rate |
$4,909.80 |
Rate for Payer: AHCCCS Medicaid |
$4,909.80
|
Rate for Payer: Allwell Medicaid |
$4,909.80
|
Rate for Payer: AZCH Complete Medicaid |
$4,909.80
|
Rate for Payer: Banner UC Health Medicaid |
$4,909.80
|
Rate for Payer: Mercy Care Medicaid |
$4,909.80
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$5,968.21
|
|
Service Code
|
APR-DRG 1102
|
Hospital Charge Code |
APRDRG1104
|
Min. Negotiated Rate |
$5,968.21 |
Max. Negotiated Rate |
$5,968.21 |
Rate for Payer: AHCCCS Medicaid |
$5,968.21
|
Rate for Payer: Allwell Medicaid |
$5,968.21
|
Rate for Payer: AZCH Complete Medicaid |
$5,968.21
|
Rate for Payer: Banner UC Health Medicaid |
$5,968.21
|
Rate for Payer: Mercy Care Medicaid |
$5,968.21
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$4,909.80
|
|
Service Code
|
APR-DRG 1101
|
Hospital Charge Code |
APRDRG1101
|
Min. Negotiated Rate |
$4,909.80 |
Max. Negotiated Rate |
$4,909.80 |
Rate for Payer: AHCCCS Medicaid |
$4,909.80
|
Rate for Payer: Allwell Medicaid |
$4,909.80
|
Rate for Payer: AZCH Complete Medicaid |
$4,909.80
|
Rate for Payer: Banner UC Health Medicaid |
$4,909.80
|
Rate for Payer: Mercy Care Medicaid |
$4,909.80
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$5,968.21
|
|
Service Code
|
APR-DRG 1102
|
Hospital Charge Code |
APRDRG1102
|
Min. Negotiated Rate |
$5,968.21 |
Max. Negotiated Rate |
$5,968.21 |
Rate for Payer: AHCCCS Medicaid |
$5,968.21
|
Rate for Payer: Allwell Medicaid |
$5,968.21
|
Rate for Payer: AZCH Complete Medicaid |
$5,968.21
|
Rate for Payer: Banner UC Health Medicaid |
$5,968.21
|
Rate for Payer: Mercy Care Medicaid |
$5,968.21
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$9,130.12
|
|
Service Code
|
APR-DRG 1103
|
Hospital Charge Code |
APRDRG1103
|
Min. Negotiated Rate |
$9,130.12 |
Max. Negotiated Rate |
$9,130.12 |
Rate for Payer: AHCCCS Medicaid |
$9,130.12
|
Rate for Payer: Allwell Medicaid |
$9,130.12
|
Rate for Payer: AZCH Complete Medicaid |
$9,130.12
|
Rate for Payer: Banner UC Health Medicaid |
$9,130.12
|
Rate for Payer: Mercy Care Medicaid |
$9,130.12
|
|
Eating Disorders
|
Facility
|
IP
|
$28,590.47
|
|
Service Code
|
APR-DRG 7594
|
Hospital Charge Code |
APRDRG7592
|
Min. Negotiated Rate |
$28,590.47 |
Max. Negotiated Rate |
$28,590.47 |
Rate for Payer: AHCCCS Medicaid |
$28,590.47
|
Rate for Payer: Allwell Medicaid |
$28,590.47
|
Rate for Payer: AZCH Complete Medicaid |
$28,590.47
|
Rate for Payer: Banner UC Health Medicaid |
$28,590.47
|
Rate for Payer: Mercy Care Medicaid |
$28,590.47
|
|
Eating Disorders
|
Facility
|
IP
|
$8,143.96
|
|
Service Code
|
APR-DRG 7592
|
Hospital Charge Code |
APRDRG7594
|
Min. Negotiated Rate |
$8,143.96 |
Max. Negotiated Rate |
$8,143.96 |
Rate for Payer: AHCCCS Medicaid |
$8,143.96
|
Rate for Payer: Allwell Medicaid |
$8,143.96
|
Rate for Payer: AZCH Complete Medicaid |
$8,143.96
|
Rate for Payer: Banner UC Health Medicaid |
$8,143.96
|
Rate for Payer: Mercy Care Medicaid |
$8,143.96
|
|
Eating Disorders
|
Facility
|
IP
|
$7,972.81
|
|
Service Code
|
APR-DRG 7591
|
Hospital Charge Code |
APRDRG7594
|
Min. Negotiated Rate |
$7,972.81 |
Max. Negotiated Rate |
$7,972.81 |
Rate for Payer: AHCCCS Medicaid |
$7,972.81
|
Rate for Payer: Allwell Medicaid |
$7,972.81
|
Rate for Payer: AZCH Complete Medicaid |
$7,972.81
|
Rate for Payer: Banner UC Health Medicaid |
$7,972.81
|
Rate for Payer: Mercy Care Medicaid |
$7,972.81
|
|
Eating Disorders
|
Facility
|
IP
|
$11,545.04
|
|
Service Code
|
APR-DRG 7593
|
Hospital Charge Code |
APRDRG7594
|
Min. Negotiated Rate |
$11,545.04 |
Max. Negotiated Rate |
$11,545.04 |
Rate for Payer: AHCCCS Medicaid |
$11,545.04
|
Rate for Payer: Allwell Medicaid |
$11,545.04
|
Rate for Payer: AZCH Complete Medicaid |
$11,545.04
|
Rate for Payer: Banner UC Health Medicaid |
$11,545.04
|
Rate for Payer: Mercy Care Medicaid |
$11,545.04
|
|
Eating Disorders
|
Facility
|
IP
|
$7,972.81
|
|
Service Code
|
APR-DRG 7591
|
Hospital Charge Code |
APRDRG7591
|
Min. Negotiated Rate |
$7,972.81 |
Max. Negotiated Rate |
$7,972.81 |
Rate for Payer: AHCCCS Medicaid |
$7,972.81
|
Rate for Payer: Allwell Medicaid |
$7,972.81
|
Rate for Payer: AZCH Complete Medicaid |
$7,972.81
|
Rate for Payer: Banner UC Health Medicaid |
$7,972.81
|
Rate for Payer: Mercy Care Medicaid |
$7,972.81
|
|
Eating Disorders
|
Facility
|
IP
|
$7,972.81
|
|
Service Code
|
APR-DRG 7591
|
Hospital Charge Code |
APRDRG7593
|
Min. Negotiated Rate |
$7,972.81 |
Max. Negotiated Rate |
$7,972.81 |
Rate for Payer: AHCCCS Medicaid |
$7,972.81
|
Rate for Payer: Allwell Medicaid |
$7,972.81
|
Rate for Payer: AZCH Complete Medicaid |
$7,972.81
|
Rate for Payer: Banner UC Health Medicaid |
$7,972.81
|
Rate for Payer: Mercy Care Medicaid |
$7,972.81
|
|
Eating Disorders
|
Facility
|
IP
|
$28,590.47
|
|
Service Code
|
APR-DRG 7594
|
Hospital Charge Code |
APRDRG7594
|
Min. Negotiated Rate |
$28,590.47 |
Max. Negotiated Rate |
$28,590.47 |
Rate for Payer: AHCCCS Medicaid |
$28,590.47
|
Rate for Payer: Allwell Medicaid |
$28,590.47
|
Rate for Payer: AZCH Complete Medicaid |
$28,590.47
|
Rate for Payer: Banner UC Health Medicaid |
$28,590.47
|
Rate for Payer: Mercy Care Medicaid |
$28,590.47
|
|
Eating Disorders
|
Facility
|
IP
|
$11,545.04
|
|
Service Code
|
APR-DRG 7593
|
Hospital Charge Code |
APRDRG7591
|
Min. Negotiated Rate |
$11,545.04 |
Max. Negotiated Rate |
$11,545.04 |
Rate for Payer: AHCCCS Medicaid |
$11,545.04
|
Rate for Payer: Allwell Medicaid |
$11,545.04
|
Rate for Payer: AZCH Complete Medicaid |
$11,545.04
|
Rate for Payer: Banner UC Health Medicaid |
$11,545.04
|
Rate for Payer: Mercy Care Medicaid |
$11,545.04
|
|