|
Du Test
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 86885
|
| Hospital Charge Code |
9229048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna of AZ Commercial |
$95.40
|
| Rate for Payer: Bisbee Police All Plans |
$27.56
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Self Pay Self Pay |
$84.80
|
|
|
DYNAFLEX COMP KIT
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
22354908
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna of AZ Commercial |
$99.90
|
| Rate for Payer: Bisbee Police All Plans |
$28.86
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Self Pay Self Pay |
$88.80
|
|
|
DYNAFLEX COMP KIT
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
22354908
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna of AZ Commercial |
$99.90
|
| Rate for Payer: Aetna of AZ Medicare |
$31.08
|
| Rate for Payer: Allwell Medicare |
$17.76
|
| Rate for Payer: Amerigroup Medicare |
$17.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$41.46
|
| Rate for Payer: AZCH Complete Medicare |
$17.76
|
| Rate for Payer: Banner UC Health Medicare |
$17.76
|
| Rate for Payer: Bisbee Police All Plans |
$28.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$75.48
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna of AZ Commercial |
$77.70
|
| Rate for Payer: Copperpoint Commercial |
$27.47
|
| Rate for Payer: Health Net of AZ Commercial |
$66.60
|
| Rate for Payer: Health Net of AZ Medicare |
$31.08
|
| Rate for Payer: Humana of AZ Medicare |
$17.76
|
| Rate for Payer: Self Pay Self Pay |
$88.80
|
| Rate for Payer: TriWest Medicare |
$17.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$64.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.98
|
|
|
EACH ADDITIONAL HOUR
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
22247980
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna of AZ Commercial |
$87.30
|
| Rate for Payer: Bisbee Police All Plans |
$25.22
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Self Pay Self Pay |
$77.60
|
|
|
EACH ADDITIONAL HOUR
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
22247980
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$15.52 |
| 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 |
$29.00
|
| Rate for Payer: Allwell Medicaid |
$29.00
|
| Rate for Payer: Allwell Medicare |
$15.52
|
| Rate for Payer: Amerigroup Medicare |
$15.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$36.23
|
| Rate for Payer: AZCH Complete Medicaid |
$29.00
|
| Rate for Payer: AZCH Complete Medicare |
$15.52
|
| Rate for Payer: Banner UC Health Medicaid |
$29.00
|
| Rate for Payer: Banner UC Health Medicare |
$15.52
|
| 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 |
$15.52
|
| Rate for Payer: Mercy Care Medicaid |
$29.00
|
| Rate for Payer: Self Pay Self Pay |
$77.60
|
| Rate for Payer: TriWest Medicare |
$15.52
|
| 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
|
$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 |
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
|
$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
|
$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
|
|
|
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 |
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
|
$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 |
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
|
$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
|
$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
|
$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
|
$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
|
$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
|
$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
|
$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
|
$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
|
|
|
EASY CLIP MONOCORTICAL FIXATION DEVICE 8X8X8
|
Facility
|
OP
|
$11,615.00
|
|
| Hospital Charge Code |
27887275
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,858.40 |
| Max. Negotiated Rate |
$10,453.50 |
| Rate for Payer: Aetna of AZ Commercial |
$10,453.50
|
| Rate for Payer: Aetna of AZ Medicare |
$3,252.20
|
| Rate for Payer: Allwell Medicare |
$1,858.40
|
| Rate for Payer: Amerigroup Medicare |
$1,858.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4,338.20
|
| Rate for Payer: AZCH Complete Medicare |
$1,858.40
|
| Rate for Payer: Banner UC Health Medicare |
$1,858.40
|
| Rate for Payer: Bisbee Police All Plans |
$3,019.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$7,898.20
|
| Rate for Payer: Cash Price |
$9,292.00
|
| Rate for Payer: Cigna of AZ Commercial |
$8,130.50
|
| Rate for Payer: Copperpoint Commercial |
$2,874.71
|
| Rate for Payer: Health Net of AZ Commercial |
$6,969.00
|
| Rate for Payer: Health Net of AZ Medicare |
$3,252.20
|
| Rate for Payer: Humana of AZ Medicare |
$1,858.40
|
| Rate for Payer: Self Pay Self Pay |
$9,292.00
|
| Rate for Payer: TriWest Medicare |
$1,858.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$6,771.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2,090.70
|
|
|
EASY CLIP MONOCORTICAL FIXATION DEVICE 8X8X8
|
Facility
|
IP
|
$11,615.00
|
|
| Hospital Charge Code |
27887275
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,019.90 |
| Max. Negotiated Rate |
$10,453.50 |
| Rate for Payer: Aetna of AZ Commercial |
$10,453.50
|
| Rate for Payer: Bisbee Police All Plans |
$3,019.90
|
| Rate for Payer: Cash Price |
$9,292.00
|
| Rate for Payer: Self Pay Self Pay |
$9,292.00
|
|
|
Eating Disorders
|
Facility
|
IP
|
$11,545.04
|
|
|
Service Code
|
APR-DRG 7593
|
| Hospital Charge Code |
APRDRG7592
|
| 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
|
$8,143.96
|
|
|
Service Code
|
APR-DRG 7592
|
| Hospital Charge Code |
APRDRG7592
|
| 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
|
|
