|
Edometrial Sampling (biopsy) w/ or w/o Endo
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
22692053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Aetna of AZ Commercial |
$167.40
|
| Rate for Payer: Bisbee Police All Plans |
$48.36
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Self Pay Self Pay |
$148.80
|
|
|
EGD
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
22531756
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$374.40 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,106.00
|
| Rate for Payer: Aetna of AZ Medicare |
$655.20
|
| Rate for Payer: AHCCCS Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicare |
$374.40
|
| Rate for Payer: Amerigroup Medicare |
$374.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$873.99
|
| Rate for Payer: AZCH Complete Medicaid |
$586.96
|
| Rate for Payer: AZCH Complete Medicare |
$374.40
|
| Rate for Payer: Banner UC Health Medicaid |
$586.96
|
| Rate for Payer: Banner UC Health Medicare |
$374.40
|
| Rate for Payer: Bisbee Police All Plans |
$608.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,638.00
|
| Rate for Payer: Copperpoint Commercial |
$579.15
|
| Rate for Payer: Health Net of AZ Commercial |
$1,404.00
|
| Rate for Payer: Health Net of AZ Medicare |
$655.20
|
| Rate for Payer: Humana of AZ Medicare |
$374.40
|
| Rate for Payer: Mercy Care Medicaid |
$586.96
|
| Rate for Payer: Self Pay Self Pay |
$1,872.00
|
| Rate for Payer: TriWest Medicare |
$374.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$421.20
|
|
|
EGD
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
22531756
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$608.40 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,106.00
|
| Rate for Payer: Bisbee Police All Plans |
$608.40
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Self Pay Self Pay |
$1,872.00
|
|
|
EGD
|
Facility
|
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
885915
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$1,760.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,760.40
|
| Rate for Payer: Bisbee Police All Plans |
$508.56
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Self Pay Self Pay |
$1,564.80
|
|
|
EGD
|
Facility
|
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
885915
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$312.96 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,760.40
|
| Rate for Payer: Aetna of AZ Medicare |
$547.68
|
| Rate for Payer: AHCCCS Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicare |
$312.96
|
| Rate for Payer: Amerigroup Medicare |
$312.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$730.57
|
| Rate for Payer: AZCH Complete Medicaid |
$586.96
|
| Rate for Payer: AZCH Complete Medicare |
$312.96
|
| Rate for Payer: Banner UC Health Medicaid |
$586.96
|
| Rate for Payer: Banner UC Health Medicare |
$312.96
|
| Rate for Payer: Bisbee Police All Plans |
$508.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,330.08
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,369.20
|
| Rate for Payer: Copperpoint Commercial |
$484.11
|
| Rate for Payer: Health Net of AZ Commercial |
$1,173.60
|
| Rate for Payer: Health Net of AZ Medicare |
$547.68
|
| Rate for Payer: Humana of AZ Medicare |
$312.96
|
| Rate for Payer: Mercy Care Medicaid |
$586.96
|
| Rate for Payer: Self Pay Self Pay |
$1,564.80
|
| Rate for Payer: TriWest Medicare |
$312.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$352.08
|
|
|
EGD DILATION
|
Facility
|
IP
|
$6,347.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
23598980
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,650.22 |
| Max. Negotiated Rate |
$5,712.30 |
| Rate for Payer: Aetna of AZ Commercial |
$5,712.30
|
| Rate for Payer: Bisbee Police All Plans |
$1,650.22
|
| Rate for Payer: Cash Price |
$5,077.60
|
| Rate for Payer: Self Pay Self Pay |
$5,077.60
|
|
|
EGD DILATION
|
Facility
|
OP
|
$6,347.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
23598980
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,015.52 |
| Max. Negotiated Rate |
$5,712.30 |
| Rate for Payer: Aetna of AZ Commercial |
$5,712.30
|
| Rate for Payer: Aetna of AZ Medicare |
$1,777.16
|
| Rate for Payer: AHCCCS Medicaid |
$1,178.14
|
| Rate for Payer: Allwell Medicaid |
$1,178.14
|
| Rate for Payer: Allwell Medicare |
$1,015.52
|
| Rate for Payer: Amerigroup Medicare |
$1,015.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,370.60
|
| Rate for Payer: AZCH Complete Medicaid |
$1,178.14
|
| Rate for Payer: AZCH Complete Medicare |
$1,015.52
|
| Rate for Payer: Banner UC Health Medicaid |
$1,178.14
|
| Rate for Payer: Banner UC Health Medicare |
$1,015.52
|
| Rate for Payer: Bisbee Police All Plans |
$1,650.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4,315.96
|
| Rate for Payer: Cash Price |
$5,077.60
|
| Rate for Payer: Cash Price |
$5,077.60
|
| Rate for Payer: Cigna of AZ Commercial |
$4,442.90
|
| Rate for Payer: Copperpoint Commercial |
$1,570.88
|
| Rate for Payer: Health Net of AZ Commercial |
$3,808.20
|
| Rate for Payer: Health Net of AZ Medicare |
$1,777.16
|
| Rate for Payer: Humana of AZ Medicare |
$1,015.52
|
| Rate for Payer: Mercy Care Medicaid |
$1,178.14
|
| Rate for Payer: Self Pay Self Pay |
$5,077.60
|
| Rate for Payer: TriWest Medicare |
$1,015.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,142.46
|
|
|
EGD W/BIOPSY SGL/MULTI
|
Facility
|
OP
|
$1,382.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
1251729
|
|
Hospital Revenue Code
|
984
|
| Min. Negotiated Rate |
$221.12 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,243.80
|
| Rate for Payer: Aetna of AZ Medicare |
$386.96
|
| Rate for Payer: AHCCCS Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicare |
$221.12
|
| Rate for Payer: Amerigroup Medicare |
$221.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$516.18
|
| Rate for Payer: AZCH Complete Medicaid |
$586.96
|
| Rate for Payer: AZCH Complete Medicare |
$221.12
|
| Rate for Payer: Banner UC Health Medicaid |
$586.96
|
| Rate for Payer: Banner UC Health Medicare |
$221.12
|
| Rate for Payer: Bisbee Police All Plans |
$359.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$939.76
|
| Rate for Payer: Cash Price |
$1,105.60
|
| Rate for Payer: Cash Price |
$1,105.60
|
| Rate for Payer: Cigna of AZ Commercial |
$967.40
|
| Rate for Payer: Copperpoint Commercial |
$342.05
|
| Rate for Payer: Health Net of AZ Commercial |
$829.20
|
| Rate for Payer: Health Net of AZ Medicare |
$386.96
|
| Rate for Payer: Humana of AZ Medicare |
$221.12
|
| Rate for Payer: Mercy Care Medicaid |
$586.96
|
| Rate for Payer: Self Pay Self Pay |
$1,105.60
|
| Rate for Payer: TriWest Medicare |
$221.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$248.76
|
|
|
EGD W/BIOPSY SGL/MULTI
|
Facility
|
IP
|
$1,382.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
1251729
|
|
Hospital Revenue Code
|
984
|
| Min. Negotiated Rate |
$359.32 |
| Max. Negotiated Rate |
$1,243.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,243.80
|
| Rate for Payer: Bisbee Police All Plans |
$359.32
|
| Rate for Payer: Cash Price |
$1,105.60
|
| Rate for Payer: Self Pay Self Pay |
$1,105.60
|
|
|
EGD W/BIOPSY SGL/MULTI ADD ON CHARGE
|
Facility
|
OP
|
$2,558.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
22331689
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$409.28 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,302.20
|
| Rate for Payer: Aetna of AZ Medicare |
$716.24
|
| Rate for Payer: AHCCCS Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicare |
$409.28
|
| Rate for Payer: Amerigroup Medicare |
$409.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$955.41
|
| Rate for Payer: AZCH Complete Medicaid |
$586.96
|
| Rate for Payer: AZCH Complete Medicare |
$409.28
|
| Rate for Payer: Banner UC Health Medicaid |
$586.96
|
| Rate for Payer: Banner UC Health Medicare |
$409.28
|
| Rate for Payer: Bisbee Police All Plans |
$665.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,739.44
|
| Rate for Payer: Cash Price |
$2,046.40
|
| Rate for Payer: Cash Price |
$2,046.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,790.60
|
| Rate for Payer: Copperpoint Commercial |
$633.11
|
| Rate for Payer: Health Net of AZ Commercial |
$1,534.80
|
| Rate for Payer: Health Net of AZ Medicare |
$716.24
|
| Rate for Payer: Humana of AZ Medicare |
$409.28
|
| Rate for Payer: Mercy Care Medicaid |
$586.96
|
| Rate for Payer: Self Pay Self Pay |
$2,046.40
|
| Rate for Payer: TriWest Medicare |
$409.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$460.44
|
|
|
EGD W/BIOPSY SGL/MULTI ADD ON CHARGE
|
Facility
|
IP
|
$2,558.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
22331689
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$665.08 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Aetna of AZ Commercial |
$2,302.20
|
| Rate for Payer: Bisbee Police All Plans |
$665.08
|
| Rate for Payer: Cash Price |
$2,046.40
|
| Rate for Payer: Self Pay Self Pay |
$2,046.40
|
|
|
EGD With PEG
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
23598984
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,336.50
|
| Rate for Payer: Aetna of AZ Medicare |
$415.80
|
| Rate for Payer: AHCCCS Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicaid |
$586.96
|
| Rate for Payer: Allwell Medicare |
$237.60
|
| Rate for Payer: Amerigroup Medicare |
$237.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$554.65
|
| Rate for Payer: AZCH Complete Medicaid |
$586.96
|
| Rate for Payer: AZCH Complete Medicare |
$237.60
|
| Rate for Payer: Banner UC Health Medicaid |
$586.96
|
| Rate for Payer: Banner UC Health Medicare |
$237.60
|
| Rate for Payer: Bisbee Police All Plans |
$386.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,009.80
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,039.50
|
| Rate for Payer: Copperpoint Commercial |
$367.54
|
| Rate for Payer: Health Net of AZ Commercial |
$891.00
|
| Rate for Payer: Health Net of AZ Medicare |
$415.80
|
| Rate for Payer: Humana of AZ Medicare |
$237.60
|
| Rate for Payer: Mercy Care Medicaid |
$586.96
|
| Rate for Payer: Self Pay Self Pay |
$1,188.00
|
| Rate for Payer: TriWest Medicare |
$237.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$267.30
|
|
|
EGD With PEG
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
23598984
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$386.10 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,336.50
|
| Rate for Payer: Bisbee Police All Plans |
$386.10
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Self Pay Self Pay |
$1,188.00
|
|
|
EKG (12 LEAD)
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
1886872
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna of AZ Commercial |
$217.80
|
| Rate for Payer: Aetna of AZ Medicare |
$67.76
|
| Rate for Payer: AHCCCS Medicaid |
$25.99
|
| Rate for Payer: Allwell Medicaid |
$25.99
|
| Rate for Payer: Allwell Medicare |
$38.72
|
| Rate for Payer: Amerigroup Medicare |
$38.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$90.39
|
| Rate for Payer: AZCH Complete Medicaid |
$25.99
|
| Rate for Payer: AZCH Complete Medicare |
$38.72
|
| Rate for Payer: Banner UC Health Medicaid |
$25.99
|
| Rate for Payer: Banner UC Health Medicare |
$38.72
|
| Rate for Payer: Bisbee Police All Plans |
$62.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$164.56
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cigna of AZ Commercial |
$169.40
|
| Rate for Payer: Copperpoint Commercial |
$59.90
|
| Rate for Payer: Health Net of AZ Commercial |
$145.20
|
| Rate for Payer: Health Net of AZ Medicare |
$67.76
|
| Rate for Payer: Humana of AZ Medicare |
$38.72
|
| Rate for Payer: Mercy Care Medicaid |
$25.99
|
| Rate for Payer: Self Pay Self Pay |
$193.60
|
| Rate for Payer: TriWest Medicare |
$38.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$141.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$43.56
|
|
|
EKG (12 LEAD)
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
1886872
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna of AZ Commercial |
$217.80
|
| Rate for Payer: Bisbee Police All Plans |
$62.92
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Self Pay Self Pay |
$193.60
|
|
|
ELASTOPLAST 4''''
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
22926420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of AZ Commercial |
$28.80
|
| Rate for Payer: Bisbee Police All Plans |
$8.32
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Self Pay Self Pay |
$25.60
|
|
|
ELASTOPLAST 4''''
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
22926420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of AZ Commercial |
$28.80
|
| Rate for Payer: Aetna of AZ Medicare |
$8.96
|
| Rate for Payer: Allwell Medicare |
$5.12
|
| Rate for Payer: Amerigroup Medicare |
$5.12
|
| Rate for Payer: APIPA Medicare/Medicaid |
$11.95
|
| Rate for Payer: AZCH Complete Medicare |
$5.12
|
| Rate for Payer: Banner UC Health Medicare |
$5.12
|
| Rate for Payer: Bisbee Police All Plans |
$8.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$21.76
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cigna of AZ Commercial |
$22.40
|
| Rate for Payer: Copperpoint Commercial |
$7.92
|
| Rate for Payer: Health Net of AZ Commercial |
$19.20
|
| Rate for Payer: Health Net of AZ Medicare |
$8.96
|
| Rate for Payer: Humana of AZ Medicare |
$5.12
|
| Rate for Payer: Self Pay Self Pay |
$25.60
|
| Rate for Payer: TriWest Medicare |
$5.12
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$18.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.76
|
|
|
ELECT ADULT QUIK-COMBO PK/2
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT A4556
|
| Hospital Charge Code |
22354171
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna of AZ Commercial |
$117.90
|
| Rate for Payer: Aetna of AZ Medicare |
$36.68
|
| Rate for Payer: Allwell Medicare |
$20.96
|
| Rate for Payer: Amerigroup Medicare |
$20.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$48.93
|
| Rate for Payer: AZCH Complete Medicare |
$20.96
|
| Rate for Payer: Banner UC Health Medicare |
$20.96
|
| Rate for Payer: Bisbee Police All Plans |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$89.08
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cigna of AZ Commercial |
$91.70
|
| Rate for Payer: Copperpoint Commercial |
$32.42
|
| Rate for Payer: Health Net of AZ Commercial |
$78.60
|
| Rate for Payer: Health Net of AZ Medicare |
$36.68
|
| Rate for Payer: Humana of AZ Medicare |
$20.96
|
| Rate for Payer: Self Pay Self Pay |
$104.80
|
| Rate for Payer: TriWest Medicare |
$20.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$76.37
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$23.58
|
|
|
ELECT ADULT QUIK-COMBO PK/2
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT A4556
|
| Hospital Charge Code |
22354171
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna of AZ Commercial |
$117.90
|
| Rate for Payer: Bisbee Police All Plans |
$34.06
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Self Pay Self Pay |
$104.80
|
|
|
Elective Hip Joint Replacement
|
Facility
|
IP
|
$13,788.12
|
|
|
Service Code
|
APR-DRG 3243
|
| Hospital Charge Code |
APRDRG3244
|
| Min. Negotiated Rate |
$13,788.12 |
| Max. Negotiated Rate |
$13,788.12 |
| Rate for Payer: AHCCCS Medicaid |
$13,788.12
|
| Rate for Payer: Allwell Medicaid |
$13,788.12
|
| Rate for Payer: AZCH Complete Medicaid |
$13,788.12
|
| Rate for Payer: Banner UC Health Medicaid |
$13,788.12
|
| Rate for Payer: Mercy Care Medicaid |
$13,788.12
|
|
|
Elective Hip Joint Replacement
|
Facility
|
IP
|
$9,593.05
|
|
|
Service Code
|
APR-DRG 3242
|
| Hospital Charge Code |
APRDRG3241
|
| Min. Negotiated Rate |
$9,593.05 |
| Max. Negotiated Rate |
$9,593.05 |
| Rate for Payer: AHCCCS Medicaid |
$9,593.05
|
| Rate for Payer: Allwell Medicaid |
$9,593.05
|
| Rate for Payer: AZCH Complete Medicaid |
$9,593.05
|
| Rate for Payer: Banner UC Health Medicaid |
$9,593.05
|
| Rate for Payer: Mercy Care Medicaid |
$9,593.05
|
|
|
Elective Hip Joint Replacement
|
Facility
|
IP
|
$8,616.70
|
|
|
Service Code
|
APR-DRG 3241
|
| Hospital Charge Code |
APRDRG3244
|
| Min. Negotiated Rate |
$8,616.70 |
| Max. Negotiated Rate |
$8,616.70 |
| Rate for Payer: AHCCCS Medicaid |
$8,616.70
|
| Rate for Payer: Allwell Medicaid |
$8,616.70
|
| Rate for Payer: AZCH Complete Medicaid |
$8,616.70
|
| Rate for Payer: Banner UC Health Medicaid |
$8,616.70
|
| Rate for Payer: Mercy Care Medicaid |
$8,616.70
|
|
|
Elective Hip Joint Replacement
|
Facility
|
IP
|
$13,788.12
|
|
|
Service Code
|
APR-DRG 3243
|
| Hospital Charge Code |
APRDRG3243
|
| Min. Negotiated Rate |
$13,788.12 |
| Max. Negotiated Rate |
$13,788.12 |
| Rate for Payer: AHCCCS Medicaid |
$13,788.12
|
| Rate for Payer: Allwell Medicaid |
$13,788.12
|
| Rate for Payer: AZCH Complete Medicaid |
$13,788.12
|
| Rate for Payer: Banner UC Health Medicaid |
$13,788.12
|
| Rate for Payer: Mercy Care Medicaid |
$13,788.12
|
|
|
Elective Hip Joint Replacement
|
Facility
|
IP
|
$8,616.70
|
|
|
Service Code
|
APR-DRG 3241
|
| Hospital Charge Code |
APRDRG3241
|
| Min. Negotiated Rate |
$8,616.70 |
| Max. Negotiated Rate |
$8,616.70 |
| Rate for Payer: AHCCCS Medicaid |
$8,616.70
|
| Rate for Payer: Allwell Medicaid |
$8,616.70
|
| Rate for Payer: AZCH Complete Medicaid |
$8,616.70
|
| Rate for Payer: Banner UC Health Medicaid |
$8,616.70
|
| Rate for Payer: Mercy Care Medicaid |
$8,616.70
|
|
|
Elective Hip Joint Replacement
|
Facility
|
IP
|
$23,099.91
|
|
|
Service Code
|
APR-DRG 3244
|
| Hospital Charge Code |
APRDRG3241
|
| Min. Negotiated Rate |
$23,099.91 |
| Max. Negotiated Rate |
$23,099.91 |
| Rate for Payer: AHCCCS Medicaid |
$23,099.91
|
| Rate for Payer: Allwell Medicaid |
$23,099.91
|
| Rate for Payer: AZCH Complete Medicaid |
$23,099.91
|
| Rate for Payer: Banner UC Health Medicaid |
$23,099.91
|
| Rate for Payer: Mercy Care Medicaid |
$23,099.91
|
|
