|
EXAM OF VAGINA AND CERVIX USING AN ENDOSCOPE
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
28068480
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna of AZ Commercial |
$423.00
|
| Rate for Payer: Bisbee Police All Plans |
$122.20
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Self Pay Self Pay |
$376.00
|
|
|
EXAM OF VAGINA AND CERVIX USING AN ENDOSCOPE
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
28068480
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of AZ Commercial |
$423.00
|
| Rate for Payer: Aetna of AZ Medicare |
$131.60
|
| Rate for Payer: AHCCCS Medicaid |
$204.07
|
| Rate for Payer: Allwell Medicaid |
$204.07
|
| Rate for Payer: Allwell Medicare |
$75.20
|
| Rate for Payer: Amerigroup Medicare |
$75.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$175.54
|
| Rate for Payer: AZCH Complete Medicaid |
$204.07
|
| Rate for Payer: AZCH Complete Medicare |
$75.20
|
| Rate for Payer: Banner UC Health Medicaid |
$204.07
|
| Rate for Payer: Banner UC Health Medicare |
$75.20
|
| Rate for Payer: Bisbee Police All Plans |
$122.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$319.60
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cigna of AZ Commercial |
$235.00
|
| Rate for Payer: Copperpoint Commercial |
$116.33
|
| Rate for Payer: Health Net of AZ Commercial |
$282.00
|
| Rate for Payer: Health Net of AZ Medicare |
$131.60
|
| Rate for Payer: Humana of AZ Medicare |
$75.20
|
| Rate for Payer: Mercy Care Medicaid |
$204.07
|
| Rate for Payer: Self Pay Self Pay |
$376.00
|
| Rate for Payer: TriWest Medicare |
$75.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,161.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$84.60
|
|
|
EXCISION INTERDIGITAL (MORTON) NEUROMA SINGLE EACH
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
24043265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$465.66 |
| Max. Negotiated Rate |
$1,611.90 |
| Rate for Payer: Aetna of AZ Commercial |
$1,611.90
|
| Rate for Payer: Bisbee Police All Plans |
$465.66
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Self Pay Self Pay |
$1,432.80
|
|
|
EXCISION INTERDIGITAL (MORTON) NEUROMA SINGLE EACH
|
Facility
|
OP
|
$1,791.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
24043265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$286.56 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,611.90
|
| Rate for Payer: Aetna of AZ Medicare |
$501.48
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$286.56
|
| Rate for Payer: Amerigroup Medicare |
$286.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$668.94
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$286.56
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$286.56
|
| Rate for Payer: Bisbee Police All Plans |
$465.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,217.88
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cigna of AZ Commercial |
$895.50
|
| Rate for Payer: Copperpoint Commercial |
$443.27
|
| Rate for Payer: Health Net of AZ Commercial |
$1,074.60
|
| Rate for Payer: Health Net of AZ Medicare |
$501.48
|
| Rate for Payer: Humana of AZ Medicare |
$286.56
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,432.80
|
| Rate for Payer: TriWest Medicare |
$286.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$322.38
|
|
|
Excision of Cervical Stump
|
Facility
|
IP
|
$4,321.00
|
|
|
Service Code
|
CPT 57540
|
| Hospital Charge Code |
27291793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,123.46 |
| Max. Negotiated Rate |
$3,888.90 |
| Rate for Payer: Aetna of AZ Commercial |
$3,888.90
|
| Rate for Payer: Bisbee Police All Plans |
$1,123.46
|
| Rate for Payer: Cash Price |
$3,456.80
|
| Rate for Payer: Self Pay Self Pay |
$3,456.80
|
|
|
Excision of Cervical Stump
|
Facility
|
OP
|
$4,321.00
|
|
|
Service Code
|
CPT 57540
|
| Hospital Charge Code |
27291793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$691.36 |
| Max. Negotiated Rate |
$3,888.90 |
| Rate for Payer: Aetna of AZ Commercial |
$3,888.90
|
| Rate for Payer: Aetna of AZ Medicare |
$1,209.88
|
| Rate for Payer: Allwell Medicare |
$691.36
|
| Rate for Payer: Amerigroup Medicare |
$691.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,613.89
|
| Rate for Payer: AZCH Complete Medicare |
$691.36
|
| Rate for Payer: Banner UC Health Medicare |
$691.36
|
| Rate for Payer: Bisbee Police All Plans |
$1,123.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,938.28
|
| Rate for Payer: Cash Price |
$3,456.80
|
| Rate for Payer: Cash Price |
$3,456.80
|
| Rate for Payer: Cigna of AZ Commercial |
$2,160.50
|
| Rate for Payer: Copperpoint Commercial |
$1,069.45
|
| Rate for Payer: Health Net of AZ Commercial |
$2,592.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,209.88
|
| Rate for Payer: Humana of AZ Medicare |
$691.36
|
| Rate for Payer: Self Pay Self Pay |
$3,456.80
|
| Rate for Payer: TriWest Medicare |
$691.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$777.78
|
|
|
Excision of Cervical Stump (vaginal)
|
Facility
|
IP
|
$2,336.00
|
|
|
Service Code
|
CPT 57550
|
| Hospital Charge Code |
27281897
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$607.36 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna of AZ Commercial |
$2,102.40
|
| Rate for Payer: Bisbee Police All Plans |
$607.36
|
| Rate for Payer: Cash Price |
$1,868.80
|
| Rate for Payer: Self Pay Self Pay |
$1,868.80
|
|
|
Excision of Cervical Stump (vaginal)
|
Facility
|
OP
|
$2,336.00
|
|
|
Service Code
|
CPT 57550
|
| Hospital Charge Code |
27281897
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$373.76 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,102.40
|
| Rate for Payer: Aetna of AZ Medicare |
$654.08
|
| Rate for Payer: AHCCCS Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicare |
$373.76
|
| Rate for Payer: Amerigroup Medicare |
$373.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$872.50
|
| Rate for Payer: AZCH Complete Medicaid |
$3,196.92
|
| Rate for Payer: AZCH Complete Medicare |
$373.76
|
| Rate for Payer: Banner UC Health Medicaid |
$3,196.92
|
| Rate for Payer: Banner UC Health Medicare |
$373.76
|
| Rate for Payer: Bisbee Police All Plans |
$607.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,588.48
|
| Rate for Payer: Cash Price |
$1,868.80
|
| Rate for Payer: Cash Price |
$1,868.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,168.00
|
| Rate for Payer: Copperpoint Commercial |
$578.16
|
| Rate for Payer: Health Net of AZ Commercial |
$1,401.60
|
| Rate for Payer: Health Net of AZ Medicare |
$654.08
|
| Rate for Payer: Humana of AZ Medicare |
$373.76
|
| Rate for Payer: Mercy Care Medicaid |
$3,196.92
|
| Rate for Payer: Self Pay Self Pay |
$1,868.80
|
| Rate for Payer: TriWest Medicare |
$373.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$420.48
|
|
|
Excision of Cervical Stump with AP repair
|
Facility
|
IP
|
$3,371.00
|
|
|
Service Code
|
CPT 57555
|
| Hospital Charge Code |
27281898
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$3,033.90 |
| Rate for Payer: Aetna of AZ Commercial |
$3,033.90
|
| Rate for Payer: Bisbee Police All Plans |
$876.46
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Self Pay Self Pay |
$2,696.80
|
|
|
Excision of Cervical Stump with AP repair
|
Facility
|
OP
|
$3,371.00
|
|
|
Service Code
|
CPT 57555
|
| Hospital Charge Code |
27281898
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$539.36 |
| Max. Negotiated Rate |
$3,196.92 |
| Rate for Payer: Aetna of AZ Commercial |
$3,033.90
|
| Rate for Payer: Aetna of AZ Medicare |
$943.88
|
| Rate for Payer: AHCCCS Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicare |
$539.36
|
| Rate for Payer: Amerigroup Medicare |
$539.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,259.07
|
| Rate for Payer: AZCH Complete Medicaid |
$3,196.92
|
| Rate for Payer: AZCH Complete Medicare |
$539.36
|
| Rate for Payer: Banner UC Health Medicaid |
$3,196.92
|
| Rate for Payer: Banner UC Health Medicare |
$539.36
|
| Rate for Payer: Bisbee Police All Plans |
$876.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,292.28
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,685.50
|
| Rate for Payer: Copperpoint Commercial |
$834.32
|
| Rate for Payer: Health Net of AZ Commercial |
$2,022.60
|
| Rate for Payer: Health Net of AZ Medicare |
$943.88
|
| Rate for Payer: Humana of AZ Medicare |
$539.36
|
| Rate for Payer: Mercy Care Medicaid |
$3,196.92
|
| Rate for Payer: Self Pay Self Pay |
$2,696.80
|
| Rate for Payer: TriWest Medicare |
$539.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,965.29
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$606.78
|
|
|
Excision of Cervical Stump with enterocele repair
|
Facility
|
OP
|
$3,192.00
|
|
|
Service Code
|
CPT 57556
|
| Hospital Charge Code |
27291802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$510.72 |
| Max. Negotiated Rate |
$3,196.92 |
| Rate for Payer: Aetna of AZ Commercial |
$2,872.80
|
| Rate for Payer: Aetna of AZ Medicare |
$893.76
|
| Rate for Payer: AHCCCS Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicaid |
$3,196.92
|
| Rate for Payer: Allwell Medicare |
$510.72
|
| Rate for Payer: Amerigroup Medicare |
$510.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,192.21
|
| Rate for Payer: AZCH Complete Medicaid |
$3,196.92
|
| Rate for Payer: AZCH Complete Medicare |
$510.72
|
| Rate for Payer: Banner UC Health Medicaid |
$3,196.92
|
| Rate for Payer: Banner UC Health Medicare |
$510.72
|
| Rate for Payer: Bisbee Police All Plans |
$829.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,170.56
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,596.00
|
| Rate for Payer: Copperpoint Commercial |
$790.02
|
| Rate for Payer: Health Net of AZ Commercial |
$1,915.20
|
| Rate for Payer: Health Net of AZ Medicare |
$893.76
|
| Rate for Payer: Humana of AZ Medicare |
$510.72
|
| Rate for Payer: Mercy Care Medicaid |
$3,196.92
|
| Rate for Payer: Self Pay Self Pay |
$2,553.60
|
| Rate for Payer: TriWest Medicare |
$510.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,860.94
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$574.56
|
|
|
Excision of Cervical Stump with enterocele repair
|
Facility
|
IP
|
$3,192.00
|
|
|
Service Code
|
CPT 57556
|
| Hospital Charge Code |
27291802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$829.92 |
| Max. Negotiated Rate |
$2,872.80 |
| Rate for Payer: Aetna of AZ Commercial |
$2,872.80
|
| Rate for Payer: Bisbee Police All Plans |
$829.92
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Self Pay Self Pay |
$2,553.60
|
|
|
EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY)
|
Facility
|
OP
|
$1,502.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
24043267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$240.32 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,351.80
|
| Rate for Payer: Aetna of AZ Medicare |
$420.56
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$240.32
|
| Rate for Payer: Amerigroup Medicare |
$240.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$561.00
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$240.32
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$240.32
|
| Rate for Payer: Bisbee Police All Plans |
$390.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,021.36
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Cigna of AZ Commercial |
$751.00
|
| Rate for Payer: Copperpoint Commercial |
$371.75
|
| Rate for Payer: Health Net of AZ Commercial |
$901.20
|
| Rate for Payer: Health Net of AZ Medicare |
$420.56
|
| Rate for Payer: Humana of AZ Medicare |
$240.32
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,201.60
|
| Rate for Payer: TriWest Medicare |
$240.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$270.36
|
|
|
EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY)
|
Facility
|
IP
|
$1,502.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
24043267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$390.52 |
| Max. Negotiated Rate |
$1,351.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,351.80
|
| Rate for Payer: Bisbee Police All Plans |
$390.52
|
| Rate for Payer: Cash Price |
$1,201.60
|
| Rate for Payer: Self Pay Self Pay |
$1,201.60
|
|
|
EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY) - 28092
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 28092
|
| Hospital Charge Code |
24043310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.72 |
| Max. Negotiated Rate |
$1,189.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,189.80
|
| Rate for Payer: Bisbee Police All Plans |
$343.72
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Self Pay Self Pay |
$1,057.60
|
|
|
EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY) - 28092
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 28092
|
| Hospital Charge Code |
24043310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.52 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$237.96
|
| Rate for Payer: Aetna of AZ Commercial |
$1,189.80
|
| Rate for Payer: Aetna of AZ Medicare |
$370.16
|
| Rate for Payer: AHCCCS Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicaid |
$1,009.45
|
| Rate for Payer: Allwell Medicare |
$211.52
|
| Rate for Payer: Amerigroup Medicare |
$211.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$493.77
|
| Rate for Payer: AZCH Complete Medicaid |
$1,009.45
|
| Rate for Payer: AZCH Complete Medicare |
$211.52
|
| Rate for Payer: Banner UC Health Medicaid |
$1,009.45
|
| Rate for Payer: Banner UC Health Medicare |
$211.52
|
| Rate for Payer: Bisbee Police All Plans |
$343.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$898.96
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cigna of AZ Commercial |
$661.00
|
| Rate for Payer: Copperpoint Commercial |
$327.19
|
| Rate for Payer: Health Net of AZ Commercial |
$793.20
|
| Rate for Payer: Health Net of AZ Medicare |
$370.16
|
| Rate for Payer: Humana of AZ Medicare |
$211.52
|
| Rate for Payer: Mercy Care Medicaid |
$1,009.45
|
| Rate for Payer: Self Pay Self Pay |
$1,057.60
|
| Rate for Payer: TriWest Medicare |
$211.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
|
|
Excision of vaginal septum
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
19665350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$796.50 |
| Rate for Payer: Aetna of AZ Commercial |
$796.50
|
| Rate for Payer: Bisbee Police All Plans |
$230.10
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Self Pay Self Pay |
$708.00
|
|
|
Excision of vaginal septum
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
19665350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$796.50
|
| Rate for Payer: Aetna of AZ Medicare |
$247.80
|
| Rate for Payer: AHCCCS Medicaid |
$1,901.83
|
| Rate for Payer: Allwell Medicaid |
$1,901.83
|
| Rate for Payer: Allwell Medicare |
$141.60
|
| Rate for Payer: Amerigroup Medicare |
$141.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$330.55
|
| Rate for Payer: AZCH Complete Medicaid |
$1,901.83
|
| Rate for Payer: AZCH Complete Medicare |
$141.60
|
| Rate for Payer: Banner UC Health Medicaid |
$1,901.83
|
| Rate for Payer: Banner UC Health Medicare |
$141.60
|
| Rate for Payer: Bisbee Police All Plans |
$230.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$601.80
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna of AZ Commercial |
$442.50
|
| Rate for Payer: Copperpoint Commercial |
$219.04
|
| Rate for Payer: Health Net of AZ Commercial |
$531.00
|
| Rate for Payer: Health Net of AZ Medicare |
$247.80
|
| Rate for Payer: Humana of AZ Medicare |
$141.60
|
| Rate for Payer: Mercy Care Medicaid |
$1,901.83
|
| Rate for Payer: Self Pay Self Pay |
$708.00
|
| Rate for Payer: TriWest Medicare |
$141.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$159.30
|
|
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$14,627.00
|
|
|
Service Code
|
APR-DRG 9112
|
| Hospital Charge Code |
APRDRG9111
|
| Min. Negotiated Rate |
$14,627.00 |
| Max. Negotiated Rate |
$14,627.00 |
| Rate for Payer: AHCCCS Medicaid |
$14,627.00
|
| Rate for Payer: Allwell Medicaid |
$14,627.00
|
| Rate for Payer: AZCH Complete Medicaid |
$14,627.00
|
| Rate for Payer: Banner UC Health Medicaid |
$14,627.00
|
| Rate for Payer: Mercy Care Medicaid |
$14,627.00
|
|
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$13,096.54
|
|
|
Service Code
|
APR-DRG 9111
|
| Hospital Charge Code |
APRDRG9111
|
| Min. Negotiated Rate |
$13,096.54 |
| Max. Negotiated Rate |
$13,096.54 |
| Rate for Payer: AHCCCS Medicaid |
$13,096.54
|
| Rate for Payer: Allwell Medicaid |
$13,096.54
|
| Rate for Payer: AZCH Complete Medicaid |
$13,096.54
|
| Rate for Payer: Banner UC Health Medicaid |
$13,096.54
|
| Rate for Payer: Mercy Care Medicaid |
$13,096.54
|
|
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$13,096.54
|
|
|
Service Code
|
APR-DRG 9111
|
| Hospital Charge Code |
APRDRG9114
|
| Min. Negotiated Rate |
$13,096.54 |
| Max. Negotiated Rate |
$13,096.54 |
| Rate for Payer: AHCCCS Medicaid |
$13,096.54
|
| Rate for Payer: Allwell Medicaid |
$13,096.54
|
| Rate for Payer: AZCH Complete Medicaid |
$13,096.54
|
| Rate for Payer: Banner UC Health Medicaid |
$13,096.54
|
| Rate for Payer: Mercy Care Medicaid |
$13,096.54
|
|
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$20,800.72
|
|
|
Service Code
|
APR-DRG 9113
|
| Hospital Charge Code |
APRDRG9112
|
| Min. Negotiated Rate |
$20,800.72 |
| Max. Negotiated Rate |
$20,800.72 |
| Rate for Payer: AHCCCS Medicaid |
$20,800.72
|
| Rate for Payer: Allwell Medicaid |
$20,800.72
|
| Rate for Payer: AZCH Complete Medicaid |
$20,800.72
|
| Rate for Payer: Banner UC Health Medicaid |
$20,800.72
|
| Rate for Payer: Mercy Care Medicaid |
$20,800.72
|
|
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$20,800.72
|
|
|
Service Code
|
APR-DRG 9113
|
| Hospital Charge Code |
APRDRG9114
|
| Min. Negotiated Rate |
$20,800.72 |
| Max. Negotiated Rate |
$20,800.72 |
| Rate for Payer: AHCCCS Medicaid |
$20,800.72
|
| Rate for Payer: Allwell Medicaid |
$20,800.72
|
| Rate for Payer: AZCH Complete Medicaid |
$20,800.72
|
| Rate for Payer: Banner UC Health Medicaid |
$20,800.72
|
| Rate for Payer: Mercy Care Medicaid |
$20,800.72
|
|
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$49,192.69
|
|
|
Service Code
|
APR-DRG 9114
|
| Hospital Charge Code |
APRDRG9113
|
| Min. Negotiated Rate |
$49,192.69 |
| Max. Negotiated Rate |
$49,192.69 |
| Rate for Payer: AHCCCS Medicaid |
$49,192.69
|
| Rate for Payer: Allwell Medicaid |
$49,192.69
|
| Rate for Payer: AZCH Complete Medicaid |
$49,192.69
|
| Rate for Payer: Banner UC Health Medicaid |
$49,192.69
|
| Rate for Payer: Mercy Care Medicaid |
$49,192.69
|
|
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$13,096.54
|
|
|
Service Code
|
APR-DRG 9111
|
| Hospital Charge Code |
APRDRG9112
|
| Min. Negotiated Rate |
$13,096.54 |
| Max. Negotiated Rate |
$13,096.54 |
| Rate for Payer: AHCCCS Medicaid |
$13,096.54
|
| Rate for Payer: Allwell Medicaid |
$13,096.54
|
| Rate for Payer: AZCH Complete Medicaid |
$13,096.54
|
| Rate for Payer: Banner UC Health Medicaid |
$13,096.54
|
| Rate for Payer: Mercy Care Medicaid |
$13,096.54
|
|
