|
Extensive Third Degree Burns With Skin Graft
|
Facility
|
IP
|
$57,269.31
|
|
|
Service Code
|
APR-DRG 8413
|
| Hospital Charge Code |
APRDRG8411
|
| Min. Negotiated Rate |
$57,269.31 |
| Max. Negotiated Rate |
$57,269.31 |
| Rate for Payer: AHCCCS Medicaid |
$57,269.31
|
| Rate for Payer: Allwell Medicaid |
$57,269.31
|
| Rate for Payer: AZCH Complete Medicaid |
$57,269.31
|
| Rate for Payer: Banner UC Health Medicaid |
$57,269.31
|
| Rate for Payer: Mercy Care Medicaid |
$57,269.31
|
|
|
Extensive Third Degree Burns With Skin Graft
|
Facility
|
IP
|
$37,216.28
|
|
|
Service Code
|
APR-DRG 8411
|
| Hospital Charge Code |
APRDRG8412
|
| Min. Negotiated Rate |
$37,216.28 |
| Max. Negotiated Rate |
$37,216.28 |
| Rate for Payer: AHCCCS Medicaid |
$37,216.28
|
| Rate for Payer: Allwell Medicaid |
$37,216.28
|
| Rate for Payer: AZCH Complete Medicaid |
$37,216.28
|
| Rate for Payer: Banner UC Health Medicaid |
$37,216.28
|
| Rate for Payer: Mercy Care Medicaid |
$37,216.28
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$33,150.97
|
|
|
Service Code
|
APR-DRG 1782
|
| Hospital Charge Code |
APRDRG1784
|
| Min. Negotiated Rate |
$33,150.97 |
| Max. Negotiated Rate |
$33,150.97 |
| Rate for Payer: AHCCCS Medicaid |
$33,150.97
|
| Rate for Payer: Allwell Medicaid |
$33,150.97
|
| Rate for Payer: AZCH Complete Medicaid |
$33,150.97
|
| Rate for Payer: Banner UC Health Medicaid |
$33,150.97
|
| Rate for Payer: Mercy Care Medicaid |
$33,150.97
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$29,471.43
|
|
|
Service Code
|
APR-DRG 1781
|
| Hospital Charge Code |
APRDRG1781
|
| Min. Negotiated Rate |
$29,471.43 |
| Max. Negotiated Rate |
$29,471.43 |
| Rate for Payer: AHCCCS Medicaid |
$29,471.43
|
| Rate for Payer: Allwell Medicaid |
$29,471.43
|
| Rate for Payer: AZCH Complete Medicaid |
$29,471.43
|
| Rate for Payer: Banner UC Health Medicaid |
$29,471.43
|
| Rate for Payer: Mercy Care Medicaid |
$29,471.43
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$33,150.97
|
|
|
Service Code
|
APR-DRG 1782
|
| Hospital Charge Code |
APRDRG1782
|
| Min. Negotiated Rate |
$33,150.97 |
| Max. Negotiated Rate |
$33,150.97 |
| Rate for Payer: AHCCCS Medicaid |
$33,150.97
|
| Rate for Payer: Allwell Medicaid |
$33,150.97
|
| Rate for Payer: AZCH Complete Medicaid |
$33,150.97
|
| Rate for Payer: Banner UC Health Medicaid |
$33,150.97
|
| Rate for Payer: Mercy Care Medicaid |
$33,150.97
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$55,484.95
|
|
|
Service Code
|
APR-DRG 1784
|
| Hospital Charge Code |
APRDRG1783
|
| Min. Negotiated Rate |
$55,484.95 |
| Max. Negotiated Rate |
$55,484.95 |
| Rate for Payer: AHCCCS Medicaid |
$55,484.95
|
| Rate for Payer: Allwell Medicaid |
$55,484.95
|
| Rate for Payer: AZCH Complete Medicaid |
$55,484.95
|
| Rate for Payer: Banner UC Health Medicaid |
$55,484.95
|
| Rate for Payer: Mercy Care Medicaid |
$55,484.95
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$38,914.37
|
|
|
Service Code
|
APR-DRG 1783
|
| Hospital Charge Code |
APRDRG1781
|
| Min. Negotiated Rate |
$38,914.37 |
| Max. Negotiated Rate |
$38,914.37 |
| Rate for Payer: AHCCCS Medicaid |
$38,914.37
|
| Rate for Payer: Allwell Medicaid |
$38,914.37
|
| Rate for Payer: AZCH Complete Medicaid |
$38,914.37
|
| Rate for Payer: Banner UC Health Medicaid |
$38,914.37
|
| Rate for Payer: Mercy Care Medicaid |
$38,914.37
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$29,471.43
|
|
|
Service Code
|
APR-DRG 1781
|
| Hospital Charge Code |
APRDRG1782
|
| Min. Negotiated Rate |
$29,471.43 |
| Max. Negotiated Rate |
$29,471.43 |
| Rate for Payer: AHCCCS Medicaid |
$29,471.43
|
| Rate for Payer: Allwell Medicaid |
$29,471.43
|
| Rate for Payer: AZCH Complete Medicaid |
$29,471.43
|
| Rate for Payer: Banner UC Health Medicaid |
$29,471.43
|
| Rate for Payer: Mercy Care Medicaid |
$29,471.43
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$55,484.95
|
|
|
Service Code
|
APR-DRG 1784
|
| Hospital Charge Code |
APRDRG1781
|
| Min. Negotiated Rate |
$55,484.95 |
| Max. Negotiated Rate |
$55,484.95 |
| Rate for Payer: AHCCCS Medicaid |
$55,484.95
|
| Rate for Payer: Allwell Medicaid |
$55,484.95
|
| Rate for Payer: AZCH Complete Medicaid |
$55,484.95
|
| Rate for Payer: Banner UC Health Medicaid |
$55,484.95
|
| Rate for Payer: Mercy Care Medicaid |
$55,484.95
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$29,471.43
|
|
|
Service Code
|
APR-DRG 1781
|
| Hospital Charge Code |
APRDRG1784
|
| Min. Negotiated Rate |
$29,471.43 |
| Max. Negotiated Rate |
$29,471.43 |
| Rate for Payer: AHCCCS Medicaid |
$29,471.43
|
| Rate for Payer: Allwell Medicaid |
$29,471.43
|
| Rate for Payer: AZCH Complete Medicaid |
$29,471.43
|
| Rate for Payer: Banner UC Health Medicaid |
$29,471.43
|
| Rate for Payer: Mercy Care Medicaid |
$29,471.43
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$29,471.43
|
|
|
Service Code
|
APR-DRG 1781
|
| Hospital Charge Code |
APRDRG1783
|
| Min. Negotiated Rate |
$29,471.43 |
| Max. Negotiated Rate |
$29,471.43 |
| Rate for Payer: AHCCCS Medicaid |
$29,471.43
|
| Rate for Payer: Allwell Medicaid |
$29,471.43
|
| Rate for Payer: AZCH Complete Medicaid |
$29,471.43
|
| Rate for Payer: Banner UC Health Medicaid |
$29,471.43
|
| Rate for Payer: Mercy Care Medicaid |
$29,471.43
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$55,484.95
|
|
|
Service Code
|
APR-DRG 1784
|
| Hospital Charge Code |
APRDRG1782
|
| Min. Negotiated Rate |
$55,484.95 |
| Max. Negotiated Rate |
$55,484.95 |
| Rate for Payer: AHCCCS Medicaid |
$55,484.95
|
| Rate for Payer: Allwell Medicaid |
$55,484.95
|
| Rate for Payer: AZCH Complete Medicaid |
$55,484.95
|
| Rate for Payer: Banner UC Health Medicaid |
$55,484.95
|
| Rate for Payer: Mercy Care Medicaid |
$55,484.95
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$38,914.37
|
|
|
Service Code
|
APR-DRG 1783
|
| Hospital Charge Code |
APRDRG1782
|
| Min. Negotiated Rate |
$38,914.37 |
| Max. Negotiated Rate |
$38,914.37 |
| Rate for Payer: AHCCCS Medicaid |
$38,914.37
|
| Rate for Payer: Allwell Medicaid |
$38,914.37
|
| Rate for Payer: AZCH Complete Medicaid |
$38,914.37
|
| Rate for Payer: Banner UC Health Medicaid |
$38,914.37
|
| Rate for Payer: Mercy Care Medicaid |
$38,914.37
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$33,150.97
|
|
|
Service Code
|
APR-DRG 1782
|
| Hospital Charge Code |
APRDRG1783
|
| Min. Negotiated Rate |
$33,150.97 |
| Max. Negotiated Rate |
$33,150.97 |
| Rate for Payer: AHCCCS Medicaid |
$33,150.97
|
| Rate for Payer: Allwell Medicaid |
$33,150.97
|
| Rate for Payer: AZCH Complete Medicaid |
$33,150.97
|
| Rate for Payer: Banner UC Health Medicaid |
$33,150.97
|
| Rate for Payer: Mercy Care Medicaid |
$33,150.97
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$38,914.37
|
|
|
Service Code
|
APR-DRG 1783
|
| Hospital Charge Code |
APRDRG1783
|
| Min. Negotiated Rate |
$38,914.37 |
| Max. Negotiated Rate |
$38,914.37 |
| Rate for Payer: AHCCCS Medicaid |
$38,914.37
|
| Rate for Payer: Allwell Medicaid |
$38,914.37
|
| Rate for Payer: AZCH Complete Medicaid |
$38,914.37
|
| Rate for Payer: Banner UC Health Medicaid |
$38,914.37
|
| Rate for Payer: Mercy Care Medicaid |
$38,914.37
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$33,150.97
|
|
|
Service Code
|
APR-DRG 1782
|
| Hospital Charge Code |
APRDRG1781
|
| Min. Negotiated Rate |
$33,150.97 |
| Max. Negotiated Rate |
$33,150.97 |
| Rate for Payer: AHCCCS Medicaid |
$33,150.97
|
| Rate for Payer: Allwell Medicaid |
$33,150.97
|
| Rate for Payer: AZCH Complete Medicaid |
$33,150.97
|
| Rate for Payer: Banner UC Health Medicaid |
$33,150.97
|
| Rate for Payer: Mercy Care Medicaid |
$33,150.97
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$38,914.37
|
|
|
Service Code
|
APR-DRG 1783
|
| Hospital Charge Code |
APRDRG1784
|
| Min. Negotiated Rate |
$38,914.37 |
| Max. Negotiated Rate |
$38,914.37 |
| Rate for Payer: AHCCCS Medicaid |
$38,914.37
|
| Rate for Payer: Allwell Medicaid |
$38,914.37
|
| Rate for Payer: AZCH Complete Medicaid |
$38,914.37
|
| Rate for Payer: Banner UC Health Medicaid |
$38,914.37
|
| Rate for Payer: Mercy Care Medicaid |
$38,914.37
|
|
|
External Heart Assist Systems
|
Facility
|
IP
|
$55,484.95
|
|
|
Service Code
|
APR-DRG 1784
|
| Hospital Charge Code |
APRDRG1784
|
| Min. Negotiated Rate |
$55,484.95 |
| Max. Negotiated Rate |
$55,484.95 |
| Rate for Payer: AHCCCS Medicaid |
$55,484.95
|
| Rate for Payer: Allwell Medicaid |
$55,484.95
|
| Rate for Payer: AZCH Complete Medicaid |
$55,484.95
|
| Rate for Payer: Banner UC Health Medicaid |
$55,484.95
|
| Rate for Payer: Mercy Care Medicaid |
$55,484.95
|
|
|
EXTERNAL PACER
|
Facility
|
IP
|
$905.00
|
|
| Hospital Charge Code |
22282951
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.30 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Aetna of AZ Commercial |
$814.50
|
| Rate for Payer: Bisbee Police All Plans |
$235.30
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Self Pay Self Pay |
$724.00
|
|
|
EXTERNAL PACER
|
Facility
|
OP
|
$905.00
|
|
| Hospital Charge Code |
22282951
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Aetna of AZ Commercial |
$814.50
|
| Rate for Payer: Aetna of AZ Medicare |
$253.40
|
| Rate for Payer: Allwell Medicare |
$135.75
|
| Rate for Payer: Amerigroup Medicare |
$135.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$338.02
|
| Rate for Payer: AZCH Complete Medicare |
$135.75
|
| Rate for Payer: Banner UC Health Medicare |
$135.75
|
| Rate for Payer: Bisbee Police All Plans |
$235.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$615.40
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cigna of AZ Commercial |
$633.50
|
| Rate for Payer: Copperpoint Commercial |
$223.99
|
| Rate for Payer: Health Net of AZ Commercial |
$543.00
|
| Rate for Payer: Health Net of AZ Medicare |
$253.40
|
| Rate for Payer: Humana of AZ Medicare |
$135.75
|
| Rate for Payer: Self Pay Self Pay |
$724.00
|
| Rate for Payer: TriWest Medicare |
$135.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$527.62
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$162.90
|
|
|
Extracorporeal Membrane Oxygenation (Ecmo)
|
Facility
|
IP
|
$32,993.15
|
|
|
Service Code
|
APR-DRG 0092
|
| Hospital Charge Code |
APRDRG0091
|
| Min. Negotiated Rate |
$32,993.15 |
| Max. Negotiated Rate |
$32,993.15 |
| Rate for Payer: AHCCCS Medicaid |
$32,993.15
|
| Rate for Payer: Allwell Medicaid |
$32,993.15
|
| Rate for Payer: AZCH Complete Medicaid |
$32,993.15
|
| Rate for Payer: Banner UC Health Medicaid |
$32,993.15
|
| Rate for Payer: Mercy Care Medicaid |
$32,993.15
|
|
|
Extracorporeal Membrane Oxygenation (Ecmo)
|
Facility
|
IP
|
$32,993.15
|
|
|
Service Code
|
APR-DRG 0091
|
| Hospital Charge Code |
APRDRG0092
|
| Min. Negotiated Rate |
$32,993.15 |
| Max. Negotiated Rate |
$32,993.15 |
| Rate for Payer: AHCCCS Medicaid |
$32,993.15
|
| Rate for Payer: Allwell Medicaid |
$32,993.15
|
| Rate for Payer: AZCH Complete Medicaid |
$32,993.15
|
| Rate for Payer: Banner UC Health Medicaid |
$32,993.15
|
| Rate for Payer: Mercy Care Medicaid |
$32,993.15
|
|
|
Extracorporeal Membrane Oxygenation (Ecmo)
|
Facility
|
IP
|
$55,111.80
|
|
|
Service Code
|
APR-DRG 0093
|
| Hospital Charge Code |
APRDRG0094
|
| Min. Negotiated Rate |
$55,111.80 |
| Max. Negotiated Rate |
$55,111.80 |
| Rate for Payer: AHCCCS Medicaid |
$55,111.80
|
| Rate for Payer: Allwell Medicaid |
$55,111.80
|
| Rate for Payer: AZCH Complete Medicaid |
$55,111.80
|
| Rate for Payer: Banner UC Health Medicaid |
$55,111.80
|
| Rate for Payer: Mercy Care Medicaid |
$55,111.80
|
|
|
Extracorporeal Membrane Oxygenation (Ecmo)
|
Facility
|
IP
|
$32,993.15
|
|
|
Service Code
|
APR-DRG 0091
|
| Hospital Charge Code |
APRDRG0094
|
| Min. Negotiated Rate |
$32,993.15 |
| Max. Negotiated Rate |
$32,993.15 |
| Rate for Payer: AHCCCS Medicaid |
$32,993.15
|
| Rate for Payer: Allwell Medicaid |
$32,993.15
|
| Rate for Payer: AZCH Complete Medicaid |
$32,993.15
|
| Rate for Payer: Banner UC Health Medicaid |
$32,993.15
|
| Rate for Payer: Mercy Care Medicaid |
$32,993.15
|
|
|
Extracorporeal Membrane Oxygenation (Ecmo)
|
Facility
|
IP
|
$32,993.15
|
|
|
Service Code
|
APR-DRG 0091
|
| Hospital Charge Code |
APRDRG0093
|
| Min. Negotiated Rate |
$32,993.15 |
| Max. Negotiated Rate |
$32,993.15 |
| Rate for Payer: AHCCCS Medicaid |
$32,993.15
|
| Rate for Payer: Allwell Medicaid |
$32,993.15
|
| Rate for Payer: AZCH Complete Medicaid |
$32,993.15
|
| Rate for Payer: Banner UC Health Medicaid |
$32,993.15
|
| Rate for Payer: Mercy Care Medicaid |
$32,993.15
|
|
