|
FALOPE-RING BAND
|
Facility
|
OP
|
$282.00
|
|
| Hospital Charge Code |
22355429
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna of AZ Commercial |
$253.80
|
| Rate for Payer: Aetna of AZ Medicare |
$78.96
|
| Rate for Payer: Allwell Medicare |
$42.30
|
| Rate for Payer: Amerigroup Medicare |
$42.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$105.33
|
| Rate for Payer: AZCH Complete Medicare |
$42.30
|
| Rate for Payer: Banner UC Health Medicare |
$42.30
|
| Rate for Payer: Bisbee Police All Plans |
$73.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$191.76
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna of AZ Commercial |
$197.40
|
| Rate for Payer: Copperpoint Commercial |
$69.80
|
| Rate for Payer: Health Net of AZ Commercial |
$169.20
|
| Rate for Payer: Health Net of AZ Medicare |
$78.96
|
| Rate for Payer: Humana of AZ Medicare |
$42.30
|
| Rate for Payer: Self Pay Self Pay |
$225.60
|
| Rate for Payer: TriWest Medicare |
$42.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$164.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$50.76
|
|
|
FALOPE-RING BAND
|
Facility
|
IP
|
$282.00
|
|
| Hospital Charge Code |
22355429
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna of AZ Commercial |
$253.80
|
| Rate for Payer: Bisbee Police All Plans |
$73.32
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Self Pay Self Pay |
$225.60
|
|
|
famotidine 10 mg/mL Inj Sol [CQCH]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 641602225
|
| Hospital Charge Code |
105921971
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of AZ Commercial |
$0.36
|
| Rate for Payer: Bisbee Police All Plans |
$0.10
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Self Pay Self Pay |
$0.32
|
|
|
famotidine 10 mg/mL Inj Sol [CQCH]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 641602225
|
| Hospital Charge Code |
105921971
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of AZ Commercial |
$0.36
|
| Rate for Payer: Aetna of AZ Medicare |
$0.11
|
| Rate for Payer: Allwell Medicare |
$0.06
|
| Rate for Payer: Amerigroup Medicare |
$0.06
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.15
|
| Rate for Payer: AZCH Complete Medicare |
$0.06
|
| Rate for Payer: Banner UC Health Medicare |
$0.06
|
| Rate for Payer: Bisbee Police All Plans |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of AZ Commercial |
$0.26
|
| Rate for Payer: Copperpoint Commercial |
$0.10
|
| Rate for Payer: Health Net of AZ Commercial |
$0.24
|
| Rate for Payer: Health Net of AZ Medicare |
$0.11
|
| Rate for Payer: Humana of AZ Medicare |
$0.06
|
| Rate for Payer: Self Pay Self Pay |
$0.32
|
| Rate for Payer: TriWest Medicare |
$0.06
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.07
|
|
|
famotidine 20 mg Tab [CQCH]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 62332000131
|
| Hospital Charge Code |
105921837
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of AZ Commercial |
$0.17
|
| Rate for Payer: Bisbee Police All Plans |
$0.05
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Self Pay Self Pay |
$0.15
|
|
|
famotidine 20 mg Tab [CQCH]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 62332000131
|
| Hospital Charge Code |
105921837
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of AZ Commercial |
$0.17
|
| Rate for Payer: Aetna of AZ Medicare |
$0.05
|
| Rate for Payer: Allwell Medicare |
$0.03
|
| Rate for Payer: Amerigroup Medicare |
$0.03
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.07
|
| Rate for Payer: AZCH Complete Medicare |
$0.03
|
| Rate for Payer: Banner UC Health Medicare |
$0.03
|
| Rate for Payer: Bisbee Police All Plans |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of AZ Commercial |
$0.12
|
| Rate for Payer: Copperpoint Commercial |
$0.05
|
| Rate for Payer: Health Net of AZ Commercial |
$0.11
|
| Rate for Payer: Health Net of AZ Medicare |
$0.05
|
| Rate for Payer: Humana of AZ Medicare |
$0.03
|
| Rate for Payer: Self Pay Self Pay |
$0.15
|
| Rate for Payer: TriWest Medicare |
$0.03
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.11
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
|
FASCIECTOMY PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)
|
Facility
|
IP
|
$1,747.00
|
|
|
Service Code
|
CPT 28060
|
| Hospital Charge Code |
24043311
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$454.22 |
| Max. Negotiated Rate |
$1,572.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,572.30
|
| Rate for Payer: Bisbee Police All Plans |
$454.22
|
| Rate for Payer: Cash Price |
$1,397.60
|
| Rate for Payer: Self Pay Self Pay |
$1,397.60
|
|
|
FASCIECTOMY PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,747.00
|
|
|
Service Code
|
CPT 28060
|
| Hospital Charge Code |
24043311
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.05 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,572.30
|
| Rate for Payer: Aetna of AZ Medicare |
$489.16
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$262.05
|
| Rate for Payer: Amerigroup Medicare |
$262.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$652.50
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$262.05
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$262.05
|
| Rate for Payer: Bisbee Police All Plans |
$454.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,187.96
|
| Rate for Payer: Cash Price |
$1,397.60
|
| Rate for Payer: Cash Price |
$1,397.60
|
| Rate for Payer: Cigna of AZ Commercial |
$873.50
|
| Rate for Payer: Copperpoint Commercial |
$432.38
|
| Rate for Payer: Health Net of AZ Commercial |
$1,048.20
|
| Rate for Payer: Health Net of AZ Medicare |
$489.16
|
| Rate for Payer: Humana of AZ Medicare |
$262.05
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,397.60
|
| Rate for Payer: TriWest Medicare |
$262.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$314.46
|
|
|
FASTPITCY 2.7MM LONG SCREW PLATE
|
Facility
|
IP
|
$6,736.00
|
|
| Hospital Charge Code |
27431789
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,751.36 |
| Max. Negotiated Rate |
$6,062.40 |
| Rate for Payer: Aetna of AZ Commercial |
$6,062.40
|
| Rate for Payer: Bisbee Police All Plans |
$1,751.36
|
| Rate for Payer: Cash Price |
$5,388.80
|
| Rate for Payer: Self Pay Self Pay |
$5,388.80
|
|
|
FASTPITCY 2.7MM LONG SCREW PLATE
|
Facility
|
OP
|
$6,736.00
|
|
| Hospital Charge Code |
27431789
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,010.40 |
| Max. Negotiated Rate |
$6,062.40 |
| Rate for Payer: Aetna of AZ Commercial |
$6,062.40
|
| Rate for Payer: Aetna of AZ Medicare |
$1,886.08
|
| Rate for Payer: Allwell Medicare |
$1,010.40
|
| Rate for Payer: Amerigroup Medicare |
$1,010.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2,515.90
|
| Rate for Payer: AZCH Complete Medicare |
$1,010.40
|
| Rate for Payer: Banner UC Health Medicare |
$1,010.40
|
| Rate for Payer: Bisbee Police All Plans |
$1,751.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4,580.48
|
| Rate for Payer: Cash Price |
$5,388.80
|
| Rate for Payer: Cigna of AZ Commercial |
$4,715.20
|
| Rate for Payer: Copperpoint Commercial |
$1,667.16
|
| Rate for Payer: Health Net of AZ Commercial |
$4,041.60
|
| Rate for Payer: Health Net of AZ Medicare |
$1,886.08
|
| Rate for Payer: Humana of AZ Medicare |
$1,010.40
|
| Rate for Payer: Self Pay Self Pay |
$5,388.80
|
| Rate for Payer: TriWest Medicare |
$1,010.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,927.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1,212.48
|
|
|
fat emulsion 20%, IV 250 mL [CQCH]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 338051909
|
| Hospital Charge Code |
109336288
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of AZ Commercial |
$0.14
|
| Rate for Payer: Aetna of AZ Medicare |
$0.04
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.06
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of AZ Commercial |
$0.10
|
| Rate for Payer: Copperpoint Commercial |
$0.04
|
| Rate for Payer: Health Net of AZ Commercial |
$0.09
|
| Rate for Payer: Health Net of AZ Medicare |
$0.04
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.12
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.09
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.03
|
|
|
fat emulsion 20%, IV 250 mL [CQCH]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 338051909
|
| Hospital Charge Code |
109336288
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of AZ Commercial |
$0.14
|
| Rate for Payer: Bisbee Police All Plans |
$0.04
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Self Pay Self Pay |
$0.12
|
|
|
FDP, Plasma LC
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
2087589
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna of AZ Commercial |
$127.80
|
| Rate for Payer: Aetna of AZ Medicare |
$39.76
|
| Rate for Payer: AHCCCS Medicaid |
$6.89
|
| Rate for Payer: Allwell Medicaid |
$6.89
|
| Rate for Payer: Allwell Medicare |
$21.30
|
| Rate for Payer: Amerigroup Medicare |
$21.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$53.04
|
| Rate for Payer: AZCH Complete Medicaid |
$6.89
|
| Rate for Payer: AZCH Complete Medicare |
$21.30
|
| Rate for Payer: Banner UC Health Medicaid |
$6.89
|
| Rate for Payer: Banner UC Health Medicare |
$21.30
|
| Rate for Payer: Bisbee Police All Plans |
$36.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$96.56
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cigna of AZ Commercial |
$92.30
|
| Rate for Payer: Copperpoint Commercial |
$35.14
|
| Rate for Payer: Health Net of AZ Commercial |
$85.20
|
| Rate for Payer: Health Net of AZ Medicare |
$39.76
|
| Rate for Payer: Humana of AZ Medicare |
$21.30
|
| Rate for Payer: Mercy Care Medicaid |
$6.89
|
| Rate for Payer: Self Pay Self Pay |
$113.60
|
| Rate for Payer: TriWest Medicare |
$21.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$82.79
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.56
|
|
|
FDP, Plasma LC
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
2087589
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna of AZ Commercial |
$127.80
|
| Rate for Payer: Bisbee Police All Plans |
$36.92
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Self Pay Self Pay |
$113.60
|
|
|
Fecal Fat, Qualitative LC
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
2087590
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of AZ Commercial |
$110.70
|
| Rate for Payer: Bisbee Police All Plans |
$31.98
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Self Pay Self Pay |
$98.40
|
|
|
Fecal Fat, Qualitative LC
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
2087590
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of AZ Commercial |
$110.70
|
| Rate for Payer: Aetna of AZ Medicare |
$34.44
|
| Rate for Payer: AHCCCS Medicaid |
$5.10
|
| Rate for Payer: Allwell Medicaid |
$5.10
|
| Rate for Payer: Allwell Medicare |
$18.45
|
| Rate for Payer: Amerigroup Medicare |
$18.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$45.94
|
| Rate for Payer: AZCH Complete Medicaid |
$5.10
|
| Rate for Payer: AZCH Complete Medicare |
$18.45
|
| Rate for Payer: Banner UC Health Medicaid |
$5.10
|
| Rate for Payer: Banner UC Health Medicare |
$18.45
|
| Rate for Payer: Bisbee Police All Plans |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$83.64
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna of AZ Commercial |
$79.95
|
| Rate for Payer: Copperpoint Commercial |
$30.44
|
| Rate for Payer: Health Net of AZ Commercial |
$73.80
|
| Rate for Payer: Health Net of AZ Medicare |
$34.44
|
| Rate for Payer: Humana of AZ Medicare |
$18.45
|
| Rate for Payer: Mercy Care Medicaid |
$5.10
|
| Rate for Payer: Self Pay Self Pay |
$98.40
|
| Rate for Payer: TriWest Medicare |
$18.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$71.71
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$22.14
|
|
|
felodipine 5 mg ER Tab [CQCH]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 23155004901
|
| Hospital Charge Code |
105922038
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of AZ Commercial |
$0.10
|
| Rate for Payer: Aetna of AZ Medicare |
$0.03
|
| Rate for Payer: Allwell Medicare |
$0.02
|
| Rate for Payer: Amerigroup Medicare |
$0.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.04
|
| Rate for Payer: AZCH Complete Medicare |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of AZ Commercial |
$0.07
|
| Rate for Payer: Copperpoint Commercial |
$0.03
|
| Rate for Payer: Health Net of AZ Commercial |
$0.07
|
| Rate for Payer: Health Net of AZ Medicare |
$0.03
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Self Pay Self Pay |
$0.09
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.06
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.02
|
|
|
felodipine 5 mg ER Tab [CQCH]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 23155004901
|
| Hospital Charge Code |
105922038
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of AZ Commercial |
$0.10
|
| Rate for Payer: Bisbee Police All Plans |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Self Pay Self Pay |
$0.09
|
|
|
Female Reproductive System Infections
|
Facility
|
IP
|
$4,371.83
|
|
|
Service Code
|
APR-DRG 5312
|
| Hospital Charge Code |
APRDRG5313
|
| Min. Negotiated Rate |
$4,371.83 |
| Max. Negotiated Rate |
$4,371.83 |
| Rate for Payer: AHCCCS Medicaid |
$4,371.83
|
| Rate for Payer: Allwell Medicaid |
$4,371.83
|
| Rate for Payer: AZCH Complete Medicaid |
$4,371.83
|
| Rate for Payer: Banner UC Health Medicaid |
$4,371.83
|
| Rate for Payer: Mercy Care Medicaid |
$4,371.83
|
|
|
Female Reproductive System Infections
|
Facility
|
IP
|
$4,371.83
|
|
|
Service Code
|
APR-DRG 5312
|
| Hospital Charge Code |
APRDRG5314
|
| Min. Negotiated Rate |
$4,371.83 |
| Max. Negotiated Rate |
$4,371.83 |
| Rate for Payer: AHCCCS Medicaid |
$4,371.83
|
| Rate for Payer: Allwell Medicaid |
$4,371.83
|
| Rate for Payer: AZCH Complete Medicaid |
$4,371.83
|
| Rate for Payer: Banner UC Health Medicaid |
$4,371.83
|
| Rate for Payer: Mercy Care Medicaid |
$4,371.83
|
|
|
Female Reproductive System Infections
|
Facility
|
IP
|
$3,251.69
|
|
|
Service Code
|
APR-DRG 5311
|
| Hospital Charge Code |
APRDRG5312
|
| Min. Negotiated Rate |
$3,251.69 |
| Max. Negotiated Rate |
$3,251.69 |
| Rate for Payer: AHCCCS Medicaid |
$3,251.69
|
| Rate for Payer: Allwell Medicaid |
$3,251.69
|
| Rate for Payer: AZCH Complete Medicaid |
$3,251.69
|
| Rate for Payer: Banner UC Health Medicaid |
$3,251.69
|
| Rate for Payer: Mercy Care Medicaid |
$3,251.69
|
|
|
Female Reproductive System Infections
|
Facility
|
IP
|
$12,709.37
|
|
|
Service Code
|
APR-DRG 5314
|
| Hospital Charge Code |
APRDRG5312
|
| Min. Negotiated Rate |
$12,709.37 |
| Max. Negotiated Rate |
$12,709.37 |
| Rate for Payer: AHCCCS Medicaid |
$12,709.37
|
| Rate for Payer: Allwell Medicaid |
$12,709.37
|
| Rate for Payer: AZCH Complete Medicaid |
$12,709.37
|
| Rate for Payer: Banner UC Health Medicaid |
$12,709.37
|
| Rate for Payer: Mercy Care Medicaid |
$12,709.37
|
|
|
Female Reproductive System Infections
|
Facility
|
IP
|
$3,251.69
|
|
|
Service Code
|
APR-DRG 5311
|
| Hospital Charge Code |
APRDRG5314
|
| Min. Negotiated Rate |
$3,251.69 |
| Max. Negotiated Rate |
$3,251.69 |
| Rate for Payer: AHCCCS Medicaid |
$3,251.69
|
| Rate for Payer: Allwell Medicaid |
$3,251.69
|
| Rate for Payer: AZCH Complete Medicaid |
$3,251.69
|
| Rate for Payer: Banner UC Health Medicaid |
$3,251.69
|
| Rate for Payer: Mercy Care Medicaid |
$3,251.69
|
|
|
Female Reproductive System Infections
|
Facility
|
IP
|
$6,993.66
|
|
|
Service Code
|
APR-DRG 5313
|
| Hospital Charge Code |
APRDRG5313
|
| Min. Negotiated Rate |
$6,993.66 |
| Max. Negotiated Rate |
$6,993.66 |
| Rate for Payer: AHCCCS Medicaid |
$6,993.66
|
| Rate for Payer: Allwell Medicaid |
$6,993.66
|
| Rate for Payer: AZCH Complete Medicaid |
$6,993.66
|
| Rate for Payer: Banner UC Health Medicaid |
$6,993.66
|
| Rate for Payer: Mercy Care Medicaid |
$6,993.66
|
|
|
Female Reproductive System Infections
|
Facility
|
IP
|
$4,371.83
|
|
|
Service Code
|
APR-DRG 5312
|
| Hospital Charge Code |
APRDRG5312
|
| Min. Negotiated Rate |
$4,371.83 |
| Max. Negotiated Rate |
$4,371.83 |
| Rate for Payer: AHCCCS Medicaid |
$4,371.83
|
| Rate for Payer: Allwell Medicaid |
$4,371.83
|
| Rate for Payer: AZCH Complete Medicaid |
$4,371.83
|
| Rate for Payer: Banner UC Health Medicaid |
$4,371.83
|
| Rate for Payer: Mercy Care Medicaid |
$4,371.83
|
|
