|
Gastric Fundoplication
|
Facility
|
IP
|
$8,538.84
|
|
|
Service Code
|
APR-DRG 2322
|
| Hospital Charge Code |
APRDRG2321
|
| Min. Negotiated Rate |
$8,538.84 |
| Max. Negotiated Rate |
$8,538.84 |
| Rate for Payer: AHCCCS Medicaid |
$8,538.84
|
| Rate for Payer: Allwell Medicaid |
$8,538.84
|
| Rate for Payer: AZCH Complete Medicaid |
$8,538.84
|
| Rate for Payer: Banner UC Health Medicaid |
$8,538.84
|
| Rate for Payer: Mercy Care Medicaid |
$8,538.84
|
|
|
Gastric Fundoplication
|
Facility
|
IP
|
$46,303.62
|
|
|
Service Code
|
APR-DRG 2324
|
| Hospital Charge Code |
APRDRG2321
|
| Min. Negotiated Rate |
$46,303.62 |
| Max. Negotiated Rate |
$46,303.62 |
| Rate for Payer: AHCCCS Medicaid |
$46,303.62
|
| Rate for Payer: Allwell Medicaid |
$46,303.62
|
| Rate for Payer: AZCH Complete Medicaid |
$46,303.62
|
| Rate for Payer: Banner UC Health Medicaid |
$46,303.62
|
| Rate for Payer: Mercy Care Medicaid |
$46,303.62
|
|
|
Gastric Fundoplication
|
Facility
|
IP
|
$46,303.62
|
|
|
Service Code
|
APR-DRG 2324
|
| Hospital Charge Code |
APRDRG2322
|
| Min. Negotiated Rate |
$46,303.62 |
| Max. Negotiated Rate |
$46,303.62 |
| Rate for Payer: AHCCCS Medicaid |
$46,303.62
|
| Rate for Payer: Allwell Medicaid |
$46,303.62
|
| Rate for Payer: AZCH Complete Medicaid |
$46,303.62
|
| Rate for Payer: Banner UC Health Medicaid |
$46,303.62
|
| Rate for Payer: Mercy Care Medicaid |
$46,303.62
|
|
|
Gastric Fundoplication
|
Facility
|
IP
|
$8,538.84
|
|
|
Service Code
|
APR-DRG 2322
|
| Hospital Charge Code |
APRDRG2322
|
| Min. Negotiated Rate |
$8,538.84 |
| Max. Negotiated Rate |
$8,538.84 |
| Rate for Payer: AHCCCS Medicaid |
$8,538.84
|
| Rate for Payer: Allwell Medicaid |
$8,538.84
|
| Rate for Payer: AZCH Complete Medicaid |
$8,538.84
|
| Rate for Payer: Banner UC Health Medicaid |
$8,538.84
|
| Rate for Payer: Mercy Care Medicaid |
$8,538.84
|
|
|
Gastric Fundoplication
|
Facility
|
IP
|
$13,458.46
|
|
|
Service Code
|
APR-DRG 2323
|
| Hospital Charge Code |
APRDRG2323
|
| Min. Negotiated Rate |
$13,458.46 |
| Max. Negotiated Rate |
$13,458.46 |
| Rate for Payer: AHCCCS Medicaid |
$13,458.46
|
| Rate for Payer: Allwell Medicaid |
$13,458.46
|
| Rate for Payer: AZCH Complete Medicaid |
$13,458.46
|
| Rate for Payer: Banner UC Health Medicaid |
$13,458.46
|
| Rate for Payer: Mercy Care Medicaid |
$13,458.46
|
|
|
Gastrointestinal Panel Filmarray PCR
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
22961678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$514.80 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,782.00
|
| Rate for Payer: Bisbee Police All Plans |
$514.80
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Self Pay Self Pay |
$1,584.00
|
|
|
Gastrointestinal Panel Filmarray PCR
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
22961678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$316.80 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,782.00
|
| Rate for Payer: Aetna of AZ Medicare |
$554.40
|
| Rate for Payer: Allwell Medicare |
$316.80
|
| Rate for Payer: Amerigroup Medicare |
$316.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$739.53
|
| Rate for Payer: AZCH Complete Medicare |
$316.80
|
| Rate for Payer: Banner UC Health Medicare |
$316.80
|
| Rate for Payer: Bisbee Police All Plans |
$514.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,287.00
|
| Rate for Payer: Copperpoint Commercial |
$490.05
|
| Rate for Payer: Health Net of AZ Commercial |
$1,188.00
|
| Rate for Payer: Health Net of AZ Medicare |
$554.40
|
| Rate for Payer: Humana of AZ Medicare |
$316.80
|
| Rate for Payer: Self Pay Self Pay |
$1,584.00
|
| Rate for Payer: TriWest Medicare |
$316.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,154.34
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$356.40
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$12,765.48
|
|
|
Service Code
|
APR-DRG 2464
|
| Hospital Charge Code |
APRDRG2461
|
| Min. Negotiated Rate |
$12,765.48 |
| Max. Negotiated Rate |
$12,765.48 |
| Rate for Payer: AHCCCS Medicaid |
$12,765.48
|
| Rate for Payer: Allwell Medicaid |
$12,765.48
|
| Rate for Payer: AZCH Complete Medicaid |
$12,765.48
|
| Rate for Payer: Banner UC Health Medicaid |
$12,765.48
|
| Rate for Payer: Mercy Care Medicaid |
$12,765.48
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$12,765.48
|
|
|
Service Code
|
APR-DRG 2464
|
| Hospital Charge Code |
APRDRG2464
|
| Min. Negotiated Rate |
$12,765.48 |
| Max. Negotiated Rate |
$12,765.48 |
| Rate for Payer: AHCCCS Medicaid |
$12,765.48
|
| Rate for Payer: Allwell Medicaid |
$12,765.48
|
| Rate for Payer: AZCH Complete Medicaid |
$12,765.48
|
| Rate for Payer: Banner UC Health Medicaid |
$12,765.48
|
| Rate for Payer: Mercy Care Medicaid |
$12,765.48
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$4,782.85
|
|
|
Service Code
|
APR-DRG 2462
|
| Hospital Charge Code |
APRDRG2462
|
| Min. Negotiated Rate |
$4,782.85 |
| Max. Negotiated Rate |
$4,782.85 |
| Rate for Payer: AHCCCS Medicaid |
$4,782.85
|
| Rate for Payer: Allwell Medicaid |
$4,782.85
|
| Rate for Payer: AZCH Complete Medicaid |
$4,782.85
|
| Rate for Payer: Banner UC Health Medicaid |
$4,782.85
|
| Rate for Payer: Mercy Care Medicaid |
$4,782.85
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$4,782.85
|
|
|
Service Code
|
APR-DRG 2462
|
| Hospital Charge Code |
APRDRG2464
|
| Min. Negotiated Rate |
$4,782.85 |
| Max. Negotiated Rate |
$4,782.85 |
| Rate for Payer: AHCCCS Medicaid |
$4,782.85
|
| Rate for Payer: Allwell Medicaid |
$4,782.85
|
| Rate for Payer: AZCH Complete Medicaid |
$4,782.85
|
| Rate for Payer: Banner UC Health Medicaid |
$4,782.85
|
| Rate for Payer: Mercy Care Medicaid |
$4,782.85
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$3,840.17
|
|
|
Service Code
|
APR-DRG 2461
|
| Hospital Charge Code |
APRDRG2464
|
| Min. Negotiated Rate |
$3,840.17 |
| Max. Negotiated Rate |
$3,840.17 |
| Rate for Payer: AHCCCS Medicaid |
$3,840.17
|
| Rate for Payer: Allwell Medicaid |
$3,840.17
|
| Rate for Payer: AZCH Complete Medicaid |
$3,840.17
|
| Rate for Payer: Banner UC Health Medicaid |
$3,840.17
|
| Rate for Payer: Mercy Care Medicaid |
$3,840.17
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$3,840.17
|
|
|
Service Code
|
APR-DRG 2461
|
| Hospital Charge Code |
APRDRG2461
|
| Min. Negotiated Rate |
$3,840.17 |
| Max. Negotiated Rate |
$3,840.17 |
| Rate for Payer: AHCCCS Medicaid |
$3,840.17
|
| Rate for Payer: Allwell Medicaid |
$3,840.17
|
| Rate for Payer: AZCH Complete Medicaid |
$3,840.17
|
| Rate for Payer: Banner UC Health Medicaid |
$3,840.17
|
| Rate for Payer: Mercy Care Medicaid |
$3,840.17
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$7,315.60
|
|
|
Service Code
|
APR-DRG 2463
|
| Hospital Charge Code |
APRDRG2462
|
| Min. Negotiated Rate |
$7,315.60 |
| Max. Negotiated Rate |
$7,315.60 |
| Rate for Payer: AHCCCS Medicaid |
$7,315.60
|
| Rate for Payer: Allwell Medicaid |
$7,315.60
|
| Rate for Payer: AZCH Complete Medicaid |
$7,315.60
|
| Rate for Payer: Banner UC Health Medicaid |
$7,315.60
|
| Rate for Payer: Mercy Care Medicaid |
$7,315.60
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$4,782.85
|
|
|
Service Code
|
APR-DRG 2462
|
| Hospital Charge Code |
APRDRG2463
|
| Min. Negotiated Rate |
$4,782.85 |
| Max. Negotiated Rate |
$4,782.85 |
| Rate for Payer: AHCCCS Medicaid |
$4,782.85
|
| Rate for Payer: Allwell Medicaid |
$4,782.85
|
| Rate for Payer: AZCH Complete Medicaid |
$4,782.85
|
| Rate for Payer: Banner UC Health Medicaid |
$4,782.85
|
| Rate for Payer: Mercy Care Medicaid |
$4,782.85
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$4,782.85
|
|
|
Service Code
|
APR-DRG 2462
|
| Hospital Charge Code |
APRDRG2461
|
| Min. Negotiated Rate |
$4,782.85 |
| Max. Negotiated Rate |
$4,782.85 |
| Rate for Payer: AHCCCS Medicaid |
$4,782.85
|
| Rate for Payer: Allwell Medicaid |
$4,782.85
|
| Rate for Payer: AZCH Complete Medicaid |
$4,782.85
|
| Rate for Payer: Banner UC Health Medicaid |
$4,782.85
|
| Rate for Payer: Mercy Care Medicaid |
$4,782.85
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$12,765.48
|
|
|
Service Code
|
APR-DRG 2464
|
| Hospital Charge Code |
APRDRG2462
|
| Min. Negotiated Rate |
$12,765.48 |
| Max. Negotiated Rate |
$12,765.48 |
| Rate for Payer: AHCCCS Medicaid |
$12,765.48
|
| Rate for Payer: Allwell Medicaid |
$12,765.48
|
| Rate for Payer: AZCH Complete Medicaid |
$12,765.48
|
| Rate for Payer: Banner UC Health Medicaid |
$12,765.48
|
| Rate for Payer: Mercy Care Medicaid |
$12,765.48
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$3,840.17
|
|
|
Service Code
|
APR-DRG 2461
|
| Hospital Charge Code |
APRDRG2463
|
| Min. Negotiated Rate |
$3,840.17 |
| Max. Negotiated Rate |
$3,840.17 |
| Rate for Payer: AHCCCS Medicaid |
$3,840.17
|
| Rate for Payer: Allwell Medicaid |
$3,840.17
|
| Rate for Payer: AZCH Complete Medicaid |
$3,840.17
|
| Rate for Payer: Banner UC Health Medicaid |
$3,840.17
|
| Rate for Payer: Mercy Care Medicaid |
$3,840.17
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$12,765.48
|
|
|
Service Code
|
APR-DRG 2464
|
| Hospital Charge Code |
APRDRG2463
|
| Min. Negotiated Rate |
$12,765.48 |
| Max. Negotiated Rate |
$12,765.48 |
| Rate for Payer: AHCCCS Medicaid |
$12,765.48
|
| Rate for Payer: Allwell Medicaid |
$12,765.48
|
| Rate for Payer: AZCH Complete Medicaid |
$12,765.48
|
| Rate for Payer: Banner UC Health Medicaid |
$12,765.48
|
| Rate for Payer: Mercy Care Medicaid |
$12,765.48
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$3,840.17
|
|
|
Service Code
|
APR-DRG 2461
|
| Hospital Charge Code |
APRDRG2462
|
| Min. Negotiated Rate |
$3,840.17 |
| Max. Negotiated Rate |
$3,840.17 |
| Rate for Payer: AHCCCS Medicaid |
$3,840.17
|
| Rate for Payer: Allwell Medicaid |
$3,840.17
|
| Rate for Payer: AZCH Complete Medicaid |
$3,840.17
|
| Rate for Payer: Banner UC Health Medicaid |
$3,840.17
|
| Rate for Payer: Mercy Care Medicaid |
$3,840.17
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$7,315.60
|
|
|
Service Code
|
APR-DRG 2463
|
| Hospital Charge Code |
APRDRG2463
|
| Min. Negotiated Rate |
$7,315.60 |
| Max. Negotiated Rate |
$7,315.60 |
| Rate for Payer: AHCCCS Medicaid |
$7,315.60
|
| Rate for Payer: Allwell Medicaid |
$7,315.60
|
| Rate for Payer: AZCH Complete Medicaid |
$7,315.60
|
| Rate for Payer: Banner UC Health Medicaid |
$7,315.60
|
| Rate for Payer: Mercy Care Medicaid |
$7,315.60
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$7,315.60
|
|
|
Service Code
|
APR-DRG 2463
|
| Hospital Charge Code |
APRDRG2461
|
| Min. Negotiated Rate |
$7,315.60 |
| Max. Negotiated Rate |
$7,315.60 |
| Rate for Payer: AHCCCS Medicaid |
$7,315.60
|
| Rate for Payer: Allwell Medicaid |
$7,315.60
|
| Rate for Payer: AZCH Complete Medicaid |
$7,315.60
|
| Rate for Payer: Banner UC Health Medicaid |
$7,315.60
|
| Rate for Payer: Mercy Care Medicaid |
$7,315.60
|
|
|
Gastrointestinal Vascular Insufficiency
|
Facility
|
IP
|
$7,315.60
|
|
|
Service Code
|
APR-DRG 2463
|
| Hospital Charge Code |
APRDRG2464
|
| Min. Negotiated Rate |
$7,315.60 |
| Max. Negotiated Rate |
$7,315.60 |
| Rate for Payer: AHCCCS Medicaid |
$7,315.60
|
| Rate for Payer: Allwell Medicaid |
$7,315.60
|
| Rate for Payer: AZCH Complete Medicaid |
$7,315.60
|
| Rate for Payer: Banner UC Health Medicaid |
$7,315.60
|
| Rate for Payer: Mercy Care Medicaid |
$7,315.60
|
|
|
GC AMPLIFICTN
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
22481475
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of AZ Commercial |
$360.00
|
| Rate for Payer: Bisbee Police All Plans |
$104.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Self Pay Self Pay |
$320.00
|
|
|
GC AMPLIFICTN
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
22481475
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of AZ Commercial |
$360.00
|
| Rate for Payer: Aetna of AZ Medicare |
$112.00
|
| Rate for Payer: Allwell Medicare |
$64.00
|
| Rate for Payer: Amerigroup Medicare |
$64.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$149.40
|
| Rate for Payer: AZCH Complete Medicare |
$64.00
|
| Rate for Payer: Banner UC Health Medicare |
$64.00
|
| Rate for Payer: Bisbee Police All Plans |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$272.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna of AZ Commercial |
$260.00
|
| Rate for Payer: Copperpoint Commercial |
$99.00
|
| Rate for Payer: Health Net of AZ Commercial |
$240.00
|
| Rate for Payer: Health Net of AZ Medicare |
$112.00
|
| Rate for Payer: Humana of AZ Medicare |
$64.00
|
| Rate for Payer: Self Pay Self Pay |
$320.00
|
| Rate for Payer: TriWest Medicare |
$64.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$233.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$72.00
|
|
