|
SIROLIMUS (RAPAMUNE)
|
Facility
IP
|
$331.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
23603249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.27 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$297.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$56.27
|
| Rate for Payer: Amerigroup Medicare |
$56.27
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$56.27
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$56.27
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$86.06
|
| Rate for Payer: Copperpoint |
$92.85
|
| Rate for Payer: Humana Medicare |
$56.27
|
| Rate for Payer: SELF PAY |
$264.80
|
| Rate for Payer: Veterans (Triwest) |
$56.27
|
|
|
Sirolimus (Rapamune), Blood LC
|
Facility
IP
|
$331.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
2029238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.27 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$297.90
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$56.27
|
| Rate for Payer: Amerigroup Medicare |
$56.27
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$56.27
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$56.27
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$86.06
|
| Rate for Payer: Copperpoint |
$92.85
|
| Rate for Payer: Humana Medicare |
$56.27
|
| Rate for Payer: SELF PAY |
$264.80
|
| Rate for Payer: Veterans (Triwest) |
$56.27
|
|
|
Sirolimus (Rapamune), Blood LC
|
Facility
OP
|
$331.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
2029238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna POS, PPO, HMO |
$297.90
|
| Rate for Payer: Aetna Medicare |
$92.68
|
| Rate for Payer: AHCCCS Medicaid |
$13.73
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$13.73
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$56.27
|
| Rate for Payer: Amerigroup Medicare |
$56.27
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$123.63
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$13.73
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$56.27
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$56.27
|
| Rate for Payer: Banner University Family Care Medicaid |
$13.73
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$86.06
|
| Rate for Payer: Cigna All Products |
$215.15
|
| Rate for Payer: Copperpoint |
$92.85
|
| Rate for Payer: HealthNet Commercial |
$198.60
|
| Rate for Payer: HealthNet Medicare |
$92.68
|
| Rate for Payer: Humana Medicare |
$56.27
|
| Rate for Payer: Mercy Care Medicaid |
$13.73
|
| Rate for Payer: SELF PAY |
$264.80
|
| Rate for Payer: Veterans (Triwest) |
$56.27
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$192.97
|
| Rate for Payer: United Healthcare Medicare |
$59.58
|
|
|
SITZ BATH
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
22355310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$10.80
|
| Rate for Payer: Aetna Medicare |
$3.36
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.04
|
| Rate for Payer: Amerigroup Medicare |
$2.04
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$4.48
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.12
|
| Rate for Payer: Cigna All Products |
$8.40
|
| Rate for Payer: Copperpoint |
$3.37
|
| Rate for Payer: HealthNet Commercial |
$7.20
|
| Rate for Payer: HealthNet Medicare |
$3.36
|
| Rate for Payer: Humana Medicare |
$2.04
|
| Rate for Payer: SELF PAY |
$9.60
|
| Rate for Payer: Veterans (Triwest) |
$2.04
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$7.00
|
| Rate for Payer: United Healthcare Medicare |
$2.16
|
|
|
SITZ BATH
|
Facility
IP
|
$12.00
|
|
| Hospital Charge Code |
22355310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna POS, PPO, HMO |
$10.80
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$2.04
|
| Rate for Payer: Amerigroup Medicare |
$2.04
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$2.04
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$2.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$3.12
|
| Rate for Payer: Copperpoint |
$3.37
|
| Rate for Payer: Humana Medicare |
$2.04
|
| Rate for Payer: SELF PAY |
$9.60
|
| Rate for Payer: Veterans (Triwest) |
$2.04
|
|
|
Sjogren's Ab, Anti-SS-A/-SS-B LC
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
1285798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$201.60
|
| Rate for Payer: Aetna Medicare |
$62.72
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$17.93
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.08
|
| Rate for Payer: Amerigroup Medicare |
$38.08
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$83.66
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$17.93
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.08
|
| Rate for Payer: Banner University Family Care Medicaid |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$138.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$58.24
|
| Rate for Payer: Cigna All Products |
$145.60
|
| Rate for Payer: Copperpoint |
$62.83
|
| Rate for Payer: HealthNet Commercial |
$134.40
|
| Rate for Payer: HealthNet Medicare |
$62.72
|
| Rate for Payer: Humana Medicare |
$38.08
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: SELF PAY |
$179.20
|
| Rate for Payer: Veterans (Triwest) |
$38.08
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$130.59
|
| Rate for Payer: United Healthcare Medicare |
$40.32
|
|
|
Sjogren's Ab, Anti-SS-A/-SS-B LC
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
1285798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$201.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$38.08
|
| Rate for Payer: Amerigroup Medicare |
$38.08
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$38.08
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$38.08
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$138.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$58.24
|
| Rate for Payer: Copperpoint |
$62.83
|
| Rate for Payer: Humana Medicare |
$38.08
|
| Rate for Payer: SELF PAY |
$179.20
|
| Rate for Payer: Veterans (Triwest) |
$38.08
|
|
|
.Sjoren's SSA LC
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22531159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$138.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$107.10
|
| Rate for Payer: Aetna Medicare |
$33.32
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$17.93
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$20.23
|
| Rate for Payer: Amerigroup Medicare |
$20.23
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$44.45
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$17.93
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$20.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$20.23
|
| Rate for Payer: Banner University Family Care Medicaid |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$138.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$30.94
|
| Rate for Payer: Cigna All Products |
$77.35
|
| Rate for Payer: Copperpoint |
$33.38
|
| Rate for Payer: HealthNet Commercial |
$71.40
|
| Rate for Payer: HealthNet Medicare |
$33.32
|
| Rate for Payer: Humana Medicare |
$20.23
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: SELF PAY |
$95.20
|
| Rate for Payer: Veterans (Triwest) |
$20.23
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$69.38
|
| Rate for Payer: United Healthcare Medicare |
$21.42
|
|
|
.Sjoren's SSA LC
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22531159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$138.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$107.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$20.23
|
| Rate for Payer: Amerigroup Medicare |
$20.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$20.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$20.23
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$138.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$30.94
|
| Rate for Payer: Copperpoint |
$33.38
|
| Rate for Payer: Humana Medicare |
$20.23
|
| Rate for Payer: SELF PAY |
$95.20
|
| Rate for Payer: Veterans (Triwest) |
$20.23
|
|
|
.Sjoren's SSB LC
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22531177
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$138.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$107.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$20.23
|
| Rate for Payer: Amerigroup Medicare |
$20.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$20.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$20.23
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$138.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$30.94
|
| Rate for Payer: Copperpoint |
$33.38
|
| Rate for Payer: Humana Medicare |
$20.23
|
| Rate for Payer: SELF PAY |
$95.20
|
| Rate for Payer: Veterans (Triwest) |
$20.23
|
|
|
.Sjoren's SSB LC
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22531177
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$138.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$107.10
|
| Rate for Payer: Aetna Medicare |
$33.32
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$17.93
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$20.23
|
| Rate for Payer: Amerigroup Medicare |
$20.23
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$44.45
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$17.93
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$20.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$20.23
|
| Rate for Payer: Banner University Family Care Medicaid |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$138.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$30.94
|
| Rate for Payer: Cigna All Products |
$77.35
|
| Rate for Payer: Copperpoint |
$33.38
|
| Rate for Payer: HealthNet Commercial |
$71.40
|
| Rate for Payer: HealthNet Medicare |
$33.32
|
| Rate for Payer: Humana Medicare |
$20.23
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: SELF PAY |
$95.20
|
| Rate for Payer: Veterans (Triwest) |
$20.23
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$69.38
|
| Rate for Payer: United Healthcare Medicare |
$21.42
|
|
|
Sjoren's SSB LC
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22531160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$138.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$107.10
|
| Rate for Payer: Aetna Medicare |
$33.32
|
| Rate for Payer: AHCCCS Medicaid |
$17.93
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$17.93
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$20.23
|
| Rate for Payer: Amerigroup Medicare |
$20.23
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$44.45
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$17.93
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$20.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$20.23
|
| Rate for Payer: Banner University Family Care Medicaid |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$138.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$30.94
|
| Rate for Payer: Cigna All Products |
$77.35
|
| Rate for Payer: Copperpoint |
$33.38
|
| Rate for Payer: HealthNet Commercial |
$71.40
|
| Rate for Payer: HealthNet Medicare |
$33.32
|
| Rate for Payer: Humana Medicare |
$20.23
|
| Rate for Payer: Mercy Care Medicaid |
$17.93
|
| Rate for Payer: SELF PAY |
$95.20
|
| Rate for Payer: Veterans (Triwest) |
$20.23
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$69.38
|
| Rate for Payer: United Healthcare Medicare |
$21.42
|
|
|
Sjoren's SSB LC
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
22531160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$138.04 |
| Rate for Payer: Aetna POS, PPO, HMO |
$107.10
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$20.23
|
| Rate for Payer: Amerigroup Medicare |
$20.23
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$20.23
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$20.23
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$138.04
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$30.94
|
| Rate for Payer: Copperpoint |
$33.38
|
| Rate for Payer: Humana Medicare |
$20.23
|
| Rate for Payer: SELF PAY |
$95.20
|
| Rate for Payer: Veterans (Triwest) |
$20.23
|
|
|
Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses
|
Facility
IP
|
$8,693.15
|
|
|
Service Code
|
APRDRG 3121
|
| Hospital Charge Code |
APRDRG3121
|
| Min. Negotiated Rate |
$8,693.15 |
| Max. Negotiated Rate |
$8,693.15 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$8,693.15
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$8,693.15
|
| Rate for Payer: Banner University Family Care Medicaid |
$8,693.15
|
| Rate for Payer: Mercy Care Medicaid |
$8,693.15
|
|
|
Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses
|
Facility
IP
|
$24,992.99
|
|
|
Service Code
|
APRDRG 3123
|
| Hospital Charge Code |
APRDRG3123
|
| Min. Negotiated Rate |
$24,992.99 |
| Max. Negotiated Rate |
$24,992.99 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$24,992.99
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$24,992.99
|
| Rate for Payer: Banner University Family Care Medicaid |
$24,992.99
|
| Rate for Payer: Mercy Care Medicaid |
$24,992.99
|
|
|
Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses
|
Facility
IP
|
$14,706.25
|
|
|
Service Code
|
APRDRG 3122
|
| Hospital Charge Code |
APRDRG3122
|
| Min. Negotiated Rate |
$14,706.25 |
| Max. Negotiated Rate |
$14,706.25 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$14,706.25
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$14,706.25
|
| Rate for Payer: Banner University Family Care Medicaid |
$14,706.25
|
| Rate for Payer: Mercy Care Medicaid |
$14,706.25
|
|
|
Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses
|
Facility
IP
|
$47,114.44
|
|
|
Service Code
|
APRDRG 3124
|
| Hospital Charge Code |
APRDRG3124
|
| Min. Negotiated Rate |
$47,114.44 |
| Max. Negotiated Rate |
$47,114.44 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$47,114.44
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$47,114.44
|
| Rate for Payer: Banner University Family Care Medicaid |
$47,114.44
|
| Rate for Payer: Mercy Care Medicaid |
$47,114.44
|
|
|
Skin Graft For Skin And Subcutaneous Tissue Diagnoses
|
Facility
IP
|
$10,155.57
|
|
|
Service Code
|
APRDRG 3611
|
| Hospital Charge Code |
APRDRG3611
|
| Min. Negotiated Rate |
$10,155.57 |
| Max. Negotiated Rate |
$10,155.57 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$10,155.57
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$10,155.57
|
| Rate for Payer: Banner University Family Care Medicaid |
$10,155.57
|
| Rate for Payer: Mercy Care Medicaid |
$10,155.57
|
|
|
Skin Graft For Skin And Subcutaneous Tissue Diagnoses
|
Facility
IP
|
$39,763.07
|
|
|
Service Code
|
APRDRG 3614
|
| Hospital Charge Code |
APRDRG3614
|
| Min. Negotiated Rate |
$39,763.07 |
| Max. Negotiated Rate |
$39,763.07 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$39,763.07
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$39,763.07
|
| Rate for Payer: Banner University Family Care Medicaid |
$39,763.07
|
| Rate for Payer: Mercy Care Medicaid |
$39,763.07
|
|
|
Skin Graft For Skin And Subcutaneous Tissue Diagnoses
|
Facility
IP
|
$20,628.17
|
|
|
Service Code
|
APRDRG 3613
|
| Hospital Charge Code |
APRDRG3613
|
| Min. Negotiated Rate |
$20,628.17 |
| Max. Negotiated Rate |
$20,628.17 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$20,628.17
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$20,628.17
|
| Rate for Payer: Banner University Family Care Medicaid |
$20,628.17
|
| Rate for Payer: Mercy Care Medicaid |
$20,628.17
|
|
|
Skin Graft For Skin And Subcutaneous Tissue Diagnoses
|
Facility
IP
|
$12,534.72
|
|
|
Service Code
|
APRDRG 3612
|
| Hospital Charge Code |
APRDRG3612
|
| Min. Negotiated Rate |
$12,534.72 |
| Max. Negotiated Rate |
$12,534.72 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$12,534.72
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$12,534.72
|
| Rate for Payer: Banner University Family Care Medicaid |
$12,534.72
|
| Rate for Payer: Mercy Care Medicaid |
$12,534.72
|
|
|
Skin Ulcers
|
Facility
IP
|
$7,217.41
|
|
|
Service Code
|
APRDRG 3803
|
| Hospital Charge Code |
APRDRG3803
|
| Min. Negotiated Rate |
$7,217.41 |
| Max. Negotiated Rate |
$7,217.41 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$7,217.41
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$7,217.41
|
| Rate for Payer: Banner University Family Care Medicaid |
$7,217.41
|
| Rate for Payer: Mercy Care Medicaid |
$7,217.41
|
|
|
Skin Ulcers
|
Facility
IP
|
$15,164.97
|
|
|
Service Code
|
APRDRG 3804
|
| Hospital Charge Code |
APRDRG3804
|
| Min. Negotiated Rate |
$15,164.97 |
| Max. Negotiated Rate |
$15,164.97 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$15,164.97
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$15,164.97
|
| Rate for Payer: Banner University Family Care Medicaid |
$15,164.97
|
| Rate for Payer: Mercy Care Medicaid |
$15,164.97
|
|
|
Skin Ulcers
|
Facility
IP
|
$4,726.73
|
|
|
Service Code
|
APRDRG 3802
|
| Hospital Charge Code |
APRDRG3802
|
| Min. Negotiated Rate |
$4,726.73 |
| Max. Negotiated Rate |
$4,726.73 |
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4,726.73
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4,726.73
|
| Rate for Payer: Banner University Family Care Medicaid |
$4,726.73
|
| Rate for Payer: Mercy Care Medicaid |
$4,726.73
|
|
|
Skin Ulcers
|
Facility
IP
|
$3,886.46
|
|
|
Service Code
|
APRDRG 3801
|
| Hospital Charge Code |
APRDRG3801
|
| Min. Negotiated Rate |
$3,886.46 |
| Max. Negotiated Rate |
$3,886.46 |
| Rate for Payer: Mercy Care Medicaid |
$3,886.46
|
| Rate for Payer: Banner University Family Care Medicaid |
$3,886.46
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$3,886.46
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$3,886.46
|
|