|
KIT, IV START
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
23254274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of AZ Commercial |
$12.60
|
| Rate for Payer: Bisbee Police All Plans |
$3.64
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Self Pay Self Pay |
$11.20
|
|
|
KIT LAPAROSCOPIC MORCELLATOR
|
Facility
|
IP
|
$3,378.00
|
|
| Hospital Charge Code |
22354835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$878.28 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna of AZ Commercial |
$3,040.20
|
| Rate for Payer: Bisbee Police All Plans |
$878.28
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Self Pay Self Pay |
$2,702.40
|
|
|
KIT LAPAROSCOPIC MORCELLATOR
|
Facility
|
OP
|
$3,378.00
|
|
| Hospital Charge Code |
22354835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$506.70 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna of AZ Commercial |
$3,040.20
|
| Rate for Payer: Aetna of AZ Medicare |
$945.84
|
| Rate for Payer: Allwell Medicare |
$506.70
|
| Rate for Payer: Amerigroup Medicare |
$506.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,261.68
|
| Rate for Payer: AZCH Complete Medicare |
$506.70
|
| Rate for Payer: Banner UC Health Medicare |
$506.70
|
| Rate for Payer: Bisbee Police All Plans |
$878.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,297.04
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cigna of AZ Commercial |
$2,364.60
|
| Rate for Payer: Copperpoint Commercial |
$836.06
|
| Rate for Payer: Health Net of AZ Commercial |
$2,026.80
|
| Rate for Payer: Health Net of AZ Medicare |
$945.84
|
| Rate for Payer: Humana of AZ Medicare |
$506.70
|
| Rate for Payer: Self Pay Self Pay |
$2,702.40
|
| Rate for Payer: TriWest Medicare |
$506.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,969.37
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$608.04
|
|
|
KIT SUCTION CATH/GLOVE 14
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
22355729
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of AZ Commercial |
$11.70
|
| Rate for Payer: Bisbee Police All Plans |
$3.38
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Self Pay Self Pay |
$10.40
|
|
|
KIT SUCTION CATH/GLOVE 14
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
22355729
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of AZ Commercial |
$11.70
|
| Rate for Payer: Aetna of AZ Medicare |
$3.64
|
| Rate for Payer: Allwell Medicare |
$1.95
|
| Rate for Payer: Amerigroup Medicare |
$1.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$4.86
|
| Rate for Payer: AZCH Complete Medicare |
$1.95
|
| Rate for Payer: Banner UC Health Medicare |
$1.95
|
| Rate for Payer: Bisbee Police All Plans |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$8.84
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cigna of AZ Commercial |
$9.10
|
| Rate for Payer: Copperpoint Commercial |
$3.22
|
| Rate for Payer: Health Net of AZ Commercial |
$7.80
|
| Rate for Payer: Health Net of AZ Medicare |
$3.64
|
| Rate for Payer: Humana of AZ Medicare |
$1.95
|
| Rate for Payer: Self Pay Self Pay |
$10.40
|
| Rate for Payer: TriWest Medicare |
$1.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$7.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.34
|
|
|
KIT SUCTION CATH/GLOVE 18
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
22355728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna of AZ Commercial |
$7.20
|
| Rate for Payer: Bisbee Police All Plans |
$2.08
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Self Pay Self Pay |
$6.40
|
|
|
KIT SUCTION CATH/GLOVE 18
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
22355728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna of AZ Commercial |
$7.20
|
| Rate for Payer: Aetna of AZ Medicare |
$2.24
|
| Rate for Payer: Allwell Medicare |
$1.20
|
| Rate for Payer: Amerigroup Medicare |
$1.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.99
|
| Rate for Payer: AZCH Complete Medicare |
$1.20
|
| Rate for Payer: Banner UC Health Medicare |
$1.20
|
| Rate for Payer: Bisbee Police All Plans |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$5.44
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cigna of AZ Commercial |
$5.60
|
| Rate for Payer: Copperpoint Commercial |
$1.98
|
| Rate for Payer: Health Net of AZ Commercial |
$4.80
|
| Rate for Payer: Health Net of AZ Medicare |
$2.24
|
| Rate for Payer: Humana of AZ Medicare |
$1.20
|
| Rate for Payer: Self Pay Self Pay |
$6.40
|
| Rate for Payer: TriWest Medicare |
$1.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.44
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$28,088.97
|
|
|
Service Code
|
APR-DRG 3134
|
| Hospital Charge Code |
APRDRG3134
|
| Min. Negotiated Rate |
$28,088.97 |
| Max. Negotiated Rate |
$28,088.97 |
| Rate for Payer: AHCCCS Medicaid |
$28,088.97
|
| Rate for Payer: Allwell Medicaid |
$28,088.97
|
| Rate for Payer: AZCH Complete Medicaid |
$28,088.97
|
| Rate for Payer: Banner UC Health Medicaid |
$28,088.97
|
| Rate for Payer: Mercy Care Medicaid |
$28,088.97
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$28,088.97
|
|
|
Service Code
|
APR-DRG 3134
|
| Hospital Charge Code |
APRDRG3133
|
| Min. Negotiated Rate |
$28,088.97 |
| Max. Negotiated Rate |
$28,088.97 |
| Rate for Payer: AHCCCS Medicaid |
$28,088.97
|
| Rate for Payer: Allwell Medicaid |
$28,088.97
|
| Rate for Payer: AZCH Complete Medicaid |
$28,088.97
|
| Rate for Payer: Banner UC Health Medicaid |
$28,088.97
|
| Rate for Payer: Mercy Care Medicaid |
$28,088.97
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$8,129.93
|
|
|
Service Code
|
APR-DRG 3131
|
| Hospital Charge Code |
APRDRG3132
|
| Min. Negotiated Rate |
$8,129.93 |
| Max. Negotiated Rate |
$8,129.93 |
| Rate for Payer: AHCCCS Medicaid |
$8,129.93
|
| Rate for Payer: Allwell Medicaid |
$8,129.93
|
| Rate for Payer: AZCH Complete Medicaid |
$8,129.93
|
| Rate for Payer: Banner UC Health Medicaid |
$8,129.93
|
| Rate for Payer: Mercy Care Medicaid |
$8,129.93
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$17,227.09
|
|
|
Service Code
|
APR-DRG 3133
|
| Hospital Charge Code |
APRDRG3132
|
| Min. Negotiated Rate |
$17,227.09 |
| Max. Negotiated Rate |
$17,227.09 |
| Rate for Payer: AHCCCS Medicaid |
$17,227.09
|
| Rate for Payer: Allwell Medicaid |
$17,227.09
|
| Rate for Payer: AZCH Complete Medicaid |
$17,227.09
|
| Rate for Payer: Banner UC Health Medicaid |
$17,227.09
|
| Rate for Payer: Mercy Care Medicaid |
$17,227.09
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$28,088.97
|
|
|
Service Code
|
APR-DRG 3134
|
| Hospital Charge Code |
APRDRG3132
|
| Min. Negotiated Rate |
$28,088.97 |
| Max. Negotiated Rate |
$28,088.97 |
| Rate for Payer: AHCCCS Medicaid |
$28,088.97
|
| Rate for Payer: Allwell Medicaid |
$28,088.97
|
| Rate for Payer: AZCH Complete Medicaid |
$28,088.97
|
| Rate for Payer: Banner UC Health Medicaid |
$28,088.97
|
| Rate for Payer: Mercy Care Medicaid |
$28,088.97
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$17,227.09
|
|
|
Service Code
|
APR-DRG 3133
|
| Hospital Charge Code |
APRDRG3134
|
| Min. Negotiated Rate |
$17,227.09 |
| Max. Negotiated Rate |
$17,227.09 |
| Rate for Payer: AHCCCS Medicaid |
$17,227.09
|
| Rate for Payer: Allwell Medicaid |
$17,227.09
|
| Rate for Payer: AZCH Complete Medicaid |
$17,227.09
|
| Rate for Payer: Banner UC Health Medicaid |
$17,227.09
|
| Rate for Payer: Mercy Care Medicaid |
$17,227.09
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$11,014.79
|
|
|
Service Code
|
APR-DRG 3132
|
| Hospital Charge Code |
APRDRG3134
|
| Min. Negotiated Rate |
$11,014.79 |
| Max. Negotiated Rate |
$11,014.79 |
| Rate for Payer: AHCCCS Medicaid |
$11,014.79
|
| Rate for Payer: Allwell Medicaid |
$11,014.79
|
| Rate for Payer: AZCH Complete Medicaid |
$11,014.79
|
| Rate for Payer: Banner UC Health Medicaid |
$11,014.79
|
| Rate for Payer: Mercy Care Medicaid |
$11,014.79
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$8,129.93
|
|
|
Service Code
|
APR-DRG 3131
|
| Hospital Charge Code |
APRDRG3133
|
| Min. Negotiated Rate |
$8,129.93 |
| Max. Negotiated Rate |
$8,129.93 |
| Rate for Payer: AHCCCS Medicaid |
$8,129.93
|
| Rate for Payer: Allwell Medicaid |
$8,129.93
|
| Rate for Payer: AZCH Complete Medicaid |
$8,129.93
|
| Rate for Payer: Banner UC Health Medicaid |
$8,129.93
|
| Rate for Payer: Mercy Care Medicaid |
$8,129.93
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$11,014.79
|
|
|
Service Code
|
APR-DRG 3132
|
| Hospital Charge Code |
APRDRG3131
|
| Min. Negotiated Rate |
$11,014.79 |
| Max. Negotiated Rate |
$11,014.79 |
| Rate for Payer: AHCCCS Medicaid |
$11,014.79
|
| Rate for Payer: Allwell Medicaid |
$11,014.79
|
| Rate for Payer: AZCH Complete Medicaid |
$11,014.79
|
| Rate for Payer: Banner UC Health Medicaid |
$11,014.79
|
| Rate for Payer: Mercy Care Medicaid |
$11,014.79
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$17,227.09
|
|
|
Service Code
|
APR-DRG 3133
|
| Hospital Charge Code |
APRDRG3133
|
| Min. Negotiated Rate |
$17,227.09 |
| Max. Negotiated Rate |
$17,227.09 |
| Rate for Payer: AHCCCS Medicaid |
$17,227.09
|
| Rate for Payer: Allwell Medicaid |
$17,227.09
|
| Rate for Payer: AZCH Complete Medicaid |
$17,227.09
|
| Rate for Payer: Banner UC Health Medicaid |
$17,227.09
|
| Rate for Payer: Mercy Care Medicaid |
$17,227.09
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$11,014.79
|
|
|
Service Code
|
APR-DRG 3132
|
| Hospital Charge Code |
APRDRG3132
|
| Min. Negotiated Rate |
$11,014.79 |
| Max. Negotiated Rate |
$11,014.79 |
| Rate for Payer: AHCCCS Medicaid |
$11,014.79
|
| Rate for Payer: Allwell Medicaid |
$11,014.79
|
| Rate for Payer: AZCH Complete Medicaid |
$11,014.79
|
| Rate for Payer: Banner UC Health Medicaid |
$11,014.79
|
| Rate for Payer: Mercy Care Medicaid |
$11,014.79
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$8,129.93
|
|
|
Service Code
|
APR-DRG 3131
|
| Hospital Charge Code |
APRDRG3134
|
| Min. Negotiated Rate |
$8,129.93 |
| Max. Negotiated Rate |
$8,129.93 |
| Rate for Payer: AHCCCS Medicaid |
$8,129.93
|
| Rate for Payer: Allwell Medicaid |
$8,129.93
|
| Rate for Payer: AZCH Complete Medicaid |
$8,129.93
|
| Rate for Payer: Banner UC Health Medicaid |
$8,129.93
|
| Rate for Payer: Mercy Care Medicaid |
$8,129.93
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$11,014.79
|
|
|
Service Code
|
APR-DRG 3132
|
| Hospital Charge Code |
APRDRG3133
|
| Min. Negotiated Rate |
$11,014.79 |
| Max. Negotiated Rate |
$11,014.79 |
| Rate for Payer: AHCCCS Medicaid |
$11,014.79
|
| Rate for Payer: Allwell Medicaid |
$11,014.79
|
| Rate for Payer: AZCH Complete Medicaid |
$11,014.79
|
| Rate for Payer: Banner UC Health Medicaid |
$11,014.79
|
| Rate for Payer: Mercy Care Medicaid |
$11,014.79
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$8,129.93
|
|
|
Service Code
|
APR-DRG 3131
|
| Hospital Charge Code |
APRDRG3131
|
| Min. Negotiated Rate |
$8,129.93 |
| Max. Negotiated Rate |
$8,129.93 |
| Rate for Payer: AHCCCS Medicaid |
$8,129.93
|
| Rate for Payer: Allwell Medicaid |
$8,129.93
|
| Rate for Payer: AZCH Complete Medicaid |
$8,129.93
|
| Rate for Payer: Banner UC Health Medicaid |
$8,129.93
|
| Rate for Payer: Mercy Care Medicaid |
$8,129.93
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$17,227.09
|
|
|
Service Code
|
APR-DRG 3133
|
| Hospital Charge Code |
APRDRG3131
|
| Min. Negotiated Rate |
$17,227.09 |
| Max. Negotiated Rate |
$17,227.09 |
| Rate for Payer: AHCCCS Medicaid |
$17,227.09
|
| Rate for Payer: Allwell Medicaid |
$17,227.09
|
| Rate for Payer: AZCH Complete Medicaid |
$17,227.09
|
| Rate for Payer: Banner UC Health Medicaid |
$17,227.09
|
| Rate for Payer: Mercy Care Medicaid |
$17,227.09
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$28,088.97
|
|
|
Service Code
|
APR-DRG 3134
|
| Hospital Charge Code |
APRDRG3131
|
| Min. Negotiated Rate |
$28,088.97 |
| Max. Negotiated Rate |
$28,088.97 |
| Rate for Payer: AHCCCS Medicaid |
$28,088.97
|
| Rate for Payer: Allwell Medicaid |
$28,088.97
|
| Rate for Payer: AZCH Complete Medicaid |
$28,088.97
|
| Rate for Payer: Banner UC Health Medicaid |
$28,088.97
|
| Rate for Payer: Mercy Care Medicaid |
$28,088.97
|
|
|
KNEE IMMOBILIZER 16
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
22354185
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Bisbee Police All Plans |
$20.28
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
|
|
KNEE IMMOBILIZER 16
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
22354185
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of AZ Commercial |
$70.20
|
| Rate for Payer: Aetna of AZ Medicare |
$21.84
|
| Rate for Payer: Allwell Medicare |
$11.70
|
| Rate for Payer: Amerigroup Medicare |
$11.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$29.13
|
| Rate for Payer: AZCH Complete Medicare |
$11.70
|
| Rate for Payer: Banner UC Health Medicare |
$11.70
|
| Rate for Payer: Bisbee Police All Plans |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$53.04
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna of AZ Commercial |
$54.60
|
| Rate for Payer: Copperpoint Commercial |
$19.30
|
| Rate for Payer: Health Net of AZ Commercial |
$46.80
|
| Rate for Payer: Health Net of AZ Medicare |
$21.84
|
| Rate for Payer: Humana of AZ Medicare |
$11.70
|
| Rate for Payer: Self Pay Self Pay |
$62.40
|
| Rate for Payer: TriWest Medicare |
$11.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$45.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.04
|
|
