|
Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure
|
Facility
|
IP
|
$3,150.69
|
|
|
Service Code
|
APR-DRG 4661
|
| Hospital Charge Code |
APRDRG4663
|
| Min. Negotiated Rate |
$3,150.69 |
| Max. Negotiated Rate |
$3,150.69 |
| Rate for Payer: AHCCCS Medicaid |
$3,150.69
|
| Rate for Payer: Allwell Medicaid |
$3,150.69
|
| Rate for Payer: AZCH Complete Medicaid |
$3,150.69
|
| Rate for Payer: Banner UC Health Medicaid |
$3,150.69
|
| Rate for Payer: Mercy Care Medicaid |
$3,150.69
|
|
|
Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure
|
Facility
|
IP
|
$6,481.64
|
|
|
Service Code
|
APR-DRG 4663
|
| Hospital Charge Code |
APRDRG4664
|
| Min. Negotiated Rate |
$6,481.64 |
| Max. Negotiated Rate |
$6,481.64 |
| Rate for Payer: AHCCCS Medicaid |
$6,481.64
|
| Rate for Payer: Allwell Medicaid |
$6,481.64
|
| Rate for Payer: AZCH Complete Medicaid |
$6,481.64
|
| Rate for Payer: Banner UC Health Medicaid |
$6,481.64
|
| Rate for Payer: Mercy Care Medicaid |
$6,481.64
|
|
|
Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure
|
Facility
|
IP
|
$11,058.97
|
|
|
Service Code
|
APR-DRG 4664
|
| Hospital Charge Code |
APRDRG4664
|
| Min. Negotiated Rate |
$11,058.97 |
| Max. Negotiated Rate |
$11,058.97 |
| Rate for Payer: AHCCCS Medicaid |
$11,058.97
|
| Rate for Payer: Allwell Medicaid |
$11,058.97
|
| Rate for Payer: AZCH Complete Medicaid |
$11,058.97
|
| Rate for Payer: Banner UC Health Medicaid |
$11,058.97
|
| Rate for Payer: Mercy Care Medicaid |
$11,058.97
|
|
|
Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure
|
Facility
|
IP
|
$6,481.64
|
|
|
Service Code
|
APR-DRG 4663
|
| Hospital Charge Code |
APRDRG4661
|
| Min. Negotiated Rate |
$6,481.64 |
| Max. Negotiated Rate |
$6,481.64 |
| Rate for Payer: AHCCCS Medicaid |
$6,481.64
|
| Rate for Payer: Allwell Medicaid |
$6,481.64
|
| Rate for Payer: AZCH Complete Medicaid |
$6,481.64
|
| Rate for Payer: Banner UC Health Medicaid |
$6,481.64
|
| Rate for Payer: Mercy Care Medicaid |
$6,481.64
|
|
|
Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure
|
Facility
|
IP
|
$11,058.97
|
|
|
Service Code
|
APR-DRG 4664
|
| Hospital Charge Code |
APRDRG4661
|
| Min. Negotiated Rate |
$11,058.97 |
| Max. Negotiated Rate |
$11,058.97 |
| Rate for Payer: AHCCCS Medicaid |
$11,058.97
|
| Rate for Payer: Allwell Medicaid |
$11,058.97
|
| Rate for Payer: AZCH Complete Medicaid |
$11,058.97
|
| Rate for Payer: Banner UC Health Medicaid |
$11,058.97
|
| Rate for Payer: Mercy Care Medicaid |
$11,058.97
|
|
|
Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure
|
Facility
|
IP
|
$4,237.16
|
|
|
Service Code
|
APR-DRG 4662
|
| Hospital Charge Code |
APRDRG4663
|
| Min. Negotiated Rate |
$4,237.16 |
| Max. Negotiated Rate |
$4,237.16 |
| Rate for Payer: AHCCCS Medicaid |
$4,237.16
|
| Rate for Payer: Allwell Medicaid |
$4,237.16
|
| Rate for Payer: AZCH Complete Medicaid |
$4,237.16
|
| Rate for Payer: Banner UC Health Medicaid |
$4,237.16
|
| Rate for Payer: Mercy Care Medicaid |
$4,237.16
|
|
|
Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure
|
Facility
|
IP
|
$3,150.69
|
|
|
Service Code
|
APR-DRG 4661
|
| Hospital Charge Code |
APRDRG4662
|
| Min. Negotiated Rate |
$3,150.69 |
| Max. Negotiated Rate |
$3,150.69 |
| Rate for Payer: AHCCCS Medicaid |
$3,150.69
|
| Rate for Payer: Allwell Medicaid |
$3,150.69
|
| Rate for Payer: AZCH Complete Medicaid |
$3,150.69
|
| Rate for Payer: Banner UC Health Medicaid |
$3,150.69
|
| Rate for Payer: Mercy Care Medicaid |
$3,150.69
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$8,119.41
|
|
|
Service Code
|
APR-DRG 3493
|
| Hospital Charge Code |
APRDRG3493
|
| Min. Negotiated Rate |
$8,119.41 |
| Max. Negotiated Rate |
$8,119.41 |
| Rate for Payer: AHCCCS Medicaid |
$8,119.41
|
| Rate for Payer: Allwell Medicaid |
$8,119.41
|
| Rate for Payer: AZCH Complete Medicaid |
$8,119.41
|
| Rate for Payer: Banner UC Health Medicaid |
$8,119.41
|
| Rate for Payer: Mercy Care Medicaid |
$8,119.41
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$5,432.34
|
|
|
Service Code
|
APR-DRG 3492
|
| Hospital Charge Code |
APRDRG3493
|
| Min. Negotiated Rate |
$5,432.34 |
| Max. Negotiated Rate |
$5,432.34 |
| Rate for Payer: AHCCCS Medicaid |
$5,432.34
|
| Rate for Payer: Allwell Medicaid |
$5,432.34
|
| Rate for Payer: AZCH Complete Medicaid |
$5,432.34
|
| Rate for Payer: Banner UC Health Medicaid |
$5,432.34
|
| Rate for Payer: Mercy Care Medicaid |
$5,432.34
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$3,643.07
|
|
|
Service Code
|
APR-DRG 3491
|
| Hospital Charge Code |
APRDRG3492
|
| Min. Negotiated Rate |
$3,643.07 |
| Max. Negotiated Rate |
$3,643.07 |
| Rate for Payer: AHCCCS Medicaid |
$3,643.07
|
| Rate for Payer: Allwell Medicaid |
$3,643.07
|
| Rate for Payer: AZCH Complete Medicaid |
$3,643.07
|
| Rate for Payer: Banner UC Health Medicaid |
$3,643.07
|
| Rate for Payer: Mercy Care Medicaid |
$3,643.07
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$14,955.25
|
|
|
Service Code
|
APR-DRG 3494
|
| Hospital Charge Code |
APRDRG3492
|
| Min. Negotiated Rate |
$14,955.25 |
| Max. Negotiated Rate |
$14,955.25 |
| Rate for Payer: AHCCCS Medicaid |
$14,955.25
|
| Rate for Payer: Allwell Medicaid |
$14,955.25
|
| Rate for Payer: AZCH Complete Medicaid |
$14,955.25
|
| Rate for Payer: Banner UC Health Medicaid |
$14,955.25
|
| Rate for Payer: Mercy Care Medicaid |
$14,955.25
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$8,119.41
|
|
|
Service Code
|
APR-DRG 3493
|
| Hospital Charge Code |
APRDRG3492
|
| Min. Negotiated Rate |
$8,119.41 |
| Max. Negotiated Rate |
$8,119.41 |
| Rate for Payer: AHCCCS Medicaid |
$8,119.41
|
| Rate for Payer: Allwell Medicaid |
$8,119.41
|
| Rate for Payer: AZCH Complete Medicaid |
$8,119.41
|
| Rate for Payer: Banner UC Health Medicaid |
$8,119.41
|
| Rate for Payer: Mercy Care Medicaid |
$8,119.41
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$14,955.25
|
|
|
Service Code
|
APR-DRG 3494
|
| Hospital Charge Code |
APRDRG3494
|
| Min. Negotiated Rate |
$14,955.25 |
| Max. Negotiated Rate |
$14,955.25 |
| Rate for Payer: AHCCCS Medicaid |
$14,955.25
|
| Rate for Payer: Allwell Medicaid |
$14,955.25
|
| Rate for Payer: AZCH Complete Medicaid |
$14,955.25
|
| Rate for Payer: Banner UC Health Medicaid |
$14,955.25
|
| Rate for Payer: Mercy Care Medicaid |
$14,955.25
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$3,643.07
|
|
|
Service Code
|
APR-DRG 3491
|
| Hospital Charge Code |
APRDRG3494
|
| Min. Negotiated Rate |
$3,643.07 |
| Max. Negotiated Rate |
$3,643.07 |
| Rate for Payer: AHCCCS Medicaid |
$3,643.07
|
| Rate for Payer: Allwell Medicaid |
$3,643.07
|
| Rate for Payer: AZCH Complete Medicaid |
$3,643.07
|
| Rate for Payer: Banner UC Health Medicaid |
$3,643.07
|
| Rate for Payer: Mercy Care Medicaid |
$3,643.07
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$8,119.41
|
|
|
Service Code
|
APR-DRG 3493
|
| Hospital Charge Code |
APRDRG3491
|
| Min. Negotiated Rate |
$8,119.41 |
| Max. Negotiated Rate |
$8,119.41 |
| Rate for Payer: AHCCCS Medicaid |
$8,119.41
|
| Rate for Payer: Allwell Medicaid |
$8,119.41
|
| Rate for Payer: AZCH Complete Medicaid |
$8,119.41
|
| Rate for Payer: Banner UC Health Medicaid |
$8,119.41
|
| Rate for Payer: Mercy Care Medicaid |
$8,119.41
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$3,643.07
|
|
|
Service Code
|
APR-DRG 3491
|
| Hospital Charge Code |
APRDRG3491
|
| Min. Negotiated Rate |
$3,643.07 |
| Max. Negotiated Rate |
$3,643.07 |
| Rate for Payer: AHCCCS Medicaid |
$3,643.07
|
| Rate for Payer: Allwell Medicaid |
$3,643.07
|
| Rate for Payer: AZCH Complete Medicaid |
$3,643.07
|
| Rate for Payer: Banner UC Health Medicaid |
$3,643.07
|
| Rate for Payer: Mercy Care Medicaid |
$3,643.07
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$3,643.07
|
|
|
Service Code
|
APR-DRG 3491
|
| Hospital Charge Code |
APRDRG3493
|
| Min. Negotiated Rate |
$3,643.07 |
| Max. Negotiated Rate |
$3,643.07 |
| Rate for Payer: AHCCCS Medicaid |
$3,643.07
|
| Rate for Payer: Allwell Medicaid |
$3,643.07
|
| Rate for Payer: AZCH Complete Medicaid |
$3,643.07
|
| Rate for Payer: Banner UC Health Medicaid |
$3,643.07
|
| Rate for Payer: Mercy Care Medicaid |
$3,643.07
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$8,119.41
|
|
|
Service Code
|
APR-DRG 3493
|
| Hospital Charge Code |
APRDRG3494
|
| Min. Negotiated Rate |
$8,119.41 |
| Max. Negotiated Rate |
$8,119.41 |
| Rate for Payer: AHCCCS Medicaid |
$8,119.41
|
| Rate for Payer: Allwell Medicaid |
$8,119.41
|
| Rate for Payer: AZCH Complete Medicaid |
$8,119.41
|
| Rate for Payer: Banner UC Health Medicaid |
$8,119.41
|
| Rate for Payer: Mercy Care Medicaid |
$8,119.41
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$5,432.34
|
|
|
Service Code
|
APR-DRG 3492
|
| Hospital Charge Code |
APRDRG3494
|
| Min. Negotiated Rate |
$5,432.34 |
| Max. Negotiated Rate |
$5,432.34 |
| Rate for Payer: AHCCCS Medicaid |
$5,432.34
|
| Rate for Payer: Allwell Medicaid |
$5,432.34
|
| Rate for Payer: AZCH Complete Medicaid |
$5,432.34
|
| Rate for Payer: Banner UC Health Medicaid |
$5,432.34
|
| Rate for Payer: Mercy Care Medicaid |
$5,432.34
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$5,432.34
|
|
|
Service Code
|
APR-DRG 3492
|
| Hospital Charge Code |
APRDRG3491
|
| Min. Negotiated Rate |
$5,432.34 |
| Max. Negotiated Rate |
$5,432.34 |
| Rate for Payer: AHCCCS Medicaid |
$5,432.34
|
| Rate for Payer: Allwell Medicaid |
$5,432.34
|
| Rate for Payer: AZCH Complete Medicaid |
$5,432.34
|
| Rate for Payer: Banner UC Health Medicaid |
$5,432.34
|
| Rate for Payer: Mercy Care Medicaid |
$5,432.34
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$5,432.34
|
|
|
Service Code
|
APR-DRG 3492
|
| Hospital Charge Code |
APRDRG3492
|
| Min. Negotiated Rate |
$5,432.34 |
| Max. Negotiated Rate |
$5,432.34 |
| Rate for Payer: AHCCCS Medicaid |
$5,432.34
|
| Rate for Payer: Allwell Medicaid |
$5,432.34
|
| Rate for Payer: AZCH Complete Medicaid |
$5,432.34
|
| Rate for Payer: Banner UC Health Medicaid |
$5,432.34
|
| Rate for Payer: Mercy Care Medicaid |
$5,432.34
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$14,955.25
|
|
|
Service Code
|
APR-DRG 3494
|
| Hospital Charge Code |
APRDRG3493
|
| Min. Negotiated Rate |
$14,955.25 |
| Max. Negotiated Rate |
$14,955.25 |
| Rate for Payer: AHCCCS Medicaid |
$14,955.25
|
| Rate for Payer: Allwell Medicaid |
$14,955.25
|
| Rate for Payer: AZCH Complete Medicaid |
$14,955.25
|
| Rate for Payer: Banner UC Health Medicaid |
$14,955.25
|
| Rate for Payer: Mercy Care Medicaid |
$14,955.25
|
|
|
Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure
|
Facility
|
IP
|
$14,955.25
|
|
|
Service Code
|
APR-DRG 3494
|
| Hospital Charge Code |
APRDRG3491
|
| Min. Negotiated Rate |
$14,955.25 |
| Max. Negotiated Rate |
$14,955.25 |
| Rate for Payer: AHCCCS Medicaid |
$14,955.25
|
| Rate for Payer: Allwell Medicaid |
$14,955.25
|
| Rate for Payer: AZCH Complete Medicaid |
$14,955.25
|
| Rate for Payer: Banner UC Health Medicaid |
$14,955.25
|
| Rate for Payer: Mercy Care Medicaid |
$14,955.25
|
|
|
Malignancy, Male Reproductive System
|
Facility
|
IP
|
$4,259.60
|
|
|
Service Code
|
APR-DRG 5001
|
| Hospital Charge Code |
APRDRG5001
|
| Min. Negotiated Rate |
$4,259.60 |
| Max. Negotiated Rate |
$4,259.60 |
| Rate for Payer: AHCCCS Medicaid |
$4,259.60
|
| Rate for Payer: Allwell Medicaid |
$4,259.60
|
| Rate for Payer: AZCH Complete Medicaid |
$4,259.60
|
| Rate for Payer: Banner UC Health Medicaid |
$4,259.60
|
| Rate for Payer: Mercy Care Medicaid |
$4,259.60
|
|
|
Malignancy, Male Reproductive System
|
Facility
|
IP
|
$4,259.60
|
|
|
Service Code
|
APR-DRG 5001
|
| Hospital Charge Code |
APRDRG5002
|
| Min. Negotiated Rate |
$4,259.60 |
| Max. Negotiated Rate |
$4,259.60 |
| Rate for Payer: AHCCCS Medicaid |
$4,259.60
|
| Rate for Payer: Allwell Medicaid |
$4,259.60
|
| Rate for Payer: AZCH Complete Medicaid |
$4,259.60
|
| Rate for Payer: Banner UC Health Medicaid |
$4,259.60
|
| Rate for Payer: Mercy Care Medicaid |
$4,259.60
|
|
