|
Malignant Breast Disorders
|
Facility
|
IP
|
$5,483.55
|
|
|
Service Code
|
APR-DRG 3822
|
| Hospital Charge Code |
APRDRG3822
|
| Min. Negotiated Rate |
$5,483.55 |
| Max. Negotiated Rate |
$5,483.55 |
| Rate for Payer: AHCCCS Medicaid |
$5,483.55
|
| Rate for Payer: Allwell Medicaid |
$5,483.55
|
| Rate for Payer: AZCH Complete Medicaid |
$5,483.55
|
| Rate for Payer: Banner UC Health Medicaid |
$5,483.55
|
| Rate for Payer: Mercy Care Medicaid |
$5,483.55
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$5,483.55
|
|
|
Service Code
|
APR-DRG 3822
|
| Hospital Charge Code |
APRDRG3824
|
| Min. Negotiated Rate |
$5,483.55 |
| Max. Negotiated Rate |
$5,483.55 |
| Rate for Payer: AHCCCS Medicaid |
$5,483.55
|
| Rate for Payer: Allwell Medicaid |
$5,483.55
|
| Rate for Payer: AZCH Complete Medicaid |
$5,483.55
|
| Rate for Payer: Banner UC Health Medicaid |
$5,483.55
|
| Rate for Payer: Mercy Care Medicaid |
$5,483.55
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$7,657.18
|
|
|
Service Code
|
APR-DRG 3823
|
| Hospital Charge Code |
APRDRG3824
|
| Min. Negotiated Rate |
$7,657.18 |
| Max. Negotiated Rate |
$7,657.18 |
| Rate for Payer: AHCCCS Medicaid |
$7,657.18
|
| Rate for Payer: Allwell Medicaid |
$7,657.18
|
| Rate for Payer: AZCH Complete Medicaid |
$7,657.18
|
| Rate for Payer: Banner UC Health Medicaid |
$7,657.18
|
| Rate for Payer: Mercy Care Medicaid |
$7,657.18
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$7,657.18
|
|
|
Service Code
|
APR-DRG 3823
|
| Hospital Charge Code |
APRDRG3821
|
| Min. Negotiated Rate |
$7,657.18 |
| Max. Negotiated Rate |
$7,657.18 |
| Rate for Payer: AHCCCS Medicaid |
$7,657.18
|
| Rate for Payer: Allwell Medicaid |
$7,657.18
|
| Rate for Payer: AZCH Complete Medicaid |
$7,657.18
|
| Rate for Payer: Banner UC Health Medicaid |
$7,657.18
|
| Rate for Payer: Mercy Care Medicaid |
$7,657.18
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$7,657.18
|
|
|
Service Code
|
APR-DRG 3823
|
| Hospital Charge Code |
APRDRG3823
|
| Min. Negotiated Rate |
$7,657.18 |
| Max. Negotiated Rate |
$7,657.18 |
| Rate for Payer: AHCCCS Medicaid |
$7,657.18
|
| Rate for Payer: Allwell Medicaid |
$7,657.18
|
| Rate for Payer: AZCH Complete Medicaid |
$7,657.18
|
| Rate for Payer: Banner UC Health Medicaid |
$7,657.18
|
| Rate for Payer: Mercy Care Medicaid |
$7,657.18
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$12,879.11
|
|
|
Service Code
|
APR-DRG 3824
|
| Hospital Charge Code |
APRDRG3821
|
| Min. Negotiated Rate |
$12,879.11 |
| Max. Negotiated Rate |
$12,879.11 |
| Rate for Payer: AHCCCS Medicaid |
$12,879.11
|
| Rate for Payer: Allwell Medicaid |
$12,879.11
|
| Rate for Payer: AZCH Complete Medicaid |
$12,879.11
|
| Rate for Payer: Banner UC Health Medicaid |
$12,879.11
|
| Rate for Payer: Mercy Care Medicaid |
$12,879.11
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$7,657.18
|
|
|
Service Code
|
APR-DRG 3823
|
| Hospital Charge Code |
APRDRG3822
|
| Min. Negotiated Rate |
$7,657.18 |
| Max. Negotiated Rate |
$7,657.18 |
| Rate for Payer: AHCCCS Medicaid |
$7,657.18
|
| Rate for Payer: Allwell Medicaid |
$7,657.18
|
| Rate for Payer: AZCH Complete Medicaid |
$7,657.18
|
| Rate for Payer: Banner UC Health Medicaid |
$7,657.18
|
| Rate for Payer: Mercy Care Medicaid |
$7,657.18
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$5,483.55
|
|
|
Service Code
|
APR-DRG 3822
|
| Hospital Charge Code |
APRDRG3821
|
| Min. Negotiated Rate |
$5,483.55 |
| Max. Negotiated Rate |
$5,483.55 |
| Rate for Payer: AHCCCS Medicaid |
$5,483.55
|
| Rate for Payer: Allwell Medicaid |
$5,483.55
|
| Rate for Payer: AZCH Complete Medicaid |
$5,483.55
|
| Rate for Payer: Banner UC Health Medicaid |
$5,483.55
|
| Rate for Payer: Mercy Care Medicaid |
$5,483.55
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$12,879.11
|
|
|
Service Code
|
APR-DRG 3824
|
| Hospital Charge Code |
APRDRG3824
|
| Min. Negotiated Rate |
$12,879.11 |
| Max. Negotiated Rate |
$12,879.11 |
| Rate for Payer: AHCCCS Medicaid |
$12,879.11
|
| Rate for Payer: Allwell Medicaid |
$12,879.11
|
| Rate for Payer: AZCH Complete Medicaid |
$12,879.11
|
| Rate for Payer: Banner UC Health Medicaid |
$12,879.11
|
| Rate for Payer: Mercy Care Medicaid |
$12,879.11
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$5,483.55
|
|
|
Service Code
|
APR-DRG 3822
|
| Hospital Charge Code |
APRDRG3823
|
| Min. Negotiated Rate |
$5,483.55 |
| Max. Negotiated Rate |
$5,483.55 |
| Rate for Payer: AHCCCS Medicaid |
$5,483.55
|
| Rate for Payer: Allwell Medicaid |
$5,483.55
|
| Rate for Payer: AZCH Complete Medicaid |
$5,483.55
|
| Rate for Payer: Banner UC Health Medicaid |
$5,483.55
|
| Rate for Payer: Mercy Care Medicaid |
$5,483.55
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$4,275.03
|
|
|
Service Code
|
APR-DRG 3821
|
| Hospital Charge Code |
APRDRG3822
|
| Min. Negotiated Rate |
$4,275.03 |
| Max. Negotiated Rate |
$4,275.03 |
| Rate for Payer: AHCCCS Medicaid |
$4,275.03
|
| Rate for Payer: Allwell Medicaid |
$4,275.03
|
| Rate for Payer: AZCH Complete Medicaid |
$4,275.03
|
| Rate for Payer: Banner UC Health Medicaid |
$4,275.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,275.03
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$4,275.03
|
|
|
Service Code
|
APR-DRG 3821
|
| Hospital Charge Code |
APRDRG3823
|
| Min. Negotiated Rate |
$4,275.03 |
| Max. Negotiated Rate |
$4,275.03 |
| Rate for Payer: AHCCCS Medicaid |
$4,275.03
|
| Rate for Payer: Allwell Medicaid |
$4,275.03
|
| Rate for Payer: AZCH Complete Medicaid |
$4,275.03
|
| Rate for Payer: Banner UC Health Medicaid |
$4,275.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,275.03
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$4,275.03
|
|
|
Service Code
|
APR-DRG 3821
|
| Hospital Charge Code |
APRDRG3821
|
| Min. Negotiated Rate |
$4,275.03 |
| Max. Negotiated Rate |
$4,275.03 |
| Rate for Payer: AHCCCS Medicaid |
$4,275.03
|
| Rate for Payer: Allwell Medicaid |
$4,275.03
|
| Rate for Payer: AZCH Complete Medicaid |
$4,275.03
|
| Rate for Payer: Banner UC Health Medicaid |
$4,275.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,275.03
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$4,275.03
|
|
|
Service Code
|
APR-DRG 3821
|
| Hospital Charge Code |
APRDRG3824
|
| Min. Negotiated Rate |
$4,275.03 |
| Max. Negotiated Rate |
$4,275.03 |
| Rate for Payer: AHCCCS Medicaid |
$4,275.03
|
| Rate for Payer: Allwell Medicaid |
$4,275.03
|
| Rate for Payer: AZCH Complete Medicaid |
$4,275.03
|
| Rate for Payer: Banner UC Health Medicaid |
$4,275.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,275.03
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$12,879.11
|
|
|
Service Code
|
APR-DRG 3824
|
| Hospital Charge Code |
APRDRG3823
|
| Min. Negotiated Rate |
$12,879.11 |
| Max. Negotiated Rate |
$12,879.11 |
| Rate for Payer: AHCCCS Medicaid |
$12,879.11
|
| Rate for Payer: Allwell Medicaid |
$12,879.11
|
| Rate for Payer: AZCH Complete Medicaid |
$12,879.11
|
| Rate for Payer: Banner UC Health Medicaid |
$12,879.11
|
| Rate for Payer: Mercy Care Medicaid |
$12,879.11
|
|
|
Malignant Breast Disorders
|
Facility
|
IP
|
$12,879.11
|
|
|
Service Code
|
APR-DRG 3824
|
| Hospital Charge Code |
APRDRG3822
|
| Min. Negotiated Rate |
$12,879.11 |
| Max. Negotiated Rate |
$12,879.11 |
| Rate for Payer: AHCCCS Medicaid |
$12,879.11
|
| Rate for Payer: Allwell Medicaid |
$12,879.11
|
| Rate for Payer: AZCH Complete Medicaid |
$12,879.11
|
| Rate for Payer: Banner UC Health Medicaid |
$12,879.11
|
| Rate for Payer: Mercy Care Medicaid |
$12,879.11
|
|
|
Malnutrition, Failure To Thrive And Other Nutritional Disorders
|
Facility
|
IP
|
$4,259.60
|
|
|
Service Code
|
APR-DRG 4212
|
| Hospital Charge Code |
APRDRG4213
|
| 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
|
|
|
Malnutrition, Failure To Thrive And Other Nutritional Disorders
|
Facility
|
IP
|
$6,868.81
|
|
|
Service Code
|
APR-DRG 4213
|
| Hospital Charge Code |
APRDRG4212
|
| Min. Negotiated Rate |
$6,868.81 |
| Max. Negotiated Rate |
$6,868.81 |
| Rate for Payer: AHCCCS Medicaid |
$6,868.81
|
| Rate for Payer: Allwell Medicaid |
$6,868.81
|
| Rate for Payer: AZCH Complete Medicaid |
$6,868.81
|
| Rate for Payer: Banner UC Health Medicaid |
$6,868.81
|
| Rate for Payer: Mercy Care Medicaid |
$6,868.81
|
|
|
Malnutrition, Failure To Thrive And Other Nutritional Disorders
|
Facility
|
IP
|
$15,381.00
|
|
|
Service Code
|
APR-DRG 4214
|
| Hospital Charge Code |
APRDRG4213
|
| Min. Negotiated Rate |
$15,381.00 |
| Max. Negotiated Rate |
$15,381.00 |
| Rate for Payer: AHCCCS Medicaid |
$15,381.00
|
| Rate for Payer: Allwell Medicaid |
$15,381.00
|
| Rate for Payer: AZCH Complete Medicaid |
$15,381.00
|
| Rate for Payer: Banner UC Health Medicaid |
$15,381.00
|
| Rate for Payer: Mercy Care Medicaid |
$15,381.00
|
|
|
Malnutrition, Failure To Thrive And Other Nutritional Disorders
|
Facility
|
IP
|
$3,281.15
|
|
|
Service Code
|
APR-DRG 4211
|
| Hospital Charge Code |
APRDRG4212
|
| Min. Negotiated Rate |
$3,281.15 |
| Max. Negotiated Rate |
$3,281.15 |
| Rate for Payer: AHCCCS Medicaid |
$3,281.15
|
| Rate for Payer: Allwell Medicaid |
$3,281.15
|
| Rate for Payer: AZCH Complete Medicaid |
$3,281.15
|
| Rate for Payer: Banner UC Health Medicaid |
$3,281.15
|
| Rate for Payer: Mercy Care Medicaid |
$3,281.15
|
|
|
Malnutrition, Failure To Thrive And Other Nutritional Disorders
|
Facility
|
IP
|
$3,281.15
|
|
|
Service Code
|
APR-DRG 4211
|
| Hospital Charge Code |
APRDRG4211
|
| Min. Negotiated Rate |
$3,281.15 |
| Max. Negotiated Rate |
$3,281.15 |
| Rate for Payer: AHCCCS Medicaid |
$3,281.15
|
| Rate for Payer: Allwell Medicaid |
$3,281.15
|
| Rate for Payer: AZCH Complete Medicaid |
$3,281.15
|
| Rate for Payer: Banner UC Health Medicaid |
$3,281.15
|
| Rate for Payer: Mercy Care Medicaid |
$3,281.15
|
|
|
Malnutrition, Failure To Thrive And Other Nutritional Disorders
|
Facility
|
IP
|
$15,381.00
|
|
|
Service Code
|
APR-DRG 4214
|
| Hospital Charge Code |
APRDRG4214
|
| Min. Negotiated Rate |
$15,381.00 |
| Max. Negotiated Rate |
$15,381.00 |
| Rate for Payer: AHCCCS Medicaid |
$15,381.00
|
| Rate for Payer: Allwell Medicaid |
$15,381.00
|
| Rate for Payer: AZCH Complete Medicaid |
$15,381.00
|
| Rate for Payer: Banner UC Health Medicaid |
$15,381.00
|
| Rate for Payer: Mercy Care Medicaid |
$15,381.00
|
|
|
Malnutrition, Failure To Thrive And Other Nutritional Disorders
|
Facility
|
IP
|
$3,281.15
|
|
|
Service Code
|
APR-DRG 4211
|
| Hospital Charge Code |
APRDRG4213
|
| Min. Negotiated Rate |
$3,281.15 |
| Max. Negotiated Rate |
$3,281.15 |
| Rate for Payer: AHCCCS Medicaid |
$3,281.15
|
| Rate for Payer: Allwell Medicaid |
$3,281.15
|
| Rate for Payer: AZCH Complete Medicaid |
$3,281.15
|
| Rate for Payer: Banner UC Health Medicaid |
$3,281.15
|
| Rate for Payer: Mercy Care Medicaid |
$3,281.15
|
|
|
Malnutrition, Failure To Thrive And Other Nutritional Disorders
|
Facility
|
IP
|
$4,259.60
|
|
|
Service Code
|
APR-DRG 4212
|
| Hospital Charge Code |
APRDRG4214
|
| 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
|
|
|
Malnutrition, Failure To Thrive And Other Nutritional Disorders
|
Facility
|
IP
|
$3,281.15
|
|
|
Service Code
|
APR-DRG 4211
|
| Hospital Charge Code |
APRDRG4214
|
| Min. Negotiated Rate |
$3,281.15 |
| Max. Negotiated Rate |
$3,281.15 |
| Rate for Payer: AHCCCS Medicaid |
$3,281.15
|
| Rate for Payer: Allwell Medicaid |
$3,281.15
|
| Rate for Payer: AZCH Complete Medicaid |
$3,281.15
|
| Rate for Payer: Banner UC Health Medicaid |
$3,281.15
|
| Rate for Payer: Mercy Care Medicaid |
$3,281.15
|
|
