|
Multiple Significant Trauma Without O.R. Procedure
|
Facility
|
IP
|
$10,476.11
|
|
|
Service Code
|
APR-DRG 9303
|
| Hospital Charge Code |
APRDRG9301
|
| Min. Negotiated Rate |
$10,476.11 |
| Max. Negotiated Rate |
$10,476.11 |
| Rate for Payer: AHCCCS Medicaid |
$10,476.11
|
| Rate for Payer: Allwell Medicaid |
$10,476.11
|
| Rate for Payer: AZCH Complete Medicaid |
$10,476.11
|
| Rate for Payer: Banner UC Health Medicaid |
$10,476.11
|
| Rate for Payer: Mercy Care Medicaid |
$10,476.11
|
|
|
Multiple Significant Trauma Without O.R. Procedure
|
Facility
|
IP
|
$5,101.98
|
|
|
Service Code
|
APR-DRG 9301
|
| Hospital Charge Code |
APRDRG9302
|
| Min. Negotiated Rate |
$5,101.98 |
| Max. Negotiated Rate |
$5,101.98 |
| Rate for Payer: AHCCCS Medicaid |
$5,101.98
|
| Rate for Payer: Allwell Medicaid |
$5,101.98
|
| Rate for Payer: AZCH Complete Medicaid |
$5,101.98
|
| Rate for Payer: Banner UC Health Medicaid |
$5,101.98
|
| Rate for Payer: Mercy Care Medicaid |
$5,101.98
|
|
|
Multiple Significant Trauma Without O.R. Procedure
|
Facility
|
IP
|
$6,601.58
|
|
|
Service Code
|
APR-DRG 9302
|
| Hospital Charge Code |
APRDRG9301
|
| Min. Negotiated Rate |
$6,601.58 |
| Max. Negotiated Rate |
$6,601.58 |
| Rate for Payer: AHCCCS Medicaid |
$6,601.58
|
| Rate for Payer: Allwell Medicaid |
$6,601.58
|
| Rate for Payer: AZCH Complete Medicaid |
$6,601.58
|
| Rate for Payer: Banner UC Health Medicaid |
$6,601.58
|
| Rate for Payer: Mercy Care Medicaid |
$6,601.58
|
|
|
Multiple Vitamins IV Sol 10 mL [CQCH]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
105933153
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of AZ Commercial |
$0.35
|
| Rate for Payer: Bisbee Police All Plans |
$0.10
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Self Pay Self Pay |
$0.31
|
|
|
Multiple Vitamins IV Sol 10 mL [CQCH]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
105933153
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of AZ Commercial |
$0.35
|
| Rate for Payer: Aetna of AZ Medicare |
$0.11
|
| Rate for Payer: Allwell Medicare |
$0.06
|
| Rate for Payer: Amerigroup Medicare |
$0.06
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.15
|
| Rate for Payer: AZCH Complete Medicare |
$0.06
|
| Rate for Payer: Banner UC Health Medicare |
$0.06
|
| Rate for Payer: Bisbee Police All Plans |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of AZ Commercial |
$0.25
|
| Rate for Payer: Copperpoint Commercial |
$0.10
|
| Rate for Payer: Health Net of AZ Commercial |
$0.23
|
| Rate for Payer: Health Net of AZ Medicare |
$0.11
|
| Rate for Payer: Humana of AZ Medicare |
$0.06
|
| Rate for Payer: Self Pay Self Pay |
$0.31
|
| Rate for Payer: TriWest Medicare |
$0.06
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.07
|
|
|
Multiple Vitamins with Minerals Tab [CQCH]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 904549261
|
| Hospital Charge Code |
105933220
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of AZ Commercial |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Self Pay Self Pay |
$0.04
|
|
|
Multiple Vitamins with Minerals Tab [CQCH]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 904549261
|
| Hospital Charge Code |
105933220
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of AZ Commercial |
$0.05
|
| Rate for Payer: Aetna of AZ Medicare |
$0.01
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.02
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of AZ Commercial |
$0.03
|
| Rate for Payer: Copperpoint Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Commercial |
$0.03
|
| Rate for Payer: Health Net of AZ Medicare |
$0.01
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.04
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.03
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
Mumps Antibodies, IgG LC
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
7314623
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Aetna of AZ Commercial |
$156.60
|
| Rate for Payer: Bisbee Police All Plans |
$45.24
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Self Pay Self Pay |
$139.20
|
|
|
Mumps Antibodies, IgG LC
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
7314623
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Aetna of AZ Commercial |
$156.60
|
| Rate for Payer: Aetna of AZ Medicare |
$48.72
|
| Rate for Payer: Allwell Medicare |
$27.84
|
| Rate for Payer: Amerigroup Medicare |
$27.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$64.99
|
| Rate for Payer: AZCH Complete Medicare |
$27.84
|
| Rate for Payer: Banner UC Health Medicare |
$27.84
|
| Rate for Payer: Bisbee Police All Plans |
$45.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$118.32
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna of AZ Commercial |
$113.10
|
| Rate for Payer: Copperpoint Commercial |
$43.06
|
| Rate for Payer: Health Net of AZ Commercial |
$104.40
|
| Rate for Payer: Health Net of AZ Medicare |
$48.72
|
| Rate for Payer: Humana of AZ Medicare |
$27.84
|
| Rate for Payer: Self Pay Self Pay |
$139.20
|
| Rate for Payer: TriWest Medicare |
$27.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$101.44
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.32
|
|
|
Mumps Antibodies, IgM LC
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
10864416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna of AZ Commercial |
$148.50
|
| Rate for Payer: Aetna of AZ Medicare |
$46.20
|
| Rate for Payer: Allwell Medicare |
$26.40
|
| Rate for Payer: Amerigroup Medicare |
$26.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$61.63
|
| Rate for Payer: AZCH Complete Medicare |
$26.40
|
| Rate for Payer: Banner UC Health Medicare |
$26.40
|
| Rate for Payer: Bisbee Police All Plans |
$42.90
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$112.20
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of AZ Commercial |
$107.25
|
| Rate for Payer: Copperpoint Commercial |
$40.84
|
| Rate for Payer: Health Net of AZ Commercial |
$99.00
|
| Rate for Payer: Health Net of AZ Medicare |
$46.20
|
| Rate for Payer: Humana of AZ Medicare |
$26.40
|
| Rate for Payer: Self Pay Self Pay |
$132.00
|
| Rate for Payer: TriWest Medicare |
$26.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$96.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$29.70
|
|
|
Mumps Antibodies, IgM LC
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
10864416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna of AZ Commercial |
$148.50
|
| Rate for Payer: Bisbee Police All Plans |
$42.90
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Self Pay Self Pay |
$132.00
|
|
|
mupirocin 2% nasal Oint [CQCH]
|
Facility
|
OP
|
$14.48
|
|
|
Service Code
|
NDC 29152611
|
| Hospital Charge Code |
105933346
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$13.03 |
| Rate for Payer: Aetna of AZ Commercial |
$13.03
|
| Rate for Payer: Aetna of AZ Medicare |
$4.05
|
| Rate for Payer: Allwell Medicare |
$2.32
|
| Rate for Payer: Amerigroup Medicare |
$2.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$5.41
|
| Rate for Payer: AZCH Complete Medicare |
$2.32
|
| Rate for Payer: Banner UC Health Medicare |
$2.32
|
| Rate for Payer: Bisbee Police All Plans |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$9.85
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Cigna of AZ Commercial |
$9.41
|
| Rate for Payer: Copperpoint Commercial |
$3.58
|
| Rate for Payer: Health Net of AZ Commercial |
$8.69
|
| Rate for Payer: Health Net of AZ Medicare |
$4.05
|
| Rate for Payer: Humana of AZ Medicare |
$2.32
|
| Rate for Payer: Self Pay Self Pay |
$11.58
|
| Rate for Payer: TriWest Medicare |
$2.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$8.44
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.61
|
|
|
mupirocin 2% nasal Oint [CQCH]
|
Facility
|
IP
|
$14.48
|
|
|
Service Code
|
NDC 29152611
|
| Hospital Charge Code |
105933346
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$13.03 |
| Rate for Payer: Aetna of AZ Commercial |
$13.03
|
| Rate for Payer: Bisbee Police All Plans |
$3.76
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Self Pay Self Pay |
$11.58
|
|
|
mupirocin Top 2% Oint [CQCH]
|
Facility
|
OP
|
$5.71
|
|
|
Service Code
|
NDC 68462018022
|
| Hospital Charge Code |
105933281
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: Aetna of AZ Commercial |
$5.14
|
| Rate for Payer: Aetna of AZ Medicare |
$1.60
|
| Rate for Payer: Allwell Medicare |
$0.91
|
| Rate for Payer: Amerigroup Medicare |
$0.91
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.13
|
| Rate for Payer: AZCH Complete Medicare |
$0.91
|
| Rate for Payer: Banner UC Health Medicare |
$0.91
|
| Rate for Payer: Bisbee Police All Plans |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.88
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Cigna of AZ Commercial |
$3.71
|
| Rate for Payer: Copperpoint Commercial |
$1.41
|
| Rate for Payer: Health Net of AZ Commercial |
$3.43
|
| Rate for Payer: Health Net of AZ Medicare |
$1.60
|
| Rate for Payer: Humana of AZ Medicare |
$0.91
|
| Rate for Payer: Self Pay Self Pay |
$4.57
|
| Rate for Payer: TriWest Medicare |
$0.91
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.03
|
|
|
mupirocin Top 2% Oint [CQCH]
|
Facility
|
IP
|
$5.71
|
|
|
Service Code
|
NDC 68462018022
|
| Hospital Charge Code |
105933281
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: Aetna of AZ Commercial |
$5.14
|
| Rate for Payer: Bisbee Police All Plans |
$1.48
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Self Pay Self Pay |
$4.57
|
|
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$14,817.08
|
|
|
Service Code
|
APR-DRG 9122
|
| Hospital Charge Code |
APRDRG9123
|
| Min. Negotiated Rate |
$14,817.08 |
| Max. Negotiated Rate |
$14,817.08 |
| Rate for Payer: AHCCCS Medicaid |
$14,817.08
|
| Rate for Payer: Allwell Medicaid |
$14,817.08
|
| Rate for Payer: AZCH Complete Medicaid |
$14,817.08
|
| Rate for Payer: Banner UC Health Medicaid |
$14,817.08
|
| Rate for Payer: Mercy Care Medicaid |
$14,817.08
|
|
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$46,137.39
|
|
|
Service Code
|
APR-DRG 9124
|
| Hospital Charge Code |
APRDRG9123
|
| Min. Negotiated Rate |
$46,137.39 |
| Max. Negotiated Rate |
$46,137.39 |
| Rate for Payer: AHCCCS Medicaid |
$46,137.39
|
| Rate for Payer: Allwell Medicaid |
$46,137.39
|
| Rate for Payer: AZCH Complete Medicaid |
$46,137.39
|
| Rate for Payer: Banner UC Health Medicaid |
$46,137.39
|
| Rate for Payer: Mercy Care Medicaid |
$46,137.39
|
|
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$24,008.22
|
|
|
Service Code
|
APR-DRG 9123
|
| Hospital Charge Code |
APRDRG9124
|
| Min. Negotiated Rate |
$24,008.22 |
| Max. Negotiated Rate |
$24,008.22 |
| Rate for Payer: AHCCCS Medicaid |
$24,008.22
|
| Rate for Payer: Allwell Medicaid |
$24,008.22
|
| Rate for Payer: AZCH Complete Medicaid |
$24,008.22
|
| Rate for Payer: Banner UC Health Medicaid |
$24,008.22
|
| Rate for Payer: Mercy Care Medicaid |
$24,008.22
|
|
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$13,661.87
|
|
|
Service Code
|
APR-DRG 9121
|
| Hospital Charge Code |
APRDRG9124
|
| Min. Negotiated Rate |
$13,661.87 |
| Max. Negotiated Rate |
$13,661.87 |
| Rate for Payer: AHCCCS Medicaid |
$13,661.87
|
| Rate for Payer: Allwell Medicaid |
$13,661.87
|
| Rate for Payer: AZCH Complete Medicaid |
$13,661.87
|
| Rate for Payer: Banner UC Health Medicaid |
$13,661.87
|
| Rate for Payer: Mercy Care Medicaid |
$13,661.87
|
|
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$14,817.08
|
|
|
Service Code
|
APR-DRG 9122
|
| Hospital Charge Code |
APRDRG9124
|
| Min. Negotiated Rate |
$14,817.08 |
| Max. Negotiated Rate |
$14,817.08 |
| Rate for Payer: AHCCCS Medicaid |
$14,817.08
|
| Rate for Payer: Allwell Medicaid |
$14,817.08
|
| Rate for Payer: AZCH Complete Medicaid |
$14,817.08
|
| Rate for Payer: Banner UC Health Medicaid |
$14,817.08
|
| Rate for Payer: Mercy Care Medicaid |
$14,817.08
|
|
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$13,661.87
|
|
|
Service Code
|
APR-DRG 9121
|
| Hospital Charge Code |
APRDRG9121
|
| Min. Negotiated Rate |
$13,661.87 |
| Max. Negotiated Rate |
$13,661.87 |
| Rate for Payer: AHCCCS Medicaid |
$13,661.87
|
| Rate for Payer: Allwell Medicaid |
$13,661.87
|
| Rate for Payer: AZCH Complete Medicaid |
$13,661.87
|
| Rate for Payer: Banner UC Health Medicaid |
$13,661.87
|
| Rate for Payer: Mercy Care Medicaid |
$13,661.87
|
|
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$13,661.87
|
|
|
Service Code
|
APR-DRG 9121
|
| Hospital Charge Code |
APRDRG9123
|
| Min. Negotiated Rate |
$13,661.87 |
| Max. Negotiated Rate |
$13,661.87 |
| Rate for Payer: AHCCCS Medicaid |
$13,661.87
|
| Rate for Payer: Allwell Medicaid |
$13,661.87
|
| Rate for Payer: AZCH Complete Medicaid |
$13,661.87
|
| Rate for Payer: Banner UC Health Medicaid |
$13,661.87
|
| Rate for Payer: Mercy Care Medicaid |
$13,661.87
|
|
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$14,817.08
|
|
|
Service Code
|
APR-DRG 9122
|
| Hospital Charge Code |
APRDRG9121
|
| Min. Negotiated Rate |
$14,817.08 |
| Max. Negotiated Rate |
$14,817.08 |
| Rate for Payer: AHCCCS Medicaid |
$14,817.08
|
| Rate for Payer: Allwell Medicaid |
$14,817.08
|
| Rate for Payer: AZCH Complete Medicaid |
$14,817.08
|
| Rate for Payer: Banner UC Health Medicaid |
$14,817.08
|
| Rate for Payer: Mercy Care Medicaid |
$14,817.08
|
|
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$46,137.39
|
|
|
Service Code
|
APR-DRG 9124
|
| Hospital Charge Code |
APRDRG9124
|
| Min. Negotiated Rate |
$46,137.39 |
| Max. Negotiated Rate |
$46,137.39 |
| Rate for Payer: AHCCCS Medicaid |
$46,137.39
|
| Rate for Payer: Allwell Medicaid |
$46,137.39
|
| Rate for Payer: AZCH Complete Medicaid |
$46,137.39
|
| Rate for Payer: Banner UC Health Medicaid |
$46,137.39
|
| Rate for Payer: Mercy Care Medicaid |
$46,137.39
|
|
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
Facility
|
IP
|
$24,008.22
|
|
|
Service Code
|
APR-DRG 9123
|
| Hospital Charge Code |
APRDRG9123
|
| Min. Negotiated Rate |
$24,008.22 |
| Max. Negotiated Rate |
$24,008.22 |
| Rate for Payer: AHCCCS Medicaid |
$24,008.22
|
| Rate for Payer: Allwell Medicaid |
$24,008.22
|
| Rate for Payer: AZCH Complete Medicaid |
$24,008.22
|
| Rate for Payer: Banner UC Health Medicaid |
$24,008.22
|
| Rate for Payer: Mercy Care Medicaid |
$24,008.22
|
|
