|
NOMOLINE HH AIRWAY ADAPTER INF NEO
|
Facility
|
IP
|
$81.51
|
|
| Hospital Charge Code |
27816998
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$73.36 |
| Rate for Payer: Aetna of AZ Commercial |
$73.36
|
| Rate for Payer: Bisbee Police All Plans |
$21.19
|
| Rate for Payer: Cash Price |
$65.21
|
| Rate for Payer: Self Pay Self Pay |
$65.21
|
|
|
NOMOLINE HH AIRWAY ADAPTER SET ADULT AND PED 7FT
|
Facility
|
OP
|
$91.00
|
|
| Hospital Charge Code |
27476057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of AZ Commercial |
$81.90
|
| Rate for Payer: Aetna of AZ Medicare |
$25.48
|
| Rate for Payer: Allwell Medicare |
$14.56
|
| Rate for Payer: Amerigroup Medicare |
$14.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$33.99
|
| Rate for Payer: AZCH Complete Medicare |
$14.56
|
| Rate for Payer: Banner UC Health Medicare |
$14.56
|
| Rate for Payer: Bisbee Police All Plans |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$61.88
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cigna of AZ Commercial |
$63.70
|
| Rate for Payer: Copperpoint Commercial |
$22.52
|
| Rate for Payer: Health Net of AZ Commercial |
$54.60
|
| Rate for Payer: Health Net of AZ Medicare |
$25.48
|
| Rate for Payer: Humana of AZ Medicare |
$14.56
|
| Rate for Payer: Self Pay Self Pay |
$72.80
|
| Rate for Payer: TriWest Medicare |
$14.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$53.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$16.38
|
|
|
NOMOLINE HH AIRWAY ADAPTER SET ADULT AND PED 7FT
|
Facility
|
IP
|
$91.00
|
|
| Hospital Charge Code |
27476057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of AZ Commercial |
$81.90
|
| Rate for Payer: Bisbee Police All Plans |
$23.66
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Self Pay Self Pay |
$72.80
|
|
|
NOMOLINE HH NASAL ORAL CO2 CANNULA ADULT
|
Facility
|
OP
|
$68.00
|
|
| Hospital Charge Code |
27548601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of AZ Commercial |
$61.20
|
| Rate for Payer: Aetna of AZ Medicare |
$19.04
|
| Rate for Payer: Allwell Medicare |
$10.88
|
| Rate for Payer: Amerigroup Medicare |
$10.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$25.40
|
| Rate for Payer: AZCH Complete Medicare |
$10.88
|
| Rate for Payer: Banner UC Health Medicare |
$10.88
|
| Rate for Payer: Bisbee Police All Plans |
$17.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$46.24
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cigna of AZ Commercial |
$47.60
|
| Rate for Payer: Copperpoint Commercial |
$16.83
|
| Rate for Payer: Health Net of AZ Commercial |
$40.80
|
| Rate for Payer: Health Net of AZ Medicare |
$19.04
|
| Rate for Payer: Humana of AZ Medicare |
$10.88
|
| Rate for Payer: Self Pay Self Pay |
$54.40
|
| Rate for Payer: TriWest Medicare |
$10.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$39.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.24
|
|
|
NOMOLINE HH NASAL ORAL CO2 CANNULA ADULT
|
Facility
|
IP
|
$68.00
|
|
| Hospital Charge Code |
27548601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of AZ Commercial |
$61.20
|
| Rate for Payer: Bisbee Police All Plans |
$17.68
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Self Pay Self Pay |
$54.40
|
|
|
NOMOLINE LH NASAL ORAL CO2 CANNUAL PED 7FT
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
27476056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna of AZ Commercial |
$66.60
|
| Rate for Payer: Bisbee Police All Plans |
$19.24
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Self Pay Self Pay |
$59.20
|
|
|
NOMOLINE LH NASAL ORAL CO2 CANNUAL PED 7FT
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
27476056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna of AZ Commercial |
$66.60
|
| Rate for Payer: Aetna of AZ Medicare |
$20.72
|
| Rate for Payer: Allwell Medicare |
$11.84
|
| Rate for Payer: Amerigroup Medicare |
$11.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$27.64
|
| Rate for Payer: AZCH Complete Medicare |
$11.84
|
| Rate for Payer: Banner UC Health Medicare |
$11.84
|
| Rate for Payer: Bisbee Police All Plans |
$19.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$50.32
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cigna of AZ Commercial |
$51.80
|
| Rate for Payer: Copperpoint Commercial |
$18.32
|
| Rate for Payer: Health Net of AZ Commercial |
$44.40
|
| Rate for Payer: Health Net of AZ Medicare |
$20.72
|
| Rate for Payer: Humana of AZ Medicare |
$11.84
|
| Rate for Payer: Self Pay Self Pay |
$59.20
|
| Rate for Payer: TriWest Medicare |
$11.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$43.14
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$13.32
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$28,429.85
|
|
|
Service Code
|
APR-DRG 0504
|
| Hospital Charge Code |
APRDRG0504
|
| Min. Negotiated Rate |
$28,429.85 |
| Max. Negotiated Rate |
$28,429.85 |
| Rate for Payer: AHCCCS Medicaid |
$28,429.85
|
| Rate for Payer: Allwell Medicaid |
$28,429.85
|
| Rate for Payer: AZCH Complete Medicaid |
$28,429.85
|
| Rate for Payer: Banner UC Health Medicaid |
$28,429.85
|
| Rate for Payer: Mercy Care Medicaid |
$28,429.85
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$8,018.40
|
|
|
Service Code
|
APR-DRG 0502
|
| Hospital Charge Code |
APRDRG0502
|
| Min. Negotiated Rate |
$8,018.40 |
| Max. Negotiated Rate |
$8,018.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,018.40
|
| Rate for Payer: Allwell Medicaid |
$8,018.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,018.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,018.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,018.40
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$14,022.39
|
|
|
Service Code
|
APR-DRG 0503
|
| Hospital Charge Code |
APRDRG0502
|
| Min. Negotiated Rate |
$14,022.39 |
| Max. Negotiated Rate |
$14,022.39 |
| Rate for Payer: AHCCCS Medicaid |
$14,022.39
|
| Rate for Payer: Allwell Medicaid |
$14,022.39
|
| Rate for Payer: AZCH Complete Medicaid |
$14,022.39
|
| Rate for Payer: Banner UC Health Medicaid |
$14,022.39
|
| Rate for Payer: Mercy Care Medicaid |
$14,022.39
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$8,018.40
|
|
|
Service Code
|
APR-DRG 0502
|
| Hospital Charge Code |
APRDRG0504
|
| Min. Negotiated Rate |
$8,018.40 |
| Max. Negotiated Rate |
$8,018.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,018.40
|
| Rate for Payer: Allwell Medicaid |
$8,018.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,018.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,018.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,018.40
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$28,429.85
|
|
|
Service Code
|
APR-DRG 0504
|
| Hospital Charge Code |
APRDRG0501
|
| Min. Negotiated Rate |
$28,429.85 |
| Max. Negotiated Rate |
$28,429.85 |
| Rate for Payer: AHCCCS Medicaid |
$28,429.85
|
| Rate for Payer: Allwell Medicaid |
$28,429.85
|
| Rate for Payer: AZCH Complete Medicaid |
$28,429.85
|
| Rate for Payer: Banner UC Health Medicaid |
$28,429.85
|
| Rate for Payer: Mercy Care Medicaid |
$28,429.85
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$28,429.85
|
|
|
Service Code
|
APR-DRG 0504
|
| Hospital Charge Code |
APRDRG0502
|
| Min. Negotiated Rate |
$28,429.85 |
| Max. Negotiated Rate |
$28,429.85 |
| Rate for Payer: AHCCCS Medicaid |
$28,429.85
|
| Rate for Payer: Allwell Medicaid |
$28,429.85
|
| Rate for Payer: AZCH Complete Medicaid |
$28,429.85
|
| Rate for Payer: Banner UC Health Medicaid |
$28,429.85
|
| Rate for Payer: Mercy Care Medicaid |
$28,429.85
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$14,022.39
|
|
|
Service Code
|
APR-DRG 0503
|
| Hospital Charge Code |
APRDRG0501
|
| Min. Negotiated Rate |
$14,022.39 |
| Max. Negotiated Rate |
$14,022.39 |
| Rate for Payer: AHCCCS Medicaid |
$14,022.39
|
| Rate for Payer: Allwell Medicaid |
$14,022.39
|
| Rate for Payer: AZCH Complete Medicaid |
$14,022.39
|
| Rate for Payer: Banner UC Health Medicaid |
$14,022.39
|
| Rate for Payer: Mercy Care Medicaid |
$14,022.39
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$8,018.40
|
|
|
Service Code
|
APR-DRG 0502
|
| Hospital Charge Code |
APRDRG0503
|
| Min. Negotiated Rate |
$8,018.40 |
| Max. Negotiated Rate |
$8,018.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,018.40
|
| Rate for Payer: Allwell Medicaid |
$8,018.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,018.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,018.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,018.40
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$4,423.73
|
|
|
Service Code
|
APR-DRG 0501
|
| Hospital Charge Code |
APRDRG0501
|
| Min. Negotiated Rate |
$4,423.73 |
| Max. Negotiated Rate |
$4,423.73 |
| Rate for Payer: AHCCCS Medicaid |
$4,423.73
|
| Rate for Payer: Allwell Medicaid |
$4,423.73
|
| Rate for Payer: AZCH Complete Medicaid |
$4,423.73
|
| Rate for Payer: Banner UC Health Medicaid |
$4,423.73
|
| Rate for Payer: Mercy Care Medicaid |
$4,423.73
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$28,429.85
|
|
|
Service Code
|
APR-DRG 0504
|
| Hospital Charge Code |
APRDRG0503
|
| Min. Negotiated Rate |
$28,429.85 |
| Max. Negotiated Rate |
$28,429.85 |
| Rate for Payer: AHCCCS Medicaid |
$28,429.85
|
| Rate for Payer: Allwell Medicaid |
$28,429.85
|
| Rate for Payer: AZCH Complete Medicaid |
$28,429.85
|
| Rate for Payer: Banner UC Health Medicaid |
$28,429.85
|
| Rate for Payer: Mercy Care Medicaid |
$28,429.85
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$14,022.39
|
|
|
Service Code
|
APR-DRG 0503
|
| Hospital Charge Code |
APRDRG0503
|
| Min. Negotiated Rate |
$14,022.39 |
| Max. Negotiated Rate |
$14,022.39 |
| Rate for Payer: AHCCCS Medicaid |
$14,022.39
|
| Rate for Payer: Allwell Medicaid |
$14,022.39
|
| Rate for Payer: AZCH Complete Medicaid |
$14,022.39
|
| Rate for Payer: Banner UC Health Medicaid |
$14,022.39
|
| Rate for Payer: Mercy Care Medicaid |
$14,022.39
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$8,018.40
|
|
|
Service Code
|
APR-DRG 0502
|
| Hospital Charge Code |
APRDRG0501
|
| Min. Negotiated Rate |
$8,018.40 |
| Max. Negotiated Rate |
$8,018.40 |
| Rate for Payer: AHCCCS Medicaid |
$8,018.40
|
| Rate for Payer: Allwell Medicaid |
$8,018.40
|
| Rate for Payer: AZCH Complete Medicaid |
$8,018.40
|
| Rate for Payer: Banner UC Health Medicaid |
$8,018.40
|
| Rate for Payer: Mercy Care Medicaid |
$8,018.40
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$14,022.39
|
|
|
Service Code
|
APR-DRG 0503
|
| Hospital Charge Code |
APRDRG0504
|
| Min. Negotiated Rate |
$14,022.39 |
| Max. Negotiated Rate |
$14,022.39 |
| Rate for Payer: AHCCCS Medicaid |
$14,022.39
|
| Rate for Payer: Allwell Medicaid |
$14,022.39
|
| Rate for Payer: AZCH Complete Medicaid |
$14,022.39
|
| Rate for Payer: Banner UC Health Medicaid |
$14,022.39
|
| Rate for Payer: Mercy Care Medicaid |
$14,022.39
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$4,423.73
|
|
|
Service Code
|
APR-DRG 0501
|
| Hospital Charge Code |
APRDRG0504
|
| Min. Negotiated Rate |
$4,423.73 |
| Max. Negotiated Rate |
$4,423.73 |
| Rate for Payer: AHCCCS Medicaid |
$4,423.73
|
| Rate for Payer: Allwell Medicaid |
$4,423.73
|
| Rate for Payer: AZCH Complete Medicaid |
$4,423.73
|
| Rate for Payer: Banner UC Health Medicaid |
$4,423.73
|
| Rate for Payer: Mercy Care Medicaid |
$4,423.73
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$4,423.73
|
|
|
Service Code
|
APR-DRG 0501
|
| Hospital Charge Code |
APRDRG0502
|
| Min. Negotiated Rate |
$4,423.73 |
| Max. Negotiated Rate |
$4,423.73 |
| Rate for Payer: AHCCCS Medicaid |
$4,423.73
|
| Rate for Payer: Allwell Medicaid |
$4,423.73
|
| Rate for Payer: AZCH Complete Medicaid |
$4,423.73
|
| Rate for Payer: Banner UC Health Medicaid |
$4,423.73
|
| Rate for Payer: Mercy Care Medicaid |
$4,423.73
|
|
|
Non-Bacterial Infections Of Nervous System Except Viral Meningitis
|
Facility
|
IP
|
$4,423.73
|
|
|
Service Code
|
APR-DRG 0501
|
| Hospital Charge Code |
APRDRG0503
|
| Min. Negotiated Rate |
$4,423.73 |
| Max. Negotiated Rate |
$4,423.73 |
| Rate for Payer: AHCCCS Medicaid |
$4,423.73
|
| Rate for Payer: Allwell Medicaid |
$4,423.73
|
| Rate for Payer: AZCH Complete Medicaid |
$4,423.73
|
| Rate for Payer: Banner UC Health Medicaid |
$4,423.73
|
| Rate for Payer: Mercy Care Medicaid |
$4,423.73
|
|
|
Non-Elective Or Complex Hip Joint Replacement
|
Facility
|
IP
|
$15,202.14
|
|
|
Service Code
|
APR-DRG 3233
|
| Hospital Charge Code |
APRDRG3234
|
| Min. Negotiated Rate |
$15,202.14 |
| Max. Negotiated Rate |
$15,202.14 |
| Rate for Payer: AHCCCS Medicaid |
$15,202.14
|
| Rate for Payer: Allwell Medicaid |
$15,202.14
|
| Rate for Payer: AZCH Complete Medicaid |
$15,202.14
|
| Rate for Payer: Banner UC Health Medicaid |
$15,202.14
|
| Rate for Payer: Mercy Care Medicaid |
$15,202.14
|
|
|
Non-Elective Or Complex Hip Joint Replacement
|
Facility
|
IP
|
$22,891.59
|
|
|
Service Code
|
APR-DRG 3234
|
| Hospital Charge Code |
APRDRG3234
|
| Min. Negotiated Rate |
$22,891.59 |
| Max. Negotiated Rate |
$22,891.59 |
| Rate for Payer: AHCCCS Medicaid |
$22,891.59
|
| Rate for Payer: Allwell Medicaid |
$22,891.59
|
| Rate for Payer: AZCH Complete Medicaid |
$22,891.59
|
| Rate for Payer: Banner UC Health Medicaid |
$22,891.59
|
| Rate for Payer: Mercy Care Medicaid |
$22,891.59
|
|
