|
Open Craniotomy For Trauma
|
Facility
|
IP
|
$24,253.71
|
|
|
Service Code
|
APR-DRG 0203
|
| Hospital Charge Code |
APRDRG0201
|
| Min. Negotiated Rate |
$24,253.71 |
| Max. Negotiated Rate |
$24,253.71 |
| Rate for Payer: AHCCCS Medicaid |
$24,253.71
|
| Rate for Payer: Allwell Medicaid |
$24,253.71
|
| Rate for Payer: AZCH Complete Medicaid |
$24,253.71
|
| Rate for Payer: Banner UC Health Medicaid |
$24,253.71
|
| Rate for Payer: Mercy Care Medicaid |
$24,253.71
|
|
|
Open Craniotomy For Trauma
|
Facility
|
IP
|
$40,117.98
|
|
|
Service Code
|
APR-DRG 0204
|
| Hospital Charge Code |
APRDRG0201
|
| Min. Negotiated Rate |
$40,117.98 |
| Max. Negotiated Rate |
$40,117.98 |
| Rate for Payer: AHCCCS Medicaid |
$40,117.98
|
| Rate for Payer: Allwell Medicaid |
$40,117.98
|
| Rate for Payer: AZCH Complete Medicaid |
$40,117.98
|
| Rate for Payer: Banner UC Health Medicaid |
$40,117.98
|
| Rate for Payer: Mercy Care Medicaid |
$40,117.98
|
|
|
Open Craniotomy For Trauma
|
Facility
|
IP
|
$40,117.98
|
|
|
Service Code
|
APR-DRG 0204
|
| Hospital Charge Code |
APRDRG0203
|
| Min. Negotiated Rate |
$40,117.98 |
| Max. Negotiated Rate |
$40,117.98 |
| Rate for Payer: AHCCCS Medicaid |
$40,117.98
|
| Rate for Payer: Allwell Medicaid |
$40,117.98
|
| Rate for Payer: AZCH Complete Medicaid |
$40,117.98
|
| Rate for Payer: Banner UC Health Medicaid |
$40,117.98
|
| Rate for Payer: Mercy Care Medicaid |
$40,117.98
|
|
|
Open Ended Flexi Tip Urethral Catheter
|
Facility
|
IP
|
$156.00
|
|
| Hospital Charge Code |
22926478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Bisbee Police All Plans |
$40.56
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Self Pay Self Pay |
$124.80
|
|
|
Open Ended Flexi Tip Urethral Catheter
|
Facility
|
OP
|
$156.00
|
|
| Hospital Charge Code |
22926478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Aetna of AZ Medicare |
$43.68
|
| Rate for Payer: Allwell Medicare |
$24.96
|
| Rate for Payer: Amerigroup Medicare |
$24.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$58.27
|
| Rate for Payer: AZCH Complete Medicare |
$24.96
|
| Rate for Payer: Banner UC Health Medicare |
$24.96
|
| Rate for Payer: Bisbee Police All Plans |
$40.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$106.08
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna of AZ Commercial |
$109.20
|
| Rate for Payer: Copperpoint Commercial |
$38.61
|
| Rate for Payer: Health Net of AZ Commercial |
$93.60
|
| Rate for Payer: Health Net of AZ Medicare |
$43.68
|
| Rate for Payer: Humana of AZ Medicare |
$24.96
|
| Rate for Payer: Self Pay Self Pay |
$124.80
|
| Rate for Payer: TriWest Medicare |
$24.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$90.95
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.08
|
|
|
OPEN END FLEXI TIP URETERAL CATHERER
|
Facility
|
OP
|
$71.00
|
|
| Hospital Charge Code |
22636871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of AZ Commercial |
$63.90
|
| Rate for Payer: Aetna of AZ Medicare |
$19.88
|
| Rate for Payer: Allwell Medicare |
$11.36
|
| Rate for Payer: Amerigroup Medicare |
$11.36
|
| Rate for Payer: APIPA Medicare/Medicaid |
$26.52
|
| Rate for Payer: AZCH Complete Medicare |
$11.36
|
| Rate for Payer: Banner UC Health Medicare |
$11.36
|
| Rate for Payer: Bisbee Police All Plans |
$18.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$48.28
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cigna of AZ Commercial |
$49.70
|
| Rate for Payer: Copperpoint Commercial |
$17.57
|
| Rate for Payer: Health Net of AZ Commercial |
$42.60
|
| Rate for Payer: Health Net of AZ Medicare |
$19.88
|
| Rate for Payer: Humana of AZ Medicare |
$11.36
|
| Rate for Payer: Self Pay Self Pay |
$56.80
|
| Rate for Payer: TriWest Medicare |
$11.36
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$41.39
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.78
|
|
|
OPEN END FLEXI TIP URETERAL CATHERER
|
Facility
|
IP
|
$71.00
|
|
| Hospital Charge Code |
22636871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of AZ Commercial |
$63.90
|
| Rate for Payer: Bisbee Police All Plans |
$18.46
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Self Pay Self Pay |
$56.80
|
|
|
OPEN END URETHRAL CATH 6FR
|
Facility
|
IP
|
$110.61
|
|
| Hospital Charge Code |
27703251
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.76 |
| Max. Negotiated Rate |
$99.55 |
| Rate for Payer: Aetna of AZ Commercial |
$99.55
|
| Rate for Payer: Bisbee Police All Plans |
$28.76
|
| Rate for Payer: Cash Price |
$88.49
|
| Rate for Payer: Self Pay Self Pay |
$88.49
|
|
|
OPEN END URETHRAL CATH 6FR
|
Facility
|
OP
|
$110.61
|
|
| Hospital Charge Code |
27703251
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$99.55 |
| Rate for Payer: Aetna of AZ Commercial |
$99.55
|
| Rate for Payer: Aetna of AZ Medicare |
$30.97
|
| Rate for Payer: Allwell Medicare |
$17.70
|
| Rate for Payer: Amerigroup Medicare |
$17.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$41.31
|
| Rate for Payer: AZCH Complete Medicare |
$17.70
|
| Rate for Payer: Banner UC Health Medicare |
$17.70
|
| Rate for Payer: Bisbee Police All Plans |
$28.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$75.21
|
| Rate for Payer: Cash Price |
$88.49
|
| Rate for Payer: Cigna of AZ Commercial |
$77.43
|
| Rate for Payer: Copperpoint Commercial |
$27.38
|
| Rate for Payer: Health Net of AZ Commercial |
$66.37
|
| Rate for Payer: Health Net of AZ Medicare |
$30.97
|
| Rate for Payer: Humana of AZ Medicare |
$17.70
|
| Rate for Payer: Self Pay Self Pay |
$88.49
|
| Rate for Payer: TriWest Medicare |
$17.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$64.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$19.91
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$8,391.55
|
|
|
Service Code
|
APR-DRG 0242
|
| Hospital Charge Code |
APRDRG0244
|
| Min. Negotiated Rate |
$8,391.55 |
| Max. Negotiated Rate |
$8,391.55 |
| Rate for Payer: AHCCCS Medicaid |
$8,391.55
|
| Rate for Payer: Allwell Medicaid |
$8,391.55
|
| Rate for Payer: AZCH Complete Medicaid |
$8,391.55
|
| Rate for Payer: Banner UC Health Medicaid |
$8,391.55
|
| Rate for Payer: Mercy Care Medicaid |
$8,391.55
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$6,133.74
|
|
|
Service Code
|
APR-DRG 0241
|
| Hospital Charge Code |
APRDRG0243
|
| Min. Negotiated Rate |
$6,133.74 |
| Max. Negotiated Rate |
$6,133.74 |
| Rate for Payer: AHCCCS Medicaid |
$6,133.74
|
| Rate for Payer: Allwell Medicaid |
$6,133.74
|
| Rate for Payer: AZCH Complete Medicaid |
$6,133.74
|
| Rate for Payer: Banner UC Health Medicaid |
$6,133.74
|
| Rate for Payer: Mercy Care Medicaid |
$6,133.74
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$28,182.25
|
|
|
Service Code
|
APR-DRG 0244
|
| Hospital Charge Code |
APRDRG0242
|
| Min. Negotiated Rate |
$28,182.25 |
| Max. Negotiated Rate |
$28,182.25 |
| Rate for Payer: AHCCCS Medicaid |
$28,182.25
|
| Rate for Payer: Allwell Medicaid |
$28,182.25
|
| Rate for Payer: AZCH Complete Medicaid |
$28,182.25
|
| Rate for Payer: Banner UC Health Medicaid |
$28,182.25
|
| Rate for Payer: Mercy Care Medicaid |
$28,182.25
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$28,182.25
|
|
|
Service Code
|
APR-DRG 0244
|
| Hospital Charge Code |
APRDRG0243
|
| Min. Negotiated Rate |
$28,182.25 |
| Max. Negotiated Rate |
$28,182.25 |
| Rate for Payer: AHCCCS Medicaid |
$28,182.25
|
| Rate for Payer: Allwell Medicaid |
$28,182.25
|
| Rate for Payer: AZCH Complete Medicaid |
$28,182.25
|
| Rate for Payer: Banner UC Health Medicaid |
$28,182.25
|
| Rate for Payer: Mercy Care Medicaid |
$28,182.25
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$15,424.49
|
|
|
Service Code
|
APR-DRG 0243
|
| Hospital Charge Code |
APRDRG0242
|
| Min. Negotiated Rate |
$15,424.49 |
| Max. Negotiated Rate |
$15,424.49 |
| Rate for Payer: AHCCCS Medicaid |
$15,424.49
|
| Rate for Payer: Allwell Medicaid |
$15,424.49
|
| Rate for Payer: AZCH Complete Medicaid |
$15,424.49
|
| Rate for Payer: Banner UC Health Medicaid |
$15,424.49
|
| Rate for Payer: Mercy Care Medicaid |
$15,424.49
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$8,391.55
|
|
|
Service Code
|
APR-DRG 0242
|
| Hospital Charge Code |
APRDRG0241
|
| Min. Negotiated Rate |
$8,391.55 |
| Max. Negotiated Rate |
$8,391.55 |
| Rate for Payer: AHCCCS Medicaid |
$8,391.55
|
| Rate for Payer: Allwell Medicaid |
$8,391.55
|
| Rate for Payer: AZCH Complete Medicaid |
$8,391.55
|
| Rate for Payer: Banner UC Health Medicaid |
$8,391.55
|
| Rate for Payer: Mercy Care Medicaid |
$8,391.55
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$28,182.25
|
|
|
Service Code
|
APR-DRG 0244
|
| Hospital Charge Code |
APRDRG0241
|
| Min. Negotiated Rate |
$28,182.25 |
| Max. Negotiated Rate |
$28,182.25 |
| Rate for Payer: AHCCCS Medicaid |
$28,182.25
|
| Rate for Payer: Allwell Medicaid |
$28,182.25
|
| Rate for Payer: AZCH Complete Medicaid |
$28,182.25
|
| Rate for Payer: Banner UC Health Medicaid |
$28,182.25
|
| Rate for Payer: Mercy Care Medicaid |
$28,182.25
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$28,182.25
|
|
|
Service Code
|
APR-DRG 0244
|
| Hospital Charge Code |
APRDRG0244
|
| Min. Negotiated Rate |
$28,182.25 |
| Max. Negotiated Rate |
$28,182.25 |
| Rate for Payer: AHCCCS Medicaid |
$28,182.25
|
| Rate for Payer: Allwell Medicaid |
$28,182.25
|
| Rate for Payer: AZCH Complete Medicaid |
$28,182.25
|
| Rate for Payer: Banner UC Health Medicaid |
$28,182.25
|
| Rate for Payer: Mercy Care Medicaid |
$28,182.25
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$6,133.74
|
|
|
Service Code
|
APR-DRG 0241
|
| Hospital Charge Code |
APRDRG0241
|
| Min. Negotiated Rate |
$6,133.74 |
| Max. Negotiated Rate |
$6,133.74 |
| Rate for Payer: AHCCCS Medicaid |
$6,133.74
|
| Rate for Payer: Allwell Medicaid |
$6,133.74
|
| Rate for Payer: AZCH Complete Medicaid |
$6,133.74
|
| Rate for Payer: Banner UC Health Medicaid |
$6,133.74
|
| Rate for Payer: Mercy Care Medicaid |
$6,133.74
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$15,424.49
|
|
|
Service Code
|
APR-DRG 0243
|
| Hospital Charge Code |
APRDRG0243
|
| Min. Negotiated Rate |
$15,424.49 |
| Max. Negotiated Rate |
$15,424.49 |
| Rate for Payer: AHCCCS Medicaid |
$15,424.49
|
| Rate for Payer: Allwell Medicaid |
$15,424.49
|
| Rate for Payer: AZCH Complete Medicaid |
$15,424.49
|
| Rate for Payer: Banner UC Health Medicaid |
$15,424.49
|
| Rate for Payer: Mercy Care Medicaid |
$15,424.49
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$6,133.74
|
|
|
Service Code
|
APR-DRG 0241
|
| Hospital Charge Code |
APRDRG0244
|
| Min. Negotiated Rate |
$6,133.74 |
| Max. Negotiated Rate |
$6,133.74 |
| Rate for Payer: AHCCCS Medicaid |
$6,133.74
|
| Rate for Payer: Allwell Medicaid |
$6,133.74
|
| Rate for Payer: AZCH Complete Medicaid |
$6,133.74
|
| Rate for Payer: Banner UC Health Medicaid |
$6,133.74
|
| Rate for Payer: Mercy Care Medicaid |
$6,133.74
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$8,391.55
|
|
|
Service Code
|
APR-DRG 0242
|
| Hospital Charge Code |
APRDRG0242
|
| Min. Negotiated Rate |
$8,391.55 |
| Max. Negotiated Rate |
$8,391.55 |
| Rate for Payer: AHCCCS Medicaid |
$8,391.55
|
| Rate for Payer: Allwell Medicaid |
$8,391.55
|
| Rate for Payer: AZCH Complete Medicaid |
$8,391.55
|
| Rate for Payer: Banner UC Health Medicaid |
$8,391.55
|
| Rate for Payer: Mercy Care Medicaid |
$8,391.55
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$8,391.55
|
|
|
Service Code
|
APR-DRG 0242
|
| Hospital Charge Code |
APRDRG0243
|
| Min. Negotiated Rate |
$8,391.55 |
| Max. Negotiated Rate |
$8,391.55 |
| Rate for Payer: AHCCCS Medicaid |
$8,391.55
|
| Rate for Payer: Allwell Medicaid |
$8,391.55
|
| Rate for Payer: AZCH Complete Medicaid |
$8,391.55
|
| Rate for Payer: Banner UC Health Medicaid |
$8,391.55
|
| Rate for Payer: Mercy Care Medicaid |
$8,391.55
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$15,424.49
|
|
|
Service Code
|
APR-DRG 0243
|
| Hospital Charge Code |
APRDRG0244
|
| Min. Negotiated Rate |
$15,424.49 |
| Max. Negotiated Rate |
$15,424.49 |
| Rate for Payer: AHCCCS Medicaid |
$15,424.49
|
| Rate for Payer: Allwell Medicaid |
$15,424.49
|
| Rate for Payer: AZCH Complete Medicaid |
$15,424.49
|
| Rate for Payer: Banner UC Health Medicaid |
$15,424.49
|
| Rate for Payer: Mercy Care Medicaid |
$15,424.49
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$15,424.49
|
|
|
Service Code
|
APR-DRG 0243
|
| Hospital Charge Code |
APRDRG0241
|
| Min. Negotiated Rate |
$15,424.49 |
| Max. Negotiated Rate |
$15,424.49 |
| Rate for Payer: AHCCCS Medicaid |
$15,424.49
|
| Rate for Payer: Allwell Medicaid |
$15,424.49
|
| Rate for Payer: AZCH Complete Medicaid |
$15,424.49
|
| Rate for Payer: Banner UC Health Medicaid |
$15,424.49
|
| Rate for Payer: Mercy Care Medicaid |
$15,424.49
|
|
|
Open Extracranial Vascular Procedures
|
Facility
|
IP
|
$6,133.74
|
|
|
Service Code
|
APR-DRG 0241
|
| Hospital Charge Code |
APRDRG0242
|
| Min. Negotiated Rate |
$6,133.74 |
| Max. Negotiated Rate |
$6,133.74 |
| Rate for Payer: AHCCCS Medicaid |
$6,133.74
|
| Rate for Payer: Allwell Medicaid |
$6,133.74
|
| Rate for Payer: AZCH Complete Medicaid |
$6,133.74
|
| Rate for Payer: Banner UC Health Medicaid |
$6,133.74
|
| Rate for Payer: Mercy Care Medicaid |
$6,133.74
|
|
