|
Orbit And Eye Procedures
|
Facility
|
IP
|
$15,146.73
|
|
|
Service Code
|
APR-DRG 0733
|
| Hospital Charge Code |
APRDRG0734
|
| Min. Negotiated Rate |
$15,146.73 |
| Max. Negotiated Rate |
$15,146.73 |
| Rate for Payer: AHCCCS Medicaid |
$15,146.73
|
| Rate for Payer: Allwell Medicaid |
$15,146.73
|
| Rate for Payer: AZCH Complete Medicaid |
$15,146.73
|
| Rate for Payer: Banner UC Health Medicaid |
$15,146.73
|
| Rate for Payer: Mercy Care Medicaid |
$15,146.73
|
|
|
Orbit And Eye Procedures
|
Facility
|
IP
|
$28,755.30
|
|
|
Service Code
|
APR-DRG 0734
|
| Hospital Charge Code |
APRDRG0731
|
| Min. Negotiated Rate |
$28,755.30 |
| Max. Negotiated Rate |
$28,755.30 |
| Rate for Payer: AHCCCS Medicaid |
$28,755.30
|
| Rate for Payer: Allwell Medicaid |
$28,755.30
|
| Rate for Payer: AZCH Complete Medicaid |
$28,755.30
|
| Rate for Payer: Banner UC Health Medicaid |
$28,755.30
|
| Rate for Payer: Mercy Care Medicaid |
$28,755.30
|
|
|
Orbit And Eye Procedures
|
Facility
|
IP
|
$6,265.61
|
|
|
Service Code
|
APR-DRG 0731
|
| Hospital Charge Code |
APRDRG0733
|
| Min. Negotiated Rate |
$6,265.61 |
| Max. Negotiated Rate |
$6,265.61 |
| Rate for Payer: AHCCCS Medicaid |
$6,265.61
|
| Rate for Payer: Allwell Medicaid |
$6,265.61
|
| Rate for Payer: AZCH Complete Medicaid |
$6,265.61
|
| Rate for Payer: Banner UC Health Medicaid |
$6,265.61
|
| Rate for Payer: Mercy Care Medicaid |
$6,265.61
|
|
|
Orbit And Eye Procedures
|
Facility
|
IP
|
$8,902.17
|
|
|
Service Code
|
APR-DRG 0732
|
| Hospital Charge Code |
APRDRG0733
|
| Min. Negotiated Rate |
$8,902.17 |
| Max. Negotiated Rate |
$8,902.17 |
| Rate for Payer: AHCCCS Medicaid |
$8,902.17
|
| Rate for Payer: Allwell Medicaid |
$8,902.17
|
| Rate for Payer: AZCH Complete Medicaid |
$8,902.17
|
| Rate for Payer: Banner UC Health Medicaid |
$8,902.17
|
| Rate for Payer: Mercy Care Medicaid |
$8,902.17
|
|
|
Orbit And Eye Procedures
|
Facility
|
IP
|
$15,146.73
|
|
|
Service Code
|
APR-DRG 0733
|
| Hospital Charge Code |
APRDRG0732
|
| Min. Negotiated Rate |
$15,146.73 |
| Max. Negotiated Rate |
$15,146.73 |
| Rate for Payer: AHCCCS Medicaid |
$15,146.73
|
| Rate for Payer: Allwell Medicaid |
$15,146.73
|
| Rate for Payer: AZCH Complete Medicaid |
$15,146.73
|
| Rate for Payer: Banner UC Health Medicaid |
$15,146.73
|
| Rate for Payer: Mercy Care Medicaid |
$15,146.73
|
|
|
Orbit And Eye Procedures
|
Facility
|
IP
|
$28,755.30
|
|
|
Service Code
|
APR-DRG 0734
|
| Hospital Charge Code |
APRDRG0732
|
| Min. Negotiated Rate |
$28,755.30 |
| Max. Negotiated Rate |
$28,755.30 |
| Rate for Payer: AHCCCS Medicaid |
$28,755.30
|
| Rate for Payer: Allwell Medicaid |
$28,755.30
|
| Rate for Payer: AZCH Complete Medicaid |
$28,755.30
|
| Rate for Payer: Banner UC Health Medicaid |
$28,755.30
|
| Rate for Payer: Mercy Care Medicaid |
$28,755.30
|
|
|
Orbit And Eye Procedures
|
Facility
|
IP
|
$8,902.17
|
|
|
Service Code
|
APR-DRG 0732
|
| Hospital Charge Code |
APRDRG0732
|
| Min. Negotiated Rate |
$8,902.17 |
| Max. Negotiated Rate |
$8,902.17 |
| Rate for Payer: AHCCCS Medicaid |
$8,902.17
|
| Rate for Payer: Allwell Medicaid |
$8,902.17
|
| Rate for Payer: AZCH Complete Medicaid |
$8,902.17
|
| Rate for Payer: Banner UC Health Medicaid |
$8,902.17
|
| Rate for Payer: Mercy Care Medicaid |
$8,902.17
|
|
|
Orbit And Eye Procedures
|
Facility
|
IP
|
$15,146.73
|
|
|
Service Code
|
APR-DRG 0733
|
| Hospital Charge Code |
APRDRG0733
|
| Min. Negotiated Rate |
$15,146.73 |
| Max. Negotiated Rate |
$15,146.73 |
| Rate for Payer: AHCCCS Medicaid |
$15,146.73
|
| Rate for Payer: Allwell Medicaid |
$15,146.73
|
| Rate for Payer: AZCH Complete Medicaid |
$15,146.73
|
| Rate for Payer: Banner UC Health Medicaid |
$15,146.73
|
| Rate for Payer: Mercy Care Medicaid |
$15,146.73
|
|
|
ORCA SUCTION WATER AND BIOPSY VALVE SET
|
Facility
|
IP
|
$50.10
|
|
| Hospital Charge Code |
27939097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$45.09 |
| Rate for Payer: Aetna of AZ Commercial |
$45.09
|
| Rate for Payer: Bisbee Police All Plans |
$13.03
|
| Rate for Payer: Cash Price |
$40.08
|
| Rate for Payer: Self Pay Self Pay |
$40.08
|
|
|
ORCA SUCTION WATER AND BIOPSY VALVE SET
|
Facility
|
OP
|
$50.10
|
|
| Hospital Charge Code |
27939097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$45.09 |
| Rate for Payer: Aetna of AZ Commercial |
$45.09
|
| Rate for Payer: Aetna of AZ Medicare |
$14.03
|
| Rate for Payer: Allwell Medicare |
$8.02
|
| Rate for Payer: Amerigroup Medicare |
$8.02
|
| Rate for Payer: APIPA Medicare/Medicaid |
$18.71
|
| Rate for Payer: AZCH Complete Medicare |
$8.02
|
| Rate for Payer: Banner UC Health Medicare |
$8.02
|
| Rate for Payer: Bisbee Police All Plans |
$13.03
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$34.07
|
| Rate for Payer: Cash Price |
$40.08
|
| Rate for Payer: Cigna of AZ Commercial |
$35.07
|
| Rate for Payer: Copperpoint Commercial |
$12.40
|
| Rate for Payer: Health Net of AZ Commercial |
$30.06
|
| Rate for Payer: Health Net of AZ Medicare |
$14.03
|
| Rate for Payer: Humana of AZ Medicare |
$8.02
|
| Rate for Payer: Self Pay Self Pay |
$40.08
|
| Rate for Payer: TriWest Medicare |
$8.02
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$29.21
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$9.02
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$7,742.75
|
|
|
Service Code
|
APR-DRG 7573
|
| Hospital Charge Code |
APRDRG7572
|
| Min. Negotiated Rate |
$7,742.75 |
| Max. Negotiated Rate |
$7,742.75 |
| Rate for Payer: AHCCCS Medicaid |
$7,742.75
|
| Rate for Payer: Allwell Medicaid |
$7,742.75
|
| Rate for Payer: AZCH Complete Medicaid |
$7,742.75
|
| Rate for Payer: Banner UC Health Medicaid |
$7,742.75
|
| Rate for Payer: Mercy Care Medicaid |
$7,742.75
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$14,824.09
|
|
|
Service Code
|
APR-DRG 7574
|
| Hospital Charge Code |
APRDRG7574
|
| Min. Negotiated Rate |
$14,824.09 |
| Max. Negotiated Rate |
$14,824.09 |
| Rate for Payer: AHCCCS Medicaid |
$14,824.09
|
| Rate for Payer: Allwell Medicaid |
$14,824.09
|
| Rate for Payer: AZCH Complete Medicaid |
$14,824.09
|
| Rate for Payer: Banner UC Health Medicaid |
$14,824.09
|
| Rate for Payer: Mercy Care Medicaid |
$14,824.09
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$4,086.36
|
|
|
Service Code
|
APR-DRG 7572
|
| Hospital Charge Code |
APRDRG7572
|
| Min. Negotiated Rate |
$4,086.36 |
| Max. Negotiated Rate |
$4,086.36 |
| Rate for Payer: AHCCCS Medicaid |
$4,086.36
|
| Rate for Payer: Allwell Medicaid |
$4,086.36
|
| Rate for Payer: AZCH Complete Medicaid |
$4,086.36
|
| Rate for Payer: Banner UC Health Medicaid |
$4,086.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,086.36
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$4,086.36
|
|
|
Service Code
|
APR-DRG 7572
|
| Hospital Charge Code |
APRDRG7571
|
| Min. Negotiated Rate |
$4,086.36 |
| Max. Negotiated Rate |
$4,086.36 |
| Rate for Payer: AHCCCS Medicaid |
$4,086.36
|
| Rate for Payer: Allwell Medicaid |
$4,086.36
|
| Rate for Payer: AZCH Complete Medicaid |
$4,086.36
|
| Rate for Payer: Banner UC Health Medicaid |
$4,086.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,086.36
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$14,824.09
|
|
|
Service Code
|
APR-DRG 7574
|
| Hospital Charge Code |
APRDRG7571
|
| Min. Negotiated Rate |
$14,824.09 |
| Max. Negotiated Rate |
$14,824.09 |
| Rate for Payer: AHCCCS Medicaid |
$14,824.09
|
| Rate for Payer: Allwell Medicaid |
$14,824.09
|
| Rate for Payer: AZCH Complete Medicaid |
$14,824.09
|
| Rate for Payer: Banner UC Health Medicaid |
$14,824.09
|
| Rate for Payer: Mercy Care Medicaid |
$14,824.09
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$7,742.75
|
|
|
Service Code
|
APR-DRG 7573
|
| Hospital Charge Code |
APRDRG7571
|
| Min. Negotiated Rate |
$7,742.75 |
| Max. Negotiated Rate |
$7,742.75 |
| Rate for Payer: AHCCCS Medicaid |
$7,742.75
|
| Rate for Payer: Allwell Medicaid |
$7,742.75
|
| Rate for Payer: AZCH Complete Medicaid |
$7,742.75
|
| Rate for Payer: Banner UC Health Medicaid |
$7,742.75
|
| Rate for Payer: Mercy Care Medicaid |
$7,742.75
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$3,070.73
|
|
|
Service Code
|
APR-DRG 7571
|
| Hospital Charge Code |
APRDRG7571
|
| Min. Negotiated Rate |
$3,070.73 |
| Max. Negotiated Rate |
$3,070.73 |
| Rate for Payer: AHCCCS Medicaid |
$3,070.73
|
| Rate for Payer: Allwell Medicaid |
$3,070.73
|
| Rate for Payer: AZCH Complete Medicaid |
$3,070.73
|
| Rate for Payer: Banner UC Health Medicaid |
$3,070.73
|
| Rate for Payer: Mercy Care Medicaid |
$3,070.73
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$14,824.09
|
|
|
Service Code
|
APR-DRG 7574
|
| Hospital Charge Code |
APRDRG7573
|
| Min. Negotiated Rate |
$14,824.09 |
| Max. Negotiated Rate |
$14,824.09 |
| Rate for Payer: AHCCCS Medicaid |
$14,824.09
|
| Rate for Payer: Allwell Medicaid |
$14,824.09
|
| Rate for Payer: AZCH Complete Medicaid |
$14,824.09
|
| Rate for Payer: Banner UC Health Medicaid |
$14,824.09
|
| Rate for Payer: Mercy Care Medicaid |
$14,824.09
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$7,742.75
|
|
|
Service Code
|
APR-DRG 7573
|
| Hospital Charge Code |
APRDRG7573
|
| Min. Negotiated Rate |
$7,742.75 |
| Max. Negotiated Rate |
$7,742.75 |
| Rate for Payer: AHCCCS Medicaid |
$7,742.75
|
| Rate for Payer: Allwell Medicaid |
$7,742.75
|
| Rate for Payer: AZCH Complete Medicaid |
$7,742.75
|
| Rate for Payer: Banner UC Health Medicaid |
$7,742.75
|
| Rate for Payer: Mercy Care Medicaid |
$7,742.75
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$3,070.73
|
|
|
Service Code
|
APR-DRG 7571
|
| Hospital Charge Code |
APRDRG7573
|
| Min. Negotiated Rate |
$3,070.73 |
| Max. Negotiated Rate |
$3,070.73 |
| Rate for Payer: AHCCCS Medicaid |
$3,070.73
|
| Rate for Payer: Allwell Medicaid |
$3,070.73
|
| Rate for Payer: AZCH Complete Medicaid |
$3,070.73
|
| Rate for Payer: Banner UC Health Medicaid |
$3,070.73
|
| Rate for Payer: Mercy Care Medicaid |
$3,070.73
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$14,824.09
|
|
|
Service Code
|
APR-DRG 7574
|
| Hospital Charge Code |
APRDRG7572
|
| Min. Negotiated Rate |
$14,824.09 |
| Max. Negotiated Rate |
$14,824.09 |
| Rate for Payer: AHCCCS Medicaid |
$14,824.09
|
| Rate for Payer: Allwell Medicaid |
$14,824.09
|
| Rate for Payer: AZCH Complete Medicaid |
$14,824.09
|
| Rate for Payer: Banner UC Health Medicaid |
$14,824.09
|
| Rate for Payer: Mercy Care Medicaid |
$14,824.09
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$3,070.73
|
|
|
Service Code
|
APR-DRG 7571
|
| Hospital Charge Code |
APRDRG7572
|
| Min. Negotiated Rate |
$3,070.73 |
| Max. Negotiated Rate |
$3,070.73 |
| Rate for Payer: AHCCCS Medicaid |
$3,070.73
|
| Rate for Payer: Allwell Medicaid |
$3,070.73
|
| Rate for Payer: AZCH Complete Medicaid |
$3,070.73
|
| Rate for Payer: Banner UC Health Medicaid |
$3,070.73
|
| Rate for Payer: Mercy Care Medicaid |
$3,070.73
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$4,086.36
|
|
|
Service Code
|
APR-DRG 7572
|
| Hospital Charge Code |
APRDRG7573
|
| Min. Negotiated Rate |
$4,086.36 |
| Max. Negotiated Rate |
$4,086.36 |
| Rate for Payer: AHCCCS Medicaid |
$4,086.36
|
| Rate for Payer: Allwell Medicaid |
$4,086.36
|
| Rate for Payer: AZCH Complete Medicaid |
$4,086.36
|
| Rate for Payer: Banner UC Health Medicaid |
$4,086.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,086.36
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$7,742.75
|
|
|
Service Code
|
APR-DRG 7573
|
| Hospital Charge Code |
APRDRG7574
|
| Min. Negotiated Rate |
$7,742.75 |
| Max. Negotiated Rate |
$7,742.75 |
| Rate for Payer: AHCCCS Medicaid |
$7,742.75
|
| Rate for Payer: Allwell Medicaid |
$7,742.75
|
| Rate for Payer: AZCH Complete Medicaid |
$7,742.75
|
| Rate for Payer: Banner UC Health Medicaid |
$7,742.75
|
| Rate for Payer: Mercy Care Medicaid |
$7,742.75
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$4,086.36
|
|
|
Service Code
|
APR-DRG 7572
|
| Hospital Charge Code |
APRDRG7574
|
| Min. Negotiated Rate |
$4,086.36 |
| Max. Negotiated Rate |
$4,086.36 |
| Rate for Payer: AHCCCS Medicaid |
$4,086.36
|
| Rate for Payer: Allwell Medicaid |
$4,086.36
|
| Rate for Payer: AZCH Complete Medicaid |
$4,086.36
|
| Rate for Payer: Banner UC Health Medicaid |
$4,086.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,086.36
|
|
