|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$3,070.73
|
|
|
Service Code
|
APR-DRG 7571
|
| Hospital Charge Code |
APRDRG7574
|
| 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
|
|
|
ORISE GEL SYRINGE KIT W/INTERJECT NEEDLE 23GA CLEAR
|
Facility
|
OP
|
$803.00
|
|
| Hospital Charge Code |
23697416
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$128.48 |
| Max. Negotiated Rate |
$722.70 |
| Rate for Payer: Aetna of AZ Commercial |
$722.70
|
| Rate for Payer: Aetna of AZ Medicare |
$224.84
|
| Rate for Payer: Allwell Medicare |
$128.48
|
| Rate for Payer: Amerigroup Medicare |
$128.48
|
| Rate for Payer: APIPA Medicare/Medicaid |
$299.92
|
| Rate for Payer: AZCH Complete Medicare |
$128.48
|
| Rate for Payer: Banner UC Health Medicare |
$128.48
|
| Rate for Payer: Bisbee Police All Plans |
$208.78
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$546.04
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cigna of AZ Commercial |
$562.10
|
| Rate for Payer: Copperpoint Commercial |
$198.74
|
| Rate for Payer: Health Net of AZ Commercial |
$481.80
|
| Rate for Payer: Health Net of AZ Medicare |
$224.84
|
| Rate for Payer: Humana of AZ Medicare |
$128.48
|
| Rate for Payer: Self Pay Self Pay |
$642.40
|
| Rate for Payer: TriWest Medicare |
$128.48
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$468.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$144.54
|
|
|
ORISE GEL SYRINGE KIT W/INTERJECT NEEDLE 23GA CLEAR
|
Facility
|
IP
|
$803.00
|
|
| Hospital Charge Code |
23697416
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$208.78 |
| Max. Negotiated Rate |
$722.70 |
| Rate for Payer: Aetna of AZ Commercial |
$722.70
|
| Rate for Payer: Bisbee Police All Plans |
$208.78
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Self Pay Self Pay |
$642.40
|
|
|
orphenadrine 60 mg/ 2 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$7.12
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
105935017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: Aetna of AZ Commercial |
$6.41
|
| Rate for Payer: Aetna of AZ Medicare |
$1.99
|
| Rate for Payer: Allwell Medicare |
$1.14
|
| Rate for Payer: Amerigroup Medicare |
$1.14
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.66
|
| Rate for Payer: AZCH Complete Medicare |
$1.14
|
| Rate for Payer: Banner UC Health Medicare |
$1.14
|
| Rate for Payer: Bisbee Police All Plans |
$1.85
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4.84
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna of AZ Commercial |
$4.63
|
| Rate for Payer: Copperpoint Commercial |
$1.76
|
| Rate for Payer: Health Net of AZ Commercial |
$4.27
|
| Rate for Payer: Health Net of AZ Medicare |
$1.99
|
| Rate for Payer: Humana of AZ Medicare |
$1.14
|
| Rate for Payer: Self Pay Self Pay |
$5.70
|
| Rate for Payer: TriWest Medicare |
$1.14
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$4.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.28
|
|
|
orphenadrine 60 mg/ 2 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$7.12
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
105935017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: Aetna of AZ Commercial |
$6.41
|
| Rate for Payer: Bisbee Police All Plans |
$1.85
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Self Pay Self Pay |
$5.70
|
|
|
oseltamivir 75 mg Cap [CQCH]
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
NDC 31722063231
|
| Hospital Charge Code |
105935149
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of AZ Commercial |
$1.56
|
| Rate for Payer: Aetna of AZ Medicare |
$0.48
|
| Rate for Payer: Allwell Medicare |
$0.28
|
| Rate for Payer: Amerigroup Medicare |
$0.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.65
|
| Rate for Payer: AZCH Complete Medicare |
$0.28
|
| Rate for Payer: Banner UC Health Medicare |
$0.28
|
| Rate for Payer: Bisbee Police All Plans |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cigna of AZ Commercial |
$1.12
|
| Rate for Payer: Copperpoint Commercial |
$0.43
|
| Rate for Payer: Health Net of AZ Commercial |
$1.04
|
| Rate for Payer: Health Net of AZ Medicare |
$0.48
|
| Rate for Payer: Humana of AZ Medicare |
$0.28
|
| Rate for Payer: Self Pay Self Pay |
$1.38
|
| Rate for Payer: TriWest Medicare |
$0.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1.01
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.31
|
|
|
oseltamivir 75 mg Cap [CQCH]
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
NDC 31722063231
|
| Hospital Charge Code |
105935149
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of AZ Commercial |
$1.56
|
| Rate for Payer: Bisbee Police All Plans |
$0.45
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Self Pay Self Pay |
$1.38
|
|
|
oseltamivir oral susp 6 mg/mL -60mL [CQCH]
|
Facility
|
OP
|
$148.46
|
|
|
Service Code
|
NDC 4082205
|
| Hospital Charge Code |
105935088
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$133.61 |
| Rate for Payer: Aetna of AZ Commercial |
$133.61
|
| Rate for Payer: Aetna of AZ Medicare |
$41.57
|
| Rate for Payer: Allwell Medicare |
$23.75
|
| Rate for Payer: Amerigroup Medicare |
$23.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.45
|
| Rate for Payer: AZCH Complete Medicare |
$23.75
|
| Rate for Payer: Banner UC Health Medicare |
$23.75
|
| Rate for Payer: Bisbee Police All Plans |
$38.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$100.95
|
| Rate for Payer: Cash Price |
$118.77
|
| Rate for Payer: Cigna of AZ Commercial |
$96.50
|
| Rate for Payer: Copperpoint Commercial |
$36.74
|
| Rate for Payer: Health Net of AZ Commercial |
$89.08
|
| Rate for Payer: Health Net of AZ Medicare |
$41.57
|
| Rate for Payer: Humana of AZ Medicare |
$23.75
|
| Rate for Payer: Self Pay Self Pay |
$118.77
|
| Rate for Payer: TriWest Medicare |
$23.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$86.55
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.72
|
|
|
oseltamivir oral susp 6 mg/mL -60mL [CQCH]
|
Facility
|
IP
|
$148.46
|
|
|
Service Code
|
NDC 4082205
|
| Hospital Charge Code |
105935088
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$133.61 |
| Rate for Payer: Aetna of AZ Commercial |
$133.61
|
| Rate for Payer: Bisbee Police All Plans |
$38.60
|
| Rate for Payer: Cash Price |
$118.77
|
| Rate for Payer: Self Pay Self Pay |
$118.77
|
|
|
Osmolality LC
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
1287369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Aetna of AZ Commercial |
$167.40
|
| Rate for Payer: Aetna of AZ Medicare |
$52.08
|
| Rate for Payer: Allwell Medicare |
$29.76
|
| Rate for Payer: Amerigroup Medicare |
$29.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$69.47
|
| Rate for Payer: AZCH Complete Medicare |
$29.76
|
| Rate for Payer: Banner UC Health Medicare |
$29.76
|
| Rate for Payer: Bisbee Police All Plans |
$48.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$126.48
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna of AZ Commercial |
$120.90
|
| Rate for Payer: Copperpoint Commercial |
$46.03
|
| Rate for Payer: Health Net of AZ Commercial |
$111.60
|
| Rate for Payer: Health Net of AZ Medicare |
$52.08
|
| Rate for Payer: Humana of AZ Medicare |
$29.76
|
| Rate for Payer: Self Pay Self Pay |
$148.80
|
| Rate for Payer: TriWest Medicare |
$29.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$108.44
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$33.48
|
|
|
Osmolality LC
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
1287369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Aetna of AZ Commercial |
$167.40
|
| Rate for Payer: Bisbee Police All Plans |
$48.36
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Self Pay Self Pay |
$148.80
|
|
|
Osmolality, Serum
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
852898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
|
|
Osmolality, Serum
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
852898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Aetna of AZ Medicare |
$49.56
|
| Rate for Payer: Allwell Medicare |
$28.32
|
| Rate for Payer: Amerigroup Medicare |
$28.32
|
| Rate for Payer: APIPA Medicare/Medicaid |
$66.11
|
| Rate for Payer: AZCH Complete Medicare |
$28.32
|
| Rate for Payer: Banner UC Health Medicare |
$28.32
|
| Rate for Payer: Bisbee Police All Plans |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$120.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$115.05
|
| Rate for Payer: Copperpoint Commercial |
$43.81
|
| Rate for Payer: Health Net of AZ Commercial |
$106.20
|
| Rate for Payer: Health Net of AZ Medicare |
$49.56
|
| Rate for Payer: Humana of AZ Medicare |
$28.32
|
| Rate for Payer: Self Pay Self Pay |
$141.60
|
| Rate for Payer: TriWest Medicare |
$28.32
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$103.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.86
|
|
|
Osmolality, Urine
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
1281255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of AZ Commercial |
$126.90
|
| Rate for Payer: Aetna of AZ Medicare |
$39.48
|
| Rate for Payer: Allwell Medicare |
$22.56
|
| Rate for Payer: Amerigroup Medicare |
$22.56
|
| Rate for Payer: APIPA Medicare/Medicaid |
$52.66
|
| Rate for Payer: AZCH Complete Medicare |
$22.56
|
| Rate for Payer: Banner UC Health Medicare |
$22.56
|
| Rate for Payer: Bisbee Police All Plans |
$36.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$95.88
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna of AZ Commercial |
$91.65
|
| Rate for Payer: Copperpoint Commercial |
$34.90
|
| Rate for Payer: Health Net of AZ Commercial |
$84.60
|
| Rate for Payer: Health Net of AZ Medicare |
$39.48
|
| Rate for Payer: Humana of AZ Medicare |
$22.56
|
| Rate for Payer: Self Pay Self Pay |
$112.80
|
| Rate for Payer: TriWest Medicare |
$22.56
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$82.20
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$25.38
|
|
|
Osmolality, Urine
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
1281255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of AZ Commercial |
$126.90
|
| Rate for Payer: Bisbee Police All Plans |
$36.66
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Self Pay Self Pay |
$112.80
|
|
|
Osmolality, Urine LC
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
1905826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Bisbee Police All Plans |
$38.48
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Self Pay Self Pay |
$118.40
|
|
|
Osmolality, Urine LC
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
1905826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Aetna of AZ Medicare |
$41.44
|
| Rate for Payer: Allwell Medicare |
$23.68
|
| Rate for Payer: Amerigroup Medicare |
$23.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.28
|
| Rate for Payer: AZCH Complete Medicare |
$23.68
|
| Rate for Payer: Banner UC Health Medicare |
$23.68
|
| Rate for Payer: Bisbee Police All Plans |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$100.64
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cigna of AZ Commercial |
$96.20
|
| Rate for Payer: Copperpoint Commercial |
$36.63
|
| Rate for Payer: Health Net of AZ Commercial |
$88.80
|
| Rate for Payer: Health Net of AZ Medicare |
$41.44
|
| Rate for Payer: Humana of AZ Medicare |
$23.68
|
| Rate for Payer: Self Pay Self Pay |
$118.40
|
| Rate for Payer: TriWest Medicare |
$23.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$86.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.64
|
|
|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$15,890.22
|
|
|
Service Code
|
APR-DRG 3444
|
| Hospital Charge Code |
APRDRG3443
|
| Min. Negotiated Rate |
$15,890.22 |
| Max. Negotiated Rate |
$15,890.22 |
| Rate for Payer: AHCCCS Medicaid |
$15,890.22
|
| Rate for Payer: Allwell Medicaid |
$15,890.22
|
| Rate for Payer: AZCH Complete Medicaid |
$15,890.22
|
| Rate for Payer: Banner UC Health Medicaid |
$15,890.22
|
| Rate for Payer: Mercy Care Medicaid |
$15,890.22
|
|
|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$4,891.56
|
|
|
Service Code
|
APR-DRG 3441
|
| Hospital Charge Code |
APRDRG3444
|
| Min. Negotiated Rate |
$4,891.56 |
| Max. Negotiated Rate |
$4,891.56 |
| Rate for Payer: AHCCCS Medicaid |
$4,891.56
|
| Rate for Payer: Allwell Medicaid |
$4,891.56
|
| Rate for Payer: AZCH Complete Medicaid |
$4,891.56
|
| Rate for Payer: Banner UC Health Medicaid |
$4,891.56
|
| Rate for Payer: Mercy Care Medicaid |
$4,891.56
|
|
|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$9,085.23
|
|
|
Service Code
|
APR-DRG 3443
|
| Hospital Charge Code |
APRDRG3443
|
| Min. Negotiated Rate |
$9,085.23 |
| Max. Negotiated Rate |
$9,085.23 |
| Rate for Payer: AHCCCS Medicaid |
$9,085.23
|
| Rate for Payer: Allwell Medicaid |
$9,085.23
|
| Rate for Payer: AZCH Complete Medicaid |
$9,085.23
|
| Rate for Payer: Banner UC Health Medicaid |
$9,085.23
|
| Rate for Payer: Mercy Care Medicaid |
$9,085.23
|
|
|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$6,142.86
|
|
|
Service Code
|
APR-DRG 3442
|
| Hospital Charge Code |
APRDRG3442
|
| Min. Negotiated Rate |
$6,142.86 |
| Max. Negotiated Rate |
$6,142.86 |
| Rate for Payer: AHCCCS Medicaid |
$6,142.86
|
| Rate for Payer: Allwell Medicaid |
$6,142.86
|
| Rate for Payer: AZCH Complete Medicaid |
$6,142.86
|
| Rate for Payer: Banner UC Health Medicaid |
$6,142.86
|
| Rate for Payer: Mercy Care Medicaid |
$6,142.86
|
|
|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$6,142.86
|
|
|
Service Code
|
APR-DRG 3442
|
| Hospital Charge Code |
APRDRG3444
|
| Min. Negotiated Rate |
$6,142.86 |
| Max. Negotiated Rate |
$6,142.86 |
| Rate for Payer: AHCCCS Medicaid |
$6,142.86
|
| Rate for Payer: Allwell Medicaid |
$6,142.86
|
| Rate for Payer: AZCH Complete Medicaid |
$6,142.86
|
| Rate for Payer: Banner UC Health Medicaid |
$6,142.86
|
| Rate for Payer: Mercy Care Medicaid |
$6,142.86
|
|
|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$15,890.22
|
|
|
Service Code
|
APR-DRG 3444
|
| Hospital Charge Code |
APRDRG3444
|
| Min. Negotiated Rate |
$15,890.22 |
| Max. Negotiated Rate |
$15,890.22 |
| Rate for Payer: AHCCCS Medicaid |
$15,890.22
|
| Rate for Payer: Allwell Medicaid |
$15,890.22
|
| Rate for Payer: AZCH Complete Medicaid |
$15,890.22
|
| Rate for Payer: Banner UC Health Medicaid |
$15,890.22
|
| Rate for Payer: Mercy Care Medicaid |
$15,890.22
|
|
|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$4,891.56
|
|
|
Service Code
|
APR-DRG 3441
|
| Hospital Charge Code |
APRDRG3443
|
| Min. Negotiated Rate |
$4,891.56 |
| Max. Negotiated Rate |
$4,891.56 |
| Rate for Payer: AHCCCS Medicaid |
$4,891.56
|
| Rate for Payer: Allwell Medicaid |
$4,891.56
|
| Rate for Payer: AZCH Complete Medicaid |
$4,891.56
|
| Rate for Payer: Banner UC Health Medicaid |
$4,891.56
|
| Rate for Payer: Mercy Care Medicaid |
$4,891.56
|
|
|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$4,891.56
|
|
|
Service Code
|
APR-DRG 3441
|
| Hospital Charge Code |
APRDRG3441
|
| Min. Negotiated Rate |
$4,891.56 |
| Max. Negotiated Rate |
$4,891.56 |
| Rate for Payer: AHCCCS Medicaid |
$4,891.56
|
| Rate for Payer: Allwell Medicaid |
$4,891.56
|
| Rate for Payer: AZCH Complete Medicaid |
$4,891.56
|
| Rate for Payer: Banner UC Health Medicaid |
$4,891.56
|
| Rate for Payer: Mercy Care Medicaid |
$4,891.56
|
|
